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.

Maintaining Muscle Strength May Counteract Postmenopausal Bone Loss

Sirola J, Rikkonen T, Tuppurainen M, Honkanen R, Jurvelin JS, Kroger H. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss-a population-based approach. Osteoporos Int. 2006 Feb 21.

Researchers writing in the medical journal Osteoporosis International say that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss and that exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.

From the study abstract:
INTRODUCTION: “Weight loss significantly increases postmenopausal bone loss, but the effects of muscle strength change on weight-loss-associated bone loss remain unclear. The study population, 587 peri- and postmenopausal women, was a random sample of the original Osteoporosis Risk Factor and Prevention Study (OSTPRE) study cohort in Kuopio, Finland.

Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual x-ray absorptiometry, and grip strength was measured with a pneumatic squeeze dynamometer at baseline in 1989-1991 and at the 10-year follow-up in 1999-2001.

METHODS: Women were divided into three groups according to change in age-grouped grip-strength quartile in both of the measurements: “decreased”, “maintained” , and “improved”.

In addition, the study sample was divided into two groups according to weight change during the follow-up: weight losers and weight gainers.

RESULTS: There were no differences in the change status of grip (muscle) strength between the weight loss and weight gain groups.

Women losing weight during the follow-up and within the improved grip-strength-change group had a significantly lower bone loss rate compared with those in the maintained and decreased grip-strength-change groups.

This was in contrast to women who gained weight during the follow-up (not significant between any grip-strength-change groups). Furthermore, women who lost body weight and were in the improved grip-strength-change group had a bone loss rate comparable with that of the women who gained body weight (not significant).

CONCLUSION: The present study suggests that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss. Accordingly, exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.”

Testosterone for Women

Testosterone is the male sex hormone, but, it is also an important sex hormone for women. A woman produces testosterone in her ovaries and adrenal glands and obviously produces a lot less than a man because women do not grow the muscles or facial and body hair characteristic of higher testosterone levels.

Girls begin to produce testosterone as they approach puberty for use as a precursor to estrogen. A woman will have peak testosterone levels in her mid-twenties and then suffer a steady decline to half those levels in her forties. In my practice, however, I frequently see some women in their thirties producing an insufficient amount of testosterone (especially after child birth).

Additionally, if a woman has a hysterectomy, testosterone levels can drop quickly and significantly.

Signs of testosterone deficiency in women:
1. Low or no sex drive
2. Lack of energy
3. Obesity, especially abdominal fat
4. Loss of muscle tone
5. Reduced bone mass
6. Increased fracture risk
7. Fatigue
8. Wrinkles
9. Hot flashes despite estrogen therapy

The importance of blood tests
Not all women in perimenopause or menopause will be testosterone deficient. Some of the symptoms listed above could be caused by other hormonal problems or health issues. This is why blood, saliva, or urine testing is so important and why self-medication with “testosterone enhancers” or Testosterone itself based on symptoms alone is dangerous.

We order a blood test for total testosterone, as well as free testosterone. While both levels are important to watch, we want to pay special attention to the “Free Testosterone” reading because it is the active hormone.

When a physician orders a total testosterone reading alone, it is possible to get back a “normal,” “within range” reading on a patient who exhibits clearly defined symptoms for testosterone deficiency. How is this possible?

Because most of the testosterone in the body is linked to proteins, the smaller remaining portion is “free” to make itself available to the cells of the body. Free Testosterone or the lack of it is most responsible for symptoms or alleviation of symptoms associated with testosterone. That is why monitoring its levels are so important in testosterone supplementation therapy.

Many scientific papers, some listed below, have cited the following benefits possible to women taking testosterone.

1. Increased sexual desire
2. Relief of menopausal symptoms
3. Reduction of bone loss / osteoporosis
4. Increased vitality
5. Reduced body fat
6. Improved skin tone by stimulating collagen growth
7. Enhanced “quality of life”

Testosterone supplementation risks
It is important to understand that not all women will benefit from Testosterone supplementation. The goals, realities, and risks of Testosterone supplementation should be discussed, at length, with your physician prior to onset of treatment.