Medical researchers may have unexpectedly discovered a key to longer life.
An anti-osteoporosis drug appears to have given frail and elderly people an extra five years of life, surprised scientists said.
A study revealed they are outliving similarly aged people who do not have osteoporosis – a result so positive it was initially met with scepticism by the researchers.
‘That was the thing that was really remarkable to us – these people were doing better than, if you like, the average community,’ said Professor John Eisman, from Sydney’s Garvan Institute of Medical Research.
‘Our initial concern was “we’ve somehow selected a healthier group… that’s why they are doing better”, but whatever way we looked at it, it didn’t seem to explain it.
Osteoporosis
‘Everything about these people imply they would do worse, but they were doing at least as well as the general population, if not better.’
Professor Eisman, and lead researcher Associate Prof Jacqueline Center, drew on data collected as part of the long-running Dubbo Osteoporosis Epidemiology Study, which started in 1989.
They looked at a group of 2000 elderly people, of whom 121 had been taking medication from the bisphosphonates class of drugs for about three years.
The medication prevents the loss of bone mass by slowing the pace at which the bones naturally renew themselves, a process that is too fast in people with osteoporosis.
Professor Eisman said the result might be linked to the toxic metals, such as lead, that are known to become stored away in our skeletons over time.
‘So when people get older, they lose bone and when this happens, these toxic metals are released back into the body and may adversely affect health,’ he said.
‘By preventing bone loss, bisphosphonates do prevent some of the toxic metal release.’
The research is published in the Journal of Endocrinology and Metabolism.
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A dramatic increase in brittle-bone diseases is forecast to hit a generation of British women at massive cost to the National Health Service. Clinicians report increasing numbers of younger women suffering low bone density, exposing them to higher risk of developing the porous bone disease osteoporosis in later life. The shift comes as the number of people with the condition is already increasingly rapidly, due to the UK’s ageing population.
Lifestyle issues such as dieting, lack of exercise, excessive drinking, smoking, contraceptive injections and high-factor sun block are being considered as contributing to a significant increase in the risk of contracting osteoporosis. Experts fear all these factors could create a surge of fragile-bone disease when this generation of young women hits the menopause. Fractures are already at “epidemic proportions”. Osteoporosis affects both sexes but is much more common in post-menopausal women, as it is often brought on by a lowering of oestrogen levels.
Hip fractures – frequently a symptom of brittle-bone disease – have increased by 17 per cent in a decade in England, and there are about 230,000 fragility fractures in the UK every year. At present the cost of osteoporotic hip fractures to the NHS is an estimated £2bn a year. That is expected to rise to £3bn by 2020.
The disease, which is often only discovered after a serious fracture in older age, can be fatal. Almost one in 10 women over the age of 55 who are admitted with a hip fracture do not make it out of hospital alive.
To raise the profile of the disease, the Duchess of Cornwall will appear this week on the radio drama The Archers, in her role as president of the National Osteoporosis Society. In the episode, aired on BBC Radio 4 on Thursday, she attends a tea party for the Borsetshire Osteoporosis Society.
Nicola Peel, a consultant at the Metabolic Bone Centre at Sheffield Teaching Hospital, said: “We are seeing an increasing number of referrals for young women [with] low bone density and many more who have the risk factors. They’re likely to reach the menopause at sub-optimal bone health, which will put them at risk of fractures. Binge drinking is harmful to the skeleton, smoking is a risk factor, as is a sedentary lifestyle, and we believe reduced levels of activity in childhood will have an effect on bone growth.”
Bone density reaches a peak in the mid-20s, making a healthy lifestyle from childhood to the age of 25 crucial to bone development. Later in life, good nutrition and exercise help to maintain bones. Exposing the skin to sunlight is important, too, as without this the body cannot manufacture vitamin D, which – along with calcium – is crucial to bone formation.
Jonathan Tobias, professor of rheumatology at Bristol University, has just completed a study into the bone density of 15 year olds. He found that those who did regular vigorous exercise had significantly stronger bones, and is worried that the sedentary lifestyles of younger people will put their bones in danger.
“There’s a potential constellation of risk factors for young women – including lack of exercise, excess dieting and progesterone-only contraceptive injections – which could mean their risk of osteoporosis in later life is even greater than that of the elderly of today. There is potentially a time bomb in terms of the incidence of fractures due to osteoporosis, which is already of epidemic proportions.”
Paul Mitchell, a lecturer at the University of Derby who specialises in hip-fracture prevention, said simple steps could prevent the problem burdening the NHS. “Of the 80,000 people who are likely to get hip fractures this year, 40,000 will have presented before with a fracture since they were 50. If we consistently intervened with the first fracture, using Fracture Liaison Services, we have the potential to prevent up to a quarter of all future hip fractures through osteoporosis drug treatment and fall prevention.”
But the latest figures show just 24 per cent of hospitals in England and Wales use Fracture Liaison Services, despite the fact that projections suggest they could save the NHS approximately £8.5m over five years.
“There is unquestionably an opportunity to improve care of this condition,” Mr Mitchell added. “We need to make sure younger adults are attaining their peak bone mass through good calcium intake, good exercise and moderate alcohol intake.”
The All-Party Parliamentary Osteoporosis Group is conducting an inquiry on the impact of nutrition on bone health, which it will finish later this spring. The group’s chair, Baroness Cumberlege, said: “There’s a very real concern that with the lifestyles people lead there’s going to be a generation with weaker bones.”
Campaigners say that the situation is exacerbated by the fact that the disease has been left out of the Quality and Outcomes Framework (QOF) for GPs. The framework, an annual reward and incentive programme for doctors, has been credited with improving treatment and diagnosis for conditions such as asthma, heart disease and stroke. The want the condition to be included when QOF is reconsidered in June.
A National Osteoporosis Society spokesman said: “The society believes that osteoporosis deserves the same recognition as other long-term conditions. Incentives are given for recognising other illnesses; we need the same for osteoporosis to ensure that it is identified and treated where appropriate.”
Scientists have found that the use of bisphosphonates – drugs already taken by millions of healthy women to prevent bone-loss – for more than one year is associated with a 50 percent reduction in the risk of postmenopausal colorectal cancer.
Lead researcher Prof. Gad Rennert, of the Technion-Israel Institute of Technology Faculty of Medicine, says these findings further support the role of bisphosphonates as a possible new drug class for cancer prevention.
Rennert and colleagues extracted data from the Molecular Epidemiology of Colorectal Cancer (MECC) study, a population-based case-control study in northern Israel, conducted together with senior author Stephen Gruber, of the University of Michigan, Ann Arbor.
Using pharmacy records, the team evaluated the use of bisphosphonates in 1,866 postmenopausal female participants.
The researchers found that the use of bisphosphonates prior to diagnosis was strongly associated with a significant reduced relative risk for colorectal cancer.
The result remain the same even after making adjustments for a large variety of known risk or protective factors for colorectal cancer such as family history, dietary components, physical activity, body mass index, and the use of other medications such as aspirin, statins and hormone replacement therapy.
The results were published this week in the Journal of Clinical Oncology.