Health and Fitness Information for Mature Adults 

June 3, 2008              

Table of Contents

  • A Geriatric Physician Discusses Osteoporosis (Terri Katz, MD)
  • Nutritional Supplements for Older Adults (More useful facts from Dr. Katz!)
  • Books for Brainiacs (Professional resources)
  • An Ancient Notable on Brain Fitness (Ciceronian philosophy)

A Geriatric Physician Discusses Osteoporosis

Terri F. Katz, MD, is director of The Center for Healthy Living in Teaneck, New Jersey. An internist specializing in the care of the elderly, Dr. Katz is associated with PMR, the Physical Medicine and Rehabilitation Center, P.A., of Englewood, New Jersey. PMR is devoted to the diagnosis and treatment of medical problems related to pain and disability, and its multidisciplinary treatment teams provide comprehensive care for sports, spine, orthopedic, and neuromuscular conditions. For more information,
please click here. Today we are pleased to present short articles by Dr. Katz on two topics of great importance to many older adults: osteoporosis and nutritional supplements.

Osteoporosis is often called the "silent disease" but affects over 10 million people in the United States. Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing one to an increased risk of fracture. Early on, there are no symptoms. Losing height or breaking a bone may be the first sign. One in three women and one in nine men older than 80 years of age will have a hip fracture as a result of osteoporosis, and 15 percent to 30 percent of these individuals will die of complications related to the fracture.

The dual energy X-ray absorptiometry (DEXA) test is the best way to diagnose osteoporosis. This is a painless and safe test that is covered by Medicare and readily available in the community.

It is never too late to initiate treatment, as many of the drugs have beneficial effects after only six months of treatment. Fosamax or Actonel are taken by mouth once a week, and Boniva, a drug that works by a similar mechanism, is taken by mouth once a month. Evista, an estrogen receptor modulator, is taken once a day. These drugs decrease bone resorption and all have similar effectiveness. Miacalcin is less effective at treating osteoporosis but does have an analgesic effect and is taken as a nasal spray. The most exciting new drug now available is Forteo, which works by laying down new bone. It is given as an injection on a daily basis.

The simplest and safest treatment, which should be initiated even as a preventive measure, is calcium (1200-1500 mg) and vitamin D (400-800 IU) supplements every day.

People who perform regular exercises involving weight bearing have a greater chance of maintaining their bone density and reducing risk of fracture than those performing only non-weight bearing exercises such as swimming.

As in my practice, medical personnel can identify osteoporosis, and physical and occupational therapists can help plan appropriate exercise programs. Don't wait for the first fracture to seek treatment -- ask your doctor whether you need evaluation for osteoporosis.

Nutritional Supplements for Older Adults

Older persons are often concerned with their diets
and whether they are receiving adequate nutrition. Age-related changes in physiology, metabolism, and function alter the nutritional requirements of older adults. Aging is associated with an increase in total body fat, especially in the abdomen, and a decrease in muscle and bone.

Older adults have different vitamin and mineral requirements than younger people. When deciding the types of food to eat, older adults can follow the traditional U.S. Department of Agriculture Food Guide Pyramid, with a few changes for the special nutritional needs of adults 70 years old and older. Most healthy older adults have lower caloric needs than when they were younger. Taking in enough fiber also becomes more important as we age, to avoid problems with constipation.

A true vitamin deficiency is defined as a low vitamin level accompanied by physiological or biochemical abnormalities. Without documentation of definite deficiency, the benefit of vitamin and herbal supplementation may be debatable, but certainly most supplementation should not cause harm. This does not mean that there is absolutely no risk associated with vitamins.

Vitamin A takes months to become depleted, and there is little data to indicate that its deficiency is a problem in older adults in the United States.

Deficiencies in Vitamin B Complex (including vitamins B1, B2, B3, and B12) have been linked to cognitive problems. Particularly vitamin B12 is measured and supplemented when there are memory problems, as well as certain types of anemia. Folate deficiency is also associated with anemia. The theory that folate and B12 can provide cardiovascular protection has not been borne out in studies.

Recognition of the importance of vitamin D in both immunological and bone disorders, along with the increased prevalence of deficient states in the elderly, has led to its becoming one of the most important vitamin supplements today. Because vitamin D deficiency is so common and the risk associated with supplementation is so low, vitamin D should be given either alone or in combination with calcium in most older individuals.

Books for Brainiacs

In more ways than one! First of all, the books described below address the subject of cognitive fitness. Secondly, they are written at an advanced academic level. The publisher recommends them for, among others, cognitive gerontologists, researchers, graduate students, and university faculty members who study or teach related topics. Since many Experience! readers fall into those categories, we want to let you know about these excellent resources.

These texts are the first two volumes of a planned three-part series on aging, exercise, and cognition published by Human Kinetics. They can be ordered through any bookstore.

Active Living, Cognitive Functioning, and Aging (2006) presents scientific findings regarding the effect of regular physical activity on cognitive functioning and general health during the aging process. Internationally recognized experts discuss pertinent issues in measurement and physiological mechanisms. Major topics include:

  • The status of research evidence;
  • Future directions of research;
  • Advances in measurement;
  • Key issues relating to aging, physical activity, cognition, and putative mechanisms;
  • The potential of intervention programs that positively influence cognition; and
  • Implications for public policy making.

Exercise and Its Mediating Effects on Cognition (2008) examines how physical activity can indirectly affect cognitive function by influencing mediators -- such as sleep quality, nutrition, disease states, anxiety, and depression -- that impact physical and mental resources for cognition. Seventeen international authorities on exercise, cognition, neurobiology, and aging review the current state of knowledge and research.

Both books were edited by Leonard Poon, PhD, and Wojtek Chodzko-Zajko, PhD. Joining them to edit the first volume was Phillip Tomporowski, PhD. Waneen Spirduso, EdD, joined in editing the second volume.

An Ancient Notable on Brain Fitness

That physical activity and cognition are linked
is not a new concept. Marcus Tullius Cicero was a Roman statesman, orator, and philosopher who lived from 106 BC to 43 BC. Cicero had this to say on the subject:

"It is exercise alone that supports the spirits, and keeps the mind in vigor."

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