Link between distal sensory polyneuropathy, insulin-like growth factor-I and bone mineral density in elderly diabetics

Background: The association between Distal Sensory Polyneuropathy (DSP) and systemic osteopenia was studied before in type 1 Diabetes Mellitus (DM), however, is not all clear, with scanty researches in type 2 DM. In addition, Insulin-like Growth Factor-I (IGF-1) could be the most important mediator of bone growth, and an important neurotrophic factor for peripheral sensory neurons. Therefore, the aim of this study was to study the association between bone mineral density (BMD) and DSP, in elderly patients with type 2 DM, and the link between IGF-1 and both BMD and DSP.Methods: Eighty eight elderly patients, aged ≥60 years, were involved in this case (43 diabetics with DSP and 17 diabetics without DSP) - control (28 non diabetics) study. BMD and IGF-1 were measured.  Results: There was no significant difference between cases and controls regarding T score of either lumbar spine or femoral neck or IGF-1 (P = 0.83, 0.96 and 0.17 consecutively). DM without DSP had higher IGF-1 than both DM with DSP& the control group (P = 0.011 and 0.010 consecutively). IGF-1 was a significant predictor of T score of both femoral neck and lumbar spine, only in the control group (P = 0.008 and <0.001 consecutively) (OR=1.44 and 2.4 consecutively) (CI=1.1-1.9 and 1.9-3.1 consecutively). Neither DSP nor IGF-1 was (were) a significant predictor of BMD in diabetics.Conclusion: There was no association between type 2 DM and BMD. IGF-1 was higher in diabetics without DSP than those with DSP or the control group. IGF-1 was a positive predictor of BMD only in the control group.

The relation between calcaneus stiffness index as a measure of bone density and body mass index in an Egyptian cohort

Background: Obesity and osteoporosis are two conditions that are associated with morbidity and mortality; there is contradictory evidence regarding this association. Purpose: The aim of the current study was to explore further the association between obesity and calcaneus stiffness index (CSI), as a measure of bone density, in a community-based cross-sectional study in an Egyptian population. Methods: A cross-sectional study was conducted among active subjects, aged ≥20 years old, over one year. CSI was measured by Quantitative ultrasound (QUS), in addition; QUS T-score and Z-score of the non-dominant heel scan were recorded. Results: Two hundred and eighty participants were recruited; 7 subjects were excluded because of Z score more than −2, mean age was 61 (± 11.9) years, and mean BMI was 29.7 (±5.6). Female participants were 77.7%, with mean of age 60.3 (± 11.6); and age range 20–82 years. Male participants were 22.3%, with mean of age 63.6 (± 12.7); and age range 30–80 years. Older subjects (>55 years) had significantly lower CSI and worse T-score than the younger subjects (P < 0.001 for both). In the younger age group, BMI was not significantly associated with CSI, even after adjustment for gender (P= 0.52). However, in the older age group, BMI was significantly associated with stiffness index (P= 0.049, O.R.= 1.73), even after adjustment for gender (P= 0.041, O.R.= 1.7). Conclusion: Compared to young subjects, older subjects (≥55 years) had significantly lower bone strength as measured by CSI, and their BMI was significantly positively associated with bone density. In younger people (<55 years), BMI was not associated with bone strength

Pattern of cognitive impairment among community-dwelling elderly in Egypt and its relation to socioeconomic status

Abstract Background Cognitive decline is one of the aging health problems that strongly affects daily functioning and quality of life of older adults and threatens their independence. The aim of this study was to assess the prevalence and pattern of cognitive impairment (CI) among community-dwelling elderly in Egypt and the contribution of socioeconomic status to inequality in cognitive impairment. Methods A cross-sectional study involved 470 community-dwelling elderly aged 60 years or older living in Kafr El-Sheikh Governorate, Egypt. Subjects were recruited from home visits, geriatric clubs, and outpatient clinics. The Montreal Cognitive Assessment tools (MoCA & MoCA-B) were used to assess the prevalence of cognitive impairment, Hachinski ischemic score (HIS) to investigate the type of cognitive impairment, Ain Shams Cognitive Assessment (ASCA) tool to assess the pattern of specific cognitive domain affection, and an Egyptian socioeconomic status (SES) scale to classify the SES of the study participants. Results The prevalence of cognitive impairment was 50.2% distributed as 37.7% for mild cognitive impairment (MCI) and 12.5% for dementia. The most common type of cognitive impairment was the degenerative type (47.9%). Pattern of specific domain affection among cognitively impaired subjects ranged from 94% for visuospatial function to 12.7% for abstraction. Cognitive impairment was significantly higher with increasing age, female sex, marital status (single or widow), low education, higher number of comorbidities, and positive family history of cognitive impairment (p < 0.001). Also, cognitive impairment was concentrated mainly among participants with low socioeconomic score (p < 0.001). Conclusion In Egypt, cognitive impairment is significantly prevalent and concentrated among those who are in low socioeconomic status. Patients with mild CI were more than those with dementia, and the most common type of CI was the degenerative type. Increasing educational level of low SES population and improving their access to healthcare services are highly recommended to improve the inequity of cognitive impairment