For women with osteoporosis who are embarking on a “holiday” from taking a bone-building drug, the message from a study released today is “Bon voyage—see you in two years or so.” After menopause, loss of bone (osteoporosis) can lead to crippling fractures of the hip and spine. Drugs called bisphosphonates—alendronate (Fosamax) was the first on the market in the mid-1990s—slow bone loss. But after taking these drugs for a number of years, the balance can begin to tip from help to harm. A new report from the Fracture Intervention Trial Long-term Extension (FLEX) shows that measuring bone density after one year added no information that would have helped doctors identify who was at risk and perhaps should start taking a bisphosphonate again. Waiting two years is a good option for most women.
One key instruction in the operating manual for healthy aging is remaining ever vigilant about osteoporosis. The quest to identify osteoporosis early has led to widespread testing of bone mineral density (BMD), the key measure of bone strength. Medicare pays for the gold-standard test, dual-energy X-ray absorptiometry (DEXA), every two years, regardless of whether their previous scan was normal or not. A study published today found that repeat bone-density testing after four years improved the ability to identify those at higher risk by only 4%. This study raises the fundamental question: Is repeating testing of older people with normal bone strength every two years too much?
Getting extra calcium from supplements is supposed to be good for your bones. The latest in a string of studies heightens concern that this simple practice could end up being bad for your heart. The results support growing recommendations to get calcium from food, not pills. The latest evidence comes from the NIH-AARP Diet and Health Study, which has followed the health of nearly 400,000 men and women since 1995. Over 12 years of follow-up, men who took more than 1,000 milligrams (mg) of daily supplemental calcium were 20% more likely to succumb to heart disease than those who didn’t take calcium supplements. There was no connection between calcium supplements and heart disease in women (which has been seen in earlier studies), and no connection with calcium from food. This one study isn’t enough to find calcium guilty of heart disease in the first degree. But it’s not the only research to point the accusing finger. This line of research has some experts placing greater emphasis on a nutritious, calcium-rich diet and weight bearing exercise than on calcium supplements for keeping bones strong.
There are several good reasons to have cataracts fixed. Restoring clear, colorful vision certainly tops the list. A study published today in the Journal of the American Medical Association (JAMA) adds another benefit—a lower risk of breaking a hip. Researchers analyzed the effect of cataract surgery on the frequency of hip fracture in the following year. Among more than a million adults ages 65 and older who had cataracts, the frequency of hip fracture was 16% lower among those who had cataract surgery compared with those who didn’t have it, and the reduction in risk was even greater (23%) if the cataract was severe. Besides the immediate benefit of improved vision on everyday activities, and the longer-term one of preventing broken hips, cataract surgery may have other, less obvious benefits. These include more independence, better physical fitness, and better mental health.
The U.S. Preventive Services Task Force (USPSTF) has stirred up a maelstrom of debate by proposing that healthy postmenopausal women lay off daily calcium and vitamin D supplements, which the task force says may do more harm than good. The USPSTF concluded that, based on the available evidence, supplements containing up to 400 IU of vitamin D and 1,000 milligrams (mg) of calcium don’t reduce fractures in postmenopausal women. Plus, these supplements may slightly increase the risk of kidney stones. As a result, the USPSTF says that postmenopausal women who aren’t at risk for osteoporosis shouldn’t be taking these supplements to prevent fractures. The jury is still out on whether it’s worth it for women and men to take higher doses of calcium and vitamin D to prevent fractures, or to take vitamin D to prevent cancer. Our experts say that most of your daily calcium should come from your kitchen, not your medicine chest.
Calcium supplements are being called on the carpet after new research showed they significantly increased risk of heart attack among women getting extra calcium from pills, but not among those who got their calcium from food. What’s the connection? Over time, calcium can accumulate in arteries. It also builds up in plaque, the cholesterol-filled pockets that can cause angina or a heart attack. Three Harvard professors say the new study doesn’t prove that calcium supplements cause heart disease, but advocate that it’s almost always best to get vitamins and minerals from food, not pills.
Since bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast) were first introduced in the mid-1990s, they’ve become a staple of osteoporosis treatment. Yet an FDA review recently published in The New England Journal of Medicine questions whether there’s any benefit to staying on these drugs long-term—especially considering their potential for side effects. A report released today in the Archives of Internal Medicine highlights one of those side effects, linking bisphosphonate use to a higher risk of unusual fractures in the femur (thighbone). If you’ve been taking bisphosphonates long-term, you may be wondering, “What now?” If you’ve been taking bisphosphonates for less than five years you probably don’t need to change what you’re doing. But if you’ve been on these drugs for more than five years, talk to your doctor about whether it’s worth continuing.
Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones. Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.
Heart disease, stroke, diabetes, asthma, osteoporosis and other common chronic diseases are often blamed on genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. An intriguing hypothesis is that these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta. During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows, so the thinking goes, programs a child’s development and sets the stage for health or disease.
A panel discussion at Harvard School of Public Health called “Boosting Vitamin D: Not Enough or Too Much?” highlights the current controversy over the once-overlooked sunshine vitamin. A panel of experts assembled by the Institute of Medicine recommends a daily dose of 600 IU per day for everyone from ages 1 to 70 and 800 IU for those over 70. Other experts think the IOM recommendation is too low. One way to get vitamin D is to spend a few minutes a day outside in the sun, but that’s a hot-button issue because sun exposure is a cause of skin cancer.