A study released in January this year in the Archives of Internal Medicine found that persons older than 50 years of age may be at increased risk for fracture due to SSRI use.

The study followed more than 170 men and women on SSRIs and about 5,000 persons not on the antidepressant medication. They compared bone mineral density and fracture incidence in the two population sets over a five year period.

For those individuals in the SSRI group, bone mineral density was lower in the hips compared to the controls. The risk of fracture was dramatically different. Persons on SSRIs had double the risk of fracture, or 200 percent greater risk, compared to a person of equal age. This effect held true after adjusting for the most common risk factors for fracture.

Most of the fractures were due to a minor fall, an occurence in older individuals. Minor falls usually do not pose a risk for fracture except in people with osteoporosis, or weak bones.

The authors speculate that the SSRI drugs affect the bone building cells, osteoclasts, which results in lower mineralization in the bony matrix.

Because of the high number of persons placed on SSRI medications, caution should be executed in older persons, especially those at risk for falls.

The study, published in the Journal of Nutrition, investigated the effects of dietary plant-derived omega 3 fatty acids on bone health. Researchers at Penn State administered three consecutive diets to 23 adults, for 24 weeks. For the first six weeks, the participants were assigned either a diet high in omega 3 alpha-linolenic acid (ALA), a diet high in omega-6 linoleic acid (LA) or an average American diet. The omega 3 ALA diet included walnuts and flaxseed oil and the omega 6 LA diet included walnuts for half of the fat. This was followed by a three week period where the participants resumed their regular diets. The participants were then assigned to one of the diets they had not previously followed for another six weeks. This was followed again by a three week period where the participants resumed their regular diets. The participants were then assigned to the remaining diet for the final six weeks. Blood tests for bone formation (bone-specific alkaline phosphatases) and bone resorption (N-telopeptides) were obtained from the participants.

The researchers found that the diet high in omega 3 ALA significantly lowered N-telopeptides levels, compared to the average American diet. This result indicated that less bone was being resorbed during the omega 3 ALA diet. The diet high in omega 6 LA also lowered N-telopeptides levels, although not as significantly. The three diets did not affect bone-specific alkaline phosphatases levels, indicating that the same amount of bone was being created.

"The results indicate that plant sources of dietary omega-3 polyunsaturated fatty acids may have a protective effect on bone metabolism via a decrease in bone resorption in the presence of consistent levels of bone formation," the study authors conclude.

REFERENCES:
1. Griel AE et al. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007 Jan 16;6:2.

The study, published in Arthritis and Rheumatism, compared TNF-blocking drugs to methotrexate (a traditional RA drug) and the risk of cancer in patients with RA. Researchers at Harvard Medical School analyzed data from 1,152 patients receiving TNF-blocking drugs for an average of 2.6 years and 7,306 patients receiving methotrexate for 4.2 years. The participants taking TNF-blocking drugs tended to have more severe RA than those taking methotrexate.

The researchers found that there was no significant difference in cancer risk between the TNF-blocking group and the methotrexate group. However, it still remains unclear if the increased cancer risk is due to RA itself or to the treatment drugs. The study authors acknowledge that the treatment drugs improve the quality of life for RA patients.

"Our results indicate that users of biologic agents are unlikely to have a substantial increase in the risk of hematologic malignancies and solid tumors as compared with methotrexate users," the study authors write. "Despite the use of large combined data sets, studying the effect of an infrequent exposure (biologic DMARDs) on rare diseases (hematologic malignancies) remains a challenge."

REFERENCES:
1. Setoguchi S et al. Tumor necrosis factor alpha antagonist use and cancer in patients with rheumatoid arthritis. Arthritis Rheum 2006 Sep;54(9):2757-64.

The study, published in Arthritis and Rheumatism, investigated curcumin's effects using an animal model of rheumatoid arthritis (RA). Researchers at the University of Arizona College of Medicine and the Arizona Center for Phytomedicine Research isolated a whole extract of turmeric root, the essential oils contained in turmeric, and an oil-depleted extract containing curcuminoids. They injected the preparations into female rats with streptococcal cell wall-induced arthritis.

The researchers found that the cucuminoid preparation significantly inhibited joint inflammation and destruction. Further analysis revealed that the cucuminoid preparation inhibited the activation of nuclear factor kappa-beta (NF-KB). NF-KB produces inflammatory proteins that destroy joint tissue, such as in rheumatoid arthritis. This result suggests that turmeric has a similar mechanism of action as some arthritis drugs.

"These translational studies demonstrate in vivo efficacy and identify a mechanism of action for a well-characterized turmeric extract that supports further clinical evaluation of turmeric dietary supplements in the treatment of RA," the study authors write.

REFERENCES:
1. Funk JL et al. Efficacy and mechanism of action of turmeric supplements in the treatment of experimental arthritis. Arthritis Rheum 2006 Nov;54(11):3452-64.

The study, published in the Journal of Rheumatology, investigated whether a high dietary caffeine intake decreases methotrexate's effects in RA patients. Researchers at Harvard Medical School in Boston, divided 264 participants with RA and taking methotrexate into three groups. The three groups were based on low, moderate, and high caffeine consumption. The participants' methotrexate response was measured by the Disease Activity Score (DAS)28, Multidimensional Health Assessment Questionnaire (MDHAQ) score, and duration of morning stiffness.

The researchers found that overall, the participants' average coffee intake was about 1.5 cups of coffee daily or 212 mg of caffeine per day. Participants in the high caffeine group had a coffee intake of 3 cups of coffee daily or 422 mg of caffeine per day. Findings also revealed that participants in the moderate to high caffeine groups did have slightly higher disease activity scores, but the differences were not significant.

"Caffeine intake among patients taking high doses of MTX for RA did not affect methotrexate efficacy and RA disease activity over time," the study authors conclude.

REFERENCES:
1. Benito-Garcia F et al. Dietary caffeine intake does not affect methotrexate efficacy in patients with rheumatoid arthritis. J Rheumatol 2006 Jul;33(7):1275-81.

Osteoporosis is a bone disease characterized by decreased mineralization in the bone. It results in weakness that is so severe minor fractures could occur from daily use. Women are at increased risk for osteoporosis after menopause due to decreased estrogen production. Postmenopausal women are also at increased risk for depression, so the two conditions could create added risk.

For the study mice were induced into a depression like state. Levels of noradrenalin, or norepinephrine, were increased. This hormone is produced by the adrenal glands in response to stress such as that which occurs during clinical depression. Norepinephrine also effects osteoclasts and osteoblasts, the cells in bone responsible for mineral metabolism.

Bone mineral density was measured in the mice pre- and post-depression. Then mice were given antidepressant medications and bone mineral density was re-assessed.

The results were published in the Proceedings of the National Academy of Sciences.

The researchers in Jerusalem found that depressed mice had decreases in bone mineral density in both the hip and vertebrae, the two areas most recognized for fractures. After treatment with the antidepressant medication the bone mineral density improved in those mice.

This is a new revalation in terms of understanding the effect of depression on bone metabolism. It is an early study, and an animal study but it can give some direction to researchers in terms of developing clinical trials in humans. It supports a previous study that found fluoxetine, an antidepressant medication, effective at increasing bone mineral density.

The study, published in the Journal of the American Medical Association, investigated the extent to which anti-TNF antibodies drugs, infliximab (Humera) and adalimumab (Remicade), may increase the risk of cancer and infections in RA patients. Researchers at the Mayo Clinic College of Medicine in Rochester, Minnesota, analyzed data from nine studies comparing 3,493 RA patients who received Humira or Remicade with 1,512 patients who received placebos, for 12 weeks or more.

The researchers found that there were 29 cancers in the drug group, compared with 3 cancers in the placebo group. Furthermore, cancer was significantly more common in patients treated with higher doses of anti-TNF antibodies drugs than those receiving lower doses. Findings also revealed that there were 126 serious infections (including pneumonia and cellulitis) in the drug group, compared with 26 infections in the placebo group.

"There is evidence of an increased risk of serious infections and a dose-dependent increased risk of malignancies in patients with rheumatoid arthritis treated with anti-TNF antibody therapy," the study authors write. "The formal meta-analysis with pooled sparse adverse events data from randomized controlled trials serves as a tool to assess harmful drug effects."

REFERENCES:
1. Bongartz T et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006 May 17;295(19):2275-85.

The American Journal of Clinical Nutrition published results of a large analysis of more than 2,500 men and women. It looked at cola consumption, including regular, diet, caffeinated and non-caffeinated drinks. They then measured bone mineral density in several areas of the hip and spine to determine any differences.

Carbonated beverages such as cola contain high amounts of phosphoric acid, which inhibits calcium absorption and may contribute to calcium loss from the bones.

Low bone mineral density contributes to fracture risk and the condition osteoporosis. Women are more at risk for osteoporosis than men, though both sexes can develop the condition.

They found that women who consumed a cola a day had lower bone mineral density than women who consumed only one cola a month. These women were more at risk for osteoporosis and fractures regardless of other risk factors and health variables.

There was no association between cola consumption and low bone mineral density in men.

They also looked at total calcium intake, and found it to be lower in women who consumed more cola, though not because of decreased dairy intake.

Women who have a family history of osteoporosis or any other factor that increases their risk should reconsider their choice if consuming cola regularly. A simple change such as beverage choice may have a serious impact on health status later in life. Drink water, its good for you and does not contribute to any health conditions and protects against many.

The study, published in Archives of Internal Medicine, investigated the association of soy intake and bone fractures in postmenopausal women. Researchers from the Vanderbilt University School of Medicine in Nashville, Tennessee analyzed the data of 24,403 postmenopausal women who had no history of fracture or cancer, as part of the Shanghai Women's Health Study between March 1, 1997 and May 23, 2000. Food frequency questionnaires were obtained from the participants. During a four and a half year follow-up, 1,770 fractures were identified.

The researchers found that high dietary soy intake was associated with the lowest risk of bone fractures among women in early menopause. Furthermore, participants with the highest soy intake (13 grams of soy protein daily) reduced the risk of bone fractures by 35 percent, compared to those with the lowest intake (5 grams of soy protein).

"Soy food consumption may reduce the risk of fracture in postmenopausal women, particularly among those in the early years following menopause," the study authors conclude.

REFERENCES:
1. Zhang X et al. Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med 2005 Sep 12;165(16):1890-5.

Researchers conducted a meta-analysis study, pooling the results of nine trials meeting the inclusion criteria, including 3493 patients who received anti-TNF antibody treatment and 1512 patients who received placebo. Patients taking higher doses of these medications had the highest risk of developing cancer. Overall, 29 cancers were noted in the medication group, while only 3 cancers were found in the patients taking placebo. Even though this increased risk exists, Dr. John Klippel, president of the Arthritis Foundation, told the Associated Press that the study will probably not change doctors' minds, because scores of patients have benefited from the drugs. While physicians may still recommend these medications, patients should be wary and weigh the increased risk of cancer and serious infections against symptomatic relief.

The study, presented at the 2006 European League Against Rheumatism Annual Meeting, investigated the frequency of remission in men and women. Researchers at the Huddinge University Hospital in Stockholm, Sweden analyzed data from the BARFOT follow-up program including 698 patients diagnosed with recent-onset RA, from 1995 to 1999. The patient mean age was 58 years old and 64 percent of the participants were women. The participants' functional disability and pain were assessed with the Swedish version of the Health Assessment Questionnaire, the patient assessment visual analogue scale, and the physician assessment five-grade Likert scale. The researchers examined the participants' frequency of remission at two years and at five years,

The researchers found that 261 of the 689 participants were in remission at the two year follow-up, and 230 or 598 patients were in remission at the five-year follow-up. However, only 32 percent of women were in remission, compared with 49 percent of men at the two year follow-up. After five years, only 31 percent of women were in remission, compared with 52 percent of men. Findings also revealed that at the two and five year follow-ups, the Health Assessment Questionnaire score, physician assessment, morning stiffness and pain were worse in women.

"Remission rates in this cohort of patients with early RA were similar to or higher than those in previous reports," the study authors write. "Importantly, women had a much lower remission rate than men although their disease activity at treatment start was not explicitly different. The reasons for this gender discrepancy are at present unclear and merit further investigation. However, the data seems solid enough to call for reinforced vigilance in the frequency and quality of follow-up in order to achieve an optimal suppression of the inflammatory process in all patients, regardless of gender."

REFERENCES:
1. Svensson B et al. "Remission of Early RA in Clinical Practice: Frequency and Gender Differences." Abstract OP0098, presented at the European League Against Rheumatism Annual Meeting, June 23, 2006. http://www.eular.org

A study published in the British Medical Journal found little use of calcium supplementation in children in terms of building bone density. The results combine information from more than 19 studies that assesed calcium supplementation and bone mineral density in nearly 3,000 children age 3-18 years of age.

Each child was given a supplement of calcium or a placebo pill for a various time periods. Bone mineral density was compared in each participant in the spine, hip and arm.

There was no difference in bone mineral density in the hip or spine between the children whether they were supplemented or not. There was a slight increase in bone mineral density of the arm with calcium supplementation.

The researchers do not negate the effect of calcium supplementation in children, but stress that some focus on bone health can be directed towards Vitamin D or other nutrients that are also involved in bone metabolism.

In the study more than 430 men and women who were hospitalized following a single hip injury were questioned about their general outlook on life and for any depressive symtpoms. Then each of the subjects were put through various performance tests/skills to determine their overall physical function,which was compared to pre-injury function.

They found that a large percentage of subjects with a greater positive outlook returned to pre-injury function, while those with a depressive mood did not. Positive attitude improved various performance tests including walking speed and standing from a chair. Subjects with a low positive outlook also functioned to a lesser degree than the high positive outlook patients, but did score higher than the depressed mood patients.

The study is the first to show that something as simple as a positive outlook can improve recovery. Positive outlook is defined as reporting general happiness, enjoying life, and feeling good about the future. For the elderly subjects in this study, attitude alone made such an impact on the ability to return to the pre-injury state.

Physician and healthcare providers as well as family members can take special care to nuture outlook and attitude in their elderly who suffer serious injuries such as hip fracture. Perhaps counseling or additional office visits to address mood and depressive symptoms could make a great differnce in their future.

To reduce the risk of osteopenia, get plenty of weight bearing exercise (walking is great), do not smoke, avoid carbonated cola drinks, limit alcohol consumption and eat a diet rich in vitamins and minerals. Taking a multinutrient supplement containing all the essentials for bone health is also recommended (especially in postmenopausal women) including calcium, magnesium, vitamin D, vitamin B6, vitamin B12, boron, copper, strontium, zinc, manganese, silicon, folic acid and vitamin K. The medicinal plant horsetail (Equisetum arvense) is a rich source of silicon.

What is often overlooked in conventional medicine is the role of digestion and absorption in assuring adequate bone mineral density. People over the age of 50 are more likely to have lower levels of hydrochloric acid in their stomachs, resulting in poor breakdown of food and less absorption of vitamins and minerals from food and supplements. As well, individuals may also suffer from inflammatory conditions of the intestines, or impaired levels of digestive enzymes than can further disrupt nutrient absorption. Seeking the help of a nutritionally oriented physician, like a naturopathic physician, is the best course of action to address these concerns.

Most water is not high in calcium, but designer waters that are high in calcium may be a significant source for non-dairy consumers. To see if calcium from water is adequately absorbed a researcher from Creighton University tested absorbablity via several serum markers and compared results to calcium from milk.

The results proved that high calcium water can be a significant source to protect against bone loss. This study may be the first to push the beverage industry to consider high calcium waters.