older women

Only one-third of older women screened for osteoporosis at internal medicine clinic

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Just one-third of women older than 65 years were screened for osteoporosis at an internal medicine clinic, and one-third of those diagnosed were untreated, noted a speaker at the 2021 North American Young Rheumatology Investigator Forum.

“About 10.2 million people in the U.S. have osteoporosis, 30% of all postmenopausal women have osteoporosis in the U.S., about 250,000 people aged 65 years and older are hospitalized for hip fractures every year, and mortality after a hip fracture is about 20% to 30% in the first year,” Shristi Khanal, MD, of the Jefferson Abington Hospital internal medicine department, in Abington, Pennsylvania, told attendees at the forum. “About 50% of patients never return to their previous functional baseline capacity and 33% require long-term care.”

Just one-third of women older than 65 years were screened for osteoporosis at an internal medicine clinic, and one-third of those diagnosed were untreated, noted a speaker at the 2021 North American Young Rheumatology Investigator Forum. Source: Adobe Stock

“Osteoporosis itself is asymptomatic and preventing osteoporotic fractures is the main goal of any osteoporosis screening strategy,” she added. “And in the absence of a fragility fracture, bone mineral density assessment by [dual-energy X-ray absorptiometry (DXA)] scan is the standard test to diagnose osteoporosis. The [U.S. Preventive Services Task Force] recommends that women aged 65 and older, or postmenopausal women younger than 65 years, who are at increased risk of osteoporosis, which is determined by formal clinical risk assessment tools like FRAX scores, have routine bone density testing for osteoporosis screening.”

To identify the burden of osteoporosis screening nonadherence among women aged older than 65 years, as well as the factors and complications related to screening and medication nonadherence, Khanal and colleagues at Jefferson Abington Hospital conducted a retrospective single-center chart review of patients at their internal medicine clinic. The study included 200 women with a mean age of 71.5 years, seen at the clinic from January 2017 to April 2020.

Data for this study were reported as percentages for categorical variables, and mean standard deviation, median and interquartile ranges were calculated for continuous variables, Khanal said.

According to the researchers, 33.5% of the included patients received a DXA scan as part of their osteoporosis screening. Among those who received a DXA scan, 32.8% had osteoporosis and 55.2% had osteopenia — just 11.9% demonstrated normal bone density. In addition, 11.5% of the total study population were found to have fragility fractures.

“This was very interesting,” Khanal said.

Among those with fragility fractures, 47.8% received a DXA scan.

Regarding treatment, 36.4% of those diagnosed with osteoporosis were untreated, receiving neither bisphosphonates nor any other recommended medications. However, 81.1% were receiving vitamin D and calcium therapy. Meanwhile, just 54.1% of patients diagnosed with osteopenia were receiving vitamin D and calcium. Lastly, only 18% of patients with fragility fractures received appropriate treatment for osteoporosis, while 47.8% were receiving vitamin D and calcium.

“We can clearly state that osteoporosis screening with DXA scan is underutilized,” Khanal said. “Almost half of the patients diagnosed with osteoporosis or osteopenia were not receiving guidelines-recommended therapy, and most of the patients with fragility fractures were not receiving treatment for osteoporosis. To decrease the mortality and morbidity related to osteoporosis, it is important to improve the screening rate.

“For that, it is important to streamline the screening process and eliminate barriers, promote education of providers on the importance of screening for osteoporosis, just like mammogram and hyperlipidemia screening, and increased public health awareness,” she added. “And not just the screening: It’s important to promote education of providers on role of bisphosphonates and other medications for osteoporosis so that they have different options based on patient profile. Last but not the least, it is important to emphasize on starting osteoporosis treatment immediately for fragility fractures.”

Some oral bacteria linked with hypertension in older women

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Journal of the American Heart Association Report

Research Highlights:

  • In a study of more than 1,200 women in the U.S., average age 63 years, 10 kinds of oral bacteria were associated with a higher risk of developing high blood pressure, while five strains of bacteria were linked with lower hypertension risk.
  • The observational study cannot prove cause and effect; however, the findings highlight possible opportunities to enhance hypertension prevention through targeted oral care, researchers said.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, March 2, 2022

DALLAS, March 2, 2022 — Some oral bacteria were associated with the development of hypertension, also known as high blood pressure, in postmenopausal women, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

High blood pressure is typically defined by two measurements: systolic blood pressure (the upper number measuring pressure when the heart beats) of 130 mm Hg or higher, and diastolic blood pressure (the lower number indicating pressure between heart beats) of 80 mm Hg or higher.

While previous research has indicated that blood pressure tends to be higher in people with existing periodontal disease compared to those without it, researchers believe that this study is the first to prospectively examine the association between oral bacteria and developing hypertension.

“Since periodontal disease and hypertension are especially prevalent in older adults, if a relationship between the oral bacteria and hypertension risk could be established, there may be an opportunity to enhance hypertension prevention through increased, targeted oral care,” said Michael J. LaMonte, Ph.D., M.P.H., one of the study’s senior authors, a research professor in epidemiology at the University at Buffalo – State University of New York and a co-investigator in the Women’s Health Initiative clinical center in the University’s epidemiology and environmental health department.

Researchers evaluated data for 1,215 postmenopausal women (average age of 63 years old at study enrollment, between 1997 and 2001) in the Buffalo Osteoporosis and Periodontal Disease Study in Buffalo, New York. At study enrollment, researchers recorded blood pressure and collected oral plaque from below the gum line, “which is where some bacteria keep the gum and tooth structures healthy, and others cause gum and periodontal disease,” LaMonte said. They also noted medication use and medical and lifestyle histories to assess if there is a link between oral bacteria and hypertension in older women.

At study enrollment, about 35% (429) of the study participants had normal blood pressure: readings below 120/80 mm Hg, with no use of blood pressure medication. Nearly 24% (306) of participants had elevated blood pressure: readings above 120/80 mm Hg with no medication use. About 40% (480) of participants were categorized as having prevalent treated hypertension: diagnosed and treated for hypertension with medication.

Researchers identified 245 unique strains of bacteria in the plaque samples. Nearly one-third of the women who did not have hypertension or were not being treated for hypertension at the beginning of the study were diagnosed with high blood pressure during the follow-up period, which was an average of 10 years.

The analysis found:

  • 10 bacteria were associated with a 10% to 16% higher risk of developing high blood pressure; and
  • five other kinds of bacteria were associated with a 9% to 18% lower hypertension risk.

These results were consistent even after considering demographic, clinical and lifestyle factors (such as older age, treatment for high cholesterol, dietary intake and smoking) that also influence the development of high blood pressure.

The potential associations for the same 15 bacteria with hypertension risk among subgroups was analyzed, comparing women younger than age 65 to those older than 65; smokers versus nonsmokers; those with normal versus elevated blood pressure at the start of the study, and other comparisons. Results remained consistent among the groups compared.

The findings are particularly relevant for postmenopausal women, since the prevalence of high blood pressure is higher among older women than older men, according to LaMonte.

More than 70% of American adults ages 65 and older have high blood pressure. That age category, the fastest growing in the U.S., is projected to reach 95 million by 2060, with women outnumbering men 2 to 1, according to a 2020 U.S. Census report. The 2020 U.S. Surgeon General’s Call to Action to Control Hypertension underscores the serious public health issue imposed by hypertension in adults, especially those in later life. Identifying new approaches to prevent this disease is, thus, paramount in an aging society.

According to the American Heart Association, nearly half of U.S. adults have high blood pressure, and many don’t know they have it. High blood pressure is a major risk factor for cardiovascular disease and stroke.

“We have come to better appreciate that health is influenced by more than just the traditional risk factors we know to be so important. This paper is a provocative reminder of the need to expand our understanding of additional health factors that may even be influenced by our environments and potentially impact our biology at the endothelial level,” said Willie Lawrence, M.D., chair of the American Heart Association’s National Hypertension Control Initiative’s (NHCI) Oversight Committee. ”Inclusive research on hypertension must continue to be a priority to better understand and address the condition.”

Due to the study’s observational approach, cause and effect cannot be inferred, limiting the researchers’ ability to identify with certainty that only some bacteria are related to lower risk of hypertension while others are related to higher risk. A randomized trial would provide the evidence necessary to confirm which bacteria were causal agents in developing – or not developing – hypertension over time, according to LaMonte.

Co-authors are Joshua H. Gordon, M.D., Ph.D.; Patricia Diaz-Moreno, D.D.S., Ph.D.; Christopher A. Andrews, Ph.D.; Daichi Shimbo, M.D.; Kathleen M. Hovey, M.S.; Michael J. Buck, Ph.D.; and Jean Wactawski-Wende, Ph.D.

The study was funded by the National Heart, Lung, and Blood Institute, the National Institute for Dental and Craniofacial Research and the National Institute of Allergy and Infectious Diseases, which are divisions of the National Institutes of Health (NIH); the U.S. Army Reserve Medical Corps; the Women’s Health Initiative program (Coordinating Center, Fred Hutchinson Cancer Research Center); and the University at Buffalo Clinical Translational Science Institute.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here. 

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with uson heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

Social isolation, loneliness drive CVD risk among older women

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Social isolation and loneliness are independently associated with an 11% to 16% higher risk for CVD among older women, according to research published in JAMA Network Open.

Natalie M. Golaszewski

“Social isolation and loneliness, while related to one another, are distinct social factors and our study showed that both factors are associated with increased risk for cardiovascular disease among older women,” Natalie M. Golaszewski, PhD, a postdoctoral fellow with the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, told Healio. “The overall CVD risk was highest for women who had high social isolation and high loneliness.”

sad woman at window

In a prospective study, Golaszewski and colleagues analyzed data from 57,825 older women participating in the Women’s Health Initiative II study with no history of CVD at baseline (mean age, 79 years; 89.1% white). Participants completed questionnaires assessing social isolation and loneliness. The main outcome was major CVD, defined as CHD, stroke and CV death.

During 186,762 person-years, researchers observed 1,599 major CVD events.

Compared with women reporting low social isolation scores, women with high social isolation scores were 18% more likely to experience a major CVD event (HR = 1.18; 95% CI, 1.13-1.23). Similarly, women with a high loneliness score were 14% more likely to experience a major CVD event vs. those with low loneliness scores (HR = 1.14; 95% CI, 1.1-1.18). The risk was slightly attenuated but persisted after adjusting for health behaviors and health status, with an HR of 1.08 for women with a high vs. low social isolation score (95% CI, 1.03-1.12) and an HR of 1.05 for women with a high vs. low loneliness score (95% CI, 1.01-1.09).

Women with both high social isolation and high loneliness scores had a 13% to 27% higher risk for incident CVD compared with women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations.

“Both social isolation and loneliness are social factors that are important in the lives of patients and should be incorporated in clinical conversations and systematically measured in doctors’ offices,” Golaszewski told Healio. “It is important to further understand the acute and long-term effects of social isolation and loneliness on cardiovascular health and overall well-being.”

John Bellettiere

Causal information is also needed to confirm conclusions from the study that reducing social isolation and loneliness can reduce CVD, according to John Bellettiere, PhD, assistant professor of epidemiology at the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego.

“This could take the form of randomized clinical trials or causal evaluations of existing programs designed to reduce social isolation and loneliness such as programs in the U.K.,” Bellettiere told Healio.

More older women are drinking hard

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New research finds an increase in binge drinking among older women.

More older American women than ever are drinking — and drinking hard, a new study shows.

Most troubling was the finding that the prevalence of binge drinking among older women is increasing dramatically, far faster than it is among older men, the researchers noted.

The difference was striking: Among men, the average prevalence of binge drinking remained stable from 1997 to 2014, while it increased an average of nearly 4 percent per year among women, the researchers found.

Increased drinking and binge drinking can be a serious health problem for women, said study author Rosalind Breslow, an epidemiologist at the U.S. National Institute on Alcohol Abuse and Alcoholism.

Women don’t tolerate alcohol as well as men, and they start to have alcohol-related problems at lower drinking levels than men, Breslow explained.

She pointed out that on average, women weigh less than men, and have less water in their bodies than men do. (Alcohol dissolves in water).

“So, after a man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, putting her at greater risk for harm,” Breslow said.

For the study, Breslow and her colleagues collected data on more than 65,000 men and women aged 60 and older who were current drinkers. Among these, more than 6,500 men and 1,700 women were binge drinkers.

Older adults, in general, are at greater risk of the effects of alcohol than younger adults, Breslow noted. “They’re more sensitive to the effects of alcohol, which can contribute to falls and other injuries, a major problem in older people,” she said.

As the U.S. population ages, the number of men and women 60 and older who drink will likely increase further, bringing with it more alcohol-related problems.

In the study, said Breslow, “we found that between 1997 and 2014, the proportion of older male drinkers in the U.S. population increased about 1 percent per year, and female drinkers increased nearly 2 percent per year.”

It’s not clear why this is happening, Breslow added.

“We did find that more younger boomers, ages 60 to 64, both men and women, were drinking than people of the same age in past generations,” Breslow added.

Whether drinking is increasing among certain racial or ethnic groups isn’t something the researchers analyzed, she said.

But alcohol can have devastating consequences, particularly for older adults, Breslow said.

“Too much drinking increases your chances of being injured or even killed. Alcohol is a factor, for example, in about 60 percent of fatal burn injuries, drownings and homicides; 50 percent of severe trauma injuries and sexual assaults; and 40 percent of fatal motor vehicle crashes, suicides and fatal falls,” she said.

In addition, heavy drinkers have a greater risk of liver disease, heart disease, sleep disorders, depression, stroke, bleeding from the stomach, sexually transmitted infections from unsafe sex, and several types of cancer, Breslow said. They may also have problems managing diabetes, high blood pressure and other chronic conditions.

“Think before you drink,” she said. Adults over age 65 who are healthy and do not take medications should not have more than three drinks a day or seven drinks in a week, Breslow said.

“Based on your health and how alcohol affects you, you may need to drink less or not at all,” she added.

Another alcohol abuse expert also felt that the rise in binge drinking among older women was the most concerning finding in the study.

“We know that, overall, women are more sensitive to the negative health consequences of alcohol than men,” said Dr. J.C. Garbutt, medical director of the University of North Carolina Alcohol and Substance Abuse Program, in Chapel Hill.

“These consequences include liver disease, high blood pressure, stroke, heart disease and cognitive impairment — serious problems — and addiction to alcohol is possible as well,” he said.

Garbutt said he couldn’t explain the increase in binge drinking among older women.

“One would have to think there are major cultural factors at work, including the greater acceptability for women to drink, family structural changes, and perhaps greater access. But we really don’t know so it would be premature to speculate,” he said.

“Regardless, this speaks to the need to continue to educate the public about the harms of alcohol, including the increased risk to women and older individuals,” he said.

The report was published March 24 in the journal Alcoholism: Clinical and Experimental Research.

A study published last October also found the gap in drinking between men and women is closing.

Women across the globe are now nearly as likely as men to drink and to engage in excessive drinking, according to researchers with the National Drug and Alcohol Research Center at the University of New South Wales in Australia.

Soure:http://www.cbsnews.com