Association between serum bone formation and resorption markers and bone mineral, structural, and strength variables derived from quantitative computed tomography (QCT) in a population-based cohort of 1745 older adults was assessed. The association was weak for lumbar spine and femoral neck areal and volumetric bone mineral density.The aim of this study was to examine the relationship between levels of bone turnover markers (BTMs; osteocalcin (OC), C-terminal cross-linking telopeptide of type I collagen (CTX), and procollagen type 1N propeptide (P1NP)) and quantitative computed tomography (QCT)-derived bone density, geometry, and strength indices in the lumbar spine and femoral neck (FN).A total of 1745 older individuals (773 men and 972 women, aged 66-92 years) from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik cohort were studied. QCT was performed in the lumbar spine and hip to estimate volumetric trabecular, cortical, and integral bone mineral density (BMD), areal BMD, bone geometry, and bone strength indices. Association between BTMs and QCT variables were explored using multivariable linear regression.Major findings showed that all BMD measures, FN cortical index, and compressive strength had a low negative correlation with the BTM levels in both men and women. Correlations between BTMs and bone size parameters were minimal or not significant. No associations were found between BTMs and vertebral cross-sectional area in women. BTMs alone accounted for only a relatively small percentage of the bone parameter variance (1-10 %).Serum CTX, OC, and P1NP were weakly correlated with lumbar spine and FN areal and volumetric BMD and strength measures. Most of the bone size indices were not associated with BTMs; thus, the selected bone remodeling markers do not reflect periosteal bone formation. These results confirmed the limited ability of the most sensitive established BTMs to predict bone structural integrity in older adults.

Force steadiness is quantified by evaluating the fluctuations in muscle force during constant-force contraction task. Aging is associated with a progressive impairment in force steadiness, indicating reduced sensorymotor function. Resistance and/or power training may improve force steadiness in aging individuals. However, the influence of resistance/power training on force steadiness in very old individuals (+80 yrs) remains unknown. PURPOSE: To examine the effect of resistance/power training on force steadiness in old (60 yrs) and very old (80 yrs) women. METHODS: Old (62.7 ± 2.2 yrs, n=20, TG60) and very old (81.8 ± 2.7, n=13, TG80) women performed 12 wks of heavy-resistance power training (HRPT) for the leg muscles (24 sessions) using training loads of 75-80% 1-RM. Two groups of non-training age-matched women served as controls (n=20, CG60; n=12, CG80). Force steadiness was evaluated during static unilateral leg extension at 20 and 60% MVC (30 and 20-s duration, respectively) using on-line visual display of the exerted force. RESULTS: Prior to training 80-yr women demonstrated impaired steadiness at 60% MVC reflected by elevated SD[force] and CV (SD[force]/force) and reduced accuracy (greater target force offset; TFO) compared to 60-yr women (p<0.05). No age deficits were observed at 20% MVC. Maximal static leg extensor strength (MVC) increased post training by 28.1 and 21.5% in TG80 and TG60, respectively (p<0.05). Post training SD, CV and TFO at 60% MVC decreased 30, 31 and 47% in TG60 (p<0.01) and 32, 36 and 39% in TG80 (p=0.01-0.06). No changes were observed in force steadiness at 20%. No changes were observed in the control groups. A 22% deficit in MVC between TG80 and CG60 was observed prior to training (p<0.05), which was removed after training (4.6%, n.s.). Likewise, pre training age deficits in SD, CV and TFO of 24, 8 and 35% all were reduced after training (-7,-14, 2%) (p<0.05). CONCLUSION: HRPT led to improved force steadiness at 60% MVC in old (60 yrs) and very old (80 yrs) women. Further, age related deficits in steadiness at 60% MVC disappeared after HRPT. No age deficits were observed at 20% MVC, where force steadiness remained unaffected by training. Resistance/power training appears to effectively enhance lower limb force steadiness control at moderate to high force levels in old and very old women (60-80 yrs).

Background Adjustment for morbidity level is important in ensuring fair comparison of outcomes between patient groups and healthcare providers. The Quality and Outcomes Framework (QOF) in UK primary care, which records numerous diseases systematically, offers potential for developing a standardised morbidity score that can be easily applied in research and service settings. Methods Using The Health Improvement Network (THIN), a large primary care database of 375 UK general practices in 2008–9, half the practices were randomly selected as a training set to derive a morbidity score based on chronic conditions recorded in QOF, and the other practices formed a validation set to assess predictive performance. A total of 653,780 patients aged 60 and over registered in 2008 were included, and mortality at one year was assessed. Results Nine QOF conditions were identified as robust co-predictors (Hazard Ratio ≥1.2) of mortality independent of age and sex, and were assigned integer score weights based on the strength of their association with mortality. Cancer (HR=3.4) and Dementia (HR=2.8) were the strongest predictors. In a Cox model with age and sex included, the addition of the QOF score improved model discrimination in predicting mortality (c-statistic=0.82 vs. 0.78), performing similarly to the Charlson index, an established morbidity index. In a multilevel logistic model, an individual’s QOF score explained more of the variation in mortality between practices than the Charlson index (46% compared to 32%). At practice level, the mean QOF score per patient was strongly correlated with practice standardised mortality ratios (r=0.64) and explained more variation in practice death rates than the Charlson index. Conclusion A simple score derived from routine QOF recording provides a morbidity index which is highly predictive of one year mortality in older UK Primary Care patients, is simpler to implement than existing morbidity scores, and explains practice level variations in mortality. This new score has potential utility in research and healthcare outcome monitoring and could be easily implemented nationally through existing mechanisms for anonymised collection of QOF data from practices.

OBJECTIVES: To determine whether magnesium intake from supplemental and dietary sources is associated with bone mineral density (BMD) in older men and women.DESIGN: Cross-sectional.SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania.PARTICIPANTS: Two thousand thirty-eight older black and white men and women aged 70 to 79 at baseline enrolled in the Health, Aging and Body Composition Study.MEASUREMENTS: Dietary intake of magnesium was assessed using a semiquantitative food frequency questionnaire, and supplement data were collected based on a medication inventory. BMD of the whole body was obtained using a fan-beam densitometer. Additional covariates included age, body mass index (BMI), smoking status, alcohol use, physical activity, estrogen use, and supplemental calcium (Ca) and vitamin D use.RESULTS: In white, but not black, men and women, magnesium intake was positively associated with BMD of the whole body after adjustment for age, self-report of osteoporosis or fracture in adulthood, caloric intake, Ca and vitamin D intake, BMI, smoking status, alcohol intake, physical activity, thiazide diuretic use, and estrogen use in women (P=.05 for men and P=.005 for women). BMD was 0.04 g/cm(2) higher in white women and 0.02 g/cm(2) higher in white men in the highest than in the lowest quintile of magnesium intake.CONCLUSION: Greater magnesium intake was significantly related to higher BMD in white women and men. The lack of association observed in black women and men may be related to differences in Ca regulation or in nutrient reporting.

BACKGROUND:Thyroid dysfunction increases with age. Less is known about the prevalence of thyroid disease in older black adults and whether an association between thyroid function and serum cholesterol level exists, as in older white adults. METHODS:A cross-sectional study of 2799 well functioning white and black participants, aged 70 to 79 years, were recruited for a population-based study. Participants underwent thyrotropin, free thyroxine, and total cholesterol testing; a medical history; and physical measurements. RESULTS:Among the entire cohort, 94% were euthyroid based on biochemical testing results. Approximately 10% were taking thyroid hormones. Subclinical hypothyroidism was the most prevalent disorder (3.1% of all participants not taking thyroid hormones), but black men and women had lower rates of this condition than white men and women. After excluding those taking thyroid or lipid medication and adjusting for potential confounders, an elevated thyrotropin level (>5.5 mIU/mL) was associated with a 9 mg/dL (0.23 mmol/L) higher cholesterol level, and a suppressed thyrotropin level (<0.35 mIU/mL) was associated with a 19 mg/dL (0.49 mmol/L) lower cholesterol level. CONCLUSION:Healthy community-dwelling older black adults have a lower prevalence of thyroid dysfunction compared with older white adults, but the association between increased thyrotropin and increased cholesterol levels is similar in both races.

OBJECTIVES: Previous studies of weight change and mortality in older adults have relied on self-reported weight loss, have not evaluated weight gain, or have had limited information on health status. Our objective was to determine whether 5% weight gain or loss in 3 years was predictive of mortality in a large sample of older adults.DESIGN: Longitudinal observational cohort study.SETTING: Four U.S. communities.PARTICIPANTS: Four thousand seven hundred fourteen community-dwelling older adults, age 65 and older.MEASUREMENTS: Weight gain or loss of 5% in a 3-year period was examined in relationship to baseline health status and interim health events. Risk for subsequent mortality was estimated in those with weight loss or weight gain compared with the group whose weight was stable.RESULTS: Weight changes occurred in 34.6% of women and 27.3% of men, with weight loss being more frequent than gain. Weight loss was associated with older age, black race, higher weight, lower waist circumference, current smoking, stroke, any hospitalization, death of a spouse, activities of daily living disability, lower grip strength, and slower gait speed. Weight loss but not weight gain of 5% or more was associated with an increased risk of mortality that persisted after multivariate adjustment (Hazard ratio (HR) = 1.67, 95% CI = 1.29-2.15) and was similar in those with no serious illness in the period of weight change. Those with weight loss and low baseline weight had the highest crude mortality rate, although the HR for weight loss was similar for all tertiles of baseline weight and for those with or without a special diet, compared with those whose weight was stable.CONCLUSIONS: This study confirms that even modest decline in body weight is an important and independent marker of risk of mortality in older adults.

We compared anthropometric data (height, weight and body mass index) from 19 geographically and ethnically varied samples of community-dwelling elderly people. Participants were stratified into three age groups, 60-69, 70-79 and 80 years or older. We present age-group-specific means and standard deviations for height, weight and body mass index (BMI, weight/height2) and the prevalence of underweight (BMI < 20) and overweight (BMI > or = 30). Across studies there are large differences in the prevalence of overweight and underweight, but in all studies mean height and BMI decreased with age. In general, mean BMI among 70-79-year-old women is greater than that for men of a similar age, and the Mediterranean samples are heavier for height than samples from Western Europe, Asia, Africa and the United States. The comparisons suggest that the sensitivity and specificity of a fixed cut-off for underweight and overweight are likely to differ by sex, age, and geographic location in samples of older persons.