Social Stress Tied to Lower Bone Density After Menopause

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Older women who are under a lot of social strain may be more likely to develop brittle, fracture-prone bones after menopause than their counterparts with worry-free lives, a recent study suggests.

Researchers followed 11,020 postmenopausal women over six years, giving them periodic bone mineral density (BMD) tests and mood assessments. Participants rated their level of social strain, or negative interactions or relationships; their social support, or positive relationships; and social functioning, or limitations in social activity.

Each one-point increase in social strain scores was associated with 0.082% greater loss of BMD in the neck, 0.108% greater loss of BMD at the hip, and 0.069% greater loss of BMD in the lower spine, the study found.

“Fractures are a major societal burden affecting 1 in 2 older women, due to a variety of risk factors that lead to bone loss,” said Shawna Follis, lead author of the study and a researcher at the University of Arizona in Tucson.

“We found that high social stress is one risk factor that increases bone loss in aging women,” Follis said by email.

Reduced estrogen production during menopause and afterward can slow production of new bone tissues in women. Over time, this process leads to decreased BMD and increases the risk of osteoporosis.

Bones thinned by osteoporosis are brittle and more easily fractured.

Much of the previous research into connections between osteoporosis and mental health has focused on whether impairment due to bone thinning or fractures might contribute to mood disorders like depression or anxiety, the researchers note.

In the current study, published in Journal of Epidemiology & Community Health, high levels of social stress were associated with lower BMD even after researchers accounted for other factors that can impact bone health like age, education, chronic health problems, weight, smoking status, alcohol use, hormone therapy, age at menopause, physical activity, and fracture history.

Lower social functioning was tied to greater decreases in BMD in the neck and hip, the current study found. And low social support was associated with greater decreases in the neck.

The study doesn’t prove that social stressors directly impact bone mineral density, and researchers also didn’t look at the connection between various social stressors and falls or fractures. And it’s impossible to say from the study whether easing of social stress would have any effect on bone health.

Still, the results suggest that older women who do a better job of managing stress may have healthier bones and a lower fracture risk, said Dr. JoAnn Pinkerton, director of midlife health at the University of Virginia Health System in Charlottesville, Virginia and executive director emeritus of the North American Menopause Society.

“For women who are anxious or have higher social stress levels, mindfulness, cognitive therapy, self-calming strategies, yoga, counseling, access to community building, or, if needed, medications might decrease the psychosocial stress levels,” Pinkerton, who wasn’t involved in the study, said by email.

When women do have osteoporosis, there are still things they can do to prevent bones from becoming more brittle, Pinkerton added.

“Calcium, vitamin D and strength training may prevent further bone loss,” Pinkerton said. “Although many women are fearful of the side effects associated with medications for treating osteoporosis, the side effects are actually rare while fractures may be life changing.”

Osteoporosis medicines such as Fosamax (alendronate sodium), Actonel (risedronate sodium), and Boniva (ibandronate sodium) work by slowing down how fast the body removes old bone, allowing time to regrow bone and make fractures less likely.

These medicines can cause nausea and abdominal pain, as well as rare but more serious side effects like cracks in the thighbone or damage to the jawbone. Alternative treatments include estrogen or two injected medicines, denosumab and teriparatide.

Source: Reuters


Bigger Waistlines a Threat to Older Women’s Health, Even Without Obesity

A widening waistline can harm the health of older women, even if they avoid obesity, new research suggests.

It’s a condition known as “central obesity” — a concentration of fat around the abdomen. Central obesity can occur even if it’s not enough to shift a person’s body mass index (BMI) into the obese range, explained researchers led by Wei Bao, a professor of epidemiology at the University of Iowa.

His study found that a large waist size — about 35 inches or more — significantly increased the risk of an early death for women over 49, even when they had a normal BMI.

The study findings suggest that doctors “look not only at body weight but also body shape when assessing a patient’s health risks,” Bao concluded in a university news release.

One expert who reviewed the new study agreed.

“How does measuring waist circumference help us understand body composition? A higher waist circumference assumes an accumulation of fat in the abdominal region,” explained Ashley Baumohl, a clinical dietitian at Lenox Hill Hospital in New York City.

“So for those that have a normal BMI but a larger waist circumference, we can assume that a higher percentage of that weight is coming from fat rather than muscle,” she added. And all that fat can take a toll on health.

In the new study, Bao’s group tracked data from more than 156,000 U.S. women, aged 50 to 79, whose health was tracked from 1993 to 2017 as part of a large national study.

Women who were considered to have normal BMI but had a large waist size had a 31% higher risk of dying during the study period, compared to those with a normal BMI but a smaller waist.

That hike in risk is comparable to the 30% increased odds for death observed among obese people with central obesity, who were in the highest risk group, the researchers said.

The two main causes of death in people with normal BMI but large waist size were heart disease and obesity-related cancers, according to the report published online July 24 in JAMA Network Open.

Right now, clinical guidelines say doctors need rely only on a person’s BMI to determine their obesity-related health risk, Bao noted. So people who are in a high-risk group because of other risk factors, such as percentage of body fat, might still believe they’re “healthy.”

Another expert, Dr. Guy Mintz, said, “This study serves as a wake-up call to physicians to not be satisfied with just a BMI, but to look at fat distribution and waist circumference.” In doing so, doctors can spot “a group of patients that might be otherwise overlooked,” he noted.

And, “once central obesity is identified, patient education is essential to change diet, exercise and flatten our abdomens,” said Mintz, who directs cardiovascular health at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

Mintz added that, “while the article looked at an older female population, I personally feel it holds true in younger patients as well.”

How could the accumulation of fat around the tummy increase early death risk? According to Mintz, this type of “visceral” fat is closely tied to chronic inflammation, the excess production of insulin, and insulin resistance — a precursor to diabetes. Together, those three factors can trigger diabetes, hardening of the arteries and heart disease, he explained.

These states can be turned around, however. Weight reduction is crucial, Baumohl said, even if it’s not always easy.

“It is important to point out that we as humans cannot target specific areas of our body to lose weight from; a phenomenon commonly referred to as ‘spot reduction,'” she said.

“There are hundreds of fad diets out there promising quick and easy tricks to get that flat stomach and to lose those love handles,” Baumohl said. However, “at this time, the only prescription for losing weight, no matter where on the body, is nutrition education, a supportive environment and personal motivation.”

Source: HealthDay

Among Older Women, 10,000 Steps Per Day Not Needed for Lower Mortality

In the world of step goals and activity trackers, the number 10,000 can sound like a magic one. Many wearable devices that track the number of steps a person takes each day come pre-programmed with a daily goal of 10,000 steps. But while a large body of evidence shows that physical activity is good for a person’s health and longevity, few studies have examined how many steps a day are associated with good health, particularly long-term health outcomes. A new study led by investigators from Brigham and Women’s Hospital sought to address this knowledge gap by examining outcomes over an average of more than four years for older women in the Women’s Health Study who had measured their steps for a full week. The team reports that, among older women, taking as few as 4,400 steps per day was significantly associated with lower risk of death compared to taking 2,700 steps per day. Risk of death continued to decrease with more steps taken but leveled off at around 7,500 steps per day — less than the 10,000 steps default goal in many wearables. The team’s results are presented today at the American College of Sports Medicine Annual Meeting and published simultaneously in JAMA Internal Medicine.

“Taking 10,000 steps a day can sound daunting. But we find that even a modest increase in steps taken is tied to significantly lower mortality in older women,” said I-Min Lee, MBBS, ScD, an epidemiologist in the Division of Preventive Medicine at the Brigham. “Our study adds to a growing understanding of the importance of physical activity for health, clarifies the number of steps related to lower mortality and amplifies the message: Step more — even a little more is helpful.”

According to previous studies, the average number of steps taken by people in the U.S. is between 4,000 and 5,000 per day. The origin of the 10,000-step goal is unclear but may trace back to 1965, when a Japanese company began marketing a pedometer called Manpo-kei, which translates to “10,000 steps meter” in Japanese.

To conduct their study, Lee and colleagues included participants from the Women’s Health Study, a randomized trial originally conducted to evaluate risk of cardiovascular disease and cancer among women taking low-dose aspirin and vitamin E. When the original trial ended, participants were invited to participate in a long-term observational study. For the present study of steps and health, almost 18,000 women were asked to wear an ActiGraph GT3X+ accelerometer device — a research grade wearable — on their hips for seven consecutive days during all waking hours. The team analyzed 16,741 of the women who were compliant with wearing the device; their average age was 72.

Participants were followed for an average of more than four years, during which time 504 women died. Participants in the bottom 25 percent of steps walked (average of 2,700 steps per day) were at greatest risk of death, with 275 women dying. Those who walked modestly more (average of 4,400 per day) were at 41 percent lower risk of death. Risk of death continued to decrease with more steps walked, up to 7,500 steps per day, after which risk leveled off. The team also found that for women who walked the same number of steps per day, the intensity — how fast or slow they walked — was not associated with risk of death.

Due to the observational nature of the study, the authors cannot definitively separate cause from correlation (that is, to differentiate between “do more steps lower mortality?” or “do women in better health step more?”). However, the team did take several measures to try to ensure that the association observed was more likely causal than not, such as excluding women with heart disease, cancer, diabetes and less than excellent or good self-rated health and excluding the first year of follow-up data. The findings also are supported by previous experiments showing physical activity causes beneficial changes in short-term markers of health e.g., blood pressure, insulin/glucose levels, lipid profile, inflammation, and more.

The Women’s Health Study included primarily older, white women, and further studies will be needed in younger and diverse populations to determine if the findings are applicable to other groups, especially those who may, on average, take more steps. Other outcomes — such as quality of life and risk of specific diseases — were not assessed, but will be addressed in future studies.

“Of course, no single study stands alone. But our work continues to make the case for the importance of physical activity,” said Lee. “Clearly, even a modest number of steps was related to lower mortality rate among these older women. We hope these findings provide encouragement for individuals for whom 10,000 steps a day may seem unattainable.”

Source: Science Daily

Read also at Reuters:

Daily strides may mean longer life for older women . . . . .

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Diet Drinks May be Associated with Strokes Among Post-menopausal Women

Among post-menopausal women, drinking multiple diet drinks daily was associated with an increase in the risk of having a stroke caused by a blocked artery, especially small arteries, according to research published in Stroke, a journal of the American Heart Association.

This is one of the first studies to look at the association between drinking artificially sweetened beverages and the risk of specific types of stroke in a large, racially diverse group of post-menopausal women. While this study identifies an association between diet drinks and stroke, it does not prove cause and effect because it was an observational study based on self-reported information about diet drink consumption.

Compared with women who consumed diet drinks less than once a week or not at all, women who consumed two or more artificially sweetened beverages per day were:

  • 23 percent more likely to have a stroke;
  • 31 percent more likely to have a clot-caused (ischemic) stroke;
  • 29 percent more likely to develop heart disease (fatal or non-fatal heart attack); and
  • 16 percent more likely to die from any cause.

Researchers found risks were higher for certain women. Heavy intake of diet drinks, defined as two or more times daily, more than doubled stroke risk in:

  • women without previous heart disease or diabetes, who were 2.44 times as likely to have a common type of stroke caused by blockage of one of the very small arteries within the brain;
  • obese women without previous heart disease or diabetes, who were 2.03 times as likely to have a clot-caused stroke; and
  • African-American women without previous heart disease or diabetes, who were 3.93 times as likely to have a clot-caused stroke.

“Many well-meaning people, especially those who are overweight or obese, drink low-calorie sweetened drinks to cut calories in their diet. Our research and other observational studies have shown that artificially sweetened beverages may not be harmless and high consumption is associated with a higher risk of stroke and heart disease,” said Yasmin Mossavar-Rahmani, Ph.D., lead author of the study and associate professor of clinical epidemiology and population health at the Albert Einstein College of Medicine in the Bronx, New York.

Researchers analyzed data on 81,714 postmenopausal women (age 50-79 years at the start) participating in the Women’s Health Initiative study that tracked health outcomes for an average of 11.9 years after they enrolled between 1993 and 1998. At their three-year evaluation, the women reported how often in the previous three months they had consumed diet drinks such as low calorie, artificially sweetened colas, sodas and fruit drinks. The data collected did not include information about the specific artificial sweetener the drinks contained.

The results were obtained after adjusting for various stroke risk factors such as age, high blood pressure, and smoking. These results in postmenopausal women may not be generalizable to men or younger women. The study is also limited by having only the women’s self-report of diet drink intake.

“We don’t know specifically what types of artificially sweetened beverages they were consuming, so we don’t know which artificial sweeteners may be harmful and which may be harmless,” Mossavar-Rahmani said.

The American Heart Association recently published a science advisory that found there was inadequate scientific research to conclude that low-calorie sweetened beverages do – or do not – alter risk factors for heart disease and stroke in young children, teens or adults. The Association recognizes diet drinks may help replace high calorie, sugary beverages, but recommends water (plain, carbonated and unsweetened flavored) as the best choice for a no calorie drink.

“Unfortunately, current research simply does not provide enough evidence to distinguish between the effects of different low-calorie sweeteners on heart and brain health. This study adds to the evidence that limiting use of diet beverages is the most prudent thing to do for your health,” said Rachel K. Johnson, Ph.D., R.D., professor of nutrition emeritus, University of Vermont and the chair of the writing group for the American Heart Association’s science advisory, Low-Calorie Sweetened Beverages and Cardiometabolic Health.

“The American Heart Association suggests water as the best choice for a no-calorie beverage. However, for some adults, diet drinks with low calorie sweeteners may be helpful as they transition to adopting water as their primary drink. Since long-term clinical trial data are not available on the effects of low-calorie sweetened drinks and cardiovascular health, given their lack of nutritional value, it may be prudent to limit their prolonged use” said Johnson.

Source: American Heart Association

Read also at HealthDay:

Could Diet Sodas Raise an Older Woman’s Stroke Risk? . . . . .

Weight Loss Linked to Lower Breast Cancer Risk for Postmenopausal Women

In a study of postmenopausal women, participants who lost weight had a lower risk of developing invasive breast cancer than those who maintained or gained weight. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that weight loss may help lower postmenopausal women’s breast cancer risk.

In a study of postmenopausal women, participants who lost weight had a lower risk of developing invasive breast cancer than those who maintained or gained weight. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that weight loss may help lower postmenopausal women’s breast cancer risk.

Although obesity has been strongly related to breast cancer risk, studies examining whether weight loss might reduce postmenopausal women’s risk have provided mixed results. To examine the issue, Rowan Chlebowski, MD, PhD, of the City of Hope National Medical Center in Duarte, California, and his colleagues analyzed information on 61,335 women participating in the World Health Initiative Observational Study who had no prior breast cancer and had normal mammogram results. The women’s body weight, height, and body mass index were assessed at the start of the study and again 3 years later.

During an average follow-up of 11.4 years, there were 3,061 new cases of invasive breast cancer diagnosed. Women with weight loss ≥5 percent had a 12 percent lower breast cancer risk compared with stable weight women, with no interaction by body mass index. Weight gain of ≥5 percent was not associated with risk of breast cancer overall but was associated with a 54 percent higher incidence of triple negative breast cancer.

“Our study indicates that moderate, relatively short-term weight reduction was associated with a statistically significant reduction in breast cancer risk for postmenopausal women,” said Dr. Chlebowski. “These are observational results, but they are also supported by randomized clinical trial evidence from the Women’s Health Initiative Dietary Modification trial where, in a randomized clinical trial setting, adopting a low-fat dietary pattern that was associated with a similar magnitude of weight loss resulted in a significant improvement in breast cancer overall survival. These findings, taken together, provide strong correlative evidence that a modest weight loss program can impact breast cancer.”

October is Breast Cancer Awareness Month.

Source: Wiley

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