Bruno Fantino

Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects.

Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults.

Vitamin D insufficiency and mild cognitive impairment: cross-sectional association.

Background:  Low serum 25‐hydroxyvitamin D (25OHD) concentrations have been associated with dementia. The association with mild cognitive impairment (MCI) has not yet been explored. Our aim was to examine the association between vitamin D status and MCI status amongst older community‐dwellers with subjective memory complaint.

Gait control: a specific subdomain of executive function?

BackgroundFew studies looked at the association between gait variability and executive subdomains (ESD). The aim of this study was to examine the association between ESD (i.e., information updating and monitoring) and stride time variability among healthy older adults.MethodsSeventy-eight healthy older adults (mean age 69.9 ± 0.9 years, 59% women) were divided into 3 groups according to stride time variability (STV) tertiles while steady state walking. Coefficient of variation of stride time was used as a marker of STV. Scores on cognitive tests evaluating information updating and monitoring (Digit Span test), mental shifting (Trail Making Test part A and part B) and cognitive inhibition (Stroop Color Word test) were used as measures of ESD.ResultsThe full adjusted and the stepwise backward logistic regression models showed that the highest tertile (i.e., the worst performance) of STV was only associated with lower Digit Span performance (Odds ratio = 0.78 with P = 0.020 and Odds ratio = 0.81 with P = 0.019).ConclusionsInformation updating and monitoring are associated with STV in the sample of studied participants, suggesting that walking may be a complex motor task depending specifically of this subdomain of executive functions.

Rheumatoid Arthritis and Fibromyalgia: A Frequent Unrelated Association Complicating Disease Management

Objective To assess the value of the 28-joint Disease Activity Score (DAS28) in evaluating disease activity in rheumatoid arthritis (RA) associated with fibromyalgia (FM). In this situation, because of the weight of the subjective measures included in the DAS28 equation, the patient’s status may be overestimated, leading to inappropriate treatment. We analyze the relationship between RA and FM and discuss whether the association is random or a marker of poor prognosis. Methods A questionnaire, developed when biologic therapies were introduced, was administered and the results analyzed in a consecutive, female outpatient population including 105 patients with RA, 49 with RA and FM (RAF), and 28 with FM. Psychosocial characteristics, disease presentation, and radiographic joint destruction evaluation were compared in the 3 populations. Results The presentation of RA was the same in patients with RA and RAF, but the 2 populations differed by socioprofessional characteristics, significantly higher disease activity in patients with RAF, and significantly more severe joint destruction in patients with RA. The RAF group was similar to the FM control population in socioprofessional and some physical characteristics. Regression analysis using the DAS28 measures differed significantly in the weight allowed to 28-joint counts for pain and swelling, but the constant factor was higher in patients with RAF. Conclusion DAS28 overestimated objective RA severity in patients who also had FM. The association between RA and FM does not appear to be a marker of worse prognosis, but rather a fortuitous association between the 2 diseases and one that may afford these patients some protection against joint destruction.

Effectiveness of the combination of memantine plus vitamin D on cognition in patients with Alzheimer disease: a pre-post pilot study.

Objective:To determine whether treatment with memantine plus vitamin D is more effective than memantine or vitamin D alone in improving cognition among patients with Alzheimer disease (AD). Methods:We studied 43 white outpatients (mean 84.7±6.3 years; 65.1% women) with a new diagnosis of AD, who had not taken anti-dementia drugs or vitamin D supplements. We prescribed memantine alone (n=18), vitamin D alone (n=17), or memantine plus vitamin D (n=8) for an average of 6 months. We assessed cognitive change with the Mini-Mental State Examination (MMSE). We used age, sex, pre-treatment MMSE score, and duration of treatment as covariables. Results:Before treatment, the 3 groups had comparable MMSE scores. At 6 months, participants taking memantine plus vitamin D increased their MMSE score by 4.0±3.7 points (P=0.034), while participants taking memantine alone remained stable (change of 0.0±1.8 points; P=0.891), as did those taking vitamin D alone (−0.6±3.1 points; P=0.504). Treatment with memantine plus vitamin D was associated with improvement in the MMSE score compared to memantine or vitamin D alone after adjustment for covariables (P<0.01). Mixed regression analysis showed that the visit by combined treatments (memantine plus vitamin D) interaction was significant (P=0.001), while memantine or vitamin D alone showed no effect. Conclusions:Patients with AD who took memantine plus vitamin D for 6 months had a statistically and clinically relevant gain in cognition, underlining possible synergistic and potentiating benefits of the combination.

A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

OBJECTIVE To develop a simple clinical screening tool for community-dwelling older adults. STUDY DESIGN AND SETTING A prospective multicenter cohort study was performed among healthy subjects of 65 years and older, examined in 10 health examination centers for the French health insurance. Falls were ascertained monthly by telephone for 12-month follow-up. Multivariate analyses using Cox regression models were performed. Regression coefficients of the predictors in the final model were added up to obtain the total score. The discriminative power was assessed using the area under the curve (AUC). RESULTS Thousand seven hundred fifty-nine subjects were included. The mean age was 70.7 years and 51% were women. At least one fall occurred among 563 (32%) participants. Gender, living alone, psychoactive drug use, osteoarthritis, previous falls, and a change in the position of the arms during the one-leg balance (OLB) test were the strongest predictors. These predictors were used to build a risk score. The AUC of the score was 0.70. For a cutoff point of 1.68 in a total of 4.90, the positive predictive value and negative predictive value were 72.0% and 72.7%, respectively. CONCLUSION A screening tool with five risk factors and the OLB test could predict falls in healthy community-dwelling older adults.

Cognitive Effects of Vitamin D Supplementation in Older Outpatients Visiting a Memory Clinic: A Pre–Post Study

independently associated with renal function and CKD in community-dwelling adults. These findings are consistent with two previous studies that suggested that circulating FGF21 concentrations were associated with renal function in individuals with diabetes mellitus and in a mixed population of healthy controls and patients undergoing hemodialysis or with CKD. In the present study, the relationship between serum FGF21 and renal function and CKD was consistent even after exclusion of participants with diabetes mellitus. Serum FGF21 concentrations may be higher in individuals with poorer renal function because of inability of the kidneys to clear FGF21 in the urine. An alternative explanation may be that high FGF21 is causally related to poorer renal function, but currently there is little evidence to support such a hypothesis. In any case, the findings from the present study highlight the potential importance of adjusting for renal function in future epidemiological studies of circulating FGF21. The strengths of this study include the large sample size of community-dwelling adults and the rigorously timed and standardized collection of fasting serum samples, because FGF21 levels have been shown to have a circadian rhythm. A limitation of the study is the cross-sectional design, because the direction of the association between high circulating FGF21 and renal function is unknown. Further studies are needed to determine whether high levels of circulating FGF21 precede compromised renal function or serve as a biomarker that is retained as renal function declines.

Severe vitamin D deficiency is associated with advanced-stage dementia in geriatric inpatients.

kind of personal conflicts with this paper. This work was funded by Grant RO1AG17649 from the National Institute on Aging and by a Paul Beeson Physician Faculty Scholarship in Aging Research to Dr. Marcantonio. Author Contributions: Marcantonio: drafting the letter. Bergmann, Kiely, Orav, and Jones: critical revision of the letter. Sponsor’s Role: The funding agencies had no role in the preparation of this letter. The authors retained full autonomy in the preparation of this letter.

Biology of gait control Vitamin D involvement

Background: Adverse neuromuscular events have been described in case of low serum 25-hydroxyvitamin D (25OHD) concentrations, suggesting that vitamin D may be involved in gait stability. The objective of this cross-sectional study was to examine the association between stride-to-stride variability of stride time (STV) and serum 25OHD concentration in adults aged 65 years and older. Methods: STV and 25OHD concentration were assessed in 411 community-dwelling older adults (mean age 70.4 ± 1.8 years, 57.9% women). The following established 25OHD thresholds were used: severe 25OHD insufficiency <10 ng/mL, moderate 10–30 ng/mL, and normal >30 ng/mL. Age, number of drugs used per day, use of psychoactive drugs, depressive symptoms, cognitive decline, history of falls, distance visual acuity, lower limb proprioception, center of mass (CoM) motion, and walking speed were considered as potential confounders. Results: A total of 16.6% (n = 68) of subjects had severe 25OHD insufficiency, 70.3% (n = 289) moderate insufficiency, and 13.1% (n = 54) normal concentrations. In the full adjusted and the stepwise backward linear regression models, high STV (worse performance) was associated with severe 25OHD insufficiency (p = 0.028 and p = 0.044, respectively), high CoM motion (p = 0.031 and p = 0.014, respectively), and low lower limb proprioception score (p = 0.017 and p = 0.008, respectively). The stepwise backward regression model also showed that high STV was associated with female gender (p = 0.041). Conclusions: Low serum 25OHD concentrations were associated with high STV reflecting a disturbed gait control. This association could be explained by a possible action of vitamin D on different components involved in gait control.

Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: the EPIDOS study

The purpose of this study was to determine whether there was an association between serum 25‐hydroxyvitamin D [25(OH)D] concentration and walking speed measured at usual and fast pace among older women. Usual‐ and fast‐pace walking speeds and 25(OH)D concentrations were assessed in 739 randomized older women (mean age 80.2 ± 3.5 years) from the EPIDOS study. The following 25(OH)D thresholds were used: 10, 20, and 30 ng/mL. Walking speed was dichotomized on being in the worst quintile or not. Age, body mass index, number of chronic diseases, physical activity, quadriceps strength, cognition, use of psychoactive drugs, and serum parathyroid hormone were used as potential confounders. The results show that 90% of subjects had 25(OH)D insufficiency. Only fast‐pace walking speed was significantly different between groups (p = .021) and decreased from normal serum 25(OH)D concentrations to severe insufficiency (trend p = .007). Serum 25(OH)D concentration was associated with walking speed at both usual and fast pace in the unadjusted linear regression (β = 0.16, p = .027 and β = 0.23, p = .009, respectively). This association remained significant only for fast‐pace walking after adjustment (adjusted β = 0.18, p = .033) and was strengthened from a lower 25(OH)D value compared with usual pace [25(OH)D = 27.15 ng/mL for fast pace and 38.65 ng/mL for usual pace). Lastly, logistic regression showed a stronger association of serum 25(OH)D insufficiency with fast‐pace walking speed whatever the 25(OH)D thresholds used [30 to 20 ng/mL: adjusted odds ratio (adjOR) = 6.01, p = .003; 20 to 10 ng/mL: adjOR = 4.10, p = .014; <10 ng/mL: adjOR = 6.95, p = .001) compared with usual pace (30 to 20 ng/mL: adjOR = 3.79, p = .022; 20 to 10 ng/mL: adjOR = 3.76, p = .016; <10 ng/mL: adjOR = 5.44, p = .003). The findings show a stronger positive association between 25(OH)D concentrations and fast‐pace walking speed that is a more sensitive marker of neuromuscular functioning compared with usual‐pace walking.