Women with higher levels of baseline physical activity were less likely to develop cognitive decline. This association was not explained by differences in baseline function or health status. This finding supports the hypothesis that physical activity prevents cognitive decline in older community-dwelling women.

Objective To estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) in a population‐based sample of elderly subjects in Beijing, China and compare it with that reported in the Framingham (Massachusetts) OA Study. Methods We recruited a sample of persons age ≥60, using door‐to‐door enumeration in randomly selected neighborhoods in Beijing. Subjects completed a home interview including questions on knee symptoms and a hospital examination including knee radiographs obtained during weight bearing. The protocol was identical to that used in the Framingham OA Study. A reader read intermingled Beijing and Framingham Study films to ensure high reliability. We defined a subject as having radiographic knee OA when the Kellgren/Lawrence grade was ≥2 in at least 1 knee. Symptomatic knee OA was recorded as present when knee pain was reported and the symptomatic knee had radiographic OA. We estimated the prevalence of these entities in elderly subjects in Beijing and compared it with OA prevalence in Framingham, using an age‐standardized prevalence ratio. Results Of 2,180 age‐eligible Beijing subjects contacted, knee radiographs were obtained in 1,787 (82.0%). The prevalence of radiographic knee OA was 42.8% in women and 21.5% in men. Symptomatic knee OA occurred in 15.0% of women and 5.6% of men. Compared with women of the same age in Framingham, women in Beijing had a higher prevalence of radiographic knee OA (prevalence ratio 1.45, 95% confidence interval 1.31–1.60) and of symptomatic knee OA (prevalence ratio 1.43, 95% confidence interval 1.16–1.75). The prevalence of knee OA in Chinese men was similar to that in their white US counterparts (for radiographic OA, prevalence ratio 0.90; for symptomatic OA, prevalence ratio 1.02). Conclusion Using identical methods and definitions to evaluate the prevalence of OA across populations, we found, surprisingly, that older Chinese women have a higher prevalence of knee OA than women in Framingham, Massachusetts. The prevalence in men was comparable. Possible explanations for these differences range from genetic differences to heavy physical activity among Chinese.

Objective To determine how physical activity at various ages over the life course is associated with cognitive impairment in late life. Design Cross-sectional study Setting Four US sites. Participants We administered a modified Mini-Mental State Examination (mMMSE) to 9344 women ≥65 years (mean 71.6 years) who self-reported teenage, age 30, age 50, and late life physical activity. Measurements We used logistic regressions to determine the association between physical activity status at each age and likelihood of cognitive impairment (mMMSE score >1.5SD below the mean, mMMSE≤22). Models were adjusted for age, education, marital status, diabetes, hypertension, depressive symptoms, smoking, and body mass index. Results Women who reported being physically active had lower prevalence of cognitive impairment in late life compared to women who were inactive at each time (teenage: 8.5% vs. 16.7%; adjusted Odds Ratio (95% Confidence Interval): 0.65 (0.53–0.80); age 30: 8.9% vs. 12.0%; 0.80 (0.67–0.96); age 50: 8.5% vs. 13.1%; 0.71 (0.59–0.85); old age: 8.2% vs. 15.9%; 0.74 (0.61–0.91)). When the four times were analyzed together, teenage physical activity was most strongly associated with lower odds of late-life cognitive impairment (OR=0.73 (0.58–0.92)). However, women who were physically inactive at teenage and became active in later life had lower risk than those who remained inactive. Conclusions Women who reported being physically active at any point over the life course, and especially at teenage, have lower likelihood of cognitive impairment in late life. Interventions should promote physical activity early in life and throughout the life course.

Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.

Context It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively.Objective To examine the association between bone mineral density (BMD) and hightrauma fracture and between high-trauma fracture and subsequent fracture in older women and men.Design, Setting, and Participants Two prospective US cohort studies in communitydwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007).Main Outcome Measures Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma).Results Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men (high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34% (95% CI, 7%-67%) greater among women with an initial high-trauma fracture and 31% (95% CI, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high-or lowtrauma fracture, respectively. Risk of subsequent fracture was not modeled for men.Conclusions Similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies.

Our findings support the hypothesis that higher levels of bioavailable testosterone, but not of bioavailable estradiol, are associated with better cognitive function in older men. In addition, bioavailable measures of testosterone may better reflect hormone levels available to the brain and thus be more closely associated with central nervous system outcomes such as cognition. Future studies, especially randomized trials, should be undertaken to determine whether testosterone may protect against cognitive decline in older men.

Background: An increased rate of hip fractures has been reported in patients with end-stage renal disease, but the effect of less severe renal dysfunction on fracture risk is uncertain. Methods: We conducted a case-cohort study within a cohort of 9704 women 65 years or older to compare baseline renal function (estimated glomerular filtration rate [eGFR] using the Cockcroft-Gault equation) in 149 women who subsequently had hip fractures and 150 women who subsequently had vertebral fractures with eGRF in 396 randomly selected women. Results: In models adjusted for age, weight, and calcaneal bone density, decreasing eGFR was associated with increased risk of hip fracture. Compared with women with an eGFR 60 mL/min per 1.73 m 2 or greater, the hazard ratio (95% confidence interval [CI]) for hip fracture was 1.57 (95% CI, 0.89-2.76) in those with an eGFR 45 to 59 mL/min per 1.73 m 2 and 2.32 (95% CI, 1.15-4.68) in those with an eGFR less than 45 mL/min per 1.73 m 2 (P for trend=.02). In particular, women with a reduced eGFR were at increased risk of trochanteric hip fracture (adjusted hazard ratio, 3.93 [95% CI, 1.37-11.30] in women with an eGFR 45-59 mL/min per 1.73 m 2 and 7.17 [95% CI, 1.93-26.67] in women with an eGFR Ͻ45 mL/min per 1.73 m 2 ; P for trend=.004). Renal function was not independently associated with risk of vertebral fracture (adjusted odds ratio, 1.08 [95% CI, 0.61-1.92] in women with an eGFR 45-59 mL/min per 1.73 m 2 and 1.33 [95% CI, 0.63-2.80] in women with an eGFR Ͻ45 mL/min per 1.73 m 2 ; P for trend=.47). Conclusion: Older women with moderate renal dysfunction are at increased risk of hip fracture.

Patients with advanced frailty, with or without cognitive impairment, have an end-of-life functional course marked by slowly progressive functional deterioration, with only a slight acceleration in the trajectory of functional loss as death approaches. Patients with cognitive impairment have particularly high rates of functional impairment at the time of death. These results suggest that end-of-life care systems that are targeted toward patients with functional trajectories clearly suggesting impending death (such as the Medicare hospice benefit) are poorly suited to older people dying with progressive frailty.