Vitamin D Alone Doesn’t Prevent Fractures, New Study Finds

Vitamin D Alone Doesn’t Prevent Fractures, New Study Finds

FRIDAY, Dec. 20, 2019 (HealthDay News) — Taking calcium and vitamin D might help older adults curb the risk of a bone fracture, but vitamin D alone does not do the job, a new research review concludes.

The analysis of 28 past studies found that older adults with higher blood levels of vitamin D were less likely to suffer a broken hip or other fracture over five to 15 years.

But the picture was different in studies that actually tested the effects of using vitamin D supplements: They found no evidence that vitamin D alone reduced older adults’ risk of fractures.

In contrast, trials that tested a combination of calcium and vitamin D showed modest protective effects.

“Combined treatment with both calcium and vitamin D reduced the risk of hip fracture by one-sixth, and was more beneficial than taking standard doses of vitamin D alone,” said senior researcher Dr. Robert Clarke, a professor of epidemiology and public health medicine at the University of Oxford in England.

The findings, published online Dec. 20 in JAMA Network Open, are not the final word on vitamin D and fractures. Some ongoing trials are testing high-dose vitamin D in people who are at increased risk of bone breaks.

But for now, there’s no proof that it works, according to Clarke.

In the United States alone, about 54 million people have low bone mass or outright osteoporosis — the brittle-bone disease that can lead to fractures, according to the National Osteoporosis Foundation (NOF). It’s estimated that after age 50, half of women and one-quarter of men will break a bone due to osteoporosis.

Calcium is critical to building and maintaining strong bones, while vitamin D helps the body absorb calcium and supports the muscle function needed to avoid falls.

But when it comes to preventing fractures in people with osteoporosis, there’s only so much that supplements can do, said the NOF’s Beth Kitchin. She was not involved with the study.

“The expectation that vitamin D and calcium, alone, will prevent fractures is probably unrealistic,” said Kitchin, who is also an assistant professor of nutrition sciences at the University of Alabama at Birmingham.

To help preserve bone mass and keep muscles strong, people need regular exercise, according to Kitchin. Exercise that makes the body move against gravity while staying upright — like jogging, jumping rope or dancing — can help maintain bone density. And exercise that builds muscle strength or improves balance can help lower the risk of falls.

Avoiding smoking and excessive drinking is also critical to preventing bone loss, according to the NOF.

Once osteoporosis is diagnosed, medications — which either slow bone breakdown or boost bone formation — may be necessary, Kitchin said. “Fall-proofing” your home is another important step. That means getting rid of tripping hazards inside and outside the house; installing grab bars in bathrooms; and keeping stairways well lit, among other measures.

Of the studies Clarke’s team analyzed, 11 were observational. They followed older adults in the “real world,” tracking fracture rates anywhere from five to 15 years. Overall, the higher a person’s blood levels of vitamin D were at the outset, the lower the risk of fracture.

“But that doesn’t prove cause and effect,” Kitchin stressed. “High vitamin D levels can be a marker of something else.”

Few foods contain vitamin D, she noted. Instead, the body synthesizes it when the skin is exposed to sunlight. So people with high vitamin D levels may spend a lot of time outdoors, for example.

The review also included 11 trials testing vitamin D alone, and six testing vitamin D and calcium. Study participants’ average age ranged from 62 to 85, and they were followed for up to five years.

Overall, people given calcium and vitamin D had a 16% lower risk of hip fracture than those given placebos or no treatment. Their risk of any bone break was 6% lower.

So how do you know if you should take supplements? You could ask your doctor to measure your blood level of vitamin D, to detect any deficiency, Kitchin said. As for calcium, she added, “take a look at your diet.”

If you’re not eating much dairy, green vegetables and foods fortified with calcium, you might need a supplement.

According to the NOF, adults younger than 51 should strive for 1,000 mg of calcium a day; after that, the recommendation goes up to 1,200 mg. As for vitamin D, people younger than 50 should get 400 to 800 international units (IU) per day, while older adults need 800 to 1,000 IU.

The advice on vitamin D does vary, however, with some groups recommending more. According to the Institute of Medicine, the safe upper limit of vitamin D is 4,000 IU per day for most adults.

More information

The National Osteoporosis Foundation has more on calcium and vitamin D.

SOURCES: Robert Clarke, M.D., professor, epidemiology and public health medicine, University of Oxford, U.K.; Elizabeth Kitchin, Ph.D., R.D.N., assistant professor, nutrition sciences, University of Alabama at Birmingham, and volunteer faculty, National Osteoporosis Foundation; JAMA Network Open, online, Dec. 20, 2019

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How to Manage Your Osteoarthritis

How to Manage Your Osteoarthritis

(HealthDay News) — Osteoarthritis is the most common form of arthritis, affecting about 31 million Americans, and is the leading cause of disability among adults.

Known as OA, it causes pain and other symptoms in joints, which can affect the ability to do everyday tasks. There’s no known cure, but there are treatments that can relieve pain and maintain joint function, according to a rheumatologist at Wake Forest Baptist Health in Winston-Salem, N.C.

“Osteoarthritis is the thinning or wearing down of cartilage, which is the cushion between the separate bones in a joint,” Dr. Francis Luk said in a health system news release. “When your doctor says you have arthritis, most often they are referring to osteoarthritis.”

The main risk factors are aging, obesity, prior injury, repetitive stress on a joint and genetics. OA can occur in any joint, but the most common are knees, hips and hands.

“Symptoms vary from person to person but someone with osteoarthritis of the knee typically will have pain when they stand up from a seated position or when they’re walking, especially when going up and down stairs,” Luk said.

“With osteoarthritis of the hands, people typically experience pain when they do things that involve gripping — washing dishes, holding a wrench, opening a jar, things like that,” he added.

Treatments include over-the-counter drugs such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve).

Other nonprescription options include topical creams and gels, such as those containing trolamine salicylate (Aspercreme), and the use of heating pads and ice packs.

Assistive devices such as canes, shoe orthotics, jar openers and tools with thicker handles can help with routine tasks.

For more advanced cases of OA, there are prescription pills and creams and steroid injections. The last resort is joint replacement surgery, especially of knees and hips.

“We always try to delay turning to surgery for as long as we can,” Luk said. “However, if you get to a point where you can’t walk from your living room chair to the bedroom, it would be a good idea to see an orthopedic surgeon.”

And, remember, two of the best ways to combat OA are maintaining a normal weight and getting regular exercise, he said.

“I tell people to do as much as they can tolerate until they have some pain and then rest,” Luk said. “I never recommend completely stopping activities, because the downside of inactivity is worse than osteoarthritis.”

More information

The American Academy of Family Physicians has more on osteoarthritis.

SOURCE: Wake Forest Baptist Health System, news release, Oct. 10, 2019

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Health Tip: The ‘Wall Test’ For Good Posture

Health Tip: The ‘Wall Test’ For Good Posture

(HealthDay News) — Proper posture can prevent pain and injury, says Mayo Clinic. To check if you have proper posture, Mayo suggests the “wall test.”

Here’s what it involves:

  1. Stand so the back of your head, shoulder blades and buttocks touch the wall. Your heels should be 2 to 4 inches apart.
  2. Place a flat hand behind the small of your back. You should be able to slide your hand between your lower back and the wall.
  3. If there’s too much space behind your lower back, draw your belly button toward your spine.
  4. If there’s too little space behind your lower back, arch your back so your hand can slide behind you.
  5. Walk away from the wall while holding proper posture. Return to the wall to check whether you kept the correct posture.
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Get Moving: Exercise Can Help Lower Older Women’s Fracture Risk

Get Moving: Exercise Can Help Lower Older Women’s Fracture Risk

FRIDAY, Oct. 25, 2019 (HealthDay News) — Older women who get even light exercise, like a daily walk, may lower their risk of suffering a broken hip, a large study suggests.

A number of studies have linked regular exercise to a lower risk of hip fracture — a potentially disabling or even fatal injury for older adults. Each year, more than 300,000 people in the United States aged 65 or older are hospitalized for a broken hip, according to the U.S. Centers for Disease Control and Prevention.

The new study, of more than 77,000 older U.S. women, took a deeper look at the types of exercise that are related to the risk of hip fracture and other bone breaks.

The researchers found that, on average, women who regularly exercised at any intensity — from walking, to doing yard work, to jogging — had a lower risk of hip fracture over 14 years, compared to inactive women.

It all suggests that even light activity is enough to curb the risk of these serious injuries, said study leader Michael LaMonte, a research associate professor at the State University of New York at Buffalo.

“We were happy to see a strong relationship between walking and lower hip fracture risk,” he said. “As we get older, we naturally do less-strenuous physical activity. This suggests that to lower your risk of hip fracture, you don’t need to do anything fancy. It can be as simple as walking.”

The findings “strongly support” longstanding recommendations for people to fit physical activity into their daily routine, according to Dr. Richard Bockman.

“Get out there and walk,” said Bockman, chief of the endocrine service at the Hospital for Special Surgery, in New York City.

Lower-impact activities do not have a big effect on bone density. But Bockman, who was not involved in the study, said that while bone density matters in hip fracture risk, other factors are also involved. They include muscle strength in the lower body, balance and agility, since broken hips are almost always the result of a fall.

The findings, published online Oct. 25 in JAMA Network Open, come from the Women’s Health Initiative — a study begun in the 1990s at 40 U.S. medical centers. It involved more than 77,000 women who were between the ages of 50 and 79 when they enrolled.

At the outset, the women reported on their usual physical activities, among other lifestyle factors.

Over an average of 14 years, one-third of the women suffered a bone fracture. When it came to hip fractures, women who’d reported higher amounts of physical activity at the study’s start typically had a lower risk.

For example, women who regularly got moderate to vigorous exercise, such as brisk walking or jogging, had a 12% lower risk of hip fracture than those who were less active. But there was also a link between “mild activity” — like slow dancing, bowling or golfing — and lower hip fracture risk. And the more often women walked, at any speed, the lower their risk of a broken hip.

The news wasn’t all good: Women who exercised at moderate to vigorous intensities had a relatively higher risk of a wrist or forearm fracture, compared to less-active women.

It’s not clear why, but LaMonte offered a guess: When women with more “functional ability” do fall, they may be more likely to stretch out an arm to break the fall, which is how wrist and forearm fractures often happen.

One question the study cannot address, LaMonte said, is whether starting exercise at an older age reduces hip fracture risk. Study participants who were physically active may have been active their whole lives.

But, he said, it is clear that “sitting less and moving more” is key in older adults’ overall health, with benefits such as better control of blood pressure and diabetes, and a lower risk of heart disease.

Besides exercise, older adults can take other steps to reduce their hip fracture risk, LaMonte noted. They include getting bone mass measurements as recommended by your doctor, and following a healthy diet with adequate amounts of calcium and vitamin D.

More information

The American Academy of Orthopaedic Surgeons has more on hip fracture prevention.

SOURCES: Michael LaMonte, Ph.D., M.P.H., research associate professor of epidemiology and environmental health, State University of New York at Buffalo; Richard Bockman, M.D., Ph.D., chief of endocrine service, Hospital for Special Surgery, and professor of medicine, Weill Cornell Medical College, New York City; Oct. 25, 2019, JAMA Network Open, online

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Your Noisy Knees May Be Trying to Tell You Something

Your Noisy Knees May Be Trying to Tell You Something

THURSDAY, Oct. 17, 2019 (HealthDay News) — Ever hear your joints clicking, creaking or crunching? Now, researchers say a new technique that listens closely to knees may help doctors diagnose and monitor osteoarthritis.

In the new study, researchers attached small microphones to participants’ knees, which allowed them to listen for high-frequency sounds as the person repeatedly stood up and sat down again.

Computer analysis of the sounds then provided information about the health of the knee, the study authors explained.

This study is the first to assess this technique in a large number of people with knee osteoarthritis. It was found to distinguish between healthy knees and those afflicted by this “wear-and-tear” form of arthritis.

The findings move the technique a step closer to use by doctors and in research, according to the report published Oct. 16 in the journal PLOS ONE.

“This work is very exciting because it involves scientists and clinicians working together as a team to develop an entirely new approach,” said project leader John Goodacre. He’s an emeritus professor at Lancaster University, in the United Kingdom.

“Potentially, this could transform ways in which knee osteoarthritis is managed. It will enable better diagnosis, and will enable treatments to be tailored more precisely according to individual knee condition. It will also enable faster, bigger and better clinical trials of new treatments,” Goodacre said in a university news release.

The next step for researchers is to develop a non-invasive portable device that health care providers could use to assess whether patients’ knees are changing or are responding to treatment for osteoarthritis.

This technique could provide a quicker, cheaper, more convenient and more accurate assessment than current methods, the study authors said.

More information

The American Academy of Family Physicians has more on osteoarthritis.

SOURCE: Lancaster University, news release, Oct. 16, 2019

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‘Smartphone Slouching’ More Serious Than It Sounds

‘Smartphone Slouching’ More Serious Than It Sounds

WEDNESDAY, Oct. 9, 2019 (HealthDay News) — The health risks that spring from poor posture while using mobile devices don’t concern many Americans, a new survey finds.

But maybe it should.

Poor posture can lead to health issues such as chronic pain in the back, neck and knees, circulation problems, heartburn and digestive problems, according to researchers from the Orlando Health system in Florida.

American adults spend an average more than 3.5 hours on their smartphones every day, meaning they may be looking down or slouching for long periods of time, they noted.

Their national survey, published Oct. 9, asked respondents their level of concern about eye strain, carpal tunnel and other potential health consequences of mobile device use. Only 47% said they were concerned about poor posture and how it affected their health.

“It’s not just when you’re scrolling on your phone, but any time you put your body in a less-than-optimal position, whether that’s reading a book, working at a desk or lounging on the couch,” said Nathaniel Melendez, an exercise physiologist at Orlando Health’s National Training Center in Clermont, Fla.

“People don’t realize the strain they’re putting on their body when it is not aligned correctly, or just how far corrective exercises and daily adjustments can go toward improving pain and postural issues,” he added in a health system news release.

“I see a lot of people compensating for poor posture with short steps, rounded shoulders, walking with their head and neck down,” Melendez said.

Even slight misalignment can put a lot of strain on the body. For every inch your head moves in front of your body, 10 pounds of pressure is added to your shoulders, he said.

“If, for example, your head is 4 inches in front of your body when you’re looking down at your phone, that’s like having a child sitting on your shoulders that whole time,” Melendez noted.

Most problems caused by poor posture are reversible with some simple changes.

“Just doing strength training will not help your posture or the pain it’s causing,” Melendez said. “I work with people specifically on strengthening their core and doing some corrective postural exercises. We also do a lot of functional training exercises, which mimic daily life.”

People who work at a desk or spend a lot of time sitting should raise their screens to eye height, sit with both feet on the floor, and take frequent breaks to get up and move around, Melendez advised.

More information

The U.S. National Library of Medicine has more on posture.

SOURCE: Orlando Health, news release, Oct. 9, 2019

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