Tag: Book review

Notes from “How Not to Age” Part 4 — Presentation by Dr. Michael Greger

This is my fourth post, following along with Dr. Greger’s presentation of his book: “How Not to Age.” The following 14 minutes, starting at 42:46, covers Part III: Preserving Function of the book. The chapters are about how to preserve the body’s function: bones, bowel and bladder function, circulation, hair, hearing, hormones, immune system, joints, mind, muscles, sex life, skin, teeth, vision, and last but not least, dignity and death.

I’m only covering two minutes of the section on Bone Health in this post; however, I spent two hours studying these two minutes. There’s much to learn. Since I received my book copy yesterday, I will read and listen to this chapter. Meanwhile, here’s what I learned from the presentation; any errors are mine.

42:46 Bone health

  • In fact, BMD [Bone mineral density]  is only a modest risk factor for fractures; about 85% of the contribution to the fracture risk in general, or to the rise in fracture risk with age, is unrelated to BMD.[70]
  • Fractures are primarily due to falling, not osteoporosis. Despite a wide consensus that fractures in adults are ‘osteoporotic’, evidence indisputably shows that both hip and vertebral fractures are predominantly traumatic (caused by an injury). ….
    It is most likely that the ageing-related muscle loss and reduced balance contribute to fracture risk through increased propensity to falling. This could, at least partly, explain the relatively poor predictive value of bone loss in identifying those at risk of sustaining fractures in old age. [71]
  • The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I2 = 25%, p = 0.005).[72]
    • COMB [ combined resistance and balance-jumping training] group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97)[73]
  • Osteoporosis drugs can cause fractures
    • Known as atypical femur fractures, these breaks occur not after a fall or other trauma, but during routine activities, like walking, twisting at the waist, or even just standing still. The injuries are devastating, Miller says, often requiring multiple surgeries, a stay at a rehabilitation facility, and months to walk normally again.
    • However, existing real-life data do not support clear clinically relevant antifracture (including hip fracture) effects of bisphosphonates[74] [Fossamax is one example[75]] or any other compounds ….. 11 atypical femoral fractures per year amongst 10 000 users of bisphosphonates. One atypical femoral fracture will occur for about 300 patients treated for 3 years.[71]
    • Known as atypical femur fractures, these breaks occur not after a fall or other trauma, but during routine activities, like walking, twisting at the waist, or even just standing still. The injuries are devastating, Miller says, often requiring multiple surgeries, a stay at a rehabilitation facility, and months to walk normally again.
      Worse yet, many atypical femur fractures can feel like a too-cruel joke to patients because they aren’t directly caused by bone disease. Rather, they may be an adverse effect of bisphosphonates – the very medications that treat osteoporosis.[76]

References

  • [70] Sievänen H, Kannus P, Järvinen TL. Bone quality: an empty term. PLoS Med. 2007 Mar;4(3):e27. doi: 10.1371/journal.pmed.0040027. PMID: 17341126; PMCID: PMC1808066. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808066 Not listed in in How Not to Age Citations
  • [71] Järvinen TL, Michaëlsson K, Aspenberg P, Sievänen H. Osteoporosis: the emperor has no clothes. J Intern Med. 2015 Jun;277(6):662-73. doi: 10.1111/joim.12366. PMID: 25809279; PMCID: PMC4497616.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497616/
    Cited as 3270, 3275, 3277, and 3293 in How Not to Age Citations
  • [72]
  • Wong RMY, Chong KC, Law SW, Ho WT, Li J, Chui CS, Chow SKH, Cheung WH. The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis. J Orthop Translat. 2020 Jun 1;24:58-65. doi: 10.1016/j.jot.2020.05.007. PMID: 32695605; PMCID: PMC7349939. https://pubmed.ncbi.nlm.nih.gov/32695605/
  • Cited as 3283 in How Not to Age Citations
    • It’s worth noting that there is more to this conclusion – the results apply to women but not both genders: However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I2 = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I2 = 0%, p = 0.15). …. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men.
  • [73] Karinkanta S, Kannus P, Uusi-Rasi K, Heinonen A, Sievänen H. Combined resistance and balance-jumping exercise reduces older women’s injurious falls and fractures: 5-year follow-up study. Age Ageing. 2015 Sep;44(5):784-9. doi: 10.1093/ageing/afv064. Epub 2015 May 18. PMID: 25990940.https://academic.oup.com/ageing/article/44/5/784/51854
    Cited as 3285 in How Not to Age Citations
  • [74] Bisphosphonates define a class of drugs widely indicated since the 1990s to treat osteoporosis both in men and women. Their effectiveness in treating osteoporosis and other conditions is related to their ability to inhibit bone resorption. ….
    • Adverse Effects [the full list of 7 adverse effects are worth studying]
      • Atypical Femur Fractures
        Another rare but serious adverse effect of bisphosphonates is an atypical femoral fracture, typically involving diaphysis or sub-trochanteric region of the femur. Over suppression of bone turnover, pathophysiological alteration in the bone quality, and impairment of fracture repair process, or thought to be responsible for these atypical femur fractures, which are considered stress fractures. The incidence is 3.2 to 50 cases per 100,000 person-years, and the risk increases with the duration of exposure to bisphosphonates. Atypical femur fractures are usually not seen within the first five years of bisphosphonate treatment, with most cases reported with more than seven years of bisphosphonate treatment. Initial symptoms are dull aching pain in the groin. Plain X-rays may reveal cortical thickening. Findings of radiographs, especially if early/mild, shall be confirmed by further imaging with magnetic resonance imaging (MRI) or bone scintigraphy. Bisphosphonates shall be discontinued in patients who suffer an atypical femur fracture in one leg; if the drug is not stopped, these patients are at higher risk of developing atypical femur fracture in the other leg. Discontinuation of bisphosphonate is associated with a decline in this risk. A drug holiday shall be considered after prolonged exposure to bisphosphonates when clinically appropriate.
    • Source Ganesan K, Goyal A, Roane D. Bisphosphonate. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470248/#article-18343.s5 accessed 6 December 202
  • [75] Bisphosphonates are usually the first choice for osteoporosis treatment. These include:
  • [76] Abbasi J. Amid Osteoporosis Treatment Crisis, Experts Suggest Addressing Patients’ Bisphosphonate Concerns. JAMA. 2018 Jun 26;319(24):2464-2466. doi: 10.1001/jama.2018.7097. PMID: 29874373. Behind paywall. Not listed in in How Not to Age Citations