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Objective: Several small studies reported increased prevalence and inciden ce of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas wit h mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other si tes remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractu res in patients with adrenal adenomas. Design: Population-based cohort study, Olmsted County, Minnesota, USA, 1995-2017. Methods: Participants were the patients with adrenal adenoma and age/sex -matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures. Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, a nd median age at diagnosis was 63 years (20-96). At the time of diagnosis, patients had a higher preval ence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0-21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of se condary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07-1.52) for developing a new fracture during follow up when compared to referent subjects. Conclusions: Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to refere nt subjects. [ABSTRACT FROM AUTHOR]

Introduction: Sarcopenia as defined by loss of muscle mass and function has an increased risk of falls, disability, and mortality. In spite of this importance, as of now there is no simple and reliable screening tool for community and outpatient settings to assess sarcopenia. We conducted a study with the motive to use an index based on serum creatinine and cystatin C to screen sarcopenia in elderly outpatients. Materials & Methods: 100 subjects above the age of 65 years were recruited from the outpatient department of Geriatric medicine of a tertiary care institute in India from July to October 2017. Muscle mass, muscle strength and physical performance was measured by DEXA scan, hand held dynamometer and 4 m gait speed respectively. Sarcopenia was identified using Asian working group of sarcopenia (AWGS) criteria. Serum creatinine and cystatin C was measured for all subjects. Serum creatinine/cystatin C ratio and biochemical total body muscle mass (TBMM) was calculated and its association was checked with sarcopenia. Results: The mean age of the subjects was 72.5 ± 6.4 years. Among the 100 subjects, 69% were male and 31% were 75 years or above. Based on the Asian Working Group criteria, the prevalence of sarcopenia was 53%. Mean serum creatinine/ cystatin C ratio was 74.79 ± 24.91. It was not significantly associated with sarcopenia. Mean biochemical TBMM of subjects was 36.40 ± 7.88. The lower value of biochemical TBMM was significantly associated with an increased risk of sarcopenia. Cut off of 33.16 was 80.43% sensitive and 50.94% specific in identification of sarcopenia [Odds Ratio (OR) - 4.604, 95% Confidence Interval (CI) - 1.86-11.40, p <0.001]. Conclusion: Out of the 2 indices, only low biochemical total body muscle mass is significantly associated with sarcopenia and a value of less than 33.16 can be used to screen sarcopenia in older people. [ABSTRACT FROM AUTHOR]

Introduction: Orthopedics procedure in elderly is on surge, especially after the introduction of life modifying surgeries like total knee replacement and total hip replacement. But the predictors of post-operative complications are still unclear. This study was aimed to assess the impact of frailty on post-operative outcome of elective major orthopaedic surgery in the older adults. Materials & Methods: A prospective cohort study of 100 elderly patients (aged Z 60years) who underwent major elective orthopaedic surgery in a tertiary hospital of India was conducted. Subjects were assessed via pre-defined protocol 1 hour before surgery to assess for frailty via NSQIP (National Surgical Quality Improvement Program) questionnaire. Post-operative outcomes like delirium, electrolytes imbalance, acute kidney injury (AKI), inotropes use, etc. were assessed on day 3 after surgery. Length of hospital stay and mortality was assessed on day 30 after surgery. Chi square/fisher exact test was used for comparison of categorical variables. Continuous variables not following normal distribution were compared with Wilcoxon rank-sum test. Result was considered significant at 5% level of significance (p<0.05). Results: Mean age of the patients was 67.8 ± 6.75 years. Among them, 45% were male. On frailty assessment using NSQIP, 72% patients were frail. Frail patients had significantly higher postoperative complications like delirium (50% vs 23.9%; p value = 0.001), hyponatremia (35.7% vs 1.3%; p value = 0.001) and AKI (28.6% vs 5.6%; p value = 0.03) when compared with non-frail patients. Length of hospital stay in frail patients was also significantly higher (Median 9 days vs 5 days; p value = 0.001). Mortality was higher in frail patients but it was not statistically significant (7.18% vs 0%; p value = 0.076). Conclusion: Frailty is a risk factor for postoperative complications in major orthopaedic surgery. All elderly patients should be assessed for frailty before undergoing surgery to identify the patients at higher risk of complications and managed accordingly. Hence, Geriatricians should be involved in management of elderly surgical patients. [ABSTRACT FROM AUTHOR]

Introduction: With increasing evidence of sarcopenia and its effect on frailty and quality of life in elderly, it is necessary to develop a community based tool to assess sarcopenia. Mid arm circumference measurement is a simple, inexpensive and non-invasive method which can be easily used in community settings. Objective of this study was to assess the association between sarcopenia and mid arm circumference in older Indian population. Material & Methods: 101 subjects above the age of 65 years were recruited from the outpatient department of Geriatric medicine, AIIMS New Delhi, a tertiary care institute in India between July and October 2017. Skeletal muscle mass was measured by DEXA scan. Grip strength and mid arm circumference were measured by handgrip strength dynamometer and standard measuring tape respectively. Gait speed was also assessed with 4 m walk test. Sarcopenia was assessed using AWGSOP (Asian Working Group for Sarcopenia) criteria. AUC for mid arm circumference was calculated and p value <0.05 was taken as significant. Results: The mean age of the subjects was 72.5 ± 6.4 years. In this study, sarcopenia was seen in 52.5% of the subjects. Mean mid arm circumference was 27±3.6 cm. Low mid arm circumference was found to be significantly associated with sarcopenia (p <0.001). AUC for mid arm circumference was 0.7740 (95% CI 0.68-0.86). Cut off of <29 cm was calculated for mid arm circumference with sensitivity 83.02 % and specificity of 52.08 % for screening sarcopenia Conclusions: Low mid arm circumference was found to be significantly associated with sarcopenia and mid arm circumference below 29 cm has a good sensitivity for screening sarcopenia in outpatient department. [ABSTRACT FROM AUTHOR]

Context: Mild autonomous cortisol secretion (MACS) is diagnosed based on post-dexamethasone cortisol>1.8 mcg/dL. Scarce evidence exists on steroid circadian secretion and steroid metabolome in MACS., Objective: To characterize 24-hour (h) urine steroid metabolome in patients with MACS and determine circadian differences in urine steroid profiling and cortisol concentrations in patients with MACS versus referent subjects., Design: Cross-sectional study, 2018-2023., Setting: Referral center., Participants: Patients with MACS and age-, sex-, BMI-, and menopausal status-matched referent subjects., Measurements: Urine was collected over 24h period as separate day- and night-time collections. High-resolution mass spectrometry assay was used to measure 25 steroids. A subgroup of patients and referent subjects were admitted for every 2h serum measurements of free and total cortisol., Outcomes: Steroids, sums, and ratios., Results: Patients with MACS (n=72) had lower mcg/24h median androgens (2084 vs 3283, P<0.001), higher glucocorticoids (15754 vs 12936, P<0.001), and higher glucocorticoid/androgen ratio (8.7 vs 3.9, P<0.001), compared to referent subjects. Patients also had lower steroid day/night ratios compared to referent subjects, reflecting a higher relative nocturnal steroid production in MACS. In a subgroup of 12 patients with MACS and 10 referent subjects, the 24-hour area under the curves for total and free cortisol were similar. However, evening mean total (5.3 vs 4.0 mcg/dL, P=0.056) and free (0.2 vs 0.1 mcg/dL, P=0.035) cortisol was higher in patients vs referent subjects., Conclusion: Patients with MACS demonstrate an abnormal urine steroid metabolome, with a high glucocorticoid to androgen ratio, and a higher nocturnal steroid production., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)