High dose statins can increase osteoporosis risk finds Annals of the Rheumatic Diseases study

A higher dose of statins, the cholesterol-lowering drug, could increase the risk of osteoporosis,  a recent has found. However, at low doses statins provide protection against bone resorption.
According to the study, whether statins decrease or increase the risk of osteoporosis is dependent on their dosage. At low doses, statins provide protection against bone resorption. However, the higher the dosage of statins greater is the risk of osteoporosis. In short, osteoporosis is underrepresented in low-dose and over-represented in high-dose statin treatment. Findings are based on an analysis of millions of patient data.

Osteoporosis is one of the most commonly occurring metabolic bone disorders. It is characterised by decreased bone mineral density (BMD) in which bones become weak and brittle. This increases the bone fragility making it susceptible to fracture.

Statins are cholesterol-lowering drugs that help the heart and brain by preventing artery plaques- buildups of cholesterol, calcium and other substances in blood vessels-- from blocking blood flow and causing a heart attack or stroke. They are among the most prescribed drugs worldwide.

Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Researchers conducted the study to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis.

Statins inhibit the synthesis of cholesterol from the liver. This lowers blood cholesterol. However, cholesterol is crucially important for many processes in the body. Among other things, it is a basic building block for the production of sex hormones such as estradiol and testosterone.

For the investigation, the researchers used Big Data. They obtained access to the health data of more than 7.9 million Australians between 2006-2007. From this big data set the patients who regularly took statins for at least one year were filtered out. The researchers also calculated the daily dosage of statins and formed different dosage groups. In a further step, the interdisciplinary team filtered out osteoporosis diagnoses.

Key findings of the study include-
* statin treatment was associated with an over-representation of diagnosed osteoporosis compared with controls.
* there was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis.
* Osteoporosis was underrepresented in low-dose statin treatment ) 0-10mg per day) including lovastatin, pravastatin, simvasatin and rosuvastatin.

The exceeding of the 40 mg threshold for simvastatin and the exceeding of a 20 mg threshold for atorastatin and for rosuvastatin was related to an over-representation of osteoporosis.

We know that low concentrations of sex hormones- especially the drop in estrogen levels during menopause-- are the main cause for the increase of osteoporosis in women, explains a Dr.  There is a similar relationship between bone density and testosterone. We were interested in whether the inhibition of cholesterol production by statins has an effect on bone formation and whether there could be a dose-response relationship.

In the lower dose groups, there were fewer osteoporosis cases than expected, points out the Dr. At doses up to 10mg of the statins lovastatin, pravastatin, simvastatin or rosuvastatin, the scientists found fewer osteoporosis diagnoses compared to patients without statin therapy. With doses of 20 mg, and more, however,  this seems to turn. We found more osteoporosis cases in patients treated with simvastatin, atorvastatin and rosuvastatin than expected, explains the Dr. The higher the dosage, the stronger the effect.

In earlier, joint studies we saw how helpful large data sets can be to examine open medical questions, says the leader of the study. The combination of medical expertise with our knowledge in big data analysis makes completely new insights possible. According to the researcher, the newly discovered correlation between statin therapy and osteoporosis risk should now be investigated in clinical studies.

With such results, we're coming closer to truly personalised and individualised medicine, maintains the Dr. We can now advise high-risk osteoporosis patients undergoing statin therapy to have their bone metabolism regularly monitored.

We propose that monitoring high-risk patients, that is postmenopausal female patients under high-dosage statin therapy, might be useful in order to offer individual therapy to prevent or treat osteoporosis. This, larger and prospective studies with a focus on dosages of statins should be conducted in order to clarify the relationship with osteoporosis, concluded the authors.
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No More Needles: New Diabetes Treatment in a Pill Approved

Diabetes has been on the rise for decades, with an estimated 422 million worldwide suffering from the condition as of 2014 according to the WHO. The majority of these patients suffer from the acquired form of the disease, known as type 2 diabetes, which is notorious for being undiagnosed for years. Until recently, the treatment of type 2 diabetes in its advanced stages, for the majority of patients, was limited to injections, which are invasive, painful, and significantly more expensive than oral medications. Luckily, that is about to change, as a new treatment of the disease has recently passed FDA approval.

The drug in question is called Rybelsus, and it belongs to a group of glucagon-like peptide (GLP-1) drugs, which are sometimes prescribed to patients who can no longer control their blood sugar with diabetes medications that come in pills. These drugs typically come in injections, as the active ingredients of these medications are destroyed by stomach acids.

Rybelsus is the first drug of this kind to come in tablet form, and it has been approved as a standalone or complementary treatment of type 2 diabetes.

The tablets will be taken daily 30 minutes before food in the morning. Though the pricing of the new drug will be comparable to similar injectable treatments, the new medication can help relieve the psychological and financial burdens for many diabetes patients, as they will no longer require painful injections and will ultimately save money on syringes. Given that type 2 diabetes is a chronic disease and patients require daily or weekly injections for years on end, this is a major improvement.

The effectiveness and safety of Rybelsus have been proven in several clinical trials and established that it can stabilize blood sugar levels in type 2 diabetes patients. The medication is not advised to treat type 1 diabetes, and the FDA doesn’t recommend Rybelsus as the first choice of treatment because it may increase the risk of a specific type of thyroid tumors as a side effect.

Still, the developers of the drug, Novo Nordisk, predict that it will become the treatment of choice for many patients and will lead the way in producing other novel treatments that are currently only available in injection form.

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Crohn disease treatment may get improved with AI-based methods

The study, used artificial intelligence (AI) to examine genetic signatures of Crohn’s disease in 111 people.

The method can help in revealing previously undiscovered genes linked to the disease, and in predicting whether thousand others had the disease.

“Our method is not a clinical diagnosis tool, but it generates interesting observations that need to be followed up,” said senior author.

“Further experimental work could reveal the molecular reasons behind some forms of Crohn’s disease and, potentially, lead to its better treatment,” the Prof. said.

Crohn’s disease affects around 780,000 people in the US.

Chronic inflammation may occur in any part of the  gastrointestinal tract, although symptoms may occur elsewhere. It can also cause joint pain and skin problems, and children with the disease may have growth problems, according to the US National Library of Medicine.

The research team evaluated genetic variants in the 111 people, including 64 with Crohn’s disease, and used AI techniques to pinpoint genes whose functions changed more in Crohn’s patients than in healthy people, and vice versa.

While the model’s accuracy might improve by including more people, it could help reveal the origin of Crohn’s disease and improve early diagnosis, the study said. “We can use the knowledge gained from this study to similarly model other genetically-linked diseases,” the  author said.

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Fitness trackers more accurate in predicting patient health outcomes

Researchers found that fitness trackers can better estimate exercise capacity and determine the health status of patients, rather than the cliche 6-minute walk distance test doctors opt for.

Researchers said the test results are another example in how wearable and monitoring devices like Fitbits and Apple watches can be used in patient care to improve outcomes.

For patients, this means we can track their progress more frequently in a manner that's less expensive and more convenient than current standarised testing, said the lead researcher.

The 6 minute walk distance is an important, objective standard used to assess exercise capacity. Patients walk for 6 minutes and then based on how many meters they cover in that time, physicians can predict outcomes and mortality for patients with chronic obstructive pulmonary disease (COPD) and cardiovascular diseases.

Normally, the 6 WMD test is done every few months or once a year. Now, we may be able to measure patients on a regular basis and know if we need to intervene if their estimated 6 WMD by step count changes, said the Dr.

In the study, researchers conducted a 12-week, blinded, randomised, cross-over trial with 52 patients, a group that included adults with a history of respiratory problems during periods of elevated air pollution. Wrist step counters tracked patient steps for those 12 weeks, and patients also filled out respiratory symptoms questionnaires.

Researchers found they could effectively estimate a patient's 6WMD results by using step counters, instead of having patients come in a clinical setting to do the 6WMD test.

Instead of having one measurements every few months, you could have weekly measurements, and have information at disease progression at more frequent intervals. This is a significant improvement and enhanced convenience for our patients, said the Dr.

The implications? Using wrist step counters will allow physicians to track how their patients are doing, the progression of the disease and whether a patient requires immediate intervention.

Being able to distill step counts into this clinically important metric is a first step in being able to think about how to use step counters in order to better manage health and detect deterioration earlier, added the Dr.

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Immunotherapy drugs when combined prevent melanoma progression

In a new trial, researchers have discovered that a combination of 2 immunotherapy drugs-ipilimumab and nivolumab- is capable of reversing or preventing the progression of advanced melanoma for 5 years or more in every 2 patients.

Just 10 years ago, only 1 in 20 patients with advanced melanoma would survive for 5 years- with many living for just 6-9 months.

The results of the trial,  represent the longest phase 3 trial follow-up for checkpoint inhibitor combination therapy.

In the past, metastatic melanoma was regarded as untreatable. Oncologists considered melanoma different to other cancers-- it couldn't be treated once it had spread. This is the first time we can say that the chances of being a long-term survivor of advanced melanoma are now over 50%, said one of the researcher.

Researchers incorporated 945 patients with advanced melanoma randomised into 3 groups- 314 patients received the ' double-hit' of nivolumab + ipilimumab; 316 patients received nivolumab + a placebo; and 315 patients received ipilimumab + placebo.

Each nivolumab arm was compared to ipilimumab by itself, and was administered until the disease progressed or until any side-effects became unacceptable.

The 5 year overall survival rate for the combination of nivolumab + ipilimumab was 52 %, with 74 % of those patients treatment-free after 5 years. The overall survival for nivolumab was 44 % and 26% for ipilimumab.

The Prof. explained, by giving these drugs together you're effectively taking 2 brakes off the immune system rather than one so that the immune system is able to recognise tumours it wasn't previously recognising and react to that and destroy them.

Importantly, for those patients who stopped treatment because of side-effects such as fatigue, skin rashes and diarrhea, the outcome was just as good as it was for those who were on the combination for longer.

One of the key points about immunotherapies is that the immune system can be re-educated even with a short duration of treatment. This is in contrast to other treatments like chemotherapy which can require a full course to be as effective.

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Being Socially Active Linked to Lower Dementia Risk

People who are socially engaged are exercising cognitive skills such as memory and language, which may help them to develop cognitive reserve - while it may not stop their brains from changing, cognitive reserve could help people cope better with the effects of age and delay any symptoms of dementia," said senior author. 

The research,  used data from the "Whitehall II" study, tracking 10,228 participants who had been asked on six occasions between 1985 and 2013 about their frequency of social contact with friends and relatives. 

The same participants also completed cognitive testing from 1997 onwards, and researchers referred to the study participants' electronic health records up until 2017 to see if they were ever diagnosed with dementia. 

For the analysis, the research team focused on the relationships between social contact at age 50, 60 and 70, and subsequent incidence of dementia, and whether social contact was linked to cognitive decline, after accounting for other factors such as education, employment, marital status and socioeconomic status. 

The researchers found that increased social contact at age 60 is associated with a significantly lower risk of developing dementia later in life. 

The analysis showed that someone who saw friends almost daily at age 60 was 12 per cent less likely to develop dementia than someone who only saw one or two friends every few months. 

They found similarly strong associations between social contact at ages 50 and 70 and subsequent dementia. 

"Spending more time with friends could also be good for mental well-being, and may correlate with being physically active, both of which can also reduce the risk of developing dementia," he added.

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10 Reasons as to why you'ld eat eggs

Besides being an incredibly versatile ingredient that can be used in most dishes - savory or sweet - eggs are exceptionally nutritious. Their goodness can be found in the yolk, which contains over 90 percent of an egg's calcium and iron, while the white part contains almost half of the egg's protein.
So, if you're not eating eggs regularly, here are 10 reasons you ought to.

1. They are among the most nutritious food on the planet.
Eggs contain a little bit of almost every nutrient we need, making them the perfect food. In fact, a single boiled egg contains:
• Vitamin A (6% of the RDA*)
• Folate (5% of the RDA)
• Vitamin B5 (7% of the RDA)
• Vitamin B12 (9% of the RDA)
• Vitamin B2 (15% of the RDA)
• Phosphorus (9% of the RDA)
• Selenium (22% of the RDA)
• Eggs also contain decent amounts of vitamin D, vitamin E, vitamin K, vitamin B6, calcium and zinc.
In total, eggs equate to 77 calories, 6 grams of protein and 5 grams of healthy fats.
*RDA - Recommended Daily Allowance
2. While eggs may be high in cholesterol, they don't adversely affect blood cholesterol.
True, eggs are high in cholesterol. In fact, a single egg contains 212mg, which is over half of the recommended daily intake of 300mg. However, while it may seem counter-productive to eat eggs, the cholesterol in eggs does not necessarily raise cholesterol in the blood. Of course, it is important to note that the response of egg consumption varies from one individual to another. But overall, studies have shown that in 70 percent of people, eggs did not raise cholesterol at all. However, in the other 30 percent (termed hyper responders) eggs mildly raised total and LDL cholesterol.

3. For the most part, eggs actually raise HDL (Healthy) cholesterol.
Often termed the good cholesterol, consuming eggs are a great way to increase HDL. In one study, it was found that those who consumed two eggs per day for six weeks, saw their HDL increase by 10 percent. It has also been shown that people with higher levels of HDL, usually have a lower risk of heart disease, stroke and various health problems.

4. Eggs contain choline - an important nutrient that most people do not get enough of.
This important nutrient is grouped within the B vitamins. It is used to build cell membranes and plays a role in the production of signaling molecules in the brain. However, according to dietary surveys, 90 percent of the U.S population is getting less than they ought to. Whole eggs are therefore an excellent source of choline, as a single egg contains more than 100mg.
5. Eggs convert LDL cholesterol particles from small and dense to large. 
This change in particles has been linked to a reduced risk of heart disease.
It is a well known fact that having high levels of LDL (bad cholesterol) is linked to an increased risk of heart disease. However, what is not well known is that there are subtypes of LDL. See, there are small, dense LDL particles, and there are also large LDL particles. Studies have shown that people who predominantly have small, dense LDL particles also have a higher risk of heart disease than those with large LDL particles.

So, as I pointed out in the third fact, while eggs may mildly raise LDL cholesterol in some individuals, studies have shown that eggs may potentially change LDL particles from small and dense to large.
6. Two of the antioxidants found in eggs (lutein and zeaxanthin) are beneficial for eye health.
Ageing usually brings with it the onset of poorer eyesight. Thankfully though, several nutrients can help counteract some of the degenerative processes which can affect our eyes. Lutein and zeaxanthin are two such powerful antioxidants which tend to build up in the retina of the eye. In a controlled trial, it was found that eating 1.3 egg yolks per day for 4.5 weeks increases blood levels of lutein (by 28 to 50 percent) and zeaxanthin (by 114-142 percent).

Furthermore, studies have shown that consuming adequate amounts of these nutrients can significantly reduce the risk of cataracts and macular degeneration - two very common eye disorders. Eggs also contain substantial amounts of vitamin A, which can reduce blindness.  
7. Eggs rich in Omega-3, lower triglycerides (a risk factor for heart disease).
Not all eggs are created equal. Their nutrient composition varies depending on what the hens were fed and how they were raised. Hens that were raised on pasture and/or fed Omega-3 enriched foods tend to lay eggs that have a much higher Omega-3 fatty acids content - a nutrient that is known to reduce blood levels of triglycerides (a risk factor for heart disease).

8. Eggs are a great source of protein - the main building blocks of the human body.
Ensuring that you get enough protein in your diet is important - in fact, it has been suggested that the Recommended Daily Amounts (RDAs) may be too low. But, seeing that eggs contain all the essential amino acids in the right ratios, our bodies are easily able to absorb the protein found in eggs. Eating adequate amounts of protein may also help with weight loss, increasing muscle mass, lowering blood pressure and optimizing bone health. One single, large egg contains 6 grams of protein.

9. Eggs may actually reduce the risk of a stroke.

Eggs have been unfairly demonized for decades, due to the levels of cholesterol found in them. However, many studies have examined the relationship between egg consumption and the risk of heart disease. In one meta-review of 17 studies, with a total of 263,938 participants, no association was found between egg consumption and heart disease or stroke.

However, some studies have found that people with diabetes who ate eggs can have an increased risk of heart disease. Nevertheless, whether the eggs are actually causing the increased risk is not known.   
10. Eggs score high on the Satiety Index, inducing feelings of fullness and reducing subsequent calorie intake.
Eggs are high in protein, which is one of the most fulfilling macronutrients. In one study of 30 overweight women, it was found that eating eggs instead of bagels for breakfast, increased feelings of fullness, making them automatically eat fewer calories during the following 36 hours.  It was also found that eating an egg for breakfast caused significant weight loss over a period of 8 weeks.

Study Underway For a New Drug to Reduce Alzheimer's Effect

Finally, the chosen 56 participants were randomly given either the placebo or 10 mg of NA-381, to be consumed strictly daily for a period of 24 weeks. According to Mr. Lloyd L. Tran, the Chairman and CEO of NeuroActiva Inc., the drug NA-831 was designed specifically to target neurotransmitters in the brain, with the aim of reconnecting them. 

From July 22nd to July 26th, 2018, the Alzheimer’s Association International Conference was held in Chicago, Illinois. Of the numerous presentations made during the Conference, one stood out as a possible medical breakthrough. According to NeuroActiva Inc., a company based out of California, research is being conducted on a drug called NA-831, which is aimed at reducing mild cognitive deterioration, associated with Alzheimer's disease.

The Clinical Trial was carried out as a double-blind placebo-controlled study on the safety and efficacy of the drug NA 831. This essentially means that none out of the final 56 participants chosen (out of nearly 150 that enrolled to participate in the trial) had knowledge of whether they were receiving the placebo or the drug, and the distribution of the same was completely randomized.


The first phase of the trial hoped that by revitalizing the communication system of the brain, both memory and functionality could be restored and improved. The main focus of the trial was reversing or lessening the effects of mild cognitive impairment (MCI), which is also defined as the “symptomatic pre-dementia stage” of the cognitive decline associated with Alzheimer’s. The first phase of the test, therefore, targeted specifically those with MCI rather than existing and prevalent dementia.

The Clinical Trial used two major scales to measure the outcomes of the study. These are :
1) Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) Score, which deals with 6 areas of cognitive function, namely memory, judgment and problem solving, orientation, home and hobbies, community affairs, and finally personal care.

2) Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (Mild Cognitive Impairment version) (ADCS-ADL MCI), which made use of the Galasko method for the study, that covered 23 different areas of self-care, mental and physical functioning.

Both scales of each patient were determined in Week 2 and Week 24 respectively, after the required dosage of either NA-831 or the placebo were taken. The results were obtained through a series of interviews and activities directed at the concerned patient as well as their loved ones. Per the results of these interviews and activities, the outcome of each patient was noted down in a 5 point scale for CDR-SB and a scoring range of 0-78 for ADCS-ADL, depending on the level of impairment.

After comparing the scores of the scales collected in Week 2 and the scores collected in Week 24, it was determined that there were improvements in numerous existing symptoms of Alzheimer’s, including but not limited to fatigue, irritability, and rectified sleep patterns along with slowly improved cognitive functioning.

In the next steps of the trial, the dose of NA-831 taken by patients was increased to 20 mg and then 40 mg. It was found that up to 50 mg of the drug could be taken and easily tolerated on daily basis by patients, with little to no side effects, with only 4 patients complaining of minor headaches and diarrhea.     

It has, however, been noted that the study did not comprehensively compare the results of the placebo and that of the drug NA-831, in a statistical manner. This makes it difficult to determine conclusively the effects of the drug on cognitive function in patients with either MCI or those suffering from moderate dementia, as a result of Alzheimer’s disease.

As the drug currently remains in the testing and trial phase, it has not been conclusively proven that NA-831 will prevent cognitive damage, nor has any health authority been in a capacity to approve manufacture or sale of the drug in a wide-scale. Nonetheless, NA-831 has opened new doors in medicine to approach Alzheimer’s treatments from a different and powerful perspective.  

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6 Persistent Myths about Exercising in Your Golden Years

Being fit is possible in any age. In fact, you’re better off doing some kind of exercise than sitting on the couch no matter if you’re 8 or 80, as regular physical activity will not only keep your physical and mental health in check, it will also help you feel more independent and capable in your everyday life. Sadly, many seniors give up on exercise, with only 30% of people past the age of 65 reporting having an active lifestyle, and we argue that the way we think about exercising in senior years is to blame.

Given everything we now know about the benefits of exercise, these false beliefs have to go, so let’s tackle these 6 common exercise myths together and get empowered for a happy and active life.

Myth 1. “Exercising in Advanced Age is Pointless Due to the Inevitable Physical and Mental Decline.”

It is certainly true that we’re more prone to chronic illness and other health conditions as we approach our advanced years, but the weakness and loss of balance that we often associate with old age are actually signs of lack of exercise, and not old age itself.

And the proof is in the pudding: the people who don’t submit to this dangerous myth can run marathons, dance ballet, or lift weights all the way into their 70’s and 80’s. Of course, these people are exceptional and being an athlete in your golden years is not for everyone, but these cases prove that staying active and capable irrespective of your age is possible.

Myth 2. “I don’t have the time or money to exercise.”

This myth isn’t specific to seniors, it’s one that spans across all age groups. The truth is, however, that you don’t actually need to exercise for hours every day at the gym to stay fit. Experts recommend exercising at least 150 minutes a week, which is around 20 minutes a day.

Even if you’re very busy, you can divide this time into 2 chunks and just spend 10 minutes of walking in the morning and another 10-15 minutes of yoga, strength building exercises or sometimes even vacuuming your house or doing any other house work to hit your daily activity goal. Any physical activity counts, and so you don’t have to sign up for a gym membership to stay fit.

If you want to lift weights, you can use cans or bottles filled with sand as your weights. If you want to improve your flexibility and balance, you can try some age-friendly chair yoga. In fact, we have an abundance of free exercise routines that target different issues you can try at home right now, here are just five:

Myth 3. “Exercising at My Age is Unsafe, I’m Afraid to Fall and Break Something.”

This myth is one of the most popular and also one of the most ridiculous ones because it is precisely the lack of exercise that makes you have a worse sense of balance and less strength, and so every time you don’t exercise, you’re raising your own risk of injury.

Furthermore, regular exercise was shown to prevent bone loss, a process precursive to osteoporosis, when the bone density begins to decrease, so physical activity can actually make your bones stronger as well. The same goes for joint health, by the way, as studies have confirmed that exercising actually helps reduce the sensitivity, stiffness, and pain accompanying arthritis.

 

Myth 4. “Exercise is only beneficial for the heart.”

After reading about the previous myth, you can probably already debunk this one on your own. To be brief, exercise benefits your entire body, starting from your heart, blood circulation, your lung capacity, metabolism, digestive issues like constipation and gas, as well as your bones and joints.

But even that is not the full list of the health benefits of exercise, as it can also help your brain work properly, preventing dementia. Finally, exercise also promotes mental health in several ways.

Myth 5. “I’m too weak to exercise.”

Often enough, our concept of what it means to exercise doesn't match our own self-image. We imagine someone who exercises as this bodybuilder or professional yogi who can do all sorts of incredible feats with their bodies. However, what is exercise to you isn’t what would count as exercise to them. This is especially true when it comes to people who just recently recovered from an illness or accident, who often find it challenging to raise their hands or get up from a chair.

Don’t think that to truly exercise, you need to start running marathons or turn yourself into a human pretzel. If you find it difficult to walk for more than a few minutes, or even if you’re bedridden, talk to a physical therapist or your physician and ask them for exercises that can get you started off on a path of self-improvement.
The best way to think of your own physical activity goals is “celebrate what you can do and your personal accomplishments and don’t compare yourself to others”.
Myth 6. “I Never Exercised When I Was Younger and Now It’s Too Late to Start.”
You definitely didn’t do yourself a favor by being a couch potato for decades, but that’s not a reason to give up on yourself now. It’s never too late to start exercising, building strength, and increasing your flexibility and balance. Certainly, experienced athletes have also reaped the long-term benefits of exercise, but the absolute minimum that starting an exercise routine will do for you is to build muscle, which will help stabilize your bones and joints, increase your blood circulation and lift your mood.
In fact, a recent study even showed that senior beginners are just as good at building muscles as experienced senior athletes. There’s also evidence that physical activity can help manage the symptoms of chronic diseases, such as diabetes, and prevent their development in seniors. So, even if you start exercising for the first time in your 60’s, 70’s or later, it will benefit you plenty.

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