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AAOS: supplement use low in patients with osteoporosis, hip fracture

(HealthDay)—Of patients diagnosed with osteoporosis who have a history of hip fracture, only 14 percent are receiving appropriate calcium and vitamin D supplementation, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.

Evan D. Nigh, of the University of Miami/Jackson Memorial Medical Center, and colleagues analyzed six years of data from the National Health and Nutrition Examination Survey (NHANES) to identify 1,065 patients who self-reported an osteoporosis diagnosis (87 percent female; mean age, 67 years). The authors evaluated dietary questionnaire and examination data for adequate calcium and vitamin D supplement intake, femoral neck bone mineral density, and a history of hip fracture.

The researchers found that 861 patients (80.8 percent) with osteoporosis were not receiving enough calcium and vitamin D supplementation (at least 1,000 mg of calcium and 600 international units of vitamin D). No significant link was seen between a history of hip fracture and appropriate treatment (OR, 0.685). In a subset analysis, 14 percent of patients were receiving enough calcium and vitamin D supplementation; only 26 percent of patients were taking adequate calcium and 32 percent were getting enough vitamin D. Factors linked to an increased likelihood of appropriate supplementation were female sex (OR, 2.354), older age (OR, 1.019), Caucasian race (OR, 1.456), and an osteoporosis diagnosis (OR, 1.651).

“While osteoporotic individuals are receiving calcium and vitamin D supplements at a higher rate than individuals without osteoporosis, our analysis of the NHANES database indicates that the majority of patients with osteoporosis are not receiving adequate therapeutic supplementation,” the authors write.

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Why some people can’t stop running, according to sport psychology

Credit: lzf/Shutterstock

Alex has a problem with running; he has become addicted to it. “I have to get out and run, whether my family like it or not,” he says. “It’s just who I am.”

Running three times a week has become ten times a week, and when life gets in the way of his running, Alex becomes irritable and racked with guilt. He has gone from what was a healthy pursuit, to an unhealthy overindulgence. His body is shot to pieces and is mentally and physically exhausted. But still, he keeps running.

The physical and mental benefits of running are indisputable. But runners can have too much of a good thing. This is especially true for long-distance runners as they tend to increase their training loads and become increasingly competitive. They’re at risk of making a shift from healthy perseverance (“I want to run”) to unhealthy and pressured overindulgence (“I have to run”).

Here’s how it happens

Say you start running because you want to get fit and be a healthy weight. You try it and you like it, so you stick with it. After a month, you notice that your clothes fit better. Then colleagues and friends comment on how healthy you look lately, and your running buddies comment on your improved technique and speed. Your times are improving. You’re achieving things, beating others, and you get a rush when you run.

But it’s not enough. Five kilometres no longer gives you the same rush, so you move to ten. This added time means you no longer have time for a lunch break where you normally chat with colleagues. But who cares? People are saying that you look great, you are getting quicker, and you feel amazing. This snowballing can continue. Why not go from 10k to a half marathon?

The danger with this situation is that your self-worth is becoming attached to running. Running is now part of who you are. If you don’t run, who are you? If you quit or reduce running, then all of those nice things you are experiencing will drop away. People value you and you value yourself because of your running. Now you have to carry on running to maintain your self-worth. It makes sense to you that the more you run, the better you feel, you have greater social standing and with it more self-worth. A belief forms: “I have to keep running or I’ll be a worthless nobody.”

Research suggests that people who strongly identify with being an exerciser (including runners) and who are anxious about their physique are more likely to become exercise dependent. In our work as sport and exercise psychologists, we often come across people who become overly consumed by an athletic identity and who form the idea that their success as an athlete reflects their worth as a human being. So, I succeed as an athlete, therefore I am valuable. I fail as an athlete, therefore I am worthless. So I have to succeed because my self-worth is on the line.

Runners can’t guarantee success, so they put themselves in a precarious position. Our research shows that people whose self-worth depends on success or achievement are more likely to have poorer psychological well-being.

Illogical

Beliefs like “I have to” and “I’d be worthless if I didn’t” are considered to be illogical in some psychotherapies, especially rational emotive behaviour therapy (REBT), which is used a lot in sport and exercise. Evidence tells us that people who have these illogical beliefs are at greater risk of developing a dependence, such as alcoholism, internet addiction and exercise addiction. And although these illogical beliefs may sound motivational, they come with considerable emotional and physical exhaustion.

There are three main reasons these beliefs are illogical. First, they hinder well-being rather than help it. Second, they reflect short-term and guilt-based motivation, where people run to avoid guilt, rather than running for its own sake.Third, they are not consistent with reality. You have to breathe, eat, hydrate and sleep. You don’t have to run.

Helping Alex

Our work helping athletes using REBT particularly distance athletes, shows that by encouraging people to think logically about their goals leads to healthier motivation and increased resilience. They are also able to achieve their performance goals and feel less socially anxious.

This work involves understanding people’s deeply held illogical beliefs, challenging these beliefs and helping them develop logical alternatives. So “I have to” and “I’d be worthless if I didn’t” become “I want but I don’t have to” and “if I didn’t I would be disappointed, but I wouldn’t be worthless.”

Our work with elite athletes shows that when faced with stumbling blocks, such as an injury, these logical beliefs will lead to more helpful emotions and actions that can help people achieve their goals.

If you feel you are at risk of developing an unhealthy relationship with running, remind yourself of the following: running is a choice. Not achieving a goal or missing a training session might feel bad, but it isn’t terrible. Also, your running achievement does not define you – you’re more than just a runner. Detach your self-worth from your actions. Being a good runner doesn’t make you a good person, just as being a bad runner doesn’t make you a bad person.

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Wake up call on pre-teen mobile phone use at night

This World Sleep Day (March 15), Australia is waking up to the fact that around a quarter of children aged 7-8 are using mobile phones at night (between 10pm and 6am) when they should be sleeping.

It’s a worrying statistic which highlights an increasing use of mobile phones in the bedroom and is based on a survey of 180,700 Australian students, aged 7-19, between 2013-2018.

The project, undertaken by researchers from the University of South Australia’s (UniSA) Behaviour-Brain-Body Research Centre and UniSA Online, in partnership with Resilient Youth Australia, also highlights the negative mental health impacts on pre-teen children of using mobile phones at night.

While the marriage of mobile phone technology and social media is a well-known factor in keeping teenagers awake at night, UniSA Online’s Dr. Stephanie Centofanti says this research highlights how even younger children are negatively impacted by night-time mobile phone use.

“This is a huge data set and it provides us with a good snapshot of how Australian children are doing in terms of their wellbeing and technology use. It will enable us to identify ways to support children in this unprecedented technological age,” Dr. Centofanti says.

“Our research is based on surveys with primary and high school students in which we found that 83 per cent of those aged 17-18 had reported using phones between 10pm-6am more than once in the previous week.

“What may be considered more surprising is that 25 per cent of those aged 7-8 also reported the same use.

“Using smartphones at night is now common among children at that age and it will be a concern for parents and carers because not only does phone use impact negatively on sleep, but we are finding that it also increases angry or hurtful communication.”

One of the more obvious ways in which using a smart phone at night disrupts sleep, relates to the phone’s light which can disrupt circadian rhythms and cause havoc to the body’s biological clock.

This research highlighted other negative effects, indicating that night time phone use was associated with a fourfold increase in the odds of receiving hurtful messages and an almost threefold increase in the odds of being cyberbullied.

This can be equated to the way children use their phones at night, through the use of messaging and communicating on social media networks. But technology use isn’t all bad—the data also indicated that night time phone use facilitated friendship building.

“Technology is a part of young people’s lives and there are benefits to using these devices but we are also finding there’s a reliance on it, a physiological addiction, with anxiety felt by children when they are cut off from these devices,” Dr. Centofanti says.

“Technology use is creeping into the evening hours and this is having a big impact on the amount of sleep children are getting and the quality of sleep; children will wake up in the middle of the night, check their phone and send text messages.

“The other issue this raises is the flow over of bullying. Bullying that might have been confined to school days is now flowing over at night as children access [for example] social media accounts. Not surprisingly this can lead to difficulties falling asleep.

“The problem is that kids aren’t able to catch up on lost sleep by having a lie-in after staying up on their phones. They still need to wake up early for school, and shorter sleep times relate to poorer functioning the next day.

“Lack of sleep can lead to poorer academic outcomes and can negatively impact mood and communication skills which can be really detrimental for kids’ ability to maintain positive relationships.”

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Marijuana is a lot more than just THC—a pharmacologist looks at the untapped healing compounds

Assorted cannabis bud strains. Credit: Roxana Gonzalez/Shutterstock.com

Medical marijuana is legal in 33 states as of November 2018. Yet the federal government still insists marijuana has no legal use and is easy to abuse. In the meantime, medical marijuana dispensaries have an increasing array of products available for pain, anxiety, sex and more.

The glass counters and their jars of products in the dispensary resemble an 18th century pharmacy. Many strains for sale have evocative and magical names like Blue Dream, Bubba Kush and Chocolope. But what does it all mean? Are there really differences in the medical qualities of the various strains? Or, are the different strains with the fanciful names all just advertising gimmicks?

I am a professor in the University of Southern California School of Pharmacy. I have lived in California a long time and remember the Haight-Ashbury Summer of Love. While in graduate school, I worked with professor Alexander Shulgin, the father of designer drugs, who taught me the chemistry of medicinal plants. Afterwards, while a professor at USC, I learned Chumash healing from a Native American Chumash healer for 14 years from 1998 until 2012. She taught me how to make medicines from Californian plants, but not marijuana, which is not native to the U.S. Currently, I am teaching a course in medical marijuana to pharmacy students.

If there is one thing about marijuana that is certain: In small doses it can boost libido in men and women, leading to more sex. But can marijuana really be used for medical conditions?

What are cannabinoids?

New research is revealing that marijuana is more than just a source of cannabinoids, chemicals that may bind to cannabinoid receptors in our brains, which are used to get high. The most well-known is tetrahydrocannabinol (THC). Marijuana is a particularly rich source of medicinal compounds that we have only begun to explore. In order to harness the full potential of the compounds in this plant, society needs to overcome misconceptions about marijuana and look at what research clearly says about the medical value.

Rafael, a Chumash who shared Californian Native American cultural knowledge with anthropologists in the 1800s. Credit: Leon de Cessac

The FDA has already made some moves in this direction by approving prescription drugs that come from marijuana including dronabinol, nabilone, nabiximols and cannabidiol. Dronabinol and nabilone are cannabinoids that are used for nausea. Nabiximols – which contain THC, the compound most responsible for marijuana’s high and cannabidiol, which does not induce a high – are used to treat multiple sclerosis. Cannabidiol, or CBD, is also used to treat some types of epilepsy.

Marijuana, originally from the Altai Mountains in Central and East Asia, contains at least 85 cannabinoids and 27 terpenes, fragrant oils that are produced by many herbs and flowers that may be active, drug-like compounds. THC is the cannabinoid everyone wants in order to get high. It is produced from THC acid – which constitutes up to 25 percent of the plant’s dry weight – by smoking or baking any part of the marijuana plant.

THC mimics a naturally occurring neurotransmitter called anandamide that works as a signaling molecule in the brain. Anandamide attaches to proteins in the brain called cannabinoid receptors, which then send signals related to pleasure, memory, thinking, perception and coordination, to name a few. THC works by hijacking these natural cannabinoid receptors, triggering a profound high.

Tetrahydrocannabivarinic acid, another cannabinoid, can constitute up to 10 percent of the dry weight. It is converted to another compound that probably contributes to a high, tetrahydrocannabivarin, when smoked or ingested in baked goods. Potent varieties like Doug’s Varin and Tangie may contain even higher concentrations.

Medical properties of marijuana

But not all cannabinoids make you high. Cannabidiol, a cannabinoid similar to THC, and its acid are also present in marijuana, especially in certain varieties. But these do not cause euphoria. The cannabidiol molecule interacts with a variety of receptors – including cannabinoid and serotonin receptors and transient receptor potential cation channels (TRP) – to reduce seizures, combat anxiety and produce other effects.

The dried bud of a Kush cannabis plant. Credit: Kerouachomsky

Marijuana also contains several monoterpenoids – small, aromatic molecules – that have a wide range of activities including pain and anxiety relief and that work by inhibiting TRP channels.

Myrcene is the most abundant monoterpenoid, a type or terpene, in marijuana. It can relax muscles. Other terpenes such as pinene, linalool, limonene and the sesquiterpene, beta-caryophyllene are pain relievers, especially when applied directly to the skin as a liniment. Some of these terpenes may add to the high when marijuana is smoked.

What do all these varieties do?

Many different varieties of marijuana are on the market and are alleged to treat a range of diseases. The FDA has no oversight for these claims, since the FDA does not recognize marijuana as a legal product.

Strains of marijuana are grown that produce more THC than cannadidiol or vice versa. Other varieties have abundant monoterpenoids. How do you know that the strain you choose is legitimate with probable medical benefits? Each strain should have a certificate of analysis that shows you how much of each active compound is present in the product you buy. Many states have a bureau of cannabis control that verifies these certificates of analysis. However, many certificates of analysis do not show the monoterpenoids present in the marijuana. The analysis of monoterpenoids is difficult since they evaporate from the plant material. If you are looking for a strain high in myrcene or linalool, ask for proof.

Marijuana can improve several conditions, but it can also make others worse and can have nasty side effects.

Certificate of analysis. Credit: CC BY-SA

As recreational use has become more widespread, marijuana hyperemesis syndrome is becoming more of a problem in our society. Some people vomit uncontrollably after smoking marijuana regularly. It can be treated by rubbing a cream made from capsaicin, from chili peppers, on the abdomen. Capsaicin cream is available in pharmacies.

Also, high THC varieties of marijuana, such as Royal Gorilla and Fat Banana, can cause anxiety and even psychosis in some people.

Researchers have also shown that anxiety can be effectively treated with strains that have more cannabidiol and linalool. It may be best to rub a cannabidiol balm or lotion on your cheeks to relieve anxiety.

Other conditions that studies have shown are improved by marijuana are: cancer induced nausea, Type 2 diabetes, two forms of epilepsy, HIV-induced weight gain, irritable bowel syndrome, migraines, multiple sclerosis, osteoarthritis, rheumatoid arthritis, pain, chronic pain, post-traumatic stress disorder, sleep disorders and traumatic brain injury.

For some of these conditions, studies show that eating or topically applying marijuana products rather than smoking is recommended.

Clearly, more research is needed from the scientific community to help guide the appropriate, safe use of marijuana. However, the FDA does not recognize the use of medical marijuana. This makes funding for research on marijuana difficult to find. Perhaps the cannabis industry should consider funding scientific research on marijuana. But conflicts of interest may become a concern as we have seen with drug company-sponsored studies.

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Testosterone therapy in hypogonadism can prevent progression to T2DM

(HealthDay)—Testosterone therapy (TTh) can prevent progression to type 2 diabetes (T2D) in men with prediabetes and hypogonadism, according to a study published online March 12 in Diabetes Care.

Aksam Yassin, M.D., Ph.D., from the Institute for Urology and Andrology in Norderstedt, Germany, and colleagues examined whether TTh in men with hypogonadism and prediabetes prevents progression to T2D. Data were included for 316 men with prediabetes and total testosterone levels ≤12.1 nmol/L combined with hypogonadism symptoms. Overall, 229 men received parenteral testosterone undecanoate (T-group) and 87 served as untreated controls. For eight years, metabolic and anthropometric parameters were measured twice yearly.

The researchers observed a decrease in hemoglobin A1c (HbA1c) by 0.39 ± 0.03 percent in the T-group and an increase of 0.63 ± 0.1 percent in the untreated group. Ninety percent of those in the T-group achieved normal glucose regulation (HbA1c 6.5 percent) occurred in 40.2 percent of those in the untreated group. Significant improvements were seen in fasting glucose, triglyceride: high-density lipoprotein (HDL) ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, low-density lipoprotein, HDL, non-HDL, triglycerides, and the Aging Males’ Symptoms scale in the T-group, while significant decreases were seen in these parameters in the untreated group.

“Testosterone treatment holds tremendous potential for the prevention of diabetes in the rapidly growing population of men with hypogonadism and prediabetes and warrants further investigation,” the authors write.

Several authors disclosed financial ties to Bayer, which funded the study.

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Taking the reins on multiple sclerosis

Multiple sclerosis doesn’t have to be an ending. With proper treatment and management, patients can manage the disease’s often unpredictable nature.

“Patients get a predisposed feeling that their life is doomed. That it’s going to be a complicated life, which isn’t necessarily so,” said Dr. Cary Twyman, a neurologist with Penn State Health. “There are many misconceptions and false information about MS on the internet, so I make sure that each of my patients properly understand what the disease is, how it occurs, and the different courses MS can take.”

The immune system of someone with MS has lost its sense of self. Cells that protect the body from disease can’t detect what is dangerous and what isn’t, so they attack the brain, optic nerve and spinal cord.

Scientists still don’t know what causes MS, but they believe the disease is triggered by an unidentified environmental factor in a person who is genetically predisposed to respond.

The progress and severity of MS and what symptoms it may cause in any one person cannot be predicted. Common ones include numbness or tingling in the face, body or arms and legs; pain; fatigue; walking difficulties; muscle spasms; general weakness; vision problems; and dizziness or vertigo.

Most people with MS find out that they have it between the ages of 20 and 50. At least twice as many women as men are diagnosed.

“MS manifests itself in the prime of these individuals’ lives,” Twyman said. “These people are usually at the ages where raising a family, finding a steady job, and creating different purposes in their lives is a priority. This disorder disrupts that.”

A combination of methods can be used to diagnose MS. These include a careful study of the patient’s medical history, a neurologic exam, and various tests, including MRI, evoked potentials and spinal fluid analysis. Some of these are included in revised guidelines released in 2017 with an aim of providing an earlier diagnosis.

“Over the years, diagnosing MS has become clearer,” Twyman said. “Incidents of MS have doubled since our last census. More than 800,000 people have been diagnosed in the U.S. alone, with approximately 10,000 new cases diagnosed every year, but there has been less misdiagnosis or people going undiagnosed.”

Twyman said finding a treatment to alter the immune system should happen immediately after diagnosis.

“We had an explosion of drugs to treat MS, where we use to have none,” he said. “There are now 15 different drugs for people with MS.”

Because everyone is different, there is no standard way to choose a drug to treat MS. Twyman said finding the right medication for a patient with MS depends on how far along the disease is, what the patient’s tolerance to the risk of the drug is, the cost of the drug, and how closely the patient needs to be monitored on the drug.

In addition to medication, Twyman said caring for a patient with MS has shifted to a team approach.

“It’s no longer a physician-only approach to treat MS,” he said. “It now involves a team that pays attention to an individual’s medical and nonmedical needs to help with their wellness as they live with MS. This team may include nurses, dieticians, social workers and therapists, including the specialties of physical therapy, occupational therapy, speech therapy, and cognitive and behavioral management.”

Twyman said identifying and creating lifestyle habits, such as staying physically fit, reducing stress, and not smoking will help a patient’s quality of life.

“As a comprehensive team, we are able to help our patients with MS look at their life conditions and see what improvements are needed, and then help them make those improvement together,” he said.

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A new battle: Veterans more likely to have heart disease

“I think it’s sort of the first indications of a coming public health crisis for veterans,” says Ramon Hinojosa, an assistant professor in UCF’s Department of Sociology and the study’s author. “Because of the wars in Afghanistan and Iraq, we have a relatively large, new, younger generation of veterans who are going to survive for 30 or 40 years after their war experience.” Credit: University of Central Florida

After the war is over, veterans face a new threat. They are more likely to have heart disease at a younger age than nonveterans, and this could herald a new health crisis on the horizon.

These results are published in a new University of Central Florida study appearing in the Journal of the American Board of Family Medicine.

“I think it’s sort of the first indications of a coming public health crisis for veterans,” says Ramon Hinojosa, an assistant professor in UCF’s Department of Sociology and the study’s author. “Because of the wars in Afghanistan and Iraq, we have a relatively large, new, younger generation of veterans who are going to survive for 30 or 40 years after their war experience.”

The study indicates that perhaps the “healthy-soldier effect” is no longer guaranteed. The effect refers to the tendency for active-duty service members to be more physically fit and less overweight than same-age, nonmilitary individuals. It’s a phenomenon that Hinojosa explores in ongoing research.

“The outcome of the analysis suggested that not only does the healthy-soldier effect not seem as potent as it once was, in fact, what I see is veterans tend to have cardiovascular morbidity earlier than nonveterans, and they tend to have a greater number of conditions,” Hinojosa says.

The researcher said the change could be due to the nature of conflict in Iraq and Afghanistan, modern warfare, changing diets, changing approaches to leisure and exercise, higher rates of obesity in younger veterans than nonveterans at the same age, and higher rates of drinking, smoking and mental illness.

In light of these results, Hinojosa said it is important for health practitioners to look closely at cardiovascular health for younger veterans so they can address preventative approaches to ward off early onset of cardiovascular diseases.

“I think that being aware we sort of have the first rumblings of what seems to be a health crisis will help us focus our attention on health resources and providing younger veterans with access to resources that can help them ameliorate the likelihood of early onset cardiovascular disease,” Hinojosa says.

The study used data from the National Health Interview Survey, a nationally representative health survey of individuals in the United States that’s conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Hinojosa looked at five particular cardiovascular conditions reported in the survey and their association with veteran status and sociodemographic status, including age.

Responses from 153,556 individuals were used, and the study looked at pooled survey data from 2012, 2013, 2014 and 2015, the most recent available data at the time.

From age 35 to about age 70, veterans reported significantly more cardiovascular conditions than nonveterans. After age 70, nonveterans reported more cardiovascular conditions than veterans.

The switch could be due to fewer veterans surviving into older age because of cardiovascular diseases, Hinojosa said.

“It’s concerning to know that the physical benefits of military service seem to be not holding as well for the younger veterans,” Hinojosa says. “This suggests the health protective benefits of military service are not what they used to be. I think that should cause us to really look at what’s going on among the veterans after they leave military service.”

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