Hot flashes linked to increased risk of hip fracture

oldladycaneWomen, take note: moderate to severe hot flashes and night sweats during menopause likely means lower bone mineral density and a greater chance of hip fracture than your peers without these symptoms, according to a new study.

“Our findings suggest women who exhibit moderate or severe menopausal symptoms are more likely to have issues with bone health than their peers,” said study author Carolyn J. Crandall, MD, MS, of the David Geffen School of Medicine at the University of California, Los Angeles. “This is the first large cohort study to examine the relationship between menopausal symptoms and bone health in menopausal women.”

About 60 percent of women experience hot flashes, which can last for several years.

Postmenopausal women face a greater risk of developing osteoporosis, a condition that causes bones to weaken and break more easily than do younger adults or either gender. According to the National Osteoporosis Foundation, 80 percent of the 10 million people in the U.S. with osteoporosis are women. Menopause speeds the body’s normal process of bone loss. In postmenopausal women, the body tends to breaks down old bone tissue faster than it can be replaced.

The prospective cohort study examined data from 23,573 participants in the Women’s Health Initiative (WHI) Clinical Trial. The participants were women between the ages of 50 and 79. The study, which was conducted at 40 clinical centers across the country, tracked women’s annual visits for 8 years, on average. Participants asked about their menopausal symptoms, including hot flashes and night sweats, during the initial visit. WHI participants then were monitored for fractures during the follow-up period.

Among the participants, 4,867 had their bone mineral density measured as part of a sub-study. The analysis found women who reported having moderate or severe hot flashes when they entered the study were more likely to fracture a hip during the follow-up period than women who had no menopausal symptoms. After researchers adjusted for age, body mass index and demographic factors, they found women who had moderate to severe menopausal symptoms had lower bone mass density at the neck and spine during the follow-up period than women with no symptoms.

“More research is needed to illuminate the connection between bone health and menopausal symptoms such as hot flashes,” said Crandall. “Improved understanding would help clinicians advise women on how to better prevent osteoporosis and other bone conditions. Women who have hot flashes and want to protect their bones may benefit from healthy lifestyle habits such as avoiding smoking and excessive alcohol consumption, exercising and getting sufficient calcium and vitamin D.”

The findings appear in the current issue of the Journal of Clinical Endocrinology & Metabolism.

Dear Readers:

I’ve been remiss in updating The Human Factor for these past few months – a very hectic time between covering health conferences like the Gerontological Society of America’s annual meeting [and chosen as a Journalism in Aging Fellow for GSA and New America Media], joining the Board of the Journalism and Women’s Symposium (JAWS) and numerous assignments that have kept me focused on deadlines, travel and paying gigs.  As you know, The Human Factor is a labor of love; unfortunately love doesn’t pay the bills… so paying work takes priority.

Fortunately, things are on an even keel at the moment and I’ll be making a more concerted effort to provide regular updates to this blog. I hope you’ll stick with it (and me) as I continue to try to put a human face on some of the many health policies and programs that affect us all.

Thanks for your continued support!

Now, please take a look at this excellent infographic from healthcare.com on enrolling in the health insurance exchanges.

Also, please check out my report this coming Thursday for HealthStyles on WBAI-FM, NYC on how innovative companies are developing tech to help older adults age in place.  Listen live between 1-2pm ET or find it in the archives later on.

Happy Thanksgiving!

Racial and Ethnic Stereotypes May Contribute to Obesity Among Hispanics

adults-obese-largeMaintaining a healthy weight can be much harder for Hispanics than for their white counterparts, according researchers at Rutgers University-Newark.

Minorities in the U.S. are often confronted with negative stereotypes and messages that suggest those groups are inferior. These attitudes can prevent people from doing what is needed to care for their health.

“When you are exposed to negative stereotypes, you may gravitate more toward unhealthy foods as opposed to healthy foods,” explains lead author and social psychologist Luis Rivera. The study appears in this summer’s edition of the Journal of Social Issues. Rivera was also a co-editor of the publication. “You may have a less positive attitude toward watching your carbs or cutting back on fast food, and toward working out and exercising.”

He says the resulting difference in motivation may help explain – at least in part – higher rates of obesity in the United States among members of minority groups than among whites.

Hispanics in the study who strongly self-stereotyped were more than three times as likely to be overweight or obese as those who did not. The data suggest that self-stereotypes diminish self-esteem – and therefore the motivation that might have helped them follow a healthier lifestyle.

Demeaning stereotypes come from many sources. For example, television and other mass media frequently carry harmful messages, such as Latinos are lazy or Latinos are unintelligent. “And then,” Rivera adds, “there are more subtle ways in conversations and interactions with others.”

There is some evidence that Latinos born in this country tend to have a poorer self-image than many recent Hispanic immigrants – suggesting that stereotypes ingrained in U.S. culture are especially potent – and that the design of his research reinforces that view, he said.

Aside from ethnicity, study participants were nearly identical. They lived in the same neighborhood, had comparable incomes, had similar access to healthy foods and were asked the same questions – additional evidence that if the whites and the Latinos saw themselves differently, society’s prejudice against Latinos was the underlying reason, he said.

So how does a person discouraged by stereotypes overcome them? According to Rivera, research suggests that exposure to positive racial and ethnic role models might help. Something else worth trying, he said, could be designing approaches to weight loss that emphasize the person’s positive qualities – as a way to counteract the corrosive effects of prejudice.

“It has been shown that when you remind people what they’re good at, it works to immunize them from the effect of stereotypes,” Rivera said. “It releases their anxieties and allows them to focus on the task before them and perform to their ability.”

Multiple Lifestyle Interventions May Help Those at Risk for Alzheimer’s

afternoon stroll-cRobert wallace

image: Robert Wallce, Flickr Creative Commons

Physical activity, nutritional guidance, cognitive training, social activities and management of heart health risk factors improved cognitive performance, according to Finnish researchers.

Data from a two year clinical trial in Finland of a multi-component lifestyle intervention, known as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) Study showed both overall and in separate measures of executive function, such as planning abilities, and the relationship between cognitive functions and physical movement. The  two-year randomized controlled trial of 1,260 participants age 60 to 77 with modifiable risk factors for cognitive impairment and Alzheimer’s. Results were presented at the Alzheimer’s Association International Conference in Copenhagen this past week.

Participants were divided into two groups; one received an intervention that included nutritional guidance, physical exercise, cognitive training, social activities, and management of heart health risk factors, while the control group received regular health advice. After two years, the intervention group performed significantly better on a comprehensive cognitive examination. In addition to performing better overall, the intervention group did significantly better on specific tests of memory, executive function (complex aspects of thought such as planning, judgment, and problem-solving), and speed of cognitive processing.

“This is the first randomized control trial showing that it is possible to prevent cognitive decline using a multi-domain intervention among older at-risk individuals. These results highlight the value of addressing multiple risk factors in improving performance in several cognitive domains,” said lead researcher Miia Kivipelto, M.D., Ph.D., Professor at the Karolinska Institutet, Sweden and the National Institute for Health and Welfare, Helsinki, Finland,  “Participants told us their experience was very positive, and dropout rate only 11 percent after two years.”

“This new data is very encouraging, and we look forward to further studies to confirm and extend these findings,” said Keith Fargo, Ph.D., Alzheimer’s Association director of Scientific Programs & Outreach.

The researchers say an extended, seven-year follow up study is planned, and will include measures of dementia/Alzheimer’s incidence and biomarkers including brain imaging with MRI and PET.

Drug Risks Outweigh Benefits for Some Type 2 Diabetes Patients

670px-Cure-Dry-Mouth-Step-1For patients with type 2 diabetes – especially those over age 50 – the negative impact of side effects like weight gain and burdens like frequent insulin shots trumps the benefits of drugs, says a new study by the University of Michigan Health System, the VA Ann Arbor Healthcare System, and University College London.

The findings, which appear in today’s Journal of the American Medical Association Internal Medicine, show that for many, the benefits of taking diabetes medications are so small that they are outweighed by the minor hassles and risks.

These findings suggest that, contrary to current guidelines for type 2 diabetes that recommend intensifying treatment until a person’s blood sugar level reaches a certain goal, the overall benefit of taking a new medicine depends less on blood sugar and more on the hassles, safety and side effects of taking the treatment.

“For people with type 2 diabetes, the goal of managing blood sugar levels is to prevent associated diabetes complications, such as kidney, eye and heart disease, but it is essential to balance complication risks and treatment burdens when deciding how aggressively to treat blood sugars,” says lead author Sandeep Vijan M.D., M.S., professor of Internal Medicine at the U-M Medical School and research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.

“If you’re a patient with fairly low complication risks, but are experiencing symptoms from low blood sugar, gaining weight or find frequent insulin shots to be disruptive to your daily life, then the drugs are doing more harm than good. Prescribing medicine isn’t just about reducing risks of complications, but also about helping patients improve their quality of life.”

Vijan notes that for many patients, once moderate levels of glucose control are achieved, there is little additional benefit to intensive blood sugar treatment, but treatment costs, burdens and risks increase substantially. The study finds that the benefits of treatment decline with age and by age 75 the harms of most treatments are likely to outweigh any benefits.

The findings exclude the 15-20 percent of people with type 2 diabetes who have very high blood glucose levels (which are defined by what’s called an A1c test ) and need more aggressive treatment to manage the disease.

Individualized treatment recommendations determined by patients’ estimated risk of diabetes complications – influenced by their age and degree of blood glucose elevation – and considering the side effects and amount of safety data of the medication being considered, is a much better approach than focusing solely on glucose goals, the researchers argue.

“Drugs that lower blood sugar levels are extremely beneficial in some patients but offer almost no benefit for others. These results have major implications for the millions of people who are currently being told that they need to increase medication in order to achieve their ‘glucose goal,’” says senior author Rodney Hayward, M.D., professor of medicine in the U-M Medical School and senior research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.

“Current quality measures do not allow doctors and patients to make good decisions for each patient because they emphasize reaching targets instead of thinking of the risks and benefits of starting new medications based on individual circumstances and preferences.”

The study is the latest to challenge “treat-to-target” guidelines in medicine. Research concluding that risks outweighed benefits of drugs intended to achieve specific blood pressure goals in some patients prompted a significant change in hypertension guidelines last year and similar recommendations were implemented for lipid-lowering therapy.

International Federation for Diabetes guidelines for treating older people says the emphasis should be on managing complexity and quality of life issues — especially for frail elderly and those with dementia. “There is a need to individualize the medication
regimen to balance the imperative to control disease states with
the imperative to avoid/minimize medicine related adverse events.
Medicines are associated with significant risks in older people such
as falls, confusion and other cognitive changes, and admission to
hospital or emergency departments could be avoided if medicines are
managed optimally.”

Both Vijan and Hayward are members of the Institute for Healthcare Policy and Innovation.