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Up Front | Nov/Dec 2013

Medical Updates

A summary of general medicine news that affects your patients, your practice, and you.

Postoperative Complications Connected to a History of Falls in Older Patients

Elderly patients who had fallen within 6 months prior to surgery tended to have more intra- and postoperative complications than those who had not fallen, according to a study in JAMA Surgery.1.

Teresa S. Jones, MD, of the University of Colorado School of Medicine, and colleagues conducted a prospective cohort study of 235 patients (mean age, 74 years) undergoing elective colorectal or cardiac operations. Postoperative outcome measures included 30-day complications, the need for discharge institutionalization, and 30-day readmission.

In the 33% of patients who had suffered preoperative falls, postoperative complications occurred more frequently compared with those who had not fallen after colorectal or cardiac operations. Patients with preoperative falls had to be discharged to a care facility more frequently than those who had no previous fall history; 30-day readmission was higher in this group as well.

“Given the high volume of surgical care provided for the elderly population, improving preoperative risk assessment for the older adult is becoming increasingly important,” the study authors concluded. “Incorporating geriatric-specific variables that reflect physiologic vulnerability of the older adult into large surgical outcomes data sets used to construct preoperative risk calculators has real potential to improve the accuracy of these tools at forecasting risk in older adults.”

  1. Jones TS, Dunn CL, Wu DS, et al. Relationship between asking an older adult about falls and surgical outcomes [published online ahead of print October 9, 2013]. JAMA Surg. doi:10.1001/jamasurg.2013.2741.

Vitamin D Supplementation May Not Prevent Osteoporosis

Vitamin D supplementation may not prevent osteoporosis in middle-aged adults, according to a study published in The Lancet.1

Ian Reid, MD, of the University of Auckland, New Zealand, and colleagues analyzed data from 23 randomized trials including a total of 4,000 healthy patients (92% women; average age, 59 years). The effect of vitamin D on bone density was measured at the spine, neck, hip, and forearm. The patients' dosages ranged from 500 to 800 units of vitamin D on different days. In some of the studies, patients were also given calcium.

The analysis showed only six findings of significant vitamin D-induced benefit and two of significant detriment; the rest were nonsignficiant. Only one study showed benefit at more than one of the four sites. Therefore, continuing widespread use of vitamin D for osteoporosis prevention in adults without specific risk factors for vitamin D deficiency may be inappropriate, the investigators concluded.

“We [are] not talking about people who are really vitamin D deficient,” Dr. Reid told The New York Times.2 “But for healthy people focused on osteoporosis prevention, vitamin D does not make a positive contribution.”

  1. Reid IR, Bolland MJ, Grey A. Effects of Vitamin D supplements on bone density: a systematic review and metaanalysis [published online ahead of print October 11, 2013]. The Lancet. doi:10.1016/S0140-6736(13)61647-5.
  2. Bakalar N. Vitamin D ineffective for preventing osteoporosis. The New York Times. October 17, 2013. Available at: http://well.blogs.nytimes.com/2013/10/17/vitamin-d-ineffective-for-preventing-osteoporosis/?_r=0. Accessed October 25, 2013.

Nonexcercise Physical Activity May Reduce Heart Risks

An active daily life, regardless of regular exercise, may be associated with cardiovascular health and longevity in older adults, according to a study in the British Journal of Sports Medicine.1

Elin Ekblom-Bak, PhD, of the Swedish School of Sport and Health Sciences and the Karolinska Institute, Stockholm, and colleagues conducted a study of 4,232 patients. At baseline, patients completed self-administered questionnaires that asked how often they took part in nonexercise physical activities such as gardening, do-it-yourself projects, and car maintenance and asked about their exercise habits. Cardiovascular health was established through physical examinations and laboratory tests. Patients were followed for an average of 12.5 years.

High nonexercise physical activity, regardless of regular exercise, was associated with more preferable waist circumference and high-density lipoprotein cholesterol and triglycerides in men and women and with lower insulin, glucose, and fibrinogen levels in men. The occurrence of metabolic syndrome was significantly lower in those with higher nonexercise physical activity levels in nonexercising and regularly exercising individuals. Reporting a high nonexercise physical activity level was associated with a lower risk of a first cardiovascular disease event and lower all-cause mortality.

  1. Ekblom-Bak E, Ekblom B, Vikstrom M, de Faire U, Hellenius ML. The importance of non-exercise physical activity for cardiovascular health and longevity [published online ahead of print October 28, 2013]. Br J Sports Med. doi:10.1136/ bjsports-2012-092038.

–Compiled by Callan Navitsky, Senior Editor