Findings: Vitamin K is essential for the activation of vitamin K-dependent proteins, which are involved not only in blood coagulation but in bone metabolism and the inhibition of arterial calcification. Vitamin K deficiency causes reductions in bone mineral density and increases the risk of fractures. Concurrent use of menaquinone and vitamin D may substantially reduce bone loss.
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Citation: Morris MS, Jacques PF, Selhub J.Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans.Bone. 2005 Aug;37(2):234-42

Findings: Authors examined data collected on older adults ( >55 years) who underwent DEXA scans of the hip as participants in phase 2 of the third U.S. National Health and Nutrition Examination Survey (n = 1550). They noted an association between hyperhomocystinemia and low Vit B12 levels and osteoporosis. Hyperhomocystinemia is known to be associated with hip fractures.
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Citation: Rude RK, Gruber HE, Norton HJ, Wei LY, Frausto A, Kilburn J. Dietary magnesium reduction to 25% of nutrient requirement disrupts bone and mineral metabolism in the rat. Bone. 2005 Aug;37(2):211-9.

Findings: Magnesium deficiency (Mg intake of 25% NR) was noted to be associated with loss of bone density in rats.
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Food for thought: It is well known that Calcium and Vit D are essential for preventing osteoporosis. Above studies seem to indicate that Vitamins K and B12, Folate and Magnesium are also essential for preventing osteoporosis. More studies are required to differentiate between association and causation of these factors on Osteoporosis. Meanwhile, providers carrying for older adults may want ensure that their patients are taking sufficient amounts of Vit K, B12 and Folate and Mg in addition to the well publicized Calcium and Vit D.

VJ Periyakoil, MD

Venue: Fairchild Auditorium, Stanford

Dates: September 23- 24, 2005

Conference highlights:

Meets California AB 487 Criteria for 12CEU Pain & Palliative Care (State mandate for most physicians)

Concurrent interactive breakout sessions for skill practice

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To register, contact:

Megan Zimmerman
Phone: (650) 498 7937
Email: meganz@stanford.edu


Conference agenda and other details are attached.

VJ Periyakoil, MD

Go to http://sgec.stanford.edu

Outline: In this case control study in UK, a large database ( more than 7 million patients) from a general practice was used to identify 9218 cases with first myocardial infarctions and 86,349 controls ( matched for age and sex). Increased risk for MI was seen when any of these drugs were used within 3 months of MI or control index date. Diclofenac (adjusted odds ratio : 1.55) rofecoxib (adjusted odds ratio, 1.32), ibuprofen ( adjusted odds ratio 1.24) seemed to be associated with increased risk compared to nonselective NSAIDs

Comment: Many elders are on NSAIDs for chronic pain etc. Naproxen (nonselective NSAID) is sometimes easier on patients do to its BID dosing and may be possibly safer(based on this single observational study. It is to be noted that there is some evidence that some NSAIDs have a protective effective against Alzheimer's Disease ( by their effect on peroxisome proliferator g nuclear transcription factor).

You must have a SUNet ID and be a member to view this forum. For more information, please contact VJ Periyakoil - vsperiyakoil@hotmail.com

Sunday, May 8, 2005

'Off-label' drug use

Editor -- Regarding your article, "A patient's right to know" (May 1): It is of vital importance that physicians discuss the use of all medications with patients and, if necessary, their relatives. However, the off-label use of medications, questioned in the article, must be allowed to continue.

In this nation, there are growing numbers of elderly patients with various demential illnesses. It is very common for such patients to develop psychosis with delusions or hallucinations, depression, anxiety and/or behavior problems (striking out, kicking, biting, etc.) as complications of degenerative dementia. These psychiatric complications are painful for the patients and often dangerous for those offering care.

At present, there is not one FDA-approved (labeled) medication available for the treatment of these problems. Most often, the only way to treat the distress that patients, families and other caregivers experience from these illnesses is to use a medication off-label. Otherwise, the suffering will continue, others may be harmed and death may very well be hastened.

Physicians must retain the option to use various drugs off-label in order to relieve these kinds of pain and suffering.

JAMES W. HAWKINS, M.D.
Geriatric psychiatrist
San Francisco

All are welcome!

Join the Stanford GEC and its partners in a DL seminar by webcast.

"Mental Health Aspects of Diabetes in Elders from Diverse Backgrounds"

Wednesday, May 4, 2005, 2:00-5:00 pm (PST).

Three speakers will present an overview, issues for American Indian Elders and African American Elders, and cultural remedies for treatment.

Participants: Health care and social service professionals, students, and others who care for older ethnic elders with diabetes.

To participate, you will need the latest version of RealPlayer. For a free download go to the site below
http://www.sjsu.edu/atn/delivery/webcasting/

and do the following:

1) Preload latest version of RealPlayer
2) Go to assigned link (see below)
3) View videostream and remember to turn up the audio/speaker
4) Phone in your question during the Q & A at 408-741-2071

Live Links:
http://atn5.sjsu.edu:8080/ramgen/encoder/mhd05040556k.rm
http://atn5.sjsu.edu:8080/ramgen/encoder/mhd050405dsl.rm

Depending on your internet connection use the link with either 56k or DSL at the end. It is preferable to use the Internet Explorer for your web browser, although other browsers would work as well.

The above links will not work now but if you go to either site you should see RealPlayer start up and then a dialogue box stating "Requested file not found." If you don't see the RealPlayer on your screen you need to update or download the free RealPlayer.

The Live Links are valid only during the seminar that is on Wednesday, May 05, 2005 from 2:00PM to 5:00PM (it starts at 1:55 p.m).

For questions, please contact San Lu, SGEC Program Manager at santlu@stanford.edu or 650-494-3528.

The seminar will be archived immediately from 5:01 pm (PST), May 5, 2005 to June 30, 2005. and can be accessed at the URLs below.

Archived Links:
http://atn5.sjsu.edu:8080/ramgen/mediacontent/mhd05040556k.rm
atn5.sjsu.edu:8080/ramgen/mediacontent/mhd050405dsl.rm

~San