Deborah J. Morton

Sarcopenia in elderly men and women: the Rancho Bernardo study.

BACKGROUND Sarcopenia risk factors are poorly understood. METHODS This study examines sarcopenia prevalence and risk factors in community-dwelling men (694) and women (1006) aged 55-98 years (mean=73) who attended a 1988-1992 Rancho Bernardo Study clinic visit. Height, weight, muscle strength, fat-free mass (FFM), fat mass by bioelectric impedance analysis, and grip strength were measured; alcohol and medication use, smoking, and physical activity were ascertained. RESULTS Mean FFM was 43.5 kg for women and 61.7 kg for men. Sarcopenia, defined as FFM of > or =2.0 standard deviations below the gender-specific mean of a young reference population, was present in 6.0% overall. Prevalence increased dramatically from 4% of men and 3% of women aged 70-75 to 16% of men and 13% of women aged 85 and older. Both men and women with sarcopenia had a significantly lower fat mass and body mass index than those without sarcopenia. Men with sarcopenia were twice as likely to have fallen in the past year compared with those without sarcopenia. Grip strength, but not quadriceps strength, was lower in men and women with sarcopenia. Physically active women were about half as likely to have sarcopenia, but no association was found in men. Few men and women were current smokers, but they were more likely to have sarcopenia. Comorbidities (heart disease, diabetes, pulmonary disease, arthritis, cancer) and medications (thyroid hormones, corticosteroids, and hormone replacement therapy) were not associated with sarcopenia. CONCLUSIONS Sarcopenia increases with age. This study also identified lack of physical activity and current smoking as reversible risk factors for sarcopenia.

Vitamin C Supplement Use and Bone Mineral Density in Postmenopausal Women

Vitamin C is known to stimulate procollagen, enhance collagen synthesis, and stimulate alkaline phosphatase activity, a marker for osteoblast formation. Studies of dietary vitamin C intake and the relation with bone mineral density (BMD) have been conflicting, probably because of the well‐known limitations of dietary nutrient assessment questionnaires. The purpose of this study was to evaluate the independent relation of daily vitamin C supplement use with BMD in a population‐based sample of postmenopausal women. Subjects were 994 women from a community‐based cohort of whom 277 women were regular vitamin C supplement users. Vitamin C supplement use was validated. Daily vitamin C supplement intake ranged from 100 to 5000 mg; the mean daily dose was 745 mg. Average duration of use was 12.4 years; 85% had taken vitamin C supplements for more than 3 years. BMD levels were measured at the ultradistal and midshaft radii, hip, and lumbar spine. After adjusting for age, body mass index (BMI), and total calcium intake, vitamin C users had BMD levels approximately 3% higher at the midshaft radius, femoral neck, and total hip (p < 0.05). In a fully adjusted model, significant differences remained at the femoral neck (p < 0.02) and marginal significance was observed at the total hip (p < 0.06). Women taking both estrogen and vitamin C had significantly higher BMD levels at all sites. Among current estrogen users, those also taking vitamin C had higher BMD levels at all sites, with marginal significance achieved at the ultradistal radius (p < 0.07), femoral neck (p < 0.07), and total hip (p < 0.09). Women who took vitamin C plus calcium and estrogen had the highest BMD at the femoral neck (p = 0.001), total hip (p = 0.05), ultradistal radius (p = 0.02), and lumbar spine. Vitamin C supplement use appears to have a beneficial effect on levels of BMD, especially among postmenopausal women using concurrent estrogen therapy and calcium supplements.

Birth weight as a predictor of adult bone mass in postmenopausal women: the Rancho Bernardo Study.

Abstract: Understanding the determinants of adult bone mass may help to identify women for prevention of osteoporosis. We postulated that birth weight would predict low adult bone mass in old age. Subjects were 305 postmenopausal Caucasian women (mean age 70 years). Bone mineral content (BMC) and bone mineral density (BMD) were measured at the wrist, forearm, hip and lumbar spine. Birth weight was assessed by self-report. Birth weight was positively correlated with BMC at the forearm (r= 0.15), hip (r= 0.12) and lumbar spine (r= 0.18), and the age-adjusted mean BMC increased significantly from the lowest to the highest birth weight tertile. Adjusting for adult weight diminished this association at the forearm and hip, but not at the spine. Adjustment for multiple other covariates, including height, did not materially change these associations. Adult weight and height were significantly correlated with birth weight (r= 0.19 and r= 0.24, respectively). Birth weight was not independently correlated with BMD. Birth weight was thus positively correlated with adult weight and BMC 70 years later. These findings suggest that low birth weight may be a marker for future low bone mass and that different mechanisms exist for establishing the adult bone envelope (estimated by BMC) versus its density (estimated by BMD).

Injuries from combat explosions in Iraq: Injury type, location, and severity

INTRODUCTION Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This studys objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. MATERIALS AND METHODS A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. RESULTS A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). CONCLUSION The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries.

Nonsteroidal Anti-Inflammatory Drugs and Bone Mineral Density in Older Women: The Rancho Bernardo Study

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are known to inhibit synthesis of prostaglandins and may help prevent bone loss, but no study has shown the differential association of type or dose of NSAID compound with bone mineral density (BMD). The purpose of this study was to determine the relation of NSAIDs by type and dose to BMD. Participants were 932 Caucasian, community‐dwelling women aged 44–98 years from southern California. Data were collected from 1988 to 1991 through the use of standardized medical questionnaires. Medication use was validated by a nurse. BMD at the ultradistal and midshaft radii were measured using single‐photon absorptiometry, and at the hip and lumbar spine using dual‐energy X‐ray absorptiometry. Women (mean age, 72 years) were classified into 818 nonusers and 114 regular daily users of NSAIDs, of which 84 used propionic acid NSAIDs and the remainder used acetic acid NSAIDs. Occasional NSAID users were excluded. Women who used propionic acid NSAIDs, but not acetic acid NSAIDs, had higher BMD at all five sites and significantly higher BMD at the midshaft radius and lumbar spine. These differences remained after controlling for known covariates of osteoporosis. When women with self‐reported osteoarthritis were excluded from the model, significantly higher BMD in propionic acid NSAID users was also observed at the femoral neck and total hip. Those who concurrently used estrogen and propionic acid NSAIDs had the highest BMD at all sites, suggesting an additive effect. We conclude that regular daily use of propionic acid NSAIDs, with or without simultaneous use of estrogen, may be helpful in preventing bone loss in older women. However, further research is needed to confirm these results before any clinical practice guidelines can be recommended due to the increased risk of serious complications associated with NSAID use.

Inhaled and oral corticosteroids: their effects on bone mineral density in older adults.

Use of oral and inhaled corticosteroids and bone mineral density were examined cross-sectionally in 1673 community-dwelling white subjects aged 56 to 91 years. Bone mineral densities at the ultradistal and midshaft radii, hip, and lumbar spine were compared in users of inhaled (n = 34) and oral (n = 44) corticosteroids and nonusers. Women who used oral corticosteroids had significantly lower bone mineral densities at the midshaft radius, hip, and spine than never users. Women who used inhaled corticosteroids had bone mineral densities at the ultradistal radius, hip, and spine that were intermediate between those of oral corticosteroid users and those of never users. Bone mineral density did not vary significantly according to corticosteroid use in men.

Prevalence of alcohol consumption among older persons

Percent prevalences of alcohol consumption were determined in a cross-sectional study of randomly chosen residents of San Diego County, California aged 45 years and over. The study sample (N=2,105) showed statistically significant drinking differences between Whites (n=819), Blacks (n=629), and Mexican-Americans (n=657). Overall, the highest prevalence of drinking occurred among the White elderly. The common belief that socioeconomic conditions are inversely associated with a high prevalence of drinking was not supported in this sample. Statistically significant differences in age-specific and sex-specific percent prevalences of alcohol intake were also found. There was a generally decreasing prevalence of alcohol consumption with advancing age, which existed regardless of ethnicity. Initial empirical measures and a better understanding of drinking correlates will identify those elderly persons at risk and provide the basis for future interventions in the areas of applied epidemiology and health promotion.

Plasma trace elements and cognitive function in older men and women: The Rancho Bernardo study

Objective. This study examines the sex-specific associations of plasma concentrations of iron, copper, and zinc with cognitive function in older community-dwelling adults.Design: Cross-sectional study.Setting: 1988–92 follow-up clinic visit.Participants: 602 men and 849 women (average age=75 ±8 years) who were community-dwelling and not clinically demented.Measurements: Blood samples were assayed for trace elements and 12 cognitive function tests were administered. Sex-specific analyses were adjusted for age, education, alcohol consumption, smoking, exercise, and estrogen use in women.Results. Men and women differed significantly in education and alcohol intake (p’s<0.001), concentrations of plasma iron, copper and zinc (p’s<0.001) and scores on 11 of 12 cognitive function tests (p=0.04 to <0.001). Regression analyses showed significant inverted U-shaped associations in men;both low and high iron levels were associated with poor performance on total and long-term recall and Serial 7’s (p’s=0.018, 0.042 and 0.004, respectively) compared to intermediate concentrations. In women, iron and copper concentrations had inverse linear associations with Buschke total, long and short-term recall and Blessed scores (p’s<0.05). Zinc was positively associated with performance on Blessed Items (p=0.008). Analyses comparing cognitive function using categorically defined mineral concentrations yielded similar sex specific results.Conclusion. Optimal trace element concentrations may exist for optimal cognitive function in older adults, and these levels may differ by sex and cognitive function domain.

Postmenopausal Estrogen and Increased Risk of Clinical Osteoarthritis at the Hip, Hand, and Knee in Older Women

OBJECTIVE We examined postmenopausal estrogen (PME) use and prevalence of clinical osteoarthritis (OA) at the hand, knee, and hip in 1001 community-dwelling postmenopausal women aged 43-97 years (mean age 72). METHODS OA at the hip, hand, and knee was defined by validated and standardized criteria based on pain history plus a clinical examination performed by a specially trained nurse. RESULTS PME, validated by examination of pills and prescriptions, had been used for at least 1 year by 638 women (63.4%) for an average duration of 14.6 (+/-10.6) years. OA prevalence was 34.5% among women who had used PME for at least 1 year and 30.9% among women who did not use PME (age adjusted p = 0.02). Knee OA prevalence did not differ by PME use (p > 0.05). A significantly larger proportion of women who used PME for at least 1 year had hip and hand OA compared with women not using PME (4.1% vs. 1.1%, age-adjusted p = 0.002, and 15.8% vs. 13.5%, age-adjusted p = 0.02, respectively). In analyses adjusted for the potential confounding effects of age, body mass index (BMI), smoking, exercise, and type of menopause, women who used PME still were more likely to have hip OA (odds ratio [OR] = 5.03, confidence interval [CI] = 1.70-14.84, p = 0.003) and hand OA ([OR] = 1.57, CI = 1.05-2.33, p = 0.03). Among estrogen users, duration of PME use was longer for women with OA than for women without OA (16 vs. 11 median years, p = 0.01). CONCLUSIONS PME is associated with a higher prevalence of clinical OA.

Pet ownership and blood pressure in old age.

Background: It has been proposed that pet ownership improves cardiovascular health. This study examines the relation of pet ownership with systolic and diastolic blood pressure, pulse pressure, mean arterial pressure, and hypertension in a large sample of older men and women. Methods: Participants were 1179 community-dwelling men (n = 498) and women (n = 681) age 50–95 years. Participants responded to a 1991–1992 mailed questionnaire ascertaining pet ownership, and they attended a 1992–1996 clinic visit at which systolic (SBP) and diastolic (DBP) blood pressures were measured and use of antihypertensive medication was validated. Pulse pressure was calculated as SBP minus DBP. Mean arterial pressure was calculated as (SBP+DBP)/2. Body mass index, waist-hip ratio, and information on other potential confounders were obtained. Results: Average age of participants was 70.4 ± 10.8 years; 30.0% reported current pet ownership. Mean SBP was 137.5 ± 21.4 mm Hg, and DBP was 76.1 ± 9.3 mm Hg; 55.6% were hypertensive (SBP ≥ 140, DBP ≥ 90 or taking hypertension medication). Pet owners were younger and slightly more overweight and they exercised less than nonowners; owners were somewhat more likely to have diabetes and to use beta-blockers. In unadjusted analyses, pet owners had lower SBP, pulse pressure, and mean arterial pressure, and a reduced risk of hypertension (odds ratio = 0.62; 95% confidence interval = 0.49–0.80). However, after adjustment for age and other confounders, pet ownership was not associated with systolic or diastolic blood pressure, pulse pressure, mean arterial pressure or risk of hypertension. Conclusions: Results suggest that pet ownership is not independently associated with blood pressure, vascular reactivity, or hypertension.