Prevalence of vertebral fracture in oldest old nursing home residents.

UNLABELLED: We evaluated vertebral fracture prevalence using DXA-based vertebral fracture assessment and its influence on the Fracture Risk Assessment (FRAX) tool-determined 10-year fracture probability in a cohort of oldest old nursing home residents. More than one third of the subjects had prevalent vertebral fracture and 50% osteoporosis. Probably in relation with the prevailing influence of age and medical history of fracture, adding these information into FRAX did not markedly modify fracture probability. INTRODUCTION: Oldest old nursing home residents are at very high risk of fracture. The prevalence of vertebral fracture in this specific population and its influence on fracture probability using the FRAX tool are not known. METHODS: Using a mobile DXA osteodensitometer, we studied the prevalence of vertebral fracture, as assessed by vertebral fracture assessment program, of osteoporosis and of sarcopenia in 151 nursing home residents. Ten-year fracture probability was calculated using appropriately calibrated FRAX tool. RESULTS: Vertebral fractures were detected in 36% of oldest old nursing home residents (mean age, 85.9 ± 0.6 years). The prevalence of osteoporosis and sarcopenia was 52% and 22%, respectively. Ten-year fracture probability as assessed by FRAX tool was 27% and 15% for major fracture and hip fracture, respectively. Adding BMD or VFA values did not significantly modify it. CONCLUSION: In oldest old nursing home residents, osteoporosis and vertebral fracture were frequently detected. Ten-year fracture probability appeared to be mainly determined by age and clinical risk factors obtained by medical history, rather than by BMD or vertebral fracture.

[Review in geriatric medicine]. / Gériatrie.

In 2010, a study emphasizes the difficulty to predict disability trajectories in the last year of life. A meta analysis shows the effectiveness of post-acute geriatric rehabilitation in reducing functional decline after hospitalisation. Several studies evaluated pneumococcal and herpes zoster vaccines' efficacy. A short and simple intervention is effective in reducing benzodiazepine use. The effect of vitamine D on falls and fractures has been further evaluated in several studies. Diagnostic criteria for dementias, including Alzheimer's disease, are moving to better acknowledge their preclinical stages.

Zinc increases the effects of essential amino acids-whey protein supplements in frail elderly.

UNLABELLED: Protein undernutrition is frequent in the elderly. It contributes to the development of osteoporosis, possibly via lower IGF-I. Dietary zinc can influence IGF-I production. OBJECTIVES: To determine the influence of dietary zinc addition on IGF-I and bone turnover responses to essential amino acids-whey (EAA-W) protein supplements in frail elderly. DESIGN AND SETTING: A daily oral protein supplement was given to hospitalized patients for 4 weeks. On a randomized, double-blind basis, patients received either an additional 30 mg/day of zinc or control. PARTICIPANTS: Sixty-one hospitalized elderly aged 66.7 to 105.8, with a mini-nutritional assessment score between 17 and 24 were enrolled. MEASUREMENTS: Activities of daily living; dietary intakes; serum IGF-I, IGF-BP3, CrossLapsTM, osteocalcin and zinc were measured before and after 1, 2 and 4 weeks of protein supplementation. RESULTS: Serum IGF-I rapidly increased in both groups. Zinc accelerated this increase with changes of +48.2 +/- 14.3 and +22.4 +/- 4.7% (p < .05) by 1 week, in the zinc-supplemented and control groups, respectively. Zinc significantly decreased the serum bone resorption marker CrossLapsTM by already 1 week. Activities of daily living improved by +27.0 +/- 3.1 and +18.3 +/- 4.5% in zinc-supplemented and control groups, respectively. CONCLUSION: In the elderly, zinc supplementation accelerated the serum IGF-I response to EAA-W protein by 1 week and decreased a biochemical marker of bone resorption.