Geriatric Update May 11, 2026
The FRAX model defines fractures occurring at the hip, vertebrae, humerus, and forearm as major osteoporotic fractures (MOF). In 1,998 patients with major fracture, all anatomical fracture sites were associated with subsequent fracture risk, including nonMOF, which were associated with 69% higher subsequent fracture risk in women (HR: 1.69; 95% CI: 1.47-1.95) and two-fold higher in men (2.06; 1.52-2.80), similar to MOF. The risk of mortality increased incrementally from distal to proximal, vertebral and hip.
In a cohort study of 17,720 patients with CVD in each group, calcium-only supplementation was associated with an increased risk of recurrence of adverse CVD events (HR, 1.10 [95% CI, 1.07–1.14]) but calcium with vitamin D supplementation was not (HR, 0.97 [95% CI, 0.93–1.01]). This study did not control for inflammation, the culprit for atherosclerosis, and the HR is far below the 2.0 threshold for an observational study.
Patients on active long-term opioid treatment – defined as 90 days or longer – fell by nearly a quarter (24%) from about 5.6 million in 2015 to 4.2 million in 2023. The average age increased from 56 to 61, indicating that fewer young patients take long-term opioids.
An AI model learned from 50,595 quality-controlled eye fundus photographs from 27,214 disease-free adults and correctly identified patient age within 2.78 years. In a systemic disease cohort of 8467 individuals, the retinal age gap (predicted minus chronological age) is significantly higher in participants with diabetes, cardiac disease, or stroke, supporting the biological relevance of retinal age.
Eating >3 servings of refined grains (white rice, white pasta, white bread) per day is linked to a greater risk for adverse outcomes HR: 1.76 [95% CI: 1.30-2.39] in patients with heart failure (HF) when compared with diets favoring 3 vegetable servings a day HR: 0.77 [95% CI: 0.61-0.97] and legumes 1-3 servings a day HR: 0.80 [95% CI: 0.65-0.98]. The analysis is based on 3,798 participants from 25 countries enrolled in the multinational G-CHF (Global Congestive Heart Failure) registry with dietary data collected through food frequency questionnaires.
The American Heart Association has issued 9 recommendations in the 2026 Dietary Guidance to Improve Cardiovascular Health:
Adjusting energy intake and expenditure to achieve and maintain a healthy body weight
Eating plenty of vegetables and fruits and choosing a wide variety
Choosing foods made mostly with whole grains rather than refined grains
Choosing healthy sources of protein
Choosing sources of unsaturated fats in place of sources of saturated fat
Choosing minimally processed foods instead of ultra-processed foods
Minimizing intake of added sugars in beverages and foods
Reducing sodium intake by choosing foods low in sodium and preparing foods with minimal or no salt
Limiting intake if alcohol is consumed; not starting if alcohol is not consumed.
Men who started out with higher sodium intake had a faster decline in their episodic recall (false discovery rate adjusted risk ratio p = 0.044). This was based on self-reported baseline sodium intake and cognitive decline over 6 years of 1208 cognitively unimpaired participants, age 71 years, from the Australian Imaging, Biomarkers and Lifestyle study. Other aspects of memory did not show an association, neither did it in women, who had significantly lower salt intake. While the study controlled for age, education, and APOE ε4, it did not control for alcohol intake, body weight, or inflammation. While this is a weak study, it is easy to cut down on salt intake and we should for many reasons.
Curcumin gel topically showed greater improvement in scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale over 28 days than did placebo use (mean increase, 9.09 vs 3.97 points). 39.3% of participants reported feeling either much or very much improved, compared with 13.3% in the placebo group (p = 0.019). While the effect size is small, the side effects are low, including skin staining, and this expands our armamentarium for arthritis pain management.
The aldosterone synthase inhibitors Baxdrostat and Lorundrostat significantly reduced systolic blood pressure (SBP) (Baxdrostat: MD -8.81 mmHg, 95% CI -10.94 to -6.67; Lorundrostat: MD -8.42 mmHg, 95% CI -11.05 to -5.78) and diastolic BP, while Osilodrostat did not show a significant difference in 2725 patients from six RCTs with resistant hypertension.
Screening older adults >65 for dementia in primary care did not improve or worsen their family members’ quality of life or psychological well-being over 24 months.
Longer daytime nap duration (adjusted hazard ratio [AHR] per 1-hour increase, 1.13; 95% CI, 1.04-1.23; P = .005) and higher nap frequency (AHR per additional daily nap, 1.07; 95% CI, 1.02-1.13; P = .003) at baseline were associated with increased mortality after adjusting for all covariates. This prospective cohort study was based on 10 days of actigraphy device worn by 1338 participants, followed over 7.5 years. While this difference is statistically significant, the AHRs are small, do not pass the HR >2 for an observational study, and I feel are not clinically significant.
Patients with short sleep duration (<6 h) or poor sleep quality lost on average 4.5 kg less weight than normal-duration sleepers 6.7 kg vs. 2.2 kg and were associated with smaller increases in physical activity. The study did not differentiate those with sleep apnea and / or CPAP users.
In 104 adults with moderate-to-severe obstructive sleep apnea (OSA), 58.2% of patients randomized to proximal hypoglossal nerve stimulation (pHGNS) had >50% improvement from baseline in the apnea-hypopnea index [AHI], AHI below 20 events/hour, and oxygen desaturation index (OSI) reduction >25% in 68.7% of patients. This was vs 13.5% of patients for AHI and 37.8% for OSI in those who had the device implanted but not turned on until after 7 months of the study.
Aging does not inevitably bring cognitive and functional decline, and 45.15% of 11,314 US participants aged >65 years showed cognitive and physical improvement over up to 12 years of follow-up. The analysis also found that holding positive beliefs about aging was associated with a greater likelihood of those improvements.
High-intensity multidomain lifestyle intervention (increased physical and cognitive activity, healthy nutrition, social engagement, and cardiovascular health monitoring) did not affect brain biomarker trajectories and was not associated with Aβ pathology over 2 years. However, older adults avg age 68.4 with specific at-risk brain characteristics, including those with lower baseline hippocampal volume, showed greater cognitive benefit.
In patients with locally advanced prostate cancer, transdermal estradiol was noninferior to luteinizing hormone–releasing hormone agonists for 3-year metastasis-free survival, with a lower incidence of hot flashes but a higher incidence of gynecomastia.
To prevent one death from lung cancer 2,000 individuals would need to be screened with low-dose CT (LDCT) imaging over 1.78 years, but only 200 individuals over 8.87 years. For our older patients, life expectancy matters, also in light of a year of recovery from major lung cancer surgery, as I recently reported.
Even though lung cancer screening uptake with low-dose CT increased from 2022 to 2024, it remains low in the US at 24.49% of eligible patients, with higher participation by older adults, 31.20% among those aged 75-79 years, and in those with military-related coverage vs. private insurance.
This podcast discusses the trillions of mutations each of our body’s cells produce per day that are kept in check by our amazing immune system, and that chemotherapy's “carpet bombing approach can promote resistance and deleterious mutations, leaving some cancer cells behind.”
The dismantling of environmental protections are a grave threat to America’s health because gas, oil and coal-fired power plants will emit large amounts of arsenic, mercury and benzene that have been shown to increase cancer, stroke, and heart attacks. The PM2.5 and ozone-generating emissions also increase cardiopulmonary morbidity such as asthma, COPD, and mortality as well as stillbirths and premature deliveries.
Of >1,500 biologists, chemists and other experts at the Environmental Protection Agency’s (EPA) that have been laid off, reassigned or pressured to retire, only 124 researchers remain.
In 1957, nearly one in 10 teenage girls gave birth. In 1969 President Nixon passed Title X to help give women access to affordable contraceptives and health care. Today, the teen pregnancy rate is closer to one in 100. For every dollar spent on family planning the government saves $7 in Medicaid costs, which affects the budget for older adults who cannot live by themselves, needing nursing home care, and who have spent their life’s savings on that care. In Project 2025, H.H.S. tells Title X clinics to emphasize “fertility-awareness-based methods," like tracking your periods or your body temperature to estimate which days you might be fertile, which can be helpful for getting pregnant, but not so for preventing pregnancy; they plan to defund Title X entirely.
We are what we repeatedly do. Excellence, then, is not an act but a habit. Aristotle
