L. Flicker

Falls Relate to Vitamin D and Parathyroid Hormone in an Australian Nursing Home and Hostel

OBJECTIVES: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone.

Self-reported ballet classes undertaken at age 10-12 years and hip bone mineral density in later life

The major effect of weightbearing exercise on adult bone mass may be exerted during childhood. We examined the relationship between reported hours of ballet classes per week undertaken as a child and adult bone mineral density (BMD) at the hip, spine, and forearm. We performed a retrospective cohort study in 99 female retired dancers (mean age 51 years, SD 14 years) and 99 normal controls, derived from a twin study, matched hierarchically for age, height, weight and menopausal status. Starting age of ballet was recalled and weekly hours of ballet as a child was self-reported on two occasions. BMD was measured using dual-energy X-ray absorptiometry and reported as a Z-score. Self-reported hours of ballet class undertaken per week at each age between 10 and 12 years was positively associated with a difference in BMD between dancers and controls at both the femoral neck site (β=0.73,p=0.001) and the total hip site (β=0.55,p <0.01). These associations were unaffected by adjustment for covariates including measures of adult activity (current physical activity, years of fulltime ballet), measures of menstrual disturbance (age of menarche, history of irregular menses), dietary history (calcium intake as a child, adolescent or adult) or lifestyle factors (lifetime smoking, lifetime alcohol). Although starting age of ballet was negatively associated with weight-adjusted within-pair hip BMD difference, it was no longer associated after adjustment for weekly hours of ballet. There was no relationship between hours of ballet undertaken as a child and differences in BMD at the lumbar spine or upper limb, at any age. Our data suggest that classical ballet classes undertaken between the ages of 10 and 12 years are independently and positively associated with a difference in hip BMD between dancers and controls. The findings are consistent with the hypothesis that this age range identifies a stage of development when the proximal femur is particularly responsive to weightbearing exercise.

The predictive value of dementia screening instruments in clinical populations

Objective. To determine the positive predictive value of the Mini‐Mental Status Examination (MMSE), the Abbreviated Mental Test (AMT) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for dementia in different clinical settings.

Risk factors for secondary hyperparathyroidism in a nursing home population

OBJECTIVEu2003Secondary hyperparathyroidism may cause bone loss and structural deterioration of bone and may thus be a cause of fracture in the elderly. Vitamin D deficiency, renal impairment and medications are potential causes of hyperparathyroidism and may also directly predispose to fracture. We present the first findings of an ongoing study of hip fracture, vitamin D deficiency and hyperparathyroidism in a large Australian nursing home.

Erratum: Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial (Journal of the American Geriatrics Society (2005) 53 (1881-1888))

Objectives: To determine whether vitamin D supplementation can reduce the incidence of falls and fractures in older people in residential care who are not classically vitamin D deficient.

Determinants of hip axis length in women aged 10-89 years: a twin study.

Hip axis length (HAL), a measure of femoral geometry, has been shown to predict hip fracture in white women over the age of 67 years, independently of bone mineral density at the femoral neck. A cross-sectional study of 304 pairs of female twins [176 monozygous (MZ) and 128 dizygous (DZ)], aged between 10 and 89 years, was performed to examine the influence of age, constitutional, lifestyle, and genetic factors on HAL. HAL was calculated from dual energy X-ray absorptiometry scans of the proximal femur using an automated technique with an Hologic QDR-1000W. Lean mass, fat mass, height, and weight were also measured. Maximum mean HAL was achieved by the age of 15 years. After this age there was no discernible dependency of mean HAL on age. Using within-pair differences, after adjusting for height there were no other independent constitutional or lifestyle predictors. Cross-sectionally, after adjustment for height, MZ and DZ correlations were 0.79 (95% CI: 0.73-0.84) and 0.54 (95% CI: 0.39-0.68), respectively, and independent of age. The MZ correlation exceeded the DZ correlation (p < 0.001). The best-fitting model apportioned 79% (SE 7%) of variation in height-adjusted HAL to additive genetic factors. There was marginal evidence that an environmental influence shared by twins explained 31% (SE 16%) of height-adjusted variance (p = 0.07), in which case the genetic variance was reduced to 51% (SE 15%). Adjustment for height had reduced the magnitude of total variance by 26%, and 95% of this reduction was in the additive genetic component. Applying a previously described theoretical model, approximately 10% of the increased risk of hip fracture associated with a maternal history of hip fracture could be attributed to the genetic factors determining HAL. We conclude that, in women, adult HAL is achieved by midadolescence. After adjustment for height, which is itself largely under genetic influence, other genetic factors appear to play the predominant role in explaining variation in HAL.

Nandrolone decanoate and intranasal calcitonin as therapy in established osteoporosis

This study used a randomized, 2 × 2 factorial design to evaluate over 2 years the effect of intranasal salmon calcitonin and intramuscular nandrolone decanoate on bone mass in elderly women with established osteoporosis. The study was double masked in relation to calcitonin and open in relation to nandrolone decanoate. One hundred and twenty-three women aged 60–88 years who had sustained a previous osteoporotic fracture, or had osteopenia, were recruited through an outpatient clinic. Women were assigned to one of four groups: (1) daily placebo nasal spray, (2) 400 IU intranasal calcitonin daily, (3) 20 intramuscular injections of 50 mg nandrolone decanoate (given as two courses of 10 injections) plus placebo nasal spray, or (4) 20 injections of 50 mg nandrolone decanoate plus 400 IU intranasal calcitonin daily. All subjects received 1000 mg calcium supplementation daily. Outcomes measured included changes in bone mineral density (BMD) at the lumbar spine, as measured by dual-energy quantitative computed tomography (DEQCT), in BMD of the proximal femur, and BMD and bone mineral content (BMC) of the lumbar spine and forearm, as measured by dual-energy X-ray absorptiometry (DXA). Significant positive changes from baseline in DXA BMC at the lumbar spine were observed over 2 years in the calcitonin group (5.0±1.9%, mean ± SE) and in the nandrolone deconate group (4.7±1.9%) but not in the placebo group (1.1±2.2%) or the combined therapy group (0.7±1.8%). Modelling based on the 2×2 factorial design revealed that nandrolone decanoate was associated with a 3.8±1.8% (p<0.05) gain in DXA BMD at the proximal femur. Modelling also revealed that calcitonin treatment was associated with a loss of 11.5±4.7% in DEQCT BMD at the lumbar spine and a loss of 3.7±1.8% in DXA BMD at the proximal femur (p<0.05). There was in vivo antagonism between the two medications of 7.9±3.9% for DXA BMC at the lumbar spine. Both agents caused positive changes from baseline in lumbar spine BMC. Nandrolone decanoate had beneficial effects on BMD at the proximal femur. This dose of intranasal calcitonin was associated with deleterious effects on trabecular BMD at the lumbar spine and total BMD at the proximal femur. There may be significant clinical antagonism between these two medications.

Do Australian women have greater spinal bone density than North American women

The interpretation of bone mineral densitometry results for a particular individual relies on valid reference data from a representative population sample. To establish local reference data, 411 Australian female volunteers had bone mineral densitometry performed at a single medical centre at the proximal femur and lumbar spine using a Hologic QDR 1000-W dual-energy X-ray absorptiometer. These data were compared with reference material from North American women compiled by Hologic. The Australian volunteers had, on average, 7% greater bone mineral density at the lumbar spine for the age range 25–55 years. Possible explanations for this include an actual population difference or the presence of a differential selection bias between the two samples.

The Effect of Aging on Intact PTH and Bone Density in Women

To determine whether age‐related bone loss is negatively associated with serum intact parathyroid hormone (PTH).

Health care costs of people referred to an aged care assessment team: the effect of cognitive impairment

Abstract: The aim of this study was to determine the effect cognitive impairment has on direct and indirect costs to elderly people, their carers and the community over one year, by following prospectively a cohort of elderly people referred to an aged care assessment team. The 78 subjects were drawn from a random sample of people referred to the NorthWest Hospital team, and validated tools were used to assess their cognitive state. Outcome measures included total costs of community services, residential care, hospital bed use, carer burden and psychological morbidity. A comparison of outcome measures was made between those with cognitive impairment and those without. Use of community services and hospital beds was high overall. Those with cognitive impairment were substantially greater users of residential care, accounting for the higher expenditure in this group. Psychological morbidity and burden remain high in carers of those with cognitive impairment despite a high rate of institutionalisation in this group. The total costs for those referred to aged care assessment teams with cognitive impairment are double those seen for those with normal cognition.