Skip to main content

Advertisement

SpringerLink
Log in

Association between quantitative bone ultrasound and self-reported physical activity in nursing homes residents

  • Research Paper
  • Published:
European Geriatric Medicine Aims and scope Submit manuscript

Key summary points

AbstractSection Aim

To determine the prevalence and risk factors for osteoporosis in persons over 65 who live in nursing homes.

AbstractSection Findings

The prevalence of osteoporosis among residents in nursing homes, based on QUS bone measurements and defined as QUI-T score ≤ − 2.2, was 51.9% in women and 8.5% in men. Physical activity was a more important factor for preserving bone health than calcium intake.

AbstractSection Message

Regular screening for osteoporosis, together with nutrition assessment and physical activity promotion, should be implemented in nursing home settings.

Abstract

Purpose

Low bone mineral density has been reported in institutionalized old people, but limited data are available on the association between bone density and physical activity (PA) and calcium intake in that population. We explored the predictors of bone density in old people living in nursing homes, focusing on PA and calcium intake.

Methods

In a cross-sectional study, we measured bone density with quantitative ultrasound (QUS) in 292 nursing homes residents (233 women and 59 men), mean age 82.4 ± 6.5 years. Information on lifestyle habits and calcium intake was obtained with questionnaires.

Results

All QUS bone parameters were significantly higher in men than in women (p < 0.001). A T score for quantitative ultrasound index (QUI) of − 2.2 or lower was found in 8.5% of men and 51.9% of women. Participants of both genders with low PA had a significantly lower QUI, QUI-T score compared to those with good/very good PA. When controlling for age, gender, body mass index and calcium intake, participants with good PA had better QUI than those with low PA (β = 7.12 with 95% CI [2.51, 11.74]) The odds of QUI-T score < − 2.2 were lower (OR 0.49 with 95% CI [0.27, 0.90]) in participants with good PA compared to those with low PA.

Conclusions

The prevalence of osteoporosis measured by QUS was high in women but not in men. In our study sample, PA played a more important role than calcium intake in preserving bone density in old people.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  2. Duque G, Lord SR, Mak J, Ganda K, Close JJT, Ebeling P, Papaioannou A, Inderjeeth CA (2016) Treatment of osteoporosis in Australian residential aged care facilities: update on consensus recommendations for fracture prevention. J Am Med Dir Assoc 17:852–859

    Article  PubMed  PubMed Central  Google Scholar 

  3. US Preventive Services Task Force (2018) Screening for osteoporosis to prevent fractures US preventive services task force recommendation statement. JAMA 319:2521–2531

    Article  Google Scholar 

  4. Wuster C, de Terlizzi F, Becker S, Cadossi M, Cadossi R, Muller R (2005) Usefulness of quantitative ultrasound in evaluating structural and mechanical properties of bone: comparison of ultrasound, dual-energy X-ray absorptiometry, micro-computed tomography, and mechanical testing of human phalanges in vitro. Technol Health Care 13:497–510

    CAS  PubMed  Google Scholar 

  5. Knapp KM (2009) Quantitative ultrasound and bone health. Salud Publica Mex 51(suppl 1):S18–S24

    PubMed  Google Scholar 

  6. Gudmundsdottir SL, Indridason OS, Franzson L, Sigurdsson G (2005) Age-related decline in bone mass measured by dual-energy x-ray absorptiometry and quantitative ultrasound in a population-based sample of both sexes. J Clin Densitom 8:80–86

    Article  PubMed  Google Scholar 

  7. Ding Z, Chen Y, Xu Y, Zhou X, Xu Y, Ma Z, Sun Y (2018) Impact of age, gender, and body composition on bone quality in an adult population from the middle areas of China. J Clin Densitom 21:83–90

    Article  PubMed  Google Scholar 

  8. Crogan NL, Alvine C, Pasvogel A (2006) Improving nutrition care for nursing home residents using the INRx process. J Nutr Elder 25:89–103

    Article  PubMed  PubMed Central  Google Scholar 

  9. Suominen MH, Hosia-Randell HM, Muurinen S, Peiponen A, Routasalo P, Soini H, Suur-Uski I, Pitkala KH (2007) Vitamin D and calcium supplementation among aged residents in nursing homes. J Nutr Health Aging 11:433–437

    CAS  PubMed  Google Scholar 

  10. Curtain CM, Williams M, Cousins JM, Peterson GM, Winzenberg T (2016) Vitamin D and calcium supplementation among aged residents in nursing homes. Drugs Aging 33:747–754

    Article  CAS  PubMed  Google Scholar 

  11. Smith RL (2003) Calcium and vitamin D supplementation in nursing home residents. JAMDA 4(suppl):S1–S88

    Google Scholar 

  12. Assantachai P, Angkamat W, Pongpim P, Weattayasuthum C, Komoltri C (2006) Risk factors of osteoporosis in institutionalized older Thai people. Osteoporos Int 17:1096–1102

    Article  CAS  PubMed  Google Scholar 

  13. Dionyssiotis Y, Paspati I, Trovas G, Galanos A, Lyritis GP (2010) Association of physical exercise and calcium intake with bone mass measured by quantitative ultrasound. BMC Women’s Health 10:12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Chandler JM, Zimmerman SI, Girman CJ, Martin AR, Hawkes W, Hebel JR, Sloane PD (2000) Low bone mineral density and risk of fracture in white female nursing home residents. JAMA 284:972–977

    Article  CAS  PubMed  Google Scholar 

  15. Morrison A, Fan T, Sen SS, Weisenfluh L (2013) Epidemiology of falls and osteoporotic fractures: a systematic review. Clinicoecon Outcomes Res 5:9–18

    PubMed  Google Scholar 

  16. Sun F, Norman IJ, While AE (2013) Physical activity in older people: a systematic review. BMC Public Health 13:449

    Article  PubMed  PubMed Central  Google Scholar 

  17. Satalic Z, Colic Baric I, Cecic I, Keser I (2007) Short food frequency questionnaire can discriminate inadequate and adequate calcium intake in Croatian postmenopausal women. Nutr Res 27:542–547

    Article  CAS  Google Scholar 

  18. Kaić-Rak A, Antonic K (1990) Food composition tables. Croatian Institute of Public Health, Zagreb

    Google Scholar 

  19. Kraljevic I, Kastelan D, Kolcic I, Kardum I, Mazalin-Protulipac J, Korsic M (2007) Calcaneal ultrasound parameters in men and women from central Croatia. Med Sci Monit 13:29–33

    Google Scholar 

  20. World Health Organization (1994 ) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. Geneva (WHO Technical Report Series, No. 843)

  21. Hans D, Hartl F, Krieg MA (2003) Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland. Osteoporos Int 14:251–258

    Article  CAS  PubMed  Google Scholar 

  22. Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38

    Article  Google Scholar 

  23. R Core Team (2017 R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/

  24. Cvijetic S, Pavlovic M, Pasalic D, Dodig S (2011) Ultrasound bone measurement in an older population with metabolic syndrome. Aging Clin Exp Res 23:29–34

    Article  CAS  PubMed  Google Scholar 

  25. Maggi S, Noale M, Giannini S, Adami S, Defeo D, Isaia G, Sinigaglia L, Filipponi P, Crepaldi G, ESOPO Study Group (2005) Quantitative heel ultrasound in a population-based study in Italy and its relationship with fracture history: the ESOPO study. Osteoporos Int 17:237–244

    Article  PubMed  Google Scholar 

  26. Ou LC, Sun ZJ, Chang YF, Chang CS, Chao TH, Kuo PH, Lin RM, Wu CH (2013) Epidemiological survey of quantitative ultrasound in risk assessment of falls in middle-aged and elderly people. PLoS ONE 8:e71053

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. de Oliveira PP, Figueiredo Marinheiro IP, Osório Wender MC, Bossoni Mendes J, Oisenberg F (2011) Quantitative ultrasound and risk of fractures in elderly women. Rev Assoc Med Bras 57:637–642

    Article  Google Scholar 

  28. Ekman A, Michaelsson K, Ljunghall S, Mallmin H (2001) Almost all institutionalized women are osteoporotic, when measured by heel and finger ultrasound. J Int Med 249:173–180

    Article  CAS  Google Scholar 

  29. Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA (2003) Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy 23:702–710

    Article  PubMed  Google Scholar 

  30. Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM (1998) Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med 104:539–545

    Article  CAS  PubMed  Google Scholar 

  31. Sallin U, Mellström D (2005) Eggertsen R. Osteoporosis in a nursing home, determined by the DEXA technique. Med Sci Monit 11:CR31-70

    Google Scholar 

  32. Hess M, Campagna EJ, Jensen KM (2018) Low bone mineral density risk factors and testing patterns in institutionalized adults with intellectual and developmental disabilities. J Appl Res Intellect Disabil 31(Suppl. 1):157–164

    Article  PubMed  Google Scholar 

  33. Vive MA, Nahar VK, Ford MA, Bass MA, Johnson AK, Davis AB, Biviji-Sharma R (2015) Risk factors for low bone mineral density in institutionalized individuals with developmental disabilities. Health Promot Perspect 5:147–152

    Article  Google Scholar 

  34. Almeida P, Neves R (2014) Physical activity—the attitude of the institutionalized elderly. JPES 14:12–15

    Google Scholar 

  35. Rydwik E, Kerstin F, Akner G (2005) Physical training in institutionalized elderly people with multiple diagnoses—a controlled pilot study. Arch Gerontol GeriatR 40:29–44

    Article  PubMed  Google Scholar 

  36. Liubicich ME, Magistro D, Candela F, Rabaglietti E, Ciairano S (2012) PA and mobility function in elderly people living in residential care facilities. “Act on aging”: a pilot study. Adv Phys Educ 2:54–60

    Article  Google Scholar 

  37. Reginster JY, Beaudart C, Buckinxa F, Bruyère O (2016) Osteoporosis and sarcopenia: Two diseases or one? Curr Opin Clin Nutr Metab Care 19:31–36

    Article  PubMed  Google Scholar 

  38. Santos L, Elliott-Sale KJ, Sale C (2017) Exercise and bone health across the lifespan. Biogerontology 18:931–946

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Marques EA, Mota J, Carvalho J (2012) Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age(Dordr) 34:1493–1515

    Google Scholar 

  40. McMillan L, Zengin A, Ebeling P, Scott D (2017) Prescribing PA for the prevention and treatment of osteoporosis in older adults. Healthcare 5:E85

    Article  PubMed  Google Scholar 

  41. Maddalozzo G, Snow C (2000) High intensity resistance training: effects on bone in older men and women. Calcif Tissue Int 66:399–404

    Article  CAS  PubMed  Google Scholar 

  42. Rumbak I, Satalić Z, Keser I, Krbavcić IP, Giljević Z, Zadro Z, Barić IC (2010) Diet quality in elderly nursing home residents evaluated by Diet Quality Index Revised (DQI-R). Coll Antropol 34:577–585

    CAS  PubMed  Google Scholar 

  43. Nguyen TV, Center JR, Eisman JA (2000) Osteoporosis in elderly men and women: effects of dietary calcium, PA, and body mass index. J Bone Min Res 15:322–331

    Article  CAS  Google Scholar 

  44. Vannucci L, Masi L, Gronchi G, Fossi C, Carossino AM, Brandi ML (2017) Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population. Arch Osteoporos 12:40

    Article  PubMed  Google Scholar 

  45. Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 13:257–264

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the residents and personnel of the nursing homes: Centar, Ksaver, Maksimir, Park, Sveti Josip and Tresnjevka for their participation, help and support.

Funding

The study was supported by the Institute for Medical Research and Occupational Health (Project “Bone mineral density and fracture risk in older institutionalized people”).

Author information

Authors and Affiliations

  1. Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10000, Zagreb, Croatia

    Selma Cvijetic & Jelena Kovacic

Authors
  1. Selma Cvijetic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jelena Kovacic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Selma Cvijetic.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was designed in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards and was approved by the Ethics Committee of the Institute of Medical Research and Occupational Health.

Informed consent

Informed consent was obtained from all individuals included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cvijetic, S., Kovacic, J. Association between quantitative bone ultrasound and self-reported physical activity in nursing homes residents. Eur Geriatr Med 10, 659–666 (2019). https://doi.org/10.1007/s41999-019-00183-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41999-019-00183-3

Keywords

Search

Navigation