BOSTON - A study published today in the Lancet Diabetes and Endocrinology reports that high-resolution peripheral computed tomography (HR-pQCT) represents an effective tool in predicting an individual’s fracture risk. The research team included scientists from the Hinda and Arthur Marcus Institute for Aging Research (Marcus Institute) at Hebrew SeniorLife, and Beth Israel Deaconess Medical Center- both Harvard Medical School affiliates. Dual-energy X-ray absorptiometry (DXA) has been considered the clinical standard for determining fracture risk, along with the Fracture Risk Assessment Tool (FRAX). A FRAX assessment considers factors such as age, gender, weight, alcohol use, smoking history and fracture history.

However, many older adults who sustain a fracture do not meet the diagnostic criteria for osteoporosis, a disease characterized by bone loss. Bones become fragile not only due to low bone mineral density (BMD), but also from deterioration in bone structure. This study indicates that while DXA measurement of BMD predicts fracture, HR-pQCT adds additional information about risk. This allows clinicians to analyze a patient’s bone microarchitecture and is an important step in identifying additional bone traits that predict fracture risk.

Fragility fractures, which lead to significant morbidity, mortality and expense, are a large public health concern. Notably, the number of women who will experience a fracture in any given year exceeds the combined number who will experience a stroke, breast cancer or myocardial infarction. Annual costs associated with fragility fractures exceed $19 billion in the US. Given the predicted growth in the number of older adults, fractures and associated costs are projected to increase two- to four-fold worldwide in the coming decades.

This study included more than 7,000 participants from the United States and four other countries with 765 fractures, and represents the largest prospective study of HR-pQCT indices and incident fracture to date. Bone is generally classified into two tissue types—cortical bone, also known as compact bone and trabecular bone, also known as cancellous or spongy bone.

“Results from this large international cohort of women and men suggest deficits in trabecular and cortical bone density and structure contribute to fracture risk independently of BMD and FRAX,” said Lisa Samelson, Ph.D., who is an epidemiologist at the Marcus Institute and Harvard Medical School, and lead author of the study. “Further, assessment of cortical and trabecular bone microstructure may be useful in those who would not otherwise have been identified as being at high risk for fracture,” Added Douglas Kiel, M.D., and Mary Bouxsein, Ph.D., Co-Principal Investigators of the study.

Research reported in this publication was supported by the National Institutes of Health (NIH) (National Institute of Arthritis Musculoskeletal and Skin Diseases [NIAMS], R01AR061445; National Heart, Lung and Blood Institute [NHLBI] Framingham Heart Study, Contract No. N01-HC-25195, (HHSN268201500001I). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional support was provided by Friends of Hebrew SeniorLife and a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme.

About the Hinda and Arthur Marcus Institute for Aging Research

Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON — New research reveals that a protein-rich diet, which includes both animal and plant sources, preserves lean muscle mass and strength in the legs of older adults. The study published in the Journal of Nutrition suggests that the type of dietary protein has different effects, with plant protein displaying a preservation of muscle strength.

As adults age a decline in muscle mass and strength increases the risk of falls and fractures which may lead to disability and loss of independence. In fact, the Centers for Disease Control and Prevention (CDC) estimates that one in three adults 65 years of age and older fall each year, with up to 30% of those falls resulting in injuries such injuries as lacerations, hip fractures, or head trauma. Previous research reports that after age 50 adults may lose 1% to 2% of muscle mass each year, and experience a decline in muscle strength of 1.5% annually up to age 60 and 3% per year after.

“Muscle mass and strength has been examined in older adults, but little is known about how modifiable risk factors in middle age can contribute to a decline in muscle health,” explains lead author Shivani Sahni, Ph.D. from Harvard Medical School–affiliated Hebrew SeniorLife Institute for Aging Research (IFAR) in Boston, Mass.

Douglas P. Kiel, M.D., M.P.H., Professor of Medicine at Harvard Medical School and Director Musculoskeletal Research Center at IFAR and coauthor of the study adds, “Diet is easy to modify and understanding the impact of protein consumption on leg muscle mass and strength in adults may help us uncover interventions that improve quality of life in older age.”
Researchers used data from the Framingham Offspring Cohort—a study initiated in 1971 to investigate familial risk factors for cardiovascular disease—for the present cross-sectional study. Participants were between 29 and 86 years of age, and included 2,656 men and women in quadriceps strength analyses and 2,636 men and women in analyses of leg lean mass. Protein intake, leg lean mass and quadriceps strength were measured at various times between 1998 and 2001.

Findings indicate that protein intake was 80 grams per day for male and 76 grams per day for women. Leg lean mass was higher in participants at the highest levels of total protein and animal protein consumption. Plant protein intake was not associated with lean mass in men or women.

Further analyses determined that quadriceps strength was higher in subjects who consumed more plant protein compared to those with less intake. However, after adjusting for fruit and vegetable intake the association was no longer significant. The authors believe plant protein may help preserve muscle strength in older adults due to the alkaline properties in the plants, or as a marker of the dietary quality of those eating more plant protein.

“Eating a diet rich in protein may help preserve leg muscle mass and strength as we age, which could mitigate risk of falls,” concludes Dr. Marian T. Hannan, Associate Professor of Medicine at Harvard Medical School, Co-Director, Musculoskeletal Research Center and co-author of the study. “Further investigation of the impact of plant protein on muscle strength is needed.”

This study was funded in part by grants from the National Institutes of Health (NIH R01 AR53205, R01 AR/AG 41398), NHLBI’s Framingham study (#N01-HC-25195), institutional grants from the General Mills Bell Institute of Health and Nutrition, NIH's National Institute of Aging (T32-AG023480), and the Melvin First Young Investigator Award and Friends of Hebrew SeniorLife.

About the Institute for Aging Research
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Geriomics Program within IFAR studies the genetic architecture underlying diseases of aging. Visit http://www.instituteforagingresearch.org.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook, or read our blog.

BOSTON — Researchers from Hebrew SeniorLife’s Institute for Aging Research (IFAR) have discovered that to begin with, proxies are a fairly accurate judge of the length of life left for their loved one with advanced dementia. Secondly, when proxies have judged that their loved one has less than 6 months to live they are more likely to have discussed goals of care with the health care team, and less likely to agree to burdensome interventions.

The results of this study were published today in the Journal of the American Medical Association Internal Medicine (JAMA IM).

To discover these findings, researchers combined data from two studies which prospectively followed nursing home residents with advanced dementia and their proxies in the Boston area for 12 months. During quarterly telephone interviews, proxies stated whether they believed the resident they represented would live less than one month, 1-6 months, 7-12 months, or more than 12 months.

Researchers then examined the association between the proxies’ prognostic estimates and the receipt of burdensome treatments by the residents, such as hospital transfers, intravenoustherapy, tube-feeding, blood draws, and insertions of catheters into the bladder. They found that residents whose proxies believed they would die within 6 months, received fewer of these burdensome treatments compared to residents whose proxies thought they would live longer.

Lead author, Andrea Loizeau MSc, a visiting doctoral student at IFAR from the Univeristy of Zurich, explains, “Proxies are reasonably good at estimating when nursing home residents with advanced dementia will die and their prognostic perceptions may influence the type of care the resident receives.”

This research was supported with the following grants: NIH-NIA R01 AG032982, NIH-NIA R01 AG043440, and NIH-NIA K2AG033640; the Swiss National Science Foundation P1AHP3_171747, and the Swiss Academy of Medical Sciences PC 22/14 The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Musculoskeletal Center within IFAR studies conditions affecting bone, muscle, and joint health with aging.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visithttp://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.