News in brief: OA risk rises with vitamin D levels; TNFi tapering safe in controlled PsA and axSpA; Dairy foods reduce fracture risk in aged care

OA risk rises with vitamin D levels

Higher circulating 25(OH)D concentrations have been associated with an increased risk of total hip replacement for osteoarthritis in men but not in women.

An Australian study of 2,651 participants in a substudy of the Melbourne Collaborative Cohort Study identified 86 men and 87 women who had received a THR for OA.

Compared with men without a total hip replacement, those with a total hip replacement were less likely to be in the lowest 25(OH)D quartile and more likely to be in the 3rd 25(OH)D quartile. The HR for total hip replacement for OA in men was 1.23.

Women having a hip replacement did not noticeably differ with respect to levels of 25(OH)D with those who did not have a hip replacement.

The results are consistent with those from the Australian Diabetes, Obesity and Lifestyle Study and suggest a balancing act is necessary between vitamin D sufficiency to reduce osteoporotic fractures and vitamin D excess.

“Our findings also highlight the need to determine the optimal levels of circulating 25(OH)D in order to reduce the risk of chronic diseases such as hip OA.”

The investigators said the mechanism for the association between higher 25(OH)D concentrations and increased risk of hip replacement for OA was not yet clear.

Read more in BMC Musculoskeletal Disorders

TNFi tapering safe in controlled PsA and axSpA

Tumour necrosis factor inhibitors (TNFi) can be tapered in stable psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients without negative effects on disease activity, according to a recent study.

The study reviewed the impacts of drug-tapering in 324 PsA and axSpA patients with mean 6.5 DAS28-CRP and 6.4 BASDAI scores, over a median of 46 and 44 months respectively.

It saw mean DAS28-CRP scores change by only 0.06 and 0.03 when doses were modulated from 108% to 62% during the disease activity-guided dose optimisation period and 78% at dose stabilisation.

Meanwhile BASDAI shifted by mean 0.03 and 0.05 with dose modification from 108% to 62% and 78%, respectively.

The authors concluded their study showed target-based tapering of TNFi “reduces drug exposure and has no negative effects on disease activity in PsA and axSpA patients compared with full dose continuation”.

Read more in Rheumatology

Dairy intake reduces fracture risk in aged care residents: RCT

Improving calcium and protein intakes with extra dairy foods can reduce the risk of falls and fractures in aged care residents.

An Australian RCT compared fractures, falls and all cause mortality in aged care residents in 30 facilities on a usual meal plan and 30 facilities providing additional milk, yogurt and cheese.

Consumption of dairy foods increased from 2.0 to 3.5 serves per day in the intervention group.

“This nutritional approach using high calcium and high protein dairy foods to increase calcium and protein intakes in institutionalised older adults replete in vitamin D was associated with a 33% reduction in risk of fractures of any type, a 46% reduction in risk of hip fractures, and an 11% reduction in risk of falls relative to controls,” the study said.

There was no observed difference in all cause mortality over the two year study period.

The study said the most likely explanation for the reduction in fractures was fewer falls and slowing progression of bone fragility.

Disclosure: The study, led by the University of Melbourne, was funded in part by Dairy Australia and other industry groups.

Read more in The BMJ

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