Impact of dementia and mild cognitive impairment on bone health in older people

doi:10.1007/s40520-024-02871-y

Review

. 2024 Dec 27;37(1):5.

doi: 10.1007/s40520-024-02871-y.

Impact of dementia and mild cognitive impairment on bone health in older people

Elizabeth M Curtis^#^{1

2}, Mario Miguel^#³, Claire McEvoy⁴, Andrea Ticinesi^{5

6}, Carla Torre^{7

8}, Nasser Al-Daghri⁹, Majed Alokail¹⁰, Ewa Bałkowiec-Iskra^{11

12}, Olivier Bruyère^{13

14}, Nansa Burlet¹⁵, Etienne Cavalier¹⁶, Francesca Cerreta¹⁷, Patricia Clark¹⁸, Antonio Cherubini^{19

20}, Cyrus Cooper^{1

2}, Patrizia D'Amelio²¹, Nicholas Fuggle^{1

2}, Celia Gregson^{22

23}, Philippe Halbout²⁴, John A Kanis^{25

26}, Jean Kaufman²⁷, Andrea Laslop²⁸, Stefania Maggi²⁹, Andrea Maier^{30

31}, Radmila Matijevic³², Eugene McCloskey^{33

34}, Sif Ormarsdóttir³⁵, Concha Prieto Yerro³⁶, Régis P Radermecker³⁷, Yves Rolland³⁸, Andrea Singer³⁹, Nicola Veronese⁴⁰, René Rizzoli⁴¹, Jean-Yves Reginster^#⁴², Nicholas C Harvey^#^{43

44}

Affiliations

¹ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
² NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK.
³ Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
⁴ Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
⁵ Department of Medicine and Surgery, University of Parma, Parma, Italy.
⁶ Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy.
⁷ Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
⁸ Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
⁹ Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
¹⁰ Biochemistry Department, College of Science, KSU, Riyadh, Kingdom of Saudi Arabia.
¹¹ Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
¹² The Office for Registration of Medicinal Products, Medical Devices and Biocidal Products & CHMP, SAWP, CNSWP, PCWP, ETF (European Medicines Agency) Member, Warsaw, Poland.
¹³ Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁴ Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium.
¹⁵ Research Unit in Epidemiology, University of Liege, Liège, Belgium.
¹⁶ Department of Clinical Chemistry, CIRM, University of Liège, CHU de Liège, Liège, Belgium.
¹⁷ Digital Health and Geriatrics, European Medicines Agency, Amsterdam, The Netherlands.
¹⁸ Clinical Epidemiology Unit, Hospital Infantil Federico Gómez-Facultad de Medicina, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
¹⁹ Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA Istituto Nazionale di Ricovero e Cura per Anziani, Ancona, Italy.
²⁰ Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
²¹ Department of Medicine, Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital, University of Lausanne, Lausanne, Switzerland.
²² Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
²³ The Health Research Unit of Zimbabwe (THRU ZIM), The Biomedical Research and Training Institute, Harare, Zimbabwe.
²⁴ International Osteoporosis Foundation, Nyon, Switzerland.
²⁵ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
²⁶ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
²⁷ Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
²⁸ Scientific Office, Austrian Medicines and Medical Devices Agency, Vienna, Austria.
²⁹ CNR Aging Branch-IN, Padua, Italy.
³⁰ Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore.
³¹ Department of Human Movement Sciences, at AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
³² Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia.
³³ Mellanby Centre for Musculoskeletal Research, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
³⁴ MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
³⁵ Medicine Assessment and Licencing, Icelandic Medicines Agency, Reykjavik, Iceland.
³⁶ Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain.
³⁷ Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium.
³⁸ HealthAge, CHU Toulouse, CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France.
³⁹ Departments of Obstetrics & Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
⁴⁰ Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy.
⁴¹ Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
⁴² Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
⁴³ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk.
⁴⁴ NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk.

^# Contributed equally.

PMID: 39725855
PMCID: PMC11671436
DOI: 10.1007/s40520-024-02871-y

Review

Impact of dementia and mild cognitive impairment on bone health in older people

Elizabeth M Curtis et al. Aging Clin Exp Res. 2024.

. 2024 Dec 27;37(1):5.

doi: 10.1007/s40520-024-02871-y.

Authors

Affiliations

¹ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
² NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK.
³ Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
⁴ Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
⁵ Department of Medicine and Surgery, University of Parma, Parma, Italy.
⁶ Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy.
⁷ Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
⁸ Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
⁹ Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
¹⁰ Biochemistry Department, College of Science, KSU, Riyadh, Kingdom of Saudi Arabia.
¹¹ Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
¹² The Office for Registration of Medicinal Products, Medical Devices and Biocidal Products & CHMP, SAWP, CNSWP, PCWP, ETF (European Medicines Agency) Member, Warsaw, Poland.
¹³ Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁴ Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium.
¹⁵ Research Unit in Epidemiology, University of Liege, Liège, Belgium.
¹⁶ Department of Clinical Chemistry, CIRM, University of Liège, CHU de Liège, Liège, Belgium.
¹⁷ Digital Health and Geriatrics, European Medicines Agency, Amsterdam, The Netherlands.
¹⁸ Clinical Epidemiology Unit, Hospital Infantil Federico Gómez-Facultad de Medicina, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
¹⁹ Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA Istituto Nazionale di Ricovero e Cura per Anziani, Ancona, Italy.
²⁰ Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
²¹ Department of Medicine, Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital, University of Lausanne, Lausanne, Switzerland.
²² Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
²³ The Health Research Unit of Zimbabwe (THRU ZIM), The Biomedical Research and Training Institute, Harare, Zimbabwe.
²⁴ International Osteoporosis Foundation, Nyon, Switzerland.
²⁵ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
²⁶ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
²⁷ Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
²⁸ Scientific Office, Austrian Medicines and Medical Devices Agency, Vienna, Austria.
²⁹ CNR Aging Branch-IN, Padua, Italy.
³⁰ Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore.
³¹ Department of Human Movement Sciences, at AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
³² Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia.
³³ Mellanby Centre for Musculoskeletal Research, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
³⁴ MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
³⁵ Medicine Assessment and Licencing, Icelandic Medicines Agency, Reykjavik, Iceland.
³⁶ Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain.
³⁷ Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium.
³⁸ HealthAge, CHU Toulouse, CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France.
³⁹ Departments of Obstetrics & Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
⁴⁰ Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy.
⁴¹ Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
⁴² Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
⁴³ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk.
⁴⁴ NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK. nch@mrc.soton.ac.uk.

^# Contributed equally.

PMID: 39725855
PMCID: PMC11671436
DOI: 10.1007/s40520-024-02871-y

Abstract

Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly ageing global population, are increasing in prevalence. These conditions are closely associated, with shared risk factors, common underlying biological mechanisms and potential direct causal pathways. In this review, the epidemiological and mechanistic links between mild cognitive impairment, dementia and skeletal health are explored. Discussion will focus on how changes in brain and bone signalling can underly associations between these conditions, and will consider the molecular and cellular drivers in the context of inflammation and the gut microbiome. There is a complex interplay between nutritional changes, which may precede or follow the onset of mild cognitive impairment (MCI) or dementia, and bone health. Polypharmacy is common in patients with MCI or dementia, and there are difficult prescribing decisions to be made due to the elevated risk of falls associated with many drugs used for associated problems, which can consequently increase fracture risk. Some medications prescribed for cognitive impairment may directly impact bone health. In addition, patients may have difficulty remembering medication without assistance, meaning that osteoporosis drugs may be prescribed but not taken. Cognitive impairment may be improved or delayed by physical activity and exercise, and there is evidence for the additional benefits of physical activity on falls and fractures. Research gaps and priorities with the aim of reducing the burden of osteoporosis and fractures in people with MCI or dementia will also be discussed.

Keywords: Bone mineral density; Cognitive impairment; Dementia; Epidemiology; Fracture; Osteoporosis.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Consents and ethical approval: This narrative article contains no original data and thus issues of ethics, informed consent and patient confidentiality do not apply.

Figures

**Fig. 1**
There are bidirectional relationships between cognitive impairment, dementia, fragility fractures and low BMD. Factors such as sedentary lifestyles, vitamin D deficiency and medication usage influencing both brain and bone health may contribute to the occurrence of falls, further complicating the interplay between falls, cognitive impairment and fractures. Modified from Ruggiero et al. Ageing Research Reviews 2024 [99] under the Creative Commons licence http://creativecommons.org/licenses/by/4.0/

**Fig. 2**
Dementia affects appetite regulation, nutritional intake and absorption. Created with Biorender

**Fig. 3**
Infographic regarding the effect of physical activity and exercise in people without cognitive impairment, in mild cognitive impairment and in dementia. Created with Biorender. This figure was reproduced from Veronese et al. European Geriatric Medicine (2023) [177] under the Creative Commons licence http://creativecommons.org/licenses/by/4.0/

See this image and copyright information in PMC

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Shrestha P, Basida B, Elam RE, Hajj JE, Le B, Fink HA, Bethel M, Tharrington SG, Carbone LD. Shrestha P, et al. Curr Osteoporos Rep. 2025 Jul 9;23(1):31. doi: 10.1007/s11914-025-00924-3. Curr Osteoporos Rep. 2025. PMID: 40634685 Review.

References

1. (2021) Decade of healthy ageing: baseline report. Summary. World Health Organization, Geneva. https://www.who.int/publications/i/item/9789240017900 Accessed 17 Oct 2024
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1. Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization. 2019
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1. American Psychiatric Association D-TF (2013) Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.): American Psychiatric Publishing, Inc

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[1] (2021) Decade of healthy ageing: baseline report. Summary. World Health Organization, Geneva. https://www.who.int/publications/i/item/9789240017900 Accessed 17 Oct 2024

[2] (2021) Decade of healthy ageing: baseline report. Summary. World Health Organization, Geneva. https://www.who.int/publications/i/item/9789240017900 Accessed 17 Oct 2024

[3] Global health estimates 2019: Life Expectancy 2000-2019. Geneva: World Health Organisation. https://www.who.int/data/global-health-estimates. Accessed 17 Oct 2024. 2020

[4] Global health estimates 2019: Life Expectancy 2000-2019. Geneva: World Health Organisation. https://www.who.int/data/global-health-estimates. Accessed 17 Oct 2024. 2020

[5] Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization. 2019

[6] Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization. 2019

[7] Tavassoli N, de Souto BP, Berbon C et al (2022) Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study. Lancet Healthy Longev 3:e394–e404 - PubMed

[8] Tavassoli N, de Souto BP, Berbon C et al (2022) Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study. Lancet Healthy Longev 3:e394–e404 - PubMed

[9] American Psychiatric Association D-TF (2013) Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.): American Psychiatric Publishing, Inc

[10] American Psychiatric Association D-TF (2013) Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.): American Psychiatric Publishing, Inc

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Impact of dementia and mild cognitive impairment on bone health in older people

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Impact of dementia and mild cognitive impairment on bone health in older people

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