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The Melatonin Osteoporosis Prevention Study (MOPS) demonstrated that nightly melatonin resulted in a time-dependent decrease in equilibrium ratios of serum osteoclasts and osteoblasts in perimenopausal women. This study examines mechanisms related to the ratios of osteoblasts and osteoclasts using coculture models (transwell or layered) of human mesenchymal stem cell (MSC) and human peripheral blood monocytes (PBMCs). Human MSC/PBMC cocultures exposed to melatonin in osteogenic (OS+) medium for 21 days induced osteoblast differentiation and mineralization; however, only in layered cocultures did melatonin inhibit osteoclastogenesis. Melatonin effects were mediated through MT2 melatonin receptors, MEK1/2, and MEK5. In layered but not transwell cocultures, melatonin increased OPG:RANKL ratios by inhibiting RANKL, suggesting that contact with osteoclasts during osteoblastogenesis inhibits RANKL secretion. Melatonin modulated expression of ERK1/2, ERK5, β1 integrin, GLUT4, and IRβ that was dependent upon the type of coculture; however, in both cultures, melatonin increased RUNX2 and decreased PPARγ expression, indicating a role for metabolic processes that control osteogenic vs adipogenic cell fates of MSCs. Furthermore, melatonin also has osteoblast-inducing effects on human adipose-derived MSCs. In vivo, one-year nightly melatonin (15 mg/L) given to neu female mice in their drinking water increased pErk1/2, pErk5, Runx2, and Opg and Rankl levels in bone consistent with melatonin’s already reported bone-enhancing effects. Finally, analysis of daily logs from the MOPS demonstrated a significant improvement in mood and perhaps sleep quality in women receiving melatonin vs placebo. The osteoblast-inducing, bone-enhancing effects of melatonin and improvement in quality of life suggest that melatonin is a safe and effective bone loss therapy.

The purpose of this double-blind study was to assess the effects of nightly melatonin supplementation on bone health and quality of life in perimenopausal women. A total of 18 women (ages 45-54) were randomized to receive melatonin (3mg, p.o., n=13) or placebo (n=5) nightly for 6months. Bone density was measured by calcaneal ultrasound. Bone turnover marker (osteocalcin, OC for bone formation and NTX for bone resorption) levels were measured bimonthly in serum. Participants completed Menopause-Specific Quality of Life-Intervention (MENQOL) and Pittsburgh Sleep Quality Index (PSQI) questionnaires before and after treatment. Subjects also kept daily diaries recording menstrual cycling, well-being, and sleep patterns. The results from this study showed no significant change (6-month-baseline) in bone density, NTX, or OC between groups; however, the ratio of NTX:OC trended downward over time toward a ratio of 1:1 in the melatonin group. Melatonin had no effect on vasomotor, psychosocial, or sexual MENQOL domain scores; however, it did improve physical domain scores compared to placebo (mean change melatonin: -0.6 versus placebo: 0.1, P

This year, the oldest baby boomers turned 65 years of age. Baby boomers, which include individuals born between 1946 and 1964, represent 25% of the US population.1 In addition, given their life experiences, this group of individuals is likely to have higher expectations for the quality of health care services, including medication safety. Thus, it is timely to discuss what new knowledge on often preventable medication-related problems (i.e., medication errors and medication adverse events) in older adults was published in 2011. Hopefully, by doing so we can begin to develop approaches to reduce medication-related problems and meet this cohort’s expectations.

Introduction Student-delivered medication therapy management (MTM) skills can be enhanced using many aspects of team-based learning and active learning principles. The use of student care teams comprised of students from differing academic years of pharmacy education, in the care of underserved patients, can help to hone student MTM skills before graduation. Methods Student care teams, comprised of third-year, fourth-year, and fifth-year students delivered MTM services to uninsured patients in a charitable clinic environment. Student care teams, under faculty supervision, were responsible for providing all aspects of MTM care. Students responded to a Likert questionnaire at the onset of the course and again at completion designed to self-assess their perceived ability to perform various MTM patient care skills. Results Students' self-assessed perception of their MTM patient care skills improved significantly because of providing direct patient care over the duration of the course ( p = 0.028). Conclusion Team learning principles used in the course allowed students to apply the didactic knowledge gained at their respective juncture of study to direct patient MTM care. It also gave more advanced students the opportunity to mentor younger team members. The students reported improvements in confidence and self-perception of skills in the delivery of MTM care. They were also able to identify personal weaknesses in some skills. Early identification of weaknesses allowed students an opportunity to work on these skills before entering licensed practice.

From 1999 to 2010, the National Institute of Health Center for Complementary and Alternative Medicine (NCCAM) had an increase in their budget allocation for research; however, the allocation in 2010 ($128.8 million) declined over the past 3 years; fiscal year (FY) 2011 budget was $127.7 million, FY 2012 budget was $128.0 million and FY 2013 budget was $120.7 million (http://nccam.nih.gov/about/ budget/appropriations.htm). This is odd and unfortunate because the prevalence of people using complementary and alternative medicine (CAM) has increased over these years. Complementary medicine, as defined by NCCAM, generally refers to a non-mainstream approach given together with conventional medicine while alternative medicine is a non-mainstream approach used in place of conventional medicine [1]. Conventional (western or allopathic) is medicine using modalities commonly learned in conventional training, by holders of a medical degree, doctor of osteopathic medical degree, and by allied health professionals such as physical therapists, psychologists and registered nurses [1]. Most people use non-mainstream approaches with conventional medicine and so NCCAM currently uses the term “complementary health approaches” to describe these practices and products, which fall into two subgroups: natural products (e.g., herbs, botanicals, vitamins, minerals, some dietary supplements, probiotics) and mind and body practices (e.g., meditation, yoga, acupuncture, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong, tai chi, movement therapy, manipulation and massage therapy) [1]. Mind-body medicine is practiced to direct the mind to affect the physical functioning of the body; this occurs by the interactions of the brain, mind, body and behavior through techniques that promote calmness and relaxation, breathing, open attitudes toward distractions and often specific physical postures. Manipulative and body-based practices focus primarily on the bones and joints, soft tissues and the circulatory and lymphatic system whereas movement therapies like the Feldenkrais method, Alexander technique, Pilates, Rolfing structural integration, and Trager psychophysical integration use movement-based approaches to promote physical, mental, emotional and spiritual well-being. Traditional healers use methods of healing that have been handed down over many generations and which incorporate whole medical systems and complete systems of theory and practice. Included in this category are Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy, and energy practices (e.g., magnet therapy, light therapy, qi gong, Reiki, and healingtouch).

Many menopausal women are seeking symptomatic relief from hot flushes, irritability, sleep disturbances, anxiety and depression, and to prevent bone loss. Instead of pharmaceutical approaches, many women are opting for alternative modalities such as yoga, meditation and natural products. Melatonin is a molecule released from the pineal gland in response to darkness and is commonly used as a sleep aid due to its soporific effects and/or due to its ability to reentrain circadian rhythms out of synchrony with the light dark cycle. The focus of this mini-review is to highlight the novel use of melatonin on managing menopausal symptoms and menopausal bone loss and describe food sources that are rich in melatonin.