100 research outputs found

    Effects of ageing and vitamin D deficiency on vitamin D receptor (VDR) expression in human skeletal muscle

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    Background and aim. Vitamin D exerts its biochemical function on skeletal muscle through vitamin D receptors (VDR). Vitamin D deficiency is highly prevalent in the general population especially in the elderly. It is postulated that lower vitamin D levels lead to reduced expression of VDR in skeletal muscles. This then may lead to reduced muscle strength, function and ultimately falls in the elderly. The aim of this study was to examine the relationship between human ageing, circulating vitamin D levels and VDR expression in human skeletal muscle. Methods. Twenty six participants were recruited to the study; 8 young participants, 8 older participants who were vitamin D sufficient (25-OH-D3 ā‰„50 nmol/L) and 10 older participants who were vitamin D insufficient (<50nmol/L). Blood samples were obtained for the determination of serum 25-OH-D3, calcium and parathyroid hormone (the latter only for older participants); and a muscle biopsy of their thigh (vastus lateralis muscle) was performed using a Magnum biopsy system. Real time quantitative PCR was used to measure the expression of VDR and some of its target genes (myostatin, Sir1, PPARĪ± and PPARĪ“) in human skeletal muscle. VDR protein content was measured using Western Blotting. Main findings. Hypovitaminosis D was highly prevalent in the young participants recruited into the study, but it was not statistically different from the older participants who were vitamin D insufficient. Higher expression of VDR and PPARĪ“ mRNA was observed in both older sufficient and insufficient groups when compared with the younger group (p=0.01). There was also higher sirt1 mRNA expression (p=0.00) and a tendency towards higher PPARĪ± expression (p=0.07) in the older sufficient group when compared to the younger group. There was no difference in skeletal muscle content of the myostatin gene between groups. When the young group was compared with the older insufficient group, levels of VDR mRNA and PPARĪ“ were still higher in the older group. Gene expression did not appear to be strongly influenced by circulating 25-OH-D3 levels in any of the respective participant groups. Western blotting was unsuccessful in detecting VDR protein content despite the use of 2 different VDR antibodies. Tissue availability and time constraints precluded further work to be done. Conclusion. Similar VDR mRNA and target gene expression levels were expressed in both older sufficient and insufficient groups; and higher VDR mRNA was seen in the older insufficient group compared with the younger participants. This suggests that the ageing process may be influencing the expression of these genes. Circulating 25-OH-D3 levels did not appear to affect gene expression

    Effects of ageing and vitamin D deficiency on vitamin D receptor (VDR) expression in human skeletal muscle

    Get PDF
    Background and aim. Vitamin D exerts its biochemical function on skeletal muscle through vitamin D receptors (VDR). Vitamin D deficiency is highly prevalent in the general population especially in the elderly. It is postulated that lower vitamin D levels lead to reduced expression of VDR in skeletal muscles. This then may lead to reduced muscle strength, function and ultimately falls in the elderly. The aim of this study was to examine the relationship between human ageing, circulating vitamin D levels and VDR expression in human skeletal muscle. Methods. Twenty six participants were recruited to the study; 8 young participants, 8 older participants who were vitamin D sufficient (25-OH-D3 ā‰„50 nmol/L) and 10 older participants who were vitamin D insufficient (<50nmol/L). Blood samples were obtained for the determination of serum 25-OH-D3, calcium and parathyroid hormone (the latter only for older participants); and a muscle biopsy of their thigh (vastus lateralis muscle) was performed using a Magnum biopsy system. Real time quantitative PCR was used to measure the expression of VDR and some of its target genes (myostatin, Sir1, PPARĪ± and PPARĪ“) in human skeletal muscle. VDR protein content was measured using Western Blotting. Main findings. Hypovitaminosis D was highly prevalent in the young participants recruited into the study, but it was not statistically different from the older participants who were vitamin D insufficient. Higher expression of VDR and PPARĪ“ mRNA was observed in both older sufficient and insufficient groups when compared with the younger group (p=0.01). There was also higher sirt1 mRNA expression (p=0.00) and a tendency towards higher PPARĪ± expression (p=0.07) in the older sufficient group when compared to the younger group. There was no difference in skeletal muscle content of the myostatin gene between groups. When the young group was compared with the older insufficient group, levels of VDR mRNA and PPARĪ“ were still higher in the older group. Gene expression did not appear to be strongly influenced by circulating 25-OH-D3 levels in any of the respective participant groups. Western blotting was unsuccessful in detecting VDR protein content despite the use of 2 different VDR antibodies. Tissue availability and time constraints precluded further work to be done. Conclusion. Similar VDR mRNA and target gene expression levels were expressed in both older sufficient and insufficient groups; and higher VDR mRNA was seen in the older insufficient group compared with the younger participants. This suggests that the ageing process may be influencing the expression of these genes. Circulating 25-OH-D3 levels did not appear to affect gene expression

    Is there a role for an orthogeriatric model of care for the management of vertebral fragility fractures in hospital?

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    Introduction: Orthogeriatric care has led to improved outcomes in the management of patients admitted to hospital with hip fractures. Such an interprofessional multidisciplinary collaboration ensured that the complex needs of older people with hip fractures are met. This thesis considered the role of an orthogeriatric model of care for patients in hospital with vertebral fragility fractures. To support such a care model, certain conditions had to be met. The number of patients admitted to hospital warrant such a service, these patients have complex care needs, their outcomes poor and that hospital care had to be delivered by healthcare professionals with specific knowledge and skills. Method: A multi-method study was conducted which synthesised findings from a systematic review of characteristics and outcomes of patients admitted to hospital with vertebral fragility fractures, an observational study of patients requiring hospital treatment, and a modified-Delphi consensus study to determine how these patients should be managed in hospital. Results: The annual incidence of hospital admission for the UK was estimated at 6 per 10,000/year in patients over the age of 50 years. Those admitted were in severe pain, especially during mobilisation which restricted their daily living. These patients were older, mostly in their ninth decade of life, reported a high prevalence of frailty, multimorbidity and cognitive impairment. In addition to treating the acute fracture, their care in hospital involved managing their concomitant medical diagnosis, falls risk, bone health and rehabilitation requirements. This required input from healthcare professionals with medical, surgical, nursing and therapy background. After an average of 2 weeks in hospital, up to half did not return to their usual residence but required an increase in care, either temporary or permanent. One-third at 6 months after hospital discharge remained in pain. Many do not return to their pre-fracture level of function. One-year mortality can be as high as 27%. Worse outcomes were associated with increasing age and comorbidities. Clinicians with responsibility for managing patients with vertebral fragility fractures in hospital agreed that a coordinated multidisciplinary approach was required. Discussion: Those admitted to hospital with vertebral fragility fractures are vulnerable to the adverse effects of their fracture and hospitalisation. A systematic organised service, i.e. orthogeriatric care for these patients can address their care needs. Conclusion: There is a role for an orthogeriatric model of care for patients admitted to hospital with vertebral fragility fractures. The next phase is to evaluate the feasibility in delivering such a service and gauge the resources required for it

    Get up and get movingā€”early mobilisation after hip fracture surgery

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    Early mobilisation must follow on from early hip fracture surgery as delayed ambulation leads to poor post-operative outcomes. Early mobilisation post-operatively was associated with better mobility and more discharges from hospital. Embedding it into routine clinical practice will require involvement of the orthogeriatric multidisciplinary team

    The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study

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    Summary We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown.PurposeMany countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital.MethodsIn our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 (ā€œprior to lockdownā€), weeks 13th to 19th in 2020 (ā€œlockdownā€) and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years.ResultsPrior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value [less than] 0.001); similar findings were observed in both sexes and age groups (all p values [less than] 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776).ConclusionDuring lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic

    Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson's disease : a systematic review and meta-analysis

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    Background: Patients with Parkinsonā€™s Disease (PD) usually experience worsening of both motor and non-motor symptoms. Dancing has been postulated to help patients with Parkinsonā€™s via several mechanisms that lead to improved physical, cognitive and social functions. Methods: This systematic review was conducted following Cochrane methodology and reported following the PRISMA guideline. Four databases (up to June 2021) were searched for RCTs comparing dance to standard or other physical therapy for improvements in disease severity, quality of life, cognitive and physical outcomes as well as adverse events in patients with PD. We synthesised data using RevMan and included certainty-of-evidence rating (GRADE) for major outcomes. Results: A total of 20 RCTs (N = 723) articles that evaluated Tango, Ballroom, Irish, Waltz-Foxtrot, Folk, Turo, mixed dances and a PD-tailored dance were included. Dancers (versus non-dancers) had better motor experience (MDS-UPDRS 3) (MD -6.01, 95 % CI -9.97 to -3.84; n = 148; 5 RCTs) and improved balance (MiniBest Test) (MD 4.47, 95 % CI 2.29 to 6.66; n = 95; 3 RCTs), with no consistent differences on gait, agility and cognitive outcomes. Small samples and methodological limitations resulted in low-certainty-evidence across outcomes. Conclusions: Apart from a suggestion that dance intervention modestly reduced motor disease severity and improved certain aspects of balance, there is insufficient evidence on all other outcomes, such as agility and motor function, cognitive, mood and social outcomes, quality of life as well as adverse events including the risk of fall. As evidence is insufficient to inform practice, evidence of benefits on motor disease severity and balance needs to be considered in the context of user-perception of benefit versus harm and acceptability in the development of practice guideline recommendations

    The clinical usefulness of muscle mass and strength measures in older people: a systematic review

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    Background: Sarcopenia is the loss of muscle mass and quality and is diagnosed using measures of muscle strength, size and mass. We evaluated the literature on whether sarcopenia measures are predictive of motor outcomes in older people in clinical settings.Methods: Electronic databases (MEDLINE Ovid, Embase, CINAHL and Web of Science) were searched for articles on measures of muscle mass, volume, thickness or strength, in older people in clinical settings, which reported cross-sectional or longitudinal associations with motor outcomes. Clinical cohorts included geriatric medical inpatients and outpatients, patients with hip fracture, geriatric rehabilitation, and care home residents. Motor outcomes were mobility, falls, balance and Activities of Daily Living. Due to high study heterogeneity, standardised mean differences were used to compare strength of associations. Results: 83 articles were identified. The most frequently studied measures were grip strength (47 studies), knee extension strength (21 studies) and bioelectrical impedance analysis (18 studies). Handgrip strength had evidence for cross-sectional associations with mobility (14 of 16 studies, 2088 participants), balance (6 of 6 studies, 1177 participants) and ADL independence (10 of 11 studies, 3228 participants), and evidence of longitudinal associations with mobility (3 of 3 studies, 883 participants) and ADL independence (7 of 10 studies, 1511 participants). There was no conclusive evidence for association with falls.Conclusions: Handgrip strength was the most studied measure and was associated with mobility, balance and ADL outcomes. There was a paucity of studies, particularly with longitudinal follow-up, measuring muscle mass, volume or thickness using gold-standard approaches
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