Dynapenic abdominal obesity and susceptibility to fall: a prospective analysis of the Osteoarthritis Initiative

Background: The prediction of the risk of falling remains a challenge in geriatric medicine and the identification of new potential reversible risk factors is a public health priority. In this study, we aim to investigate the association between DAO (dynapenic abdominal obesity) and incident falls in a large sample of people with knee OA (osteoarthritis) or at high risk for this condition, over 8 years of follow-up. Methods: DAO was defined using a waist circumference more than 102 cm in men and 88 cm in women and a concomitant presence of dynapenia, defined as a time over 15 s in the five times chair stands time. Falls, during follow-up, were recorded using self-reported information in the previous year. A logistic binary regression analysis was run, adjusted for potential confounders at the baseline, reporting the data as odds ratios (ORs) with their 95% confidence intervals (CIs). Results: Overall, 3,844 subjects were included, majority of whom had abdominal obesity. Across the 8 years of follow-up, 2,695 participants fell vs. 1,149 not reporting any fall. Taking those without DAO as reference, the presence of only dynapenia was not associated with risk of falls (OR = 1.18;95%CI: 0.73–1.91; p = 0.50), whilst the presence of abdominal obesity (OR = 1.30; 95%CI: 1.09–1.56; p = 0.004) and DAO (OR = 1.31; 95%CI:1.01–1.73; p = 0.04) were significantly associated with a higher risk of incident falls. Conclusion: DAO significantly increased risk of falls as well as the presence of abdominal obesity

Tophaceous gout in the elderly: a clinical case review

Gout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in the elderly, including some unusual sites; its incidence is similar in both genders in the elderly even if the latency period between its initial diagnosis and the onset of tophi is higher in men; and vertebral localizations are rising and often solitary. The components of metabolic syndrome are the most common medical conditions associated with tophaceous gout. In conclusion, tophaceous gout in the elderly may be a growing medical problem and cause of disability in years, partly because of the new sites involve

Chronic gout in the elderly

Gout is the most common cause of inflammatory arthritis in men over 40 years old; it is a debilitating disease and, if untreated, can result in a chronic progressive disease, including tophaceous gout. In the elderly it represents a special issue, with notable clinical and therapeutic differences from the classical form with a systemic involvement. The burden of the disease increases particularly in the very old people, in whom arthritis, impaired gait and eyesight problems may enhance the related disability. Chronic gout moreover could aggravate heart and kidney disease and increase overall mortality and organ-related damage. Early diagnosis and appropriate treatment are important goals for the clinician that should to rely on the cooperation of specialists working together through the methodology of comprehensive geriatric assessment. The aim of the present review was to analyze chronic gout in old people in terms of epidemiology, pathophysiology, risk factors, clinical approach, and current treatmen

A case of hypocalcemia

Hypocalcemia is a common disorder in the elderly, affecting 10% of the elderly population as a whole, 18% of those in hospital and 36% of those in long-term care [1, 2]. Many conditions can lead to hypocalcemia in adults young and old, e.g. primary hypoparathyroidism, chronic renal failure, gastrointestinal diseases (such as celiac disease or Crohn\u2019s disease), drugs (particularly diuretics, bisphosphonates and antiepileptics), acute pancreatitis and thyroid surgery. Rare causes of hypocalcemia include isolated vitamin 1.25(OH)D3 deficiency or vitamin 1.25(OH)D3 resistance. Another, often neglected cause of hypocalcemia relating to functional parathyroid deficiency is hypomagnesemia. Considering the important role of magnesium in a normal health status, and the potentially serious consequences of hypomagnesemia, clinicians need to identify and treat this condition as soon as possible, thus avoiding serious risks for the patient, particularly in the elderl

A rare case of sepsis due to Corynebacterium macginleyi from central venous catheter in an elderly woman

Corynebacterium macginleyi is a gram positive rod that causes especially ocular infections: since now only six elderly cases of extraocular infection are described. A 76 years old bedridden woman with a central venous catheter was hospitalized for 10 days of persistent fever. She was treated before with vancomicin and then with imipenem. The clinical conditions improved and the patient was discharged after two weeks of hospitalization. Among recognised risk factors for this infection the advanced age, indwelling devices and immunosuppression seem the most important. On the other hand, the antibiotics of choice are glycopeptides while the association of another antibiotic is recommended in our opinion only in severe clinical manifestatio

The Potential Role of miRNAs in Cognitive Frailty

Frailty is an aging related condition, which has been defined as a state of enhanced vulnerability to stressors, leading to a limited capacity to meet homeostatic demands. Cognitive impairment is also frequent in older people, often accompanying frailty. Age is the main independent risk factor for both frailty and cognitive impairment, and compelling evidence suggests that similar age-associated mechanisms could underlie both clinical conditions. Accordingly, it has been suggested that frailty and cognitive impairment share common pathways, and some authors proposed “cognitive frailty” as a single complex phenotype. Nevertheless, so far, no clear common underlying pathways have been discovered for both conditions. microRNAs (miRNAs) have emerged as key fine-tuning regulators in most physiological processes, as well as pathological conditions. Importantly, miRNAs have been proposed as both peripheral biomarkers and potential molecular factors involved in physiological and pathological aging. In this review, we discuss the evidence linking changes of selected miRNAs expression with frailty and cognitive impairment. Overall, miR-92a-5p and miR-532-5p, as well as other miRNAs implicated in pathological aging, should be investigated as potential biomarkers (and putative molecular effectors) of cognitive frailty

Relationship between increased endogenous parathormone levels and bone density in postmenopausal women treated with bisphosphonates

Bisphosphonates increase bone mineral density (BMD) and also increase parathyroid hormone (PTH): the rule of increased PTH on BMD is not well known. The aim of our study was to assess the relationship between endogenous PTH levels and BMD after 18 months of antiresorptive therapy in a group of post-menopausal women with normal baseline PTH levels. A retrospective study was conducted on 62 women with normal baseline PTH levels (mean age 62.7 +/- 8.6 years) who underwent dual-energy X-ray absorptiometry, thoraciclumbar radiography, and blood and urine sampling at the baseline and after 18 months. All patients were treated with bisphosphonates and received calcium and vitamin D3 supplementation. In the whole group, after 18 months, mean BMD improved both at lumbar spine (0.53 +/- 0.09 vs. 0.49 +/- 0.09 g/cm(2); P0 or 50), the group with Delta PTH>0 had higher percentage increase of BMD at spine (8.0 +/- 9% vs. 4 +/- 7.5 %; P<0.001) and at total hip (3 +/- 9% vs. 0.49 +/- 8.9%; P<0.001) while the bone alkaline phosphatase significantly decreased (-11.80 +/- 2.19 vs. -4.05 +/- 3.08 ug/L; P<0.001) than the other group. Increased endogenous PTH levels seems to be associated with a higher BMD increase in patients treated with bisphosphonates for postmenopausal osteoporosis. The increase of PTH must be clarified by further investigation

A case of naturally evolving gout in an elderly man

Gout is a common disorder in adults that can lead to severe organ decline, disability and impaired quality of life due to the formation of periarticular tophi. We report a case of massive tophaceous gout in a 78-year-old man with a 16-year-long history of untreated disease. The patient gradually became disabled, his renal function deteriorated, and he finally died of sepsis. Our case demonstrates that chronic gout not only affects the joints, but is also associated with organ function decline and can, even nowadays, lead to death

Prophylactic or therapeutic doses of heparins for COVID-19 infection? A retrospective study

Background: Coronavirus disease 19 (COVID-19) is a global outbreak. COVID-19 patients seem to have relevant coagulative abnormalities, even if they are not typical of disseminated intravascular coagulopathy (DIC) of the kind seen in septicaemia. Therefore, anticoagulant therapy with heparins is increasing in interest for a clinical approach to these patients, particularly if older. Studies comparing if prophylactic doses are more effective than therapeutic ones are still missing. Methods: Data were collected in the Geriatric Section of the Dolo Hospital, ULSS 3 \u201cSerenissima\u201d, Venice from 31st March to 01st May 2020. Heparins (calciparin, fondaparinux, enoxaparine) were divided into prophylactic or therapeutic doses. People previously treated with oral anticoagulants were removed. Vital status was assessed using administrative data. Cox\u2019s regression analysis, adjusted for potential confounders, was used for assessing the strength of the association between heparins and mortality. The data were reported as hazard ratio (HR) with 95% confidence intervals (CIs). Results: 81 older people (mean age 84.1&nbsp;years; females = 61.9%) were included. No significant differences in terms of demographic and clinical characteristics emerged between people treated with prophylactic or therapeutic doses, including age, gender, X-rays findings or severity of disease. Therapeutic doses were not associated to a better survival rate (HR 1.06; 95% CI 0.47\u20132.60; p = 0.89), even after adjusting for 15 confounders related to mortality (HR 0.89; 95% CI 0.30\u20132.71; p = 0.84). Conclusions: Our paper indicates that in older people affected by COVID-19 there is no justification for using therapeutic doses instead of prophylactic ones, having a similar impact on mortality risk. \ua9 2020, Springer Nature Switzerland AG