Geriatrician Advice on Vitamin D, Lecanemab, and Social Media

Geriatrician Advice on Vitamin D, Lecanemab, and Social Media

This text discusses updates in geriatrics from research revealed in 2022 to early 2023. The subjects coated embody vitamin D supplementation and incident fractures, the affiliation of social isolation and dementia, and the discharge of lecanemab, the second disease-modifying remedy for delicate Alzheimer dementia.

Vitamin D Supplementation and Incident Fractures

Vitamin D supplementation is a generally beneficial intervention for bone well being, however information to help its influence on decreasing fracture danger has been variable.

A research within the New England Journal of Medication by LeBoff and colleagues has garnered a lot consideration since its publication in July 2022.1 Within the ancillary research of the Vitamin D and Omega-3-Trial (VITAL), the authors examined the influence of vitamin D supplementation versus placebo on incident fractures. The research discovered that vitamin D supplementation, as in contrast with placebo, led to no vital distinction within the incidence of whole, nonvertebral, and hip fractures in midlife and older adults over the 5-year interval of follow-up.

The generalizability of those findings has been raised as a priority because the research doesn’t describe adults at increased danger for fracture. The authors of the research specified of their conclusion that vitamin D supplementation doesn’t scale back fracture danger in “usually wholesome midlife and older adults who weren’t chosen for vitamin D deficiency, low bone mass or osteoporosis.”

With a imply participant age of 67 years and exclusion of individuals with a historical past of heart problems, stroke, cirrhosis and different critical diseases, the research doesn’t replicate the multimorbid older grownup inhabitants that geriatricians sometimes look after. Moreover, efficacy of vitamin D supplementation on fracture danger will be the most impactful in these with osteoporosis and with extreme vitamin D deficiency (outlined by vitamin D 25[OH]D degree lower than 12 ng/mL).

In put up hoc analyses, there was no vital distinction in fracture danger in these subgroups, nonetheless the authors acknowledged that the findings could also be restricted by the small proportion of individuals with extreme vitamin D deficiency (2.4%) and osteoporosis included within the research (5%).

Lecanemab for Delicate Cognitive Impairment and Early Alzheimer’s Dementia

On Jan. 6, 2023, the Meals and Drug Administration accepted lecanemab, the second-ever disease-modifying remedy for Alzheimer’s dementia following the approval of aducanumab in 2021. Lecanemab is a monoclonal antibody focusing on bigger amyloid-beta oligomers, which has been proven in vitro to have increased affinity for amyloid-beta, in contrast with aducanumab. FDA approval adopted shortly after the publication of the CLARITY-AD trial, which investigated the impact of lecanemab versus placebo on cognitive decline and burden of amyloid in adults with delicate cognitive impairment and delicate Alzheimer’s dementia. Over an 18-month interval, the research discovered that individuals who obtained lecanemab, in contrast with placebo, had a considerably smaller decline in cognition and performance, and discount in amyloid burden on PET CT.2

The medical significance of those findings, nonetheless, is unclear. As famous by an editorial revealed in The Lancet in 2022, the distinction in Scientific Dementia Score-Sum of Packing containers (CDR-SB) scale between the remedy and placebo teams was 0.45. On an 18-point scale, prior analysis has famous {that a} minimal clinically significance distinction of 0.98 is important in these with delicate cognitive impairment and 1.63 in delicate Alzheimer dementia.3

Moreover, the CLARITY-AD trial reported that lecanemab resulted in infusion reactions in 26.4% of individuals and mind edema (an amyloid-related imaging abnormality known as ARIA-E) in 12.6% of individuals. This discovering highlights issues for security and the necessity for shut monitoring, in addition to ongoing implications of financial feasibility and equitable entry for all those that qualify for remedy.2

Social Isolation and Dementia Danger

There’s rising consciousness of the influence of social isolation on well being outcomes, significantly amongst older adults. Prior analysis has reported that one in 4 older adults are thought of socially remoted and that social isolation will increase danger of untimely loss of life, dementia, melancholy, and heart problems.4

A research by Huang and colleagues is the primary nationally consultant cohort research inspecting the affiliation between social isolation and incident dementia for older adults in neighborhood dwelling settings. A cohort of 5,022 older adults collaborating within the Nationwide Well being and Ageing Developments Research was adopted from 2011 to 2020. When adjusting for demographic and well being elements, together with race, degree of training, and variety of continual well being circumstances, socially remoted adults had a larger danger of creating dementia, in contrast with adults who weren’t socially remoted (hazard ratio, 1.27; 95% CI, 1.08 – 1.49). Potential mechanisms to clarify this affiliation embody the elevated danger of heart problems and melancholy in older adults who’re socially remoted, thereby growing dementia danger.

Decreased cognitive exercise/engagement and entry to assets equivalent to caregiving and healthcare may be linked to the elevated danger of dementia in socially remoted older adults.5

One other observational cohort research from the Nationwide Well being and Ageing Developments Research investigated whether or not entry and use of know-how can decrease the chance of social isolation. The research discovered that older adults who used e mail or textual content messaging had a decrease danger of social isolation than older adults who didn’t use know-how (incidence charge ratio, 0.64; 95% CI, 0.51 – 0.80).6 These findings spotlight the significance of addressing social isolation as an vital modifiable well being danger issue, and the necessity for offering equitable entry to know-how in susceptible populations as well being intervention.

Mengru “Ruru” Wang is a geriatrician and internist on the College of Washington, Seattle. She practices full-spectrum medication, seeing sufferers in main care, nursing houses, and acute care. Wang has no disclosures associated to this piece.

This text initially appeared on MDedge.com, a part of the Medscape Skilled Community.

Leave a Reply

Your email address will not be published. Required fields are makes.