Some Talks by Scholars in IAG 2005

1. Some Talks by Scholars in IAG 2005 Reported by Claudia K Y Lai, RN, PhD

2. Topics Osteoporosis Frailty Caloric Restriction & Longevity Psychosocial Theory (SOC) in Aging Longitudinal Studies

3. Osteoporosis (Hajime Orimo, Japan; Jun 28, 2005) Risk of arthrosclerosis with Ca++ Parathyroid hormone increase in advancing age Factors involved in pathogenesis osteoporosis and arthrosclerosis Vitamin K (important in producing Ca binding proteins) Cytokines Oxidized LDL Matrix Glaprotein [Gamma-carboxyglutamate] (may be protective of protein from calcification) Sources of vitamin K: turnip greens, broccoli, cabbage, lettuce, liverSources of vitamin K: turnip greens, broccoli, cabbage, lettuce, liver

4. Bone Turnover Osteocalcin is a vitamin-dependent protein produced by osteoclast Bone strength significantly decreased in mouse without osteocalcin Vitamin K2 regulation of bone homeostatis versus mediated by the steroid xenobiotic receptor (SXR)

5. Vitamin Intake & Fracture Higher consumption of Natto (fermented beans) decreased fracture of hip Japan Natto contains tremendous amount of K2 K2 only found in Natto, not in other types of food USA increase intake of vit K1 correlated with lower incidence of hip # 2 years administration of vitamin K decrease significantly vertebral # Rotterdam study: vit K reduces the risk of coronary heart disease especially vit K2 Vit K2 has an anti-aging effect

6. Osteoporosis Assessment Current (2002) International Osteoporosis Foundation (IOF) Guidelines: History, bone mineral density (BMD) with risk factors Proposed: # risk for given BMD levels varies according to age and other risk factors Cases with T scores > -2.5 are at risk for hip # NORA study: 52% of women with osteoporotic # had peripheral T scores between -1 & - 2.5 (Siris et al., 2004)

7. WHO # Risk Assessment Tool 2004 WHO Assessment Recommendations: Age BMD Smoking Ever use cortisol Alcohol Parental history

8. 2003 National Osteoporosis Foundation (NOF) Guidelines In absence of risk factors, start therapy to reduce # risk in female with BMD T-scores below -2.0 by DXA (Dual energy X-ray Absorptiometry) of the hip or spine. With one or more risk factors, treatment for people below -1.5 DXA of the hip or spine.

9. Whom to treat? WHO is developing an algorithm that will combine BMD T-scores data at the hip with other key clinical risk factors to assess # probability over a 10-year period Treatment determine by available resources, societal values, etc.

10. Which treatment is best? HRT (Hormonal Replacement Therapy)– initial after menopause Raloxifene (A selective estrogen receptor modulator) Bisphosphonates: bone specific Parathyroid Hormone (PTH) Calcium Vitamin D3 Vitamin K2 Consider different age groups Bone plus and bone only agents – many options estrogen and raloxifene leads to general effects beyond bones -bisphosphonates calcitonin – bone specificConsider different age groups Bone plus and bone only agents – many options estrogen and raloxifene leads to general effects beyond bones -bisphosphonates calcitonin – bone specific

11. Use of Estrogen Uses Side-effects “Women Health Initiative” study: Increase risk of Coronary Heart Disease Increase stroke Increase breast cancer Increase PE Decrease risk of colon cancer

12. 5 Ways to Prevent Osteoporosis Maintain a Calcium-rich diet Get plenty of Vitamin D Engage in weight bearing exercise Limit your drink and don’t smoke Consider HRT or other types of medication

13. Frailty: frail older adults are vulnerable and at high risk for a range of adverse health outcomes. Prevalence of phenotype of frailty: overall 7%, increase with age.