Men: higher chance of secondary fractures, value of bone strengthening exercises

Two new studies released this week shine a spotlight on men's bone health which is often overshadowed by the focus on osteoporosis and fracture risk in women. The findings are being presented at the American Society for Bone and Mineral Research (ASBMR) 2018 Annual Meeting in Montréal, the premier scientific meeting in the world on bone, mineral and musculoskeletal science.
Canadian researchers found that men had a three-fold higher risk of sustaining a secondary fracture within one year of a first fracture compared to those who did not, while the risk for women with a prior fracture was only 1.8 times higher compared to women without one. The large and long-term study looked at the risk of subsequent fractures at the hip, spine, forearm and the upper arm in 17,721 men and 57, 783 women over 50 years of age in Canada over a period of 25 years (1989-2006). Suzanne Morin, M.D., M. Sc., FRCPC, FACP, Associate Professor of Medicine, McGill University and her colleagues found that while the risk of secondary fracture was elevated in both men and women during that time period, it was highest in the first three years following a prior fracture.
"These results underscore the importance of timely recognition of fracture events especially in men, a population in whom secondary prevention is under-implemented, "said Morin. "This tells us we should be focusing on anti-fracture strategies early after the fracture event."
Another study presented by researchers from the Osteoporotic Fractures in Men Study is the first to show the relationship between different levels of physical activity and bone strength in older men. While numerous studies have shown the effects of exercise in women, this study evaluated nearly 1,000 older men (with a mean age of 84) and their time spent doing exercise vs. those that were sedentary. Researchers found that those that spent more time engaged in at least moderate physical activity (including housework and some sports such as walking, golf, soft ball, and tai-chi) and those with greater total activity over a period of seven years had higher bone strength measures with resultant lower risk of fracture.
"Older men are at a higher risk of life altering fractures. This was a breakthrough to finally have data to show that physical activity among men late in life was related to bone strength and fracture risk, therefore showing that remaining active over the life-course could reduce the risk of these fractures," said Lisa Langsetmo, Ph.D., M.Sc., Senior Research Associate, University of Minnesota.
"These two studies really show the importance of gains in bone mass for both men and women and how bone health and risk of osteoporosis is not just an issue for women," said Michael Econs, M.D., ASBMR Council President and endocrinology and metabolism specialist and professor of medicine at the Indiana University School of Medicine. "We need to be vigilant in sharing the benefits of building bone mass for men living longer and who

Mediterranean diet prevents a leading cause of blindness

Evidence is mounting that a poor diet plays an important role in the development of age-related macular degeneration (AMD), a leading cause of blindness in the United States. A large collaboration of researchers from the European Union investigating the connection between genes and lifestyle on the development of AMD has found that people who adhered to a Mediterranean diet cut their risk of late-stage AMD by 41 percent. This research expands on previous studies and suggests that such a diet is beneficial for everyone, whether you already have the disease or are at risk of developing it.

The new research is now online in Ophthalmology, the journal of the American Academy of Ophthalmology.

A Mediterranean diet emphasizes eating less meat and more fish, vegetables, fruits, legumes, unrefined grains, and olive oil. Previous research has linked it to a longer lifespan and a reduced incidence of heart disease and cognitive decline. But only a few studies have evaluated its impact on AMD. Some studies showed it can help with certain types of AMD, or only at different stages of the disease.

But combining this earlier research on AMD with the latest data, and a clear picture emerges. Diet has the potential to prevent a blinding disease.

AMD is a degenerative eye disease. It causes loss of central vision, which is crucial for simple everyday activities, such as the ability to see faces, drive, read, and write. It's a leading cause of vision loss among people age 50 and older, affecting 1.8 million Americans. By 2020, that number is expected to climb to nearly 3 million.

For this latest study, researchers analyzed food-frequency questionnaires from nearly 5,000 people who participated in two previous investigations - the Rotterdam Study, which evaluated disease risk in people age 55 and older, and the Alienor Study, which assessed the association between eye diseases and nutritional factors in people aged 73 and older. Patients in the Rotterdam study were examined and completed food questionnaires every five years over a 21-year period, while patients in the Alienor Study were seen every two years over a 4-year period. The researchers found that those who closely followed the diet were 41 percent less likely to develop AMD compared with those who did not follow the diet.
They also found that none of the individual components of a Mediterranean diet on their own - fish, fruit, vegetables, etc. - lowered the risk of AMD. Rather, it was the entire pattern of eating a nutrient-rich diet that significantly reduced the risk of late AMD.
"You are what you eat," said Emily Chew, M.D., a clinical spokesperson for the American Academy of Ophthalmology, who serves on an advisory board to the research group conducting the study. "I believe this is a public health issue on the same scale as smoking. Chronic diseases such as AMD, dementia, obesity, and diabetes, all have roots in poor dietary habits. It's time to take quitting a poor diet as seriously as quitting smoking."
There are two kinds of AMD - dry and wet. The dry type affects about 80 to 90 percent of people with AMD. In dry AMD, small white or yellowish deposits, called drusen, form on the retina, causing it to deteriorate over time. In the wet form, blood vessels grow under the retina and leak. While there is an effective treatment available for the wet type, there is no treatment available for dry AMD.

Yo-yoing weight, blood pressure, cholesterol and blood sugar readings may raise heart attack and stroke risk

Fluctuations in weight, blood pressure, cholesterol and/or blood sugar levels in otherwise healthy people may be associated with a higher risk of heart attack, stroke and death from any cause compared to people with more stable readings, according to new research in the American Heart Association's journal Circulation.

This is the first study to suggest that high variability of these risk factors has a negative impact on relatively healthy people. The study is also the first to indicate that having multiple measures with high variability adds to the risk.

Compared to people who had stable measurements during an average 5.5 year follow-up period, those with the highest amount of variability (in the upper 25 percent) on all measurements were:

• 127 percent more likely to die;
• 43 percent more likely to have a heart attack;
• 41 percent more likely to have a stroke.

Using data from the Korean National Health Insurance system, researchers examined data on 6,748,773 people who had no previous heart attacks and were free of diabetes, high blood pressure, or high cholesterol at the beginning of the study. All participants had at least three health examinations between 2005 and 2012 (every two years is recommended in the system). Records of the exams documented body weight, fasting blood sugar, systolic (top number) blood pressure and total cholesterol.

Because high variability could result from either positive or negative changes, the researchers looked separately at the effect of variability in participants who were more than 5 percent improved or worsened on each measurement. In both the improved and the worsened groups, high variability was associated with a significantly higher risk of death.
"Healthcare providers should pay attention to the variability in measurements of a patient's blood pressure, cholesterol and glucose levels as well as body weight. Trying to stabilize these measurements may be an important step in helping them improve their health," said Seung-Hwan Lee, M.D., Ph.D., senior author of the study and professor of endocrinology at the College of Medicine of the Catholic University of Korea in Seoul, South Korea.
The study was observational, which means that it cannot prove a cause-and-effect relationship between high variability and the risk of heart attacks, strokes or death from any cause. The study also did not delve into the reasons behind the fluctuations in the participants' risk factor measurements.
"It is not certain whether these results from Korea would apply to the United States. However, several previous studies on variability were performed in other populations, suggesting that it is likely to be a common phenomenon," Lee said.

Artificial sweeteners have toxic effects on gut microbes

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FDA-approved artificial sweeteners and sport supplements were found to be toxic to digestive gut microbes, according to a new paper published in Molecules by researchers at Ben-Gurion University of the Negev (BGU) in Israel and Nanyang Technological University in Singapore.

The collaborative study indicated relative toxicity of six artificial sweeteners (aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k) and 10 sport supplements containing these artificial sweeteners. The bacteria found in the digestive system became toxic when exposed to concentrations of only one mg./ml. of the artificial sweeteners.

"We modified bioluminescent E. coli bacteria, which luminesce when they detect toxicants and act as a sensing model representative of the complex microbial system," says Prof. Ariel Kushmaro, John A. Ungar Chair in Biotechnology in the Avram and Stella Goldstein-Goren Department of Biotechnology Engineering, and member of the Ilse Katz Institute for Nanoscale Science and Technology and the National Institute for Biotechnology in the Negev. "This is further evidence that consumption of artificial sweeteners adversely affects gut microbial activity which can cause a wide range of health issues."

Artificial sweeteners are used in countless food products and soft drinks with reduced sugar content. Many people consume this added ingredient without their knowledge. Moreover, artificial sweeteners have been identified as emerging environmental pollutants, and can be found in drinking and surface water, and groundwater aquifers.

"The results of this study might help in understanding the relative toxicity of artificial sweeteners and the potential of negative effects on the gut microbial community as well as the environment.
Furthermore, the tested bioluminescent bacterial panel can potentially be used for detecting artificial sweeteners in the environment," says Prof. Kushmaro.

Virtual reality can reduce pain and increase performance during exercise

The research, led by PhD candidate Maria Matsangidou from EDA, set out to determine how using VR while exercising could affect performance by measuring a raft of criteria: heart rate, including pain intensity, perceived exhaustion, time to exhaustion and private body consciousness.

To do this they monitored 80 individuals performing an isometric bicep curl set at 20% of the maximum weight they could lift, which they were then asked to hold for as long as possible. Half of the group acted as a control group who did the lift and hold inside a room that had a chair, a table and yoga mat on the floor.
The VR group were placed in the same room with the same items. They then put on a VR headset and saw the same environment, including a visual representation of an arm and the weight (see image below). They then carried out the same lift and hold as the non-VR group.
The results showed a clear reduction in perception of pain and effort when using VR technology. The data showed that after a minute the VR group had reported a pain intensity that was 10% lower than the non-VR group.
Furthermore the time to exhaustion for the VR group was around two minutes longer than those doing conventional exercise. The VR group also showed a lower heart rate of three beats per minute than the non-VR group.
Results from the study also showed no significant effect of private body consciousness on the positive impact of VR. Private body consciousness is the subjective awareness each of us has to bodily sensations.
Previous research has shown that individuals who have a high private body consciousness tend to better understand their body and as a result perceive higher pain when exercising. However, the study's findings revealed that VR was effective in reducing perceived pain and that private body consciousness did not lessen this effect.
As such, the improvements shown by the VR group suggest that it could be a possible way to encourage less active people to exercise by reducing the perceived pain that exercise can cause and improving performance, regardless of private body consciousness.
Lead researcher Maria Matsangidou said: 'It is clear from the data gathered that the use of VR technology can improve performance during exercise on a number of criteria. This could have major implications for exercise regimes for everyone, from occasional gym users to professional athletes.'

Exercise is an effective treatment for major mental health conditions

Based on compelling evidence from a meta-review of existing research, the European Psychiatric Association (EPA) has issued new guidelines to promote exercise as a key additional treatment for mental health conditions. A global team of scientists collaborated on the new EPA guidelines published in European Psychiatry, which suggest a regime of structured exercise should be added to standard medication and psychotherapy. The authors found that exercise can effectively reduce mental health symptoms, improve cognition, and strengthen cardiovascular fitness among patients with depression and schizophrenia.

Their analysis, issued as the EPA's position statement and guidelines, demonstrates that moderate intensity aerobic exercise, two to three times a week for at least 150 minutes, reduces symptoms of depression and schizophrenia and improves cognition and cardiorespiratory health in schizophrenia spectrum disorders. Evidence also supports combining aerobic with resistance exercise to improve outcomes for individuals with schizophrenia spectrum disorders and major depression.

The EPA guidance was also endorsed by the International Organization of Physical Therapists in Mental Health (IOPTMH). The multidisciplinary team of experts in physiotherapy, psychiatry, psychology, and sports medicine conducted a systematic review of top-tier research around exercise for mental health.

"Our comprehensive review provides clear evidence that physical activity has a central role in reducing the burden of mental health symptoms in people with depression and schizophrenia. Our guidelines provide direction for future clinical practice. Specifically, we provide convincing evidence that it is now time for professionally-delivered physical activity interventions to move from the fringes of healthcare and become a core component in the treatment of mental health conditions," explained lead investigator Brendon Stubbs, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, London, UK.
Long-term outcomes and full recovery among people with mental illness are often poor, even for those receiving appropriate medications. People with mental illness also experience very poor physical health and drastic physical health inequalities, which lead to this population dying up to twenty years prematurely.
"Signs and symptoms of premature cardiovascular diseases can be identified early in the disease course of mental disorders, when patients are in their thirties to forties," commented senior-author Kai G. Kahl, PhD, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany. "Interventions that modify cardiometabolic risks are clearly needed, and should be recommended as early as possible, as an integral part of a multimodal treatment plan." Thus, new add-on treatments for mental illness that can support full recovery and address poor physical health are urgently needed. The guidance advocates the development of structural changes in hospitals and other institutions concerned with the treatment of mental disorders that establish exercise facilities and physiotherapists or exercise specialists to support the treatment of severe mental illness. It also points to the need to modify insurance reimbursement guidelines to include the recommended treatments.
This initiative began with Dr. Stubbs' discussions with co-investigators Prof. Hans-J?rgen Möller, MD, PhD, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany, and Prof. Dr. Kahl, who were among the authors of the first EPA position statement on cardiovascular disease and diabetes in people with severe mental illnesses. Issued in 2009, the authors recommended screening and treating cardiovascular risk factors and diabetes in patients with mental illness. "The current EPA position statement on exercise in mental illness can be seen as sequel to this first EPA position statement," Prof. Dr. Kahl noted.
This study provides evidence that physical activity plays an important role in reducing cardiovascular symptoms and improving physical health and fitness. "Our systematic review of top-tier evidence has convincingly demonstrated that exercise training, delivered by physical activity professionals, does indeed provide an effective add-on treatment for improving both physical and mental health outcomes in people with mental illness," said Dr. Stubbs.
Additional research on the effect of exercise therapy on patients with bipolar disorder, on anthropometric measures (such as BMI), as well as its long-term impact and cost-effectiveness is recommended. Understanding the neurobiological mechanism by which exercise affects mental health and the potential impact of sedentary behaviors on mental health are also important subjects for future study. 

Drinking more water reduces bladder infections in women

In the controlled trial, women who drank an additional 1.5 liters of water daily experienced 48 percent fewer repeat bladder infections than those who drank their usual volume of fluids, said senior author Dr. Yair Lotan, Professor of Urology and with the Simmons Cancer Center at UT Southwestern. The participants self-reported their usual volume as less than 1.5 liters of fluid daily, which is about six 8-ounce glasses.

"That's a significant difference," said Dr. Lotan, Chief of Urologic Oncology at UT Southwestern Medical Center. "These findings are important because more than half of all women report having bladder infections, which are one of the most common infections in women."

More than a quarter of women experience a secondary infection within six months of an initial infection and 44 to 77 percent will have a recurrence within a year, said Dr. Lotan, holder of the Helen J. and Robert S. Strauss Professorship in Urology at UT Southwestern and Medical Director of the Urology Clinic at Parkland Health & Hospital System.

Physicians suspect more fluids help to reduce bacteria and limit the ability of bacteria to attach to the bladder.

Symptoms for acute uncomplicated cystitis, a type of urinary tract infection (UTI), include painful or difficulty in urination, a feeling of a full bladder, an urgency or frequency of urination, tenderness in the lower abdominal area, and possibly blood in the urine.

Because these infections are typically treated with antibiotics, the increased fluid could help reduce use of antibiotics and thereby help control antibiotic resistance, the researchers said.
The findings appear in JAMA Internal Medicine. Among the highlights over the 12-month study period:

• 93 percent of women in the Water Group had two or fewer episodes of cystitis compared with 88 percent of women in the Control Group who had three or more episodes.
• The number of cystitis episodes was about half in the Water Group compared with the Control Group.
• Overall, there were 327 cystitis episodes: 111 in the Water Group and 216 in the Control Group.
• The estimated mean annual number of antimicrobial regimens used to treat cystitis episodes was 1.9 in the Water Group compared with 3.6 in the Control Group.
• The mean number of antimicrobial regimens used to treat cystitis episodes was 1.8 in the Water Group compared with 3.5 in the Control Group.
• The mean time interval between cystitis events was 142.9 days in the Water Group compared with 85.2 days in the Control Group.
• The median time to the first cystitis episode was 148 days in the Water Group compared with 93.5 days in the Control Group.