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Smoking is recognized among the risk factors for osteoporosis, but only few studies have comprehensively explored its influence on bone metabolism and strength. We aimed to evaluate smoking effects on calcium-phosphate metabolism, bone mineral density (BMD) and fracture risk in postmenopausal women.Our sample included 1067 postmenopausal women who arrived to our osteoporosis outpatient clinic. Anamnestic data, smoking habits (categorized as never, former, and current; and by smoking intensity and duration), biochemical parameters, lumbar/femoral BMD, and presence of vertebral fractures were recorded. In a subsample of 357 women, the changes in BMD after a 2-yr follow-up period were also assessed.Current smokers had shorter reproductive age, lower body mass index, and higher prevalence of heavy alcohol consumption than former/never smokers. They also had lower PTH values and weaker linear association between serum vitamin D and parathyroid hormone (current β = -0.11[SE = 0.004]; former β = -0.14[SE = 0.01]; never β = -0.20[SE = 0.003]; p0.01 for all). Baseline BMD did not reflect differences based on smoking habits, duration or intensity. However, after 2 years, only current smokers significantly worsened in femural BMD. After adjustment for confounders, the chance of having sustained vertebral fractures at the first evaluation increased by 74% (95% confidence interval:1.07-2.83) in current compared with never smokers, especially among heavy smokers.Smoking may negatively affect bone by inhibiting vitamin D-parathyroid hormone axis, reducing estrogen exposure, promoting risky health behaviors, and accelerating bone loss, especially at the femur. No significant differences were observed in these outcomes among former smokers, suggesting that quitting smoking has beneficial effects on bone health.

Background and aims The influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults. Methods and results Prospective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02–1.32) and CV mortality (RR = 1.34, 95% CI: 1.03–1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22–1.50) more than in older men (RR = 1.21, 95% CI: 1.13–1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04–1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03–1.32) and showed marginal significant results for CV death only among women. Conclusions The impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.

Vertebral fractures are associated with persistent pain, disability and mortality. However, around two thirds of women with vertebral fractures are unaware of them. We aimed to analyze which factors could mostly be associated to the presence of vertebral fractures in post-menopausal women, and evaluate the effectiveness of current screening criteria for the detection of vertebral fractures in an outpatient setting.We evaluated 1132 post-menopausal women referred to the osteoporosis outpatient clinic of the Geriatrics Department of Padova. For each participant we assessed: anthropometric data, femoral and lumbar bone mineral density (BMD), dorso-lumbar X-rays, bone metabolism markers. Current recommendations for X-ray examinations by SIOMMMS (Società Italiana di Osteoporosi, Metabolismo Minerale e Malattie dello Scheletro) and ISCD (International Society of Clinical Densitometry) versus routine X-ray examinations were considered, and fracture risk was assessed through the derived FRAX (DeFRA) tool.Of the women included in our study, 28% presented vertebral fractures, most of these previously unknown (82.8%). Lumbar BMD did not differ between patients with and without vertebral fractures. According to SIOMMMS guidelines, 50% of patients60 years with unknown vertebral fractures would have been excluded from spinal X-ray examination. According to ISCD recommendations, the number of patients excluded reached 94.6% in the60 age-group and 84.9% in the 60-70 age-group. The under-identification of vertebral fractures led to the 10-year risk of fractures computed by DeFRA being underestimated by around 15%.BMD, particularly in the lumbar site, may not properly predict the presence of vertebral fractures in post-menopausal women. Improvement of the current recommendations for spinal X-ray examination may lead to early identification and better management of patients with vertebral fractures.

Background hip fracture has negative consequences for elderly people. Alternative models of care, with respect to traditional model, were developed to minimize complications and improve functional outcomes. The interdisciplinary model in orthopaedic wards has less evidence of efficacy compared to orthogeriatric units. Objective to compare the efficacy (in–hospital outcomes, mortality, functional status at 6 months after discharge) of an interdisciplinary pathway, based on comprehensive geriatric assessment, compared to a traditional model of care, in hip-fractured elderly patients. Design prospective study with retrospective control group conducted in a first-level trauma center Orthopaedic Unit. Subjects 97 patients treated with the traditional model and 127 with an interdisciplinary pathway (mean age 83.9 ± 7.4 vs 84 ± 6.7 years, p = 0.89). Methods in all participants we assessed: clinical history, functional pre-fracture status utilising Activities of Daily Living (ADL), in-hospital details. At 6 months after discharge, we evaluated functional status, place of residence, hospital readmissions, mortality. Results during hospital stay, significant differences emerged in mortality and in external visits. A higher proportion of patients of the orthogeriatric group lived alone at home at 6 months and showed a lower functional decline. Comprehensive geriatric assessment was associated with the ADL score (partial R2: 0.08, p Conclusions an interdisciplinary pathway in hip-fractured elderly patients, could reduce in–hospital mortality, improve functional recovery and increase the probability of living alone at home, at 6 months.

Objectives The aim of this prospective study was to investigate whether two cellular and metabolic health indices, phase angle (PhA) and metabolic equivalents (METs), can predict changes in frailty states in fit community-dwelling older people. Methods A sample of 118 individuals aged ≥65 years who attended a twice-weekly mild fitness program of aerobic and/or resistance exercises was enrolled in the study. At baseline and after three years, individuals underwent a clinical examination, biochemical determinations, bioelectrical impedance analysis, body composition assessment with dual energy X-ray absorptiometry, physical performance tests, and frailty and sarcopenia assessment. In 78 participants was executed indirect calorimetry, too. Based on frailty transitions during the follow-up between non-frailty, pre-frailty and frailty, participants were categorized as improved, stable (non-frail or pre-frail), and worsened or remaining frail. The chances to experience different frailty changes by baseline PhA and METs were explored through multinomial regression analysis and expressed as odds ratios (OR) and 95% Confidence intervals (95%CI). Results During the follow-up, 8 participants improved in frailty status, 84 were stable and 26 worsened or remained frail. For each one-unit increase in PhA, the odds of improving in frailty increased by 4.53 times (95%CI:1.18–17.46); while for each one-unit increase in METs, the odds of worsening in frailty decreased by 65% (95%CI:0.16–0.79). Conclusions PhA and METs may be indirect measures of functional reserve, with lower values being potential biomarkers of evolving frailty.

Purpose The association between serum 25-hydroxyvitamin D (25-OHD) levels and cortical/trabecular bone parameters has been explored in the elderly, but less so in younger adults; body composition may also influence bone parameters across the life span. We aimed to investigate, with peripheral quantitative computerized tomography (pQCT), the relationship between serum 25-OHD levels and bone geometry and strength and, at the same time, to explore the influence of fat mass and fat-free mass on bone parameters, for the tibia and radius, in healthy young and elderly adults. Methods The study involved 149 healthy adults grouped by age: 65 were under 65 years old, and 84 were older. All participants were assessed in terms of: clinical history; serum 25-OHD levels; fat-free mass (FFM) and fat mass (FM), measured with DXA; total and cortical bone cross-sectional area (CSA, CSAc), and trabecular and cortical bone mineral density (BMDt, BMDc); and fracture load x and y for the tibia and radius, measured with pQCT. Results In the younger group, the association between 25-OHD levels and bone parameters did not remain as significant for any parameters after multivariate adjustment. In the elderly, 25-OHD correlated with CSAc (partial R2 = 0.33), fracture load x (partial R2 = 0.54), and fracture load y (partial R2 = 0.46) for the radius, and marginally with BMDt (partial R2 = 0.09; B-H adjusted p Conclusion While serum 25-OHD levels correlated only weakly with bone parameters in younger adults, a significant relationship was observed for elderly people. Fat-free mass showed positive simple correlation with pQCT-derived bone parameters in both age groups except with BMDc in the younger group. Further longitudinal studies are needed to clarify these relationships.