Hip fracture

Vegetarian women at increased risk for hip fracture

Posted by

0


In a large cohort of women, those who were vegetarians demonstrated an elevated risk for hip fracture compared with their meat-eating counterparts, according to recent research.

For the analysis, which featured data from the U.K. Women’s Cohort Study, Janet E. Cade, PhD, professor of nutritional epidemiology and public health at University of Leeds, United Kingdom, and colleagues sought to compare the hip fracture risk among occasional meat-eaters, pescatarians and vegetarians with regular meat-eaters. They also aimed to assess whether BMI affected associations between each diet group and hip fracture risk.

Pescatarian women have a lower risk for hip fractures than meat eaters.
Women who eat a pescatarian diet have a lower risk for hip fractures compared with meat-eaters, whereas the risk for hip fractures is higher in women eating a vegetarian diet. Data were derived from Webster J, et al. BMC Med. 2022;doi:10.1186/s12916-022-02468-0.

The study included 26,318 U.K. women aged 35 to 69 years. Researchers used a validated 217-item food frequency questionnaire completed from 1995 to 1998 to classify women as regular meat-eaters ( 5 servings/week), occasional meat-eaters (< 5 servings/week), pescatarian (ate fish but not meat) or vegetarian (ate neither meat nor fish). They determined incident hip fractures via linkage to Hospital Episode Statistics through March 2019.

In all, 3.1% of the cohort experienced a hip fracture during a median follow-up of 22.3 years. Researchers adjusted for cofounders and found that compared with meat-eaters, vegetarians (HR = 1.33; 95% CI, 1.03-1.71) had the greatest risk for hip fracture, whereas occasional meat-eaters (HR = 1; 95% CI, 0.85-1.18) and pescatarians (HR = 0.97; 95% CI, 0.75-1.26) did not demonstrate an increased risk.

Results also indicated no clear evidence of a BMI effect modification in any diet group (P for interaction = .3).

In other data, the prevalence of cardiovascular disease, cancer or diabetes at recruitment was highest among regular meat-eaters (10.2%) and lowest among vegetarians (5.8%). Regular meat-eaters had the highest absolute dietary intakes of protein, vitamin D and vitamin B12, whereas vegetarians had the lowest.

“Overall, vegetarians, but not occasional meat-eaters or pescatarians, were at a higher risk of hip fracture compared to regular meat-eaters in this cohort of U.K. women,” Webster and colleagues concluded. “Further research is needed to confirm this in other populations, such as men and non-European populations, and to identify the factors responsible for the observed risk difference. In particular, further research exploring the roles of BMI and nutrients abundant in animal-sourced foods is recommended so that public health interventions and policy guidelines aiming to reduce hip fracture risk in vegetarians through dietary change or weight management can be formed.”

Moderate to severe menopausal vasomotor symptoms increased hip fracture risk

Posted by

0


Women with moderate to severe vasomotor symptoms during menopause showed lower bone mineral density and higher rates of hip fracture than women without the symptoms, according to research published in The Journal of Clinical Endocrinology & Metabolism.

“Compared with women who did not have hot flashes at the beginning of the study, women who reported having hot flashes at the beginning of the study had almost double the risk of hip fractures,” Carolyn J. Crandall, MD, of David Geffen School of Medicine, University of California, Los Angeles, toldEndocrine Today. “Women who reported hot flashes also had lower bone density at the lumbar spine and the hip.”

Carolyn Crandall

Carolyn J. Crandall

Gaining a better understanding of the factors underlying these associations could inform the design of strategies that could avert fractures in women at risk, the researchers said.

“We need to determine the biological mechanisms that explain the links between hot flashes and hip fracture risk so that we can develop preventive measures to help women reduce their hip fracture risk,” Crandall said.

Using data on women aged 50 to 79 years involved in theWomen’s Health Initiative clinical trial (n=23,573), Crandall and colleagues prospectively observed associations of baseline vasomotor symptoms (VMS) with fracture incidence and BMD during an average of 8.2 years from 1993 to 2005.

The women, from 40 clinical centers across the United States, were not on menopausal hormone therapy; 4,867 women had BMD data from participating in a substudy.

The investigators measured baseline VMS, incident adjudicated fractures and BMD at baseline and four annual visits, separated by 3 years. Adjustments were made for age, BMI, race/ethnicity, smoking and education.

The HR for hip fracture among women with baseline moderate/severe VMS compared with no VMS was 1.78 (95% CI, 1.2-2.64); no association was observed between VMS and vertebral fracture. Severity of VMS was inversely associated with BMD (P=.004 for femoral neck; P=.045 for lumbar spine).

Women with moderate/severe VMS demonstrated 0.015 g/cm2 lower femoral neck BMD (95% CI, –0.025 to –0.005) and 0.016 g/cm2 lower lumbar spine BMD (95% CI, –0.032 to –0.004) than women who reported no VMS in repeated measures models.

“Hot flashes are common — experienced by at least 60% of women,” Crandall said. “We clearly have to start exploring the reasons for our findings. In the meantime, women with hot flashes may benefit from greater attention to healthy lifestyle habits to maintain bone health, such as avoiding excessive alcohol intake and smoking, maintaining adequate calcium and vitamin D intake, and getting adequate physical activity.” – by Allegra Tiver

Clopidogrel Is Safe Before Hip Fracture Surgery.

Posted by

0


In an observational study, clopidogrel did not confer risk for serious perioperative bleeding.

In general, surgery should be done promptly after hip fracture. However, when the patient has been taking clopidogrel (Plavix), the surgeon might be concerned about excessive perioperative bleeding. In fact, the following statement appears in the official prescribing information for clopidogrel: “If a patient is to undergo surgery and an antiplatelet effect is not desired, discontinue Plavix five days prior to surgery.”

In this retrospective cohort study from Mayo Clinic, investigators identified 40 hip-fracture patients who were taking clopidogrel at admission and who underwent surgery within 36 hours. Cases were compared with 80 controls (matched for age, sex, and several other clinical variables) who also underwent prompt surgery for hip fractures and who had not been taking clopidogrel. Two major bleeding events occurred in the clopidogrel group, and three occurred among controls (a nonsignificant difference). The incidence of a broader combined bleeding outcome (encompassing major bleeding events, need for transfusions, and fall in hemoglobin level) also was similar in the two groups.

Comment: This study suggests that clopidogrel is not associated with substantial excess risk for serious bleeding in patients who undergo hip fracture surgery. Whether surgeons had more technical difficulty in controlling intraoperative bleeding in clopidogrel recipients than in controls was not addressed in this report.

 

Source: Journal Watch General Medicine

 

 

Association between low vitamin D, clinical outcomes varied.

Posted by

0


Previous studies have suggested that low 25-hydroxyvitamin D concentration could be a modifiable risk factor associated with chronic disease. However, recent data derived from four cohort studies now suggest genetic variants might modify the association between low 25-hydroxyvitamin D and adverse health outcomes such as hip fractures, incident myocardial infarction, incident cancer or death from any cause.

Gregory P. Levin, PhD, of the University of Washington in Seattle, and colleagues examined 141 single nucleotide polymorphisms (SNPs) from a discovery cohort of 1,514 patients from the Cardiovascular Health Study (CHS). From 1992 to 1993, 2,312 patients underwent serum 25-(OH)D measurements and were followed for 11 years.

Besides the CHS, researchers used replication meta-analyses in the US Health, Aging, and Body Composition study (Health ABC; n=922) with follow-up in 1998-1999 through 2005. They also used the Italian Invecchiare in Chianti study (InCHIANTI; n=835) with follow-up in 1998-2000 through 2006; and the Swedish Uppsala Longitudinal Study of Adult Men (ULSAM; n=970) with follow-up in 1991-1995 through 2008.

Levin and colleagues found that interactions between 5 SNPs and low 25-(OH)D were identified in the CHS discovery cohort and one SNP associated with a variant in the VDR gene replicated from the Health ABC study.

Of the patients examined from the CHS, researchers discovered that low 25-(OH)D was linked to hip fractures, incident MI, incident cancer or death from any cause (composite outcomes) in patients with one minor allele at rs7968585 (HR=1.40; 95% CI, 1.12-1.74) and in patients with two minor alleles at rs7968585 (HR=1.82; 95% CI, 1.31-2.54). However, researchers wrote there was no evidence of an association in patients with no minor alleles (HR=0.93; 95% CI, 0.70-1.24).

“These results suggest that individuals with specific 25-(OH)D metabolism genotypes may be particularly susceptible to, or protected from, the potential adverse health effects of low vitamin D,” the researchers wrote.

Source: Endocrine Today.