Older first-time moms not at higher depression risk

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By Amy Norton

NEW YORK | Tue Oct 25, 2011 1:15pm EDT

NEW YORK (Reuters Health) - Women who have their first baby at an older age aren't at greater risk of postpartum depression, according to a new report that contradicts earlier concerns.

In a study of more than 500 first-time mothers, Australian researchers found that moms age 37 or older were no more likely to get postpartum depression than their younger counterparts -- whether they conceived naturally or had infertility treatment.

Overall, eight percent of the women had major depression symptoms four months after giving birth. That's at the lower end of what's seen among new mothers in general, the researchers say.

And they found no evidence that age itself affected a woman's risk of developing postpartum depression.

The idea that older first-time mothers might face a higher depression risk has been largely based on speculation and "popular culture anecdote," according to study leader Catherine A. McMahon, an associate professor of psychology at Macquarie University in Australia.

"Older mothers are frequently discussed in the media," McMahon noted in an email. "There are a lot of myths, and limited empirical data."

There's been some speculation, for instance, that older mothers might have a tougher time adjusting to motherhood -- after, presumably, being in the workforce for a long time. Or they might be more "set in their ways" than younger women, and have more difficulty dealing with the lifestyle changes that a baby brings.

But, McMahon said, "there is no research evidence to support these speculations."

On the other hand, it is known that older mothers have a higher risk of pregnancy complications, like high blood pressure and diabetes. And pregnancy complications, in turn, have been linked to postpartum depression risk.

For their study, reported in the journal Fertility and Sterility, McMahon's team followed 266 women who had conceived naturally and 275 who'd undergone fertility treatment. All of the women answered questionnaires during their third trimester, and had a diagnostic interview for depression when their babies were four months old.

Overall, 180 women were age 37 or older when they gave birth. And they were no more likely to develop postpartum depression than younger women were, the study found.

"The findings suggest that older first-time mothers are not at greater risk of postpartum depression, at least in the first four months after birth," McMahon said.

That, she added, highlights the importance of not "labeling" older moms as high-risk for depression -- something that, itself, could stress out a new mother.

Still, McMahon said that there are questions for future studies. One is whether going through menopause while caring for a young child presents challenges.

"There is considerable evidence that vulnerability to depression is greatest in mid-life for women," McMahon noted.

She said it would also be interesting to see how older mothers fare when they go back to work, since they may be more "emotionally committed" to their careers compared with younger mothers.

McMahon also pointed out that this study looked only at depression among women who successfully had a baby. She said there's a need for studies that look at the psychological well-being of women who put off having a baby, and then are unable to conceive.

SOURCE: bit.ly/vfffcx Fertility and Sterility, online September 30, 2011.

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For older women, year following hip fracture can be especially deadly

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Fractures appeared to be most dangerous in the youngest segment of study participants.Many hip fractures happen in postmenopausal women with osteoporosisStudy is first to suggest cause-and-effect relationship between hip fracture and deathSeventeen percent of the women who experienced a fracture died during the year

(Health.com) -- Women age 65 and older who fracture a hip are much more likely to die from any cause during the following year than they would be if they had avoided injury, a new study suggests.

The increased risk of death associated with hip fractures was especially dramatic among younger women. In the 65- to 69-year-old age group, the odds of death were five times higher for women in a post-fracture year than they were for non-injured women of the same age, the study found.

Many of the 300,000 hip fractures that occur each year in the United States happen in postmenopausal women with the bone-thinning disease osteoporosis, typically after a fall or other accident. Researchers have already established that these fractures increase the risk of death, but they haven't been able to rule out the possibility that women who fracture a hip are already at greater risk before their injury.

Health.com: How to fight osteoporosis

The new study, which carefully compared age-matched women with and without fractures, is the first to suggest a possible cause-and-effect relationship between hip fracture and death, says lead author Erin LeBlanc, M.D., a researcher at Kaiser Permanente Northwest, the large nonprofit health plan in Portland, Oregon, that funded the study.

"Before we might have assumed that sicker women are just more likely to get hip fractures," she says. "But now we know that there is something about the hip fracture itself, and not an underlying condition, that is bringing on this increased risk of death."

LeBlanc and her colleagues, whose findings appear in the Archives of Internal Medicine, tracked women in four states across the country between 1986 and 2005, as part of a larger study funded by the National Institutes of Health. From this pool of study participants, the researchers matched each of the 1,116 women who'd had hip fractures with four women of the same age who had not.

Health.com: Surprising facts about healthy bones

Overall, women who suffered a hip fracture had twice the odds of dying within one year of their injury than did their counterparts in the control group during the same year. Seventeen percent of the women who experienced a fracture died during the year, versus 8% in the control group. (In addition to matching the women by age, the researchers took into account body mass index, medical history, and several other risk factors for hip fracture.)

The top three causes of death -- heart disease, stroke, and sepsis -- were the same for both the fracture and control groups. But more than half of the deaths in the fracture group occurred within three months of the injury, and nearly three-quarters occurred within six months; this suggests that something about the surgery, hospital time, immobility, or rehabilitation required after a hip fracture makes women more vulnerable, says LeBlanc.

In an effort to separate out the effect of hip fractures from the underlying death risk associated with preexisting health problems, the researchers performed a more detailed analysis in women age 80 and up, a group that is generally sicker and more likely to die.

Hip fracture did not measurably increase the one-year odds of death in this age group as a whole, but it nearly tripled the odds among the subset of women who considered themselves to be in good or excellent health. The fact that hip fracture was linked to an increased risk of death only when illness was removed from the picture provides more evidence that fracture can be a cause of death, the researchers say.

Health.com: 10 ways to prevent falls at home

Fractures appeared to be most dangerous in the youngest segment of study participants: For women 65 to 69, hip fracture quintupled the odds of death within one year. This was also the only age group in which the odds of death remained higher in the fracture group after the one-year mark.

The findings in these relatively young women should be a wake-up call to physicians and patients alike, says Silvina Levis, M.D., director of the osteoporosis center at the University of Miami Miller School of Medicine.

"Many people assume that this increased mortality mostly applies to the very old," says Levis, who was not involved in the study. "But having seen this result, I think younger women are the ones who should be very much aware and should talk to their doctors about ways of assessing risk."

Women should have a bone-density test at age 65 (or younger if they have other osteoporosis risk factors), and those with low bone mass or osteoporosis may want to consider taking medications to reduce their risk of fractures, Levis says.

Health.com: 11 foods for healthy bones

LeBlanc says it's important for all postmenopausal women to get enough bone-strengthening calcium and vitamin D in their diet, avoid smoking and excessive alcohol intake, and assess their homes for hazards that could cause slips and falls. "Thinning of the bones is silent," she says. "It doesn't hurt, and if you're not proactive you might not know you have it until you break something."

These steps are especially important for a woman who has already had a fracture, LeBlanc adds, since she is at high risk for a second one.

Copyright Health Magazine 2010

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Novartis drug may help older breast cancer patients

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By Kate Kelland

STOCKHOLM | Sun Sep 25, 2011 11:20am EDT

STOCKHOLM (Reuters) - Novartis's bone drug Zometa extended survival in older breast cancer patients but failed to improve disease-free survival among younger women patients in a large-scale clinical trial, researchers said on Sunday.

Detailed data presented at the European Multidisciplinary Cancer Congress (EMCC) in Stockholm showed that Zometa, a bisphosphonate drug known generically as zoledronic acid, only improved overall survival rates in patients who had undergone the menopause at least five years earlier.

Researchers said the effect was likely to be linked to levels of reproductive hormones, which are lower in women who have been through the menopause.

"This is not a treatment for ever woman with breast cancer," said Robert Coleman of Britain's Sheffield University, who led the study. But for women with low levels of female hormones, either due to aging or specific treatments to induce menopause, Zometa "appears very promising."

An analysis of the subset of older patients showed that at a the five-year follow-up, there was a 26 percent reduction in recurrence of tumors, Coleman said, as well as a 26 percent reduction in the risk of an early death.

These strong results could lead to "a major new treatment approach" for post-menopausal patients, he said.

Zometa, which generated sales of $2.1 billion for Novartis in 2010, is an intravenous drug from a widely used class of osteoporosis medicines called bisphosphonates.

It is increasingly being prescribed to help reduce or delay fractures and other skeletal complications in a variety of cancers that have spread to the bones. From 65 to 75 percent of breast cancer recurrences occur in the bones.

This trial, called AZURE and also published in the New England Journal of Medicine on Sunday, involved 3,360 women with early-stage breast cancer from 174 centers in Britain, Australia, Spain, Ireland, Portugal, Taiwan and Thailand.

Patients randomly allocated receive standard chemotherapy and/or hormone therapy, either with or without the addition of Zometa, a drug that works by inhibiting the cells that break down bone, called osteoclasts.

The results showed that looking across all trial participants, there was no significant difference in disease-free survival or overall survival between patients who received Zometa and those who didn't. But in a subset of older patients, the addition of the Novartis drug did bring clear benefits.

These women, who had at least five years since their last period, had an overall survival rate at five years of 85 percent on Zometa compared with 79 percent for those not on the drug. For all other patients, overall five-year survival was similar, at 86 percent in the Zometa group and 85 percent in the control group.

Investigators said that most surprising among the findings was the drug's effect on the rate at which the cancer recurred outside the bone. The relative risk for developing metastases, or secondary tumors, outside bone during treatment with Zometa was approximately halved in the postmenopausal women compared with the younger patients.

Coleman said the results shed new light on the role bones may play in the progress of the disease.

"The effects on metastasis and recurrence outside bone suggests that the bone marrow is an important sanctuary for tumor cells which can be activated after, sometimes, many years of dormancy," he said. "With help from bone marrow stem cells, they may then spread via the blood stream to set up metastases at other sites."

(Editing by Will Waterman)

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