Research news from the Friedman School of Nutrition Science and Policy at Tufts University

10/14/04

Focus on osteoporosis

NOTE: The US Surgeon General's Report on Bone Health and Osteoporosis was released on October 14th. Osteoporosis is a critical health issue in this country, particularly for elders. Dr. Bess Dawson-Hughes, president of the board of trustees for the National Osteoporosis Foundation and a nationally renowned expert on osteoporosis, notes in a recent journal article (summarized below) that it is "the most common metabolic bone disease in the United States, reaching epidemic proportions in the elderly population."*

The National Osteoporosis Foundation reports that "One in every two women and one in every four men age 50 and older will experience an osteoporosis-related fracture in their lifetime."

This issue of Nutrition Notes focuses on two recent studies from Tufts University on osteoporosis.

--Gap in Care Found for Fracture Patients--

In a recent one-year study following the care of patients over the age of 51 who had been seen at a hospital for an acute fracture, researchers at Tufts and other institutions found that few of these patients were treated for osteoporosis. The authors note that the risk of re-fracture could be reduced drastically if more patients were evaluated and treated for osteoporosis.

In the study, six months after the fracture, of the 86 patients who could be reached, only 36% of the women and 7% of the men had recently discussed osteoporosis with their primary care physician, and there was no increase in the use of osteoporosis medications by the patients. Among the men and women who were advised by their doctors to increase intake of vitamin D and calcium, there was a significant increase in the use of vitamin D and calcium supplements, and an increase in the consumption of dairy foods. But, importantly, the men and women who did not receive this advice showed no significant changes in their intake of these substances. At twelve months, the treatment profiles were unchanged.

"Our study shows that when doctors do recommend increasing vitamin D and calcium, that patients comply," said corresponding author Bess Dawson-Hughes, MD, director of the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts. "Primary care physicians are in a position to help patients reduce their risk of re-fracture by taking prescription osteoporosis medication and by increasing vitamin D and calcium in their diets. These patients just need a bit of counsel."

"In conclusion, the occurrence of a fracture did not prompt additional prescription bone medication use in either the women or the men in this study. Men were not advised to increase their calcium intakes after their fractures and did not do so. Calcium supplement use and dairy food intake did increase after the fractures in the women, and these increases occurred specifically in those women who were advised by their physicians to consume more calcium. The responsiveness of our patients to the advice of their physicians suggests that the primary care physician is well positioned to bring about much needed change in the care of fracture patients," reported Bess Dawson-Hughes and co-authors in the conclusion of the study.

For "Fast Facts" about the prevalence of osteoporosis, please visit the National Osteoporosis Foundation web site at: http://www.nof.org/osteoporosis/diseasefacts.htm

*Pro-Risquez, A., Harris, S., Song, L., Rudicel, S., Barnewolt, B., Dawson-Hughes, B. Osteoporosis International, 2004, 15: 689-694. "Calcium supplement and osteoporosis medication use in women and men with recent fractures."

--A Pick-Up Game Now May Mean Healthier Bones Later--

There might be more to sports in college than building team spirit and camaraderie. According to a study of college-aged students (ages 17-21), young Caucasian adults may require more moderate to vigorous physical activity, such as sports, than is currently recommended for overall health and to help reduce the risk of osteoporosis. The data are from the Tufts Longitudinal Health Study, an ongoing study that is researching the relationships between health knowledge, attitudes, behaviors, and physiologic outcomes of college-age students over time.

Osteoporosis, a disease characterized by low-bone density, can lead to debilitating injuries, but often progresses undetected for years before symptoms appear. Weight-bearing exercise, particularly in the first three decades of life, is key to preventing it. Yet, one national survey reported that only 38% of college students in the US engage in vigorous activity and 20% engage in moderate physical activity.

"We know that life transitions, like entering college, represent an opportunity to influence physical activity," said Christina Economos, PhD, assistant professor at the Friedman School of Nutrition Science and Policy at Tufts. "And we know that weight-bearing physical activity is critical to preventing osteoporosis. We found that sports participation and weight training are associated with a stronger bone stiffness for both men and women. Bone stiffness is related to bone strength and higher bone stiffness is associated with lower risk for osteoporosis."

Economos and a colleague examined the relationship between skeletal status and physical activity in a group of 235 college students between the ages of 17 and 21. The study examined how participation in different physical activities affected bone health in men and women.

Both moderate and vigorous sports participation, as well as weightlifting, were associated with higher bone stiffness in both men and women. Muscle mass and strength affected bone quality differently in men and women, but taking part in physical activity improved bone stiffness in both groups. The vigorous sports, such as soccer, basketball, ultimate Frisbee, baseball, cheerleading and rugby were clearly weight-bearing and high-impact activities which are known to reduce the risk of osteoporosis. However, participation in moderate sports, such as leisure volleyball, golf, and doubles tennis, was also found to be associated with increased bone quality, but this effect among women was much lower than the effect of vigorous sports.

Economos, who is also associate director of the John Hancock Center for Physical Activity and Nutrition at Tufts, noted, "Our study showed that young people should be encouraged to participate more in sports of all kinds -- whether they play on a varsity team or just get into the habit of participating in intramural or pick up games -- the difference may be health benefits for years to come."

Wetter, A., Economos, C., Osteoporosis International, 2004, 15: 799-806. "Relationship between quantitative ultrasound, anthropometry and sports participation in college aged adults."

Source: Eurekalert & others

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