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Calcium and Vitamin D Help Hormones Help Bones

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Should women take calcium and vitamin D supplements after menopause for bone health?

Recommendations conflict, and opinions are strong.

But now, an analysis from the major Women's Health Initiative (WHI) trial throws weight on the supplement side -- at least for women taking hormones after menopause.

Among the nearly 30,000 postmenopausal women in the hormone trial, some 8,000 took supplemental calcium (1,000 mg/day) and vitamin D (400 mg/day), and some 8,000 took look-alike placebos. These women came from all the hormone groups in the study -- those who took estrogen plus a progestogen (required for women with a uterus), those who took estrogen alone, and those who took the hormone look-alike placebos.

The researchers looked at how the rates of hip fracture differed among women who took hormones and supplements, those who took hormones alone, and those who took neither.

The supplements and hormones had a synergistic effect.

Women using both therapies had much greater protection against hip fractures than with either therapy alone. Taking supplements alone wasn't significantly better than taking no supplements and no hormones. The benefit of hormone therapy was strong in women who had a total calcium intake (supplements plus diet) greater than 1,200 mg/day.

Similarly, the benefit was strong in women who had higher intakes of vitamin D, but the individual effect of each one could not be determined because the two supplements were given together.

The effects translated into 11 hip fractures per 10,000 women per year among the women who took both hormones and supplements compared with 18 per 10,000 women per year among those who took hormones only, 25 per 10,000 women per year among those who took supplements alone, and 22 among those who got neither therapy.

These results suggest, said the authors, that women taking postmenopausal hormone therapy should also take supplemental calcium and vitamin D.

Although they couldn't specify how much, they noted that the benefits seem to increase with increasing total intake of calcium and vitamin D. The dose will depend on keeping side effects, such as constipation from too much calcium, to a minimum, they said.

That differs from the recommendation of the US Preventive Services Task Force (USPSTF), made earlier this year. USPSTF stated there was no basis for recommending calcium and vitamin D supplements to prevent fractures. But now, with a study this large, there may well be.

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The above story is based on the June 26, 2013 news release by The North American Menopause Society (NAMS).

The analysis was published ahead of print edition of Menopause:

Robbins JA, Aragaki A, Crandall CJ, Manson JE, Carbone L, Jackson R, Lewis CE, Johnson KC, Sarto G, Stefanick ML, Wactawski-Wende J. Women's Health Initiative clinical trials: interaction of calcium and vitamin D with hormone therapy. Menopause, 2013; DOI: 10.1097/GME.0b013e3182963901

More information

Learn more about calcium and where to find it in your diet from the U.S. National Institutes of Health Office 

of Dietary Supplements.

Alzheimer's Memory Loss: How Exercise Can Slow its Onset

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Exercise can prevent and delay Alzheimer’s Disease. But it has been unclear how this happens.

Now, a team of researchers from The University of Nottingham has identified a stress hormone, corticotrophin-releasing factor or CRF, produced during moderate exercise that may slow down the progression of memory loss in people with Alzheimer's disease.

The work, funded by Research into Ageing (Age UK) and the University and published in the Journal of Alzheimer's Disease, may also explain why people who are susceptible to stress are at more risk of developing the disease.

Protective effect of CRF

The Nottingham team, led by Dr Marie-Christine Pardon in the School of Biomedical Sciences, has discovered that the stress hormone CRF -- may have a protective effect on the brain from the memory changes brought on by Alzheimer's disease.

CRF is most associated with producing stress and is found in high levels in people experiencing some forms of anxiety and depressive diseases. Normal levels of CRF, however, are beneficial to the brain, keeping the mental faculties sharp and aiding the survival of nerve cells. Unsurprisingly then, studies have shown that people with Alzheimer's disease have a reduced level of CRF.

The researchers used an experimental drug to prevent the hormone from binding to a brain receptor called CRFR1 in mice with Alzheimer's disease that were free from memory impairments, therefore blocking the effects of the hormone. They discovered that the mice had an abnormal stress response with reduced anxiety but increased behavioural inhibition when confronted by a stressful situation -- in this case being placed in a new environment -- and this is was due to the abnormal functioning of the CRFR1. This abnormal stress response before the onset of symptoms may explain why people susceptible to stress are more at risk of developing Alzheimer's.

Memory enhancing effect of CRF

Dr Pardon and her team also found that interrupting the hormone from binding on to the CRFR1 receptor blocked the improvement of memory normally promoted by exercise. However, in mice with Alzheimer's a repeated regime of moderate exercise restored the normal function of the CRF system allowing its memory enhancing effects. The results are in line with the idea that regular exercise is a means of improving one's ability to deal with everyday stress in addition to keeping mental abilities keen.

Finally, their study showed that the switching on of this particular brain receptor during exercise increased the density of synapses, which makes the connection between nerve cells, the loss of which is thought to be responsible for the early memory loss seen in Alzheimer's patients.

Dr Pardon said: "This is the first time that researchers have been able to identify a brain process directly responsible for the beneficial effects of exercise in slowing down the progression of the early memory decline characteristics of Alzheimer's disease.

"Overall, this research provides further evidence that a healthy lifestyle involving exercise slows down the risk of Alzheimer's disease and opens avenues for the new interventions targeting the altered CRFR1 function associated with the early stages of the disease."

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The above story is based on the January 23, 2013 news release by University of Nottingham.

This research, funded by Research into Ageing (Age UK) and the University, has been published in the Journal of Alzheimer's Disease:

Scullion GA, Hewitt KN, Pardon MC. Corticotropin-releasing factor receptor 1 activation during exposure to novelty stress protects against Alzheimer's disease-like cognitive decline in AβPP/PS1 mice. J Alzheimers Dis. 2013;34(3):781-93. doi: 10.3233/JAD-122164.

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Incontinence Takes Mental Toll on Younger Women

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Urinary incontinence affects approximately 35% of the female population. The main cause in women is pregnancy, with the number of children they have increasing their chances of becoming incontinent.

New research from the University of Adelaide shows middle-aged women are more likely to suffer depression from this common medical problem that they find too embarrassing to talk about.

In a study of the experiences of women with urinary incontinence, researcher Jodie Avery found that middle-aged women with incontinence (aged 43-65) were more likely to be depressed than older women (aged 65-89).

Speaking in the lead up to World Continence Week (24-30 June), Ms Avery says the younger women's self-esteem is often hit hard by urinary incontinence, while older women tend to be more resilient and accepting of their condition.

Key issues for younger women affected by incontinence are family, sexual relationships and sport and leisure activities.

"The most common difficulties women express about their incontinence are things like: 'I can't play netball', 'I can't go to the gym', 'I can't go for walks', or 'I can't go dancing', and these are real issues for women who are still in the prime of their lives."

"Our studies show that 20% of the incontinent population has depression, and this is something that we need both sufferers and GPs to better understand," Ms Avery says.

"Ultimately, we hope that our research helps to raise awareness in the community about both the mental and physical issues associated with incontinence. We know it's embarrassing, but if you discuss it with your GP, your life really can change."

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The above story is based on the June 14, 2013 news release provided by Universityof Adelaide. 

More Information

To learn more about urinary incontinence visit Patient.co.uk

Undescended Testicles in Newborns Linked to BPA

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BPA is banned in products such as baby bottles and sippy cups, but the chemical continues to be used in many other consumer products. The most prominent continuing use of BPA is in the lining of aluminum and tin cans, where it prevents corrosion.

A new study links foetal exposure to a common chemical pollutant, bisphenol A(BPA), to defects of a testicular hormone in new-borns with undescended testicles.

Cryptorchidism, the medical name for undescended testicles, occurs in 2 to 5 percent of full-term male newborns, according to the authors.

Sometimes the testicles descend on their own within six months after birth otherwise surgery is required to bring the testes out of the abdominal cavity. Untreated, it carries an increased risk in adulthood of decreased fertility and testicular cancer.

The findings do not draw a direct link between BPA and cryptorchidism, as the newborns with undescended testicles did not have greatly increased levels of BPA compared with newborns without the birth defect.

Researchers found, however, that the BPA level in newborns' cord blood inversely correlated with the level of INSL3. That is, the higher the BPA level, the lower the level of the important testicular hormone.

"Alone, our study cannot be considered as definitive evidence for an environmental cause of undescended testis," said lead author Patrick Fenichel, MD, PhD, professor and head of reproductive endocrinology at the University Hospital of Nice in France. "But it suggests, for the first time in humans, a link that could contribute to one co-factor of idiopathic [unexplained] undescended testis, the most frequent congenital malformation in male newborns."

Research is needed to study exposure to BPA during pregnancy.

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The above story is based on the June 17, 2013 news release by Endocrine Society. 

The results of the study were presented at The Endocrine Society's 95th Annual Meeting in San Francisco.

More information

To learn more about BPA, visit the U.S. National Institute of Environmental Health Sciences.

For more on Undescended Testicles, visit Kidshealth.org