Sleep and Risk of Fractures

Researchers writing in the Journal of the American Geriatrics Society say that long sleep and daily napping are associated with greater risk of falls and fractures in older women.

Stone KL, Ewing SK, Lui LY, Ensrud KE, Ancoli-Israel S, Bauer DC, Cauley JA, Hillier TA, Cummings SR. Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. J Am Geriatr Soc. 2006 Aug;54(8):1177-83.

From the study abstract:

OBJECTIVES: To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women.

DESIGN: Study of Osteoporotic Fractures prospective cohort study.

SETTING: Clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, near Pittsburgh, Pennsylvania.
PARTICIPANTS: Eight thousand one hundred one community-dwelling Caucasian women aged 69 and older (mean 77.0).

MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Fall frequency during the subsequent year was ascertained using tri-annual questionnaire. Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports. RESULTS: Five hundred fifty-three women suffered hip fractures, and 1,938 suffered nonspinal fractures. In multivariate models, women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year (odds ratio=1.32, 95% confidence interval (CI)=1.03-1.69) and were more likely to suffer a hip fracture (hazard ratio (HR)=1.33, 95% CI=0.99-1.78) than women who did not nap daily. Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than (HR=1.26, 95% CI=1.00-1.58) and a similar but nonsignificant increased risk of hip fracture to (HR=1.43, 95% CI=0.95-2.15) those who reported sleeping between 8 and 9 hours.

CONCLUSION: Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women. Interventions to improve sleep may reduce their risk of falls and fractures. Future research is needed to determine whether specific sleep disorders contribute to these relationships.

Osteoporosis in Men

Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. J Clin Endocrinol Metab. 2006 Jul 18

From the article abstract:
Context: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain.

Objective: To examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

Participants: 2447 community-dwelling men aged >/=65.

Main Outcome Measures: Total testosterone deficiency defined as <200 ng/dl.

Total estradiol deficiency defined as <10 pg/ml.

Results: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3% and 6.0% (P = 0.003), and in those with deficient and normal total estradiol was 15.4% and 2.8% (P < 0.0001).

Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9% and 3.2% (P = 0.01) and prevalence of total estradiol deficiency was 9.2% and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5% and 8.6% (P = 0.007), and in those with deficient and normal total estradiol was 14.3% and 6.3% (P = 0.08).

Conclusions: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

Lifelong Risk Factors for Osteoporosis and Fractures in Elderly Women with Low Body Mass Index

Researchers writing in the medical journal Bone, evaluated the association between lifelong lifestyle factors and bone density, falls and postmenopausal fractures in elderly women with low body mass index.

Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S. Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index-A population-based study. Bone. 2006 Aug;39(2):385-91.

From the abstract:
Low body weight is associated with an increased risk for osteoporosis and fractures, but the contribution of other lifestyle related factors have not been previously studied within lean elderly women. The present study evaluated the association between lifelong lifestyle factors and bone density, falls and postmenopausal fractures in elderly women with low body mass index (BMI).

Poor functional ability and symptoms of depression were associated with recent falling. In elderly women with low BMI, lifelong physical activity may protect from fractures, while low calcaneum bone mass and living unpartnered appear to be associated with an increased risk for fractures.

Poor functional ability and presence of depression may be associated with risk of falling. Type 2 diabetes may modify the risk of low bone mass and low-trauma postmenopausal fractures. Albeit that the results of this study need to be confirmed in prospective follow-up studies, multifactorial program with the emphasis on physical and social activation in the primary care setting for preventing falls and fractures in lean elderly women is recommended.

Bone Loss

Estradiol, Testosterone, and Hip Fractures in Men
Researchers writing in The American Journal of Medicine say “Men with low estradiol levels are at an increased risk for future hip fracture. Men with both low estradiol and low testosterone levels seem to be at greatest risk for hip fracture.”

The Importance of Strength Training Exercises in Aging
Researchers writing in the medical journal Aging Clinical and Experimental Research say that “although aerobic exercise is important in maintaining overall health, the resistance type of muscle training may be more applicable to the basic rules of bone adaptation and site-specific effects of exercise, have more favorable effects in maintaining or improving bone mass and architecture, and be safe and feasible for older people.”

DHEA, Bone Mineral Density, Older Adults
Researchers writing in the medical journal The Journal of Clinical Endocrinology & Metabolism, say that DHEA replacement therapy for one year improved hip Bone Mineral Density in older adults and spine Bone Mineral Density in older women.

Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index
Researchers writing in the medical journal Bone, evaluated the association between lifelong lifestyle factors and bone density, falls and postmenopausal fractures in elderly women with low body mass index.

Osteoporosis in Men Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Hip Fracture in High Risk Groups
Researchers writing in the Journal of Postgraduate Medicine say “prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.”

Sleep and Risk of Fractures
Researchers writing in the Journal of the American Geriatrics Society say that long sleep and daily napping are associated with greater risk of falls and fractures in older women

Why take progesterone?

As cited above, progesterone down-regulates estrogen. Other reasons are listed below:

Progesterone deficiency may possibly lead to:
1. Irregular and heavy menstrual bleeding
2. Osteoporosis
3. Heart disease
4. Decrease in libido

Progesterone supplementation has been used for:
1. PMS syndrome
2. Infertility
3. Supporting healthy pregnancy

Other potential benefits
1. Benefits against certain cancers
2. Prevents osteoporosis
3. Improves well-being, antidepressant
4. Helps restore sex drive
5. Helps convert fat to energy.

Warnings
The American College of Obstetricians and Gynecologists warns that there is no proof bio-identical hormones are any safer than the combination estrogen/progestin therapy.

Although there are no long-term studies on prolonged effects of progesterone, it appears that Progesterone therapy is a safe therapy, when indicated. Improper use of progesterone can lead to irregular menses and bleeding. This should be reported to your physician immediately.

SELECTED RESEARCH
Hot Flashes
Haimov-Kochman R, Hochner-Celnikier D.Acta Obstet Gynecol Scand. 2005 Oct;84(10):972-9.

Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us?

Background: Hot flashes are the most frequent symptoms of menopause and the most common reason for climacteric women seeking medical advice. Estrogen therapy is by far the most effective therapy. However, fears of side-effect of estrogen therapy urged many patients to seek alternative modalities for symptomatic relief.

Results and Conclusions: A critical review of the literature shows that progesterone may have an independent effect on relieving hot flashes.

SELECTED RESEARCH
Effects on Skin
Holzer G, Riegler E, Honigsmann H, Farokhnia S, Schmidt JB. Br J Dermatol. 2005 Sep;153(3):626-34

Effects and side-effects of 2% progesterone cream on the skin of peri-and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study.

Background: For many years topical progesterone has been prescribed by gynecologists as an antiageing and skin-firming treatment, without any clinical scientific evidence of its effects, tolerability and safety when applied to skin.

Objectives: To evaluate the influence of 2% progesterone cream on function and texture of the skin in peri- and postmenopausal women.

Results: The study demonstrated a significant…increase of the elastic skin properties in the treatment group, as demonstrated by objective measurements of three skin elasticity parameters, whereas in the control group no such effect was observed. This effect in the treatment group was further paralleled by the results of the clinical monitoring, where the 2% progesterone cream yielded consistent superiority over vehicle in counteracting different signs of ageing in the skin of peri- and postmenopausal women.

Clinical monitoring showed a greater reduction in wrinkle…around the right eye, a greater decrease in nasolabial wrinkle depth…and a significantly higher…increase in skin firmness…in the treatment group. Epidermal hydration and skin surface lipids did not change significantly in either group during the study. Progesterone was well absorbed in the systemic circulation…No serious side-effects of the treatment were observed.

Conclusions: The results of this study demonstrate that topical 2% progesterone acts primarily in increasing elasticity and firmness in the skin of peri-and postmenopausal women. These effects in combination with good tolerability make progesterone a possible treatment agent for slowing down the ageing process of female skin after onset of the menopause.

<<Article Segment 1 2