The maligned prune.....good for your bones
Posted by on September 13, 2011 - 6:55am

No bones about it:  eating prunes helps prevent fractures and osteoporosis.   When it comes to improving bone health in postmenopausal women — and people of all ages, actually — a Florida State University researcher has found a simple, proactive solution to help prevent fractures and osteoporosis: eating dried plums.

“Over my career, I have tested numerous fruits, including figs, dates, strawberries and raisins, and none of them come anywhere close to having the effect on bone density that dried plums, or prunes, have,” said Bahram H. Arjmandi, of  Florida’s chairman of the Department of Nutrition, Food and Exercise Sciences in the College of Human Sciences. “All fruits and vegetables have a positive effect on nutrition, but in terms of bone health, this particular food is exceptional.”

Arjmandi and a group of researchers from Florida State and Oklahoma State University tested two groups of postmenopausal women. Over a 12-month period, the first group, consisting of 55 women, was instructed to consume 100 grams of dried plums (about 10 prunes) each day, while the second — a comparative control group of 45 women — was told to consume 100 grams of dried apples. All of the study’s participants also received daily doses of calcium (500 milligrams) and vitamin D (400 international units).

The group that consumed dried plums had significantly higher bone mineral density in the ulna (one of two long bones in the forearm) and spine, in comparison with the group that ate dried apples. This, according to Arjmandi, was due in part to the ability of dried plums to suppress the rate of bone resorption, or the breakdown of bone, which tends to exceed the rate of new bone growth as people age.

The group’s research, “Comparative Effects of Dried Plum and Dried Apple on Bone in Post Menopausal Women,” was published in the British Journal of Nutrition.  In the United States, about 8 million women have osteoporosis because of the sudden cessation of ovarian hormone production at the onset of menopause. What’s more, about 2 million men also have osteoporosis.

“In the first five to seven postmenopausal years, women are at risk of losing bone at a rate of 3 to 5 percent per year,” Arjmandi said. “However, osteoporosis is not exclusive to women and, indeed, around the age of 65, men start losing bone with the same rapidity as women.”

Arjmandi encourages people who are interested in maintaining or improving their bone health to take note of the extraordinarily positive effect that dried plums have on bone density.

“Don’t wait until you get a fracture or you are diagnosed with osteoporosis and have to have prescribed medicine,” Arjmandi said. “Do something meaningful and practical beforehand. People could start eating two to three dried plums per day and increase gradually to perhaps six to 10 per day. Prunes can be eaten in all forms and can be included in a variety of recipes.”

Source: Florida State University

Soy not so 'hot' for menopause symptoms
Posted by on September 7, 2011 - 6:06am

Soy supplements do not help women in menopause, according to the findings of a two-year, $3 million study conducted at the Miller School of Medicine’s Osteoporosis Center. The study was funded by the National Institutes of Health to determine if the widely popular product could preserve bone health and ease symptoms in the first years of menopause. The results show that, contrary to popular belief, soy isoflavone supplements neither prevent bone loss nor reduce menopausal symptoms.

The findings of the SPARE Study, which stands for Soy Phytoestrogens As Replacement Estrogen, were published in the August 8 issue of the Archives of Internal Medicine.

“The consumption of soy foods and soy supplements has dramatically increased in the last few years, particularly among women who start taking various over-the-counter products around the time of menopause, believing that these products will provide all the benefits and none of the risks of menopausal hormone therapy,” said Silvina Levis, professor of medicine, director of the Osteoporosis Center, and principal investigator and lead author of the study. “Our study showed that soy phytoestrogen tablets do not provide any benefit, but fortunately do not cause any apparent harm either. The participants had the same rates of bone loss and menopausal symptoms, whether they were taking soy tablets or placebo tablets (sugar pills). The women on the soy tablets actually had more constipation and abdominal bloating.”

The participants, women aged 45 to 60 and within five years of menopause, were randomly assigned, in equal proportions, to receive either daily soy isoflavone tablets or the placebo and were not aware of which they were taking.

The women were followed for two years and underwent a bone density test (DXA) at the beginning and the end of the study to measure the rate of bone loss. The study showed no meaningful difference in the rate of bone loss between those taking the soy tablets and those taking the placebo. Additionally, those women taking the soy supplement reported no measurable improvement in the number or severity of menopausal symptoms such as hot flashes or in vaginal cytology or cholesterol levels.

While the study is not an endorsement of hormone therapy, it objectively demonstrated that women who take soy isoflavone supplements will not enjoy any clinical benefits.

Source:  University of Miami Veritas

Facial Wrinkles May Predict Bone Density
Posted by on July 4, 2011 - 7:56am

"In postmenopausal women the appearance of the skin may offer a glimpse of the skeletal well-being, a relationship not previously described," said Lubna Pal, MD, a reproductive endocrinologist at Yale School of Medicine, New Haven, Conn.

The study demonstrates only an association between bone density and skin wrinkling. However, Dr. Pal called these findings noteworthy."This information," Pal said, "may allow for the possibility of identifying postmenopausal women at fracture risk at a glance, without dependence on costly tests."

The study is an ancillary study to an ongoing multicenter trial called the Kronos Early Estrogen Prevention Study, or KEEPS, which is funded by the Aurora Foundation and the Kronos Longevity Research Institute in Phoenix. This ancillary study included 114 women in their late 40s and early 50s who had had their last menstrual period within the past three years and who were not taking hormone therapy. Women were excluded from participating if they had undergone any cosmetic skin procedures.

Women received a score for face and neck wrinkles based on the number of sites with wrinkles and on the depth of the wrinkles. The skin firmness or rigidity was measured at the forehead and the cheek with a device called a durometer. Study participants also underwent measurement of bone density by dual X-ray absorptiometry (DEXA) and by a portable heel ultrasound device.

The investigators found a significant inverse correlation between the wrinkle score and the bone density, meaning the higher the score (and the worse the wrinkles), the lower the bone density. This relationship was evident at all skeletal sites -- hip, lumbar spine and heel -- and was independent of age, body composition or other factors known to influence bone density, Pal said. Additionally, firmer skin of the face and forehead was associated with greater bone density.

Although the connection between bones and skin may seem unclear, Pal explained that they share common building blocks -- a group of proteins known as collagens. As we age, changes in collagen occur that may account for age related skin changes including worsening skin wrinkles and sagging skin, and also contribute to deterioration in bone quality and quantity.

Long-term studies are needed to substantiate a relationship between wrinkles and the risk of bone fracture, Pal said.

"Ultimately, we want to know if intensity of skin wrinkles can allow identification of women who are more likely to fracture a bone, especially the femoral neck or the hip, an often fatal injury in older people," she said. "If this is the case, then including the study of skin wrinkles to other clinical risk factors may allow identification of fracture risk in populations that do not have access to more costly technology."   The results were presented at The Endocrine Society's 93rd Annual Meeting in Boston.

Green Tea and Tai Chi--a Healthy Partnership
Posted by on May 16, 2011 - 12:13pm

Green tea has become an international mainstay beyond the Orient.   Many observational studies have shown that green tea is full of potent polyphenols (an antioxidant) that lower the risk of several chronic degenerative diseases such as heart disease and osteoporosis.  A recent study from Dr. Chwan-Li (Leslie)  Shen, an associate professor and a researcher at the Laura W. Bush Institute for Women's Health at Texas Tech University Health Sciences Center looked at the mechanism behind this correlation and believes it may have to do with lowering chronic levels of inflammation.

Dr. Shen has developed an animal model to study  green tea consumption and its protective effect on the breakdown of the bone's microarchitecture.  In humans, this can lead to osteoporosis, a condition common in postmenopausal women.  In her most recent study, she investigated the potential for green tea to work synergistically with tai chi, a moderately aerobic exercise popular among Chinese cultures.  Together, can these two interventions enhance bone strength?

Her randomized controlled study (the gold standard) included 171 postmenopausal women (average age was 57) who had weak bones but not full fledged osteoporosis.  They were divided into 4 groups:

  • Placebo (starch pill) and no tai chi
  • Green tea polyphenols (GTP)  and no tai chi (TC)
  • Placebo and tai chi
  • GTP plus TC

Blood and urine samples were collected on all women for 6 months and muscle strength assessed..

The GTP + TC group showed enhanced markers of bone health and muscle strength at 3 and 6 months.   Of greatest interest was the Dr. Shen's finding that both GTP and TC had on biological markers of oxidative stress, the precursor to inflammation.  Inflammation is not only a factor in osteoporosis but other chronic diseases as well.  Her findings were presented in a poster at the Experimental biology meetings in April.   Further studies are needed to confirm and better understand the mechanisms involved.

In the meantime, drinking green tea and trying tai chi sounds like a good idea, especially for premenopausal women!

Calcium and vitamin D may be better than drugs for early osteoporosis prevention
Posted by on May 4, 2011 - 6:56am

If a bone density scan has placed you at risk for osteoporosis, you might want to think twice before starting a bone-building medication as a first course of action. Changing your diet to include more calcium and vitamin D is an effective and less risky strategy that doctors often disregard, according to a recent University of Illinois study published in the journal Nutrients.

Many doctors are quick to prescribe bone-building medication because they believe it's unlikely that people will change their diets, said study co-author Karen Chapman-Novakofski, professor of nutrition at University of Illinois. But these medications have risks, which ironically include an increase in hip fractures and jaw necrosis, and therefore should be used as a last resort when diet and supplements don’t help, she said.

In the study, which analyzed 219 articles in scientific journals, the researchers found that adults who increase their intake of vitamin D and calcium, whether through food or supplements, usually increase their bone mineral density and reduce their risk for hip fracture significantly.

The National Osteoporosis Foundation recommends that adults age 50 and older get a total of 1,200 mg of calcium and 800-1,000 international units (IUs) of vitamin D every day. Karen Plawecki, lead author of the study, said it is possible to consume the recommended calcium without gaining weight. Three glasses of 1 percent or skim milk contain 900 mg of calcium, and many other foods, like soy milk, orange juice, cereal and bread, are often fortified with calcium and vitamin D.

The researchers also noted that following a low-sodium diet seems to have a positive effect on bone density. Click the National Osteoporosis Foundation links below for tips on getting enough calcium and vitamin D.

http://www.nof.org/aboutosteoporosis/prevention/calcium

http://www.nof.org/aboutosteoporosis/prevention/vitamind

Obesity and Osteoporosis
Posted by on April 21, 2011 - 3:03pm

It has been reported in the past that obesity (body fat mass) is  protective against osteoporosis and fracture.  However, a recent study has documented a high prevalence of obesity in postmenopausal women with fragility fracture.

An international group of researchers has presented research at the European Congress on Osteoporosis & Osteoarthritis that compares the prevalence and location of fractures in obese (Body Mass Index≥30 kg/m2) and non-obese postmenopausal women and examines specific risk factors for fracture.

A history of fracture after age 45 years was observed in 23% of obese and 24% of non-obese women. Nearly one in four postmenopausal women with fractures is obese. The upper arm, ankle and lower leg were significantly more likely to be affected in obese than non-obese women with a prevalent fracture, whereas fractures of the wrist, hip and pelvis were significantly less common than in non-obese women. When compared to non-obese women, obese women with a prevalent fracture were more likely to be current cortisone users, to report early menopause, to report fair or poor general health, to use arms to assist standing from a sitting position, and to report more than two falls in the past year.

The research demonstrates that obese postmenopausal women are almost as likely to fracture as non-obese women, and that poor mobility and increased risk of falls may play an important role. The findings have significant public health implications in view of the rapidly rising numbers of obese people in the population.

 

Breast Cancer Therapy Contributes to Hip Fracture Risk
Posted by on February 23, 2011 - 7:10am

Painful Hip Fractures Strike Breast Cancer Survivors

A hip fracture is not common in a 54-year-old woman, unless she is a 54-year-old breast cancer survivor, according to a new Northwestern Medicine study. Researchers found that a combination of early menopause due to breast cancer treatment and common drugs used to treat breast cancer, could be weakening the bones of breast cancer survivors once they hit middle age, leading to hip fractures.

Results of the study are published in the February 2011 issue of Clinical Cancer Research.

Hip fractures are rare in people under 70. Yet, Northwestern Medicine physician Beatrice Edwards, M.D., found that several breast cancer survivors in their early 50s were coming to her for treatment of hip fractures.  Edwards is director of the Bone Health and Osteoporosis program and associate professor of medicine and of orthopaedic surgery at Northwestern University Feinberg School of Medicine.

Researchers studied six of these women over one year and assessed the type of breast cancer they had, the treatment they underwent and a hip fracture’s effect on quality of life, said Edwards, lead author of the study.

“One year after the fracture the women still reported difficulty with climbing stairs, shopping and heavy housekeeping,” Edwards said. “Their health care costs may increase and their fractures contribute to losing some independence.”

Edwards was surprised to find that the majority of the women did not have osteoporosis, but did have lower than normal bone mineral density (osteopenia). This suggests that rapid change in bone architecture from chemotherapy, early menopause and adjuvant therapy may not be evident on bone mineral density test, Edwards said.

The women had early-stage breast cancer and received treatment including lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin one to four years before the fracture occurred. They were all perimenopausal at the time of the fracture.

Four of the six women had breast cancer that grew in response to estrogen and received aromatase inhibitors (AIs) as part of their cancer therapy to block their bodies from making estrogen. Recent studies have linked AIs with possible bone loss in women.   Edwards’ team also reviewed reports from the FDA’s adverse event reporting system and other databases and found that AIs were the most common drug class associated with hip fractures.

“Although the majority of women with breast cancer can expect to be fully cured from the disease, the prevention of cancer treatment-induced bone loss is important to consider in cancer survival,” Edwards said. “More research needs to be done before treatment guidelines are changed, but greater awareness of the adverse effects of certain breast cancer drugs is needed.”

Edwards said the next step is for researchers to conduct a clinical trial and give bone density screenings to women before they enter breast cancer chemotherapy. High-risk patients would be flagged and given preventive bone loss therapy and monitored for premature hip fractures.

“The pain and suffering and hospital stays and higher health costs associated with these hip fractures might be prevented through early intervention,” Edwards said.

The title of the paper is “Cancer therapy associated bone loss: Implications for hip fractures in mid-life women with breast cancer.”

By Erin White, Northwestern Newscenter

Osteoporosis Screening Recommended for All Women over Age 65
Posted by on January 21, 2011 - 3:09pm

In an update to its 2002 recommendation, the U.S. Preventive Services Task Force (USPSTF) now recommends that all women ages 65 and older be routinely screened for osteoporosis. This is the first final recommendation statement to be published since the USPSTF implemented a new process in July 2010 in which all of its draft recommendation statements are posted for public comment on the USPSTF Web site prior to being issued in final form.

The USPSTF also recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. White women are used as the benchmark because they have a markedly higher rate of osteoporosis and fractures than other ethnic groups. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass and parental history of fractures.

The USPSTF did not indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age and the evidence indicates that benefits can be realized within 18 to 24 months after starting treatment. The USPSTF also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time. This new final recommendation will become effective when it appears in the January 18 online issue of Annals of Internal Medicine and will also be available on the USPSTF Web site.

Osteoporosis screening involves a measurement of bone density, which is currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on DXA tests alone. The USPSTF noted that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.

In postmenopausal women who have no prior fractures caused by osteoporosis, the USPSTF found convincing evidence that drug therapies (including bisphosphonates, parathyroid hormone, raloxifene and estrogen) reduce the risk for osteoporosis-related fractures.  It should be noted that risks regarding long term use of some of these therapies are being studied and other blogs on this site discuss that.

Osteoporosis, a condition that occurs when bone tissue thins or develops small holes, can cause pain, broken bones and loss of body height. Osteoporosis is more common in women than men and is more common in whites than any other racial group. For all demographic groups, the rates of osteoporosis rise with increasing age.

The USPSTF is an independent panel of private-sector experts in prevention and evidence-based medicine that conducts rigorous, impartial assessments of the scientific evidence and makes recommendations on the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. The USPSTF does not consider costs or cost-effectiveness in creating recommendations. The Agency for Healthcare Research and Quality (AHRQ) is authorized by statute to convene the USPSTF and provide scientific and administrative support.

Are We Getting Enough Vitamin D and Calcium?
Posted by on January 6, 2011 - 8:26am

Calcium and Vitamin D are essential nutrients known for their role in bone health.   However, a lot of vitamin companies have been touting these two substances for all kinds of health benefits beyond the skeletal system. This has created some confusion about nutritional messaging.

To help clarify this issue, the US and Canadian governments requested the Institute of Medicine (IOM) to assess the current data and outcomes related to these two nutrients.  Their findings were released in a brief on  November 2010 and are they are summarized below.

The overall conclusion was that most Americans and Canadians are receiving adequate amount of calcium and vitamin D.  However, there is some emerging evidence that too much of either substance can be harmful.  The committee looked at a full range of health outcomes ranging from a variety of health conditions including cancer, pregnancy, hypertension and bone health.   What they found is that a strong body of scientific evidence substantiates the importance of these two substances in bone health.   However, their review in areas outside of bone health, found that those studies often produced mixed or inconclusive results.   Higher levels of these products above the normal recommended amounts (there is a chart with recommendations by age group in the brief) have been linked to other health problems, challenging the concept "more is better".

Bisphosphonates for Bones Back in the News
Posted by on October 13, 2010 - 3:09pm

On March 11, 2010, this site posted a BLOG about news reports that raised the question about whether or not there is an increased risk of atypical subtrochanteric femur fractures in patients taking bisphosphonate medication for osteoporosis.  At that time, the data that the FDA reviewed did not show a clear connection between these rare fractures and these drugs but physicians patients were encouraged to be vigilant if using these drugs.

Today, October 13, 2010,  the Food and Drug Administration (FDA) issued a somewhat stronger warning that there is a possible increased risk of this rare thigh bone fracture in patients taking bisphosphonates.  FDA still says it is not clear whether bisphosphonates are the cause of the unusual bone breaks known as subtrochanteric femur fractures, which occur just below the hip joint,  and diaphyseal femur fractures, which occur in the long part of the thigh.   However, they are concerned enough to change the labeling  and the medication guides.

The FDA says the optimal duration of using these drugs to treat osteoporosis is unknown--an uncertainly the agency is highlighting because these fractures may be related to use of bisphosphonates for longer than five years.  They will continue to evaluate the effect of long-term treatment.   To view the updated FDA article, click HERE.

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