Osteoarthritis

WASHINGTON — With elderly patients taking more medications than ever before, convenient bisphosphonate regimen options may help reduce the overall medication burden and improve compliance with the osteoporosis therapy, suggest findings from a recent study of prescription trends.

In an investigation of prescription data for 250,286 postmenopausal women, about 65% of those prescribed daily or weekly bisphosphonates were also prescribed one to three concomitant medications, Deborah T. Gold, Ph.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

What's more, 12% of the study population received four concomitant medications, 7% received five, and 17% received six or more. On average, the women were taking more than three concomitant medications, a burden shown to increase the risk of noncompliance in elderly patients (Arthritis Rheum. 2004;15[Suppl.]:S513).

Compliance is a significant problem with bisphosphonate therapy, in part because the strict fasting and administration requirements of the osteoporosis drugs can conflict with those of other medications.

Dr. Gold of Duke University, Durham, North Carolina, and colleagues analyzed information from a longitudinal patient database to determine the degree of concomitant medication use among women prescribed bisphosphonates.

Overall, the mean number of concomitant medications among women who received daily bisphosphonates increased from 3.1 in November 1999 to 4.2 in June 2004.

The number of prescribed concomitant medications increased with patient age, from 2.7 to 3.2 among women aged 50–64 years, compared with 3.2 to 4.0 among women aged 75 years and older.

The most common medications prescribed in conjunction with bisphosphonates were levothyroxine, atorvastatin, atenolol, furosemide, amlodipine, potassium chloride, hydrochlorothiazide, lisinopril, celecoxib, and simvastatin.

WASHINGTON — With elderly patients taking more medications than ever before, convenient bisphosphonate regimen options may help reduce the overall medication burden and improve compliance with the osteoporosis therapy, suggest findings from a recent study of prescription trends.

In an investigation of prescription data for 250,286 postmenopausal women, about 65% of those prescribed daily or weekly bisphosphonates were also prescribed one to three concomitant medications, Deborah T. Gold, Ph.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

What's more, 12% of the study population received four concomitant medications, 7% received five, and 17% received six or more. On average, the women were taking more than three concomitant medications, a burden shown to increase the risk of noncompliance in elderly patients (Arthritis Rheum. 2004;15[Suppl.]:S513).

Compliance is a significant problem with bisphosphonate therapy, in part because the strict fasting and administration requirements of the osteoporosis drugs can conflict with those of other medications.

Dr. Gold of Duke University, Durham, North Carolina, and colleagues analyzed information from a longitudinal patient database to determine the degree of concomitant medication use among women prescribed bisphosphonates.

Overall, the mean number of concomitant medications among women who received daily bisphosphonates increased from 3.1 in November 1999 to 4.2 in June 2004.

The number of prescribed concomitant medications increased with patient age, from 2.7 to 3.2 among women aged 50–64 years, compared with 3.2 to 4.0 among women aged 75 years and older.

The most common medications prescribed in conjunction with bisphosphonates were levothyroxine, atorvastatin, atenolol, furosemide, amlodipine, potassium chloride, hydrochlorothiazide, lisinopril, celecoxib, and simvastatin.

WASHINGTON — With elderly patients taking more medications than ever before, convenient bisphosphonate regimen options may help reduce the overall medication burden and improve compliance with the osteoporosis therapy, suggest findings from a recent study of prescription trends.

In an investigation of prescription data for 250,286 postmenopausal women, about 65% of those prescribed daily or weekly bisphosphonates were also prescribed one to three concomitant medications, Deborah T. Gold, Ph.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

What's more, 12% of the study population received four concomitant medications, 7% received five, and 17% received six or more. On average, the women were taking more than three concomitant medications, a burden shown to increase the risk of noncompliance in elderly patients (Arthritis Rheum. 2004;15[Suppl.]:S513).

Compliance is a significant problem with bisphosphonate therapy, in part because the strict fasting and administration requirements of the osteoporosis drugs can conflict with those of other medications.

Dr. Gold of Duke University, Durham, North Carolina, and colleagues analyzed information from a longitudinal patient database to determine the degree of concomitant medication use among women prescribed bisphosphonates.

Overall, the mean number of concomitant medications among women who received daily bisphosphonates increased from 3.1 in November 1999 to 4.2 in June 2004.

The number of prescribed concomitant medications increased with patient age, from 2.7 to 3.2 among women aged 50–64 years, compared with 3.2 to 4.0 among women aged 75 years and older.

The most common medications prescribed in conjunction with bisphosphonates were levothyroxine, atorvastatin, atenolol, furosemide, amlodipine, potassium chloride, hydrochlorothiazide, lisinopril, celecoxib, and simvastatin.

Calcium and vitamin D supplements do not appear to reduce the risk of fractures among older, community-dwelling women, according to David J. Torgerson, Ph.D., of the University of York (England), and his colleagues.

Although supplementation with calcium and vitamin D are routinely recommended for fracture prevention in the elderly, this is the second study to recently call this practice into question.

Results from a secondary prevention trial, also in the United Kingdom, failed to show any benefit of calcium or vitamin D, either alone or in combination, in preventing fractures (Lancet 2005;365:1621–8).

Dr. Torgerson's study randomly assigned 1,321 women to receive 1,000 mg calcium plus 800 IU cholecalciferol (vitamin D3) daily and a leaflet on calcium intake and prevention of falls, and 1,993 women were given the leaflet only.

The women were aged 70 years or older, and had one or more risk factors for hip fracture (BMJ 2005;330:1003).

Over an average follow-up of 25 months, there were 149 clinical fractures, which was lower than expected. But the difference in fracture rates between the supplemented group and the control group was not significant (58 vs. 91). In the supplemented group, the odds ratio was 1.01 for all fractures and 0.75 for hip fractures.

There was no evidence that vitamin D supplementation reduced the incidence of falls, as previously hypothesized. A recent metaanalysis found a 22% reduction in falls in the elderly with vitamin D supplementation (JAMA 2004;291:1999–2006).

Calcium and vitamin D supplements have been shown to reduce hip fractures among women living in nursing homes. “People living in sheltered accommodation or nursing homes may be at more risk of a low calcium and vitamin D intake and at higher risk of fracture,” the authors suggest. Limitations of the study were that it lacked a placebo preparation, was underpowered, and had relatively wide confidence intervals, the authors noted.

Calcium and vitamin D supplements do not appear to reduce the risk of fractures among older, community-dwelling women, according to David J. Torgerson, Ph.D., of the University of York (England), and his colleagues.

Although supplementation with calcium and vitamin D are routinely recommended for fracture prevention in the elderly, this is the second study to recently call this practice into question.

Results from a secondary prevention trial, also in the United Kingdom, failed to show any benefit of calcium or vitamin D, either alone or in combination, in preventing fractures (Lancet 2005;365:1621–8).

Dr. Torgerson's study randomly assigned 1,321 women to receive 1,000 mg calcium plus 800 IU cholecalciferol (vitamin D3) daily and a leaflet on calcium intake and prevention of falls, and 1,993 women were given the leaflet only.

The women were aged 70 years or older, and had one or more risk factors for hip fracture (BMJ 2005;330:1003).

Over an average follow-up of 25 months, there were 149 clinical fractures, which was lower than expected. But the difference in fracture rates between the supplemented group and the control group was not significant (58 vs. 91). In the supplemented group, the odds ratio was 1.01 for all fractures and 0.75 for hip fractures.

There was no evidence that vitamin D supplementation reduced the incidence of falls, as previously hypothesized. A recent metaanalysis found a 22% reduction in falls in the elderly with vitamin D supplementation (JAMA 2004;291:1999–2006).

Calcium and vitamin D supplements have been shown to reduce hip fractures among women living in nursing homes. “People living in sheltered accommodation or nursing homes may be at more risk of a low calcium and vitamin D intake and at higher risk of fracture,” the authors suggest. Limitations of the study were that it lacked a placebo preparation, was underpowered, and had relatively wide confidence intervals, the authors noted.

Calcium and vitamin D supplements do not appear to reduce the risk of fractures among older, community-dwelling women, according to David J. Torgerson, Ph.D., of the University of York (England), and his colleagues.

Although supplementation with calcium and vitamin D are routinely recommended for fracture prevention in the elderly, this is the second study to recently call this practice into question.

Results from a secondary prevention trial, also in the United Kingdom, failed to show any benefit of calcium or vitamin D, either alone or in combination, in preventing fractures (Lancet 2005;365:1621–8).

Dr. Torgerson's study randomly assigned 1,321 women to receive 1,000 mg calcium plus 800 IU cholecalciferol (vitamin D3) daily and a leaflet on calcium intake and prevention of falls, and 1,993 women were given the leaflet only.

The women were aged 70 years or older, and had one or more risk factors for hip fracture (BMJ 2005;330:1003).

Over an average follow-up of 25 months, there were 149 clinical fractures, which was lower than expected. But the difference in fracture rates between the supplemented group and the control group was not significant (58 vs. 91). In the supplemented group, the odds ratio was 1.01 for all fractures and 0.75 for hip fractures.

There was no evidence that vitamin D supplementation reduced the incidence of falls, as previously hypothesized. A recent metaanalysis found a 22% reduction in falls in the elderly with vitamin D supplementation (JAMA 2004;291:1999–2006).

Calcium and vitamin D supplements have been shown to reduce hip fractures among women living in nursing homes. “People living in sheltered accommodation or nursing homes may be at more risk of a low calcium and vitamin D intake and at higher risk of fracture,” the authors suggest. Limitations of the study were that it lacked a placebo preparation, was underpowered, and had relatively wide confidence intervals, the authors noted.

WASHINGTON — The severity of vertebral fractures increases significantly in patients whose trabecular bone volume falls below the critical value of 15%, Harry K. Genant, M.D., said in his oral presentation of a poster at an international symposium sponsored by the National Osteoporosis Foundation.

Dr. Genant, a member of the Osteoporosis and Arthritis Research Group at the University of California, San Francisco, and his colleagues assessed the bone quality of 190 postmenopausal women, mean age 69 years, using radiographic data from 2-D histomorphometry and 3-D microCT.

The women were categorized into four groups based on varying severity of vertebral fractures, with 0 meaning “no fracture,” and 1, 2, and 3, relating to mild, moderate, and severe fracture levels, respectively.

Based on the radiographic data, patients in the moderate and severe fracture groups had significantly reduced 2-dimensional trabecular bone volumes (0.15 and 0.13, respectively), compared with patients who had no fractures (0.20). On further analysis of the radiographs, the researchers found that as the severity of vertebral fractures grew worse, patients had progressively worse bone quality based on measurements including trabecular separation, trabecular number, and 3-dimensional trabecular bone volume.

These results are consistent with earlier findings that patients are at significantly increased risk of fracture when the trabecular bone volume falls below approximately 15%. Dr. Genant has received grants and research support, as well as an honorarium, from Eli Lilly & Co.

WASHINGTON — The severity of vertebral fractures increases significantly in patients whose trabecular bone volume falls below the critical value of 15%, Harry K. Genant, M.D., said in his oral presentation of a poster at an international symposium sponsored by the National Osteoporosis Foundation.

Dr. Genant, a member of the Osteoporosis and Arthritis Research Group at the University of California, San Francisco, and his colleagues assessed the bone quality of 190 postmenopausal women, mean age 69 years, using radiographic data from 2-D histomorphometry and 3-D microCT.

The women were categorized into four groups based on varying severity of vertebral fractures, with 0 meaning “no fracture,” and 1, 2, and 3, relating to mild, moderate, and severe fracture levels, respectively.

Based on the radiographic data, patients in the moderate and severe fracture groups had significantly reduced 2-dimensional trabecular bone volumes (0.15 and 0.13, respectively), compared with patients who had no fractures (0.20). On further analysis of the radiographs, the researchers found that as the severity of vertebral fractures grew worse, patients had progressively worse bone quality based on measurements including trabecular separation, trabecular number, and 3-dimensional trabecular bone volume.

These results are consistent with earlier findings that patients are at significantly increased risk of fracture when the trabecular bone volume falls below approximately 15%. Dr. Genant has received grants and research support, as well as an honorarium, from Eli Lilly & Co.

WASHINGTON — The severity of vertebral fractures increases significantly in patients whose trabecular bone volume falls below the critical value of 15%, Harry K. Genant, M.D., said in his oral presentation of a poster at an international symposium sponsored by the National Osteoporosis Foundation.

Dr. Genant, a member of the Osteoporosis and Arthritis Research Group at the University of California, San Francisco, and his colleagues assessed the bone quality of 190 postmenopausal women, mean age 69 years, using radiographic data from 2-D histomorphometry and 3-D microCT.

The women were categorized into four groups based on varying severity of vertebral fractures, with 0 meaning “no fracture,” and 1, 2, and 3, relating to mild, moderate, and severe fracture levels, respectively.

Based on the radiographic data, patients in the moderate and severe fracture groups had significantly reduced 2-dimensional trabecular bone volumes (0.15 and 0.13, respectively), compared with patients who had no fractures (0.20). On further analysis of the radiographs, the researchers found that as the severity of vertebral fractures grew worse, patients had progressively worse bone quality based on measurements including trabecular separation, trabecular number, and 3-dimensional trabecular bone volume.

These results are consistent with earlier findings that patients are at significantly increased risk of fracture when the trabecular bone volume falls below approximately 15%. Dr. Genant has received grants and research support, as well as an honorarium, from Eli Lilly & Co.

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

BETHESDA, MD. — Among the many novel technologies cropping up to help analyze bone quality noninvasively, near-infrared spectroscopy may eventually prove to be quite useful, according to results from a preliminary study.

In an investigation that involved mice as subjects, the near-infrared spectroscopy technique has been shown to detect differences in mineralization of those with and without a mutation that models type III osteogenesis imperfecta, Guiyang Li, Ph.D., reported at a meeting on bone quality.

Dual x-ray absorptiometry scans are limited in that they cannot obtain “information on molecular structure of bone and its primary components—hydroxyapatite mineral and collagen,” explained Dr. Li, of the musculoskeletal imaging and spectroscopy laboratory at the Hospital for Special Surgery in New York.

Near-infrared spectroscopy can penetrate millimeters to centimeters through the skin—farther than its close cousin, mid-infrared spectroscopy, which can only penetrate about 10 μm into skin, Dr. Li noted.

Mid-infrared spectroscopy has stronger absorbance bands than near infrared.

The relatively low intensity of near infrared absorbance necessitates the use of special modeling methods to analyze the resulting spectrum, he explained at the meeting, which was sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The meeting was cosponsored by the American Society for Bone and Mineral Research.

BETHESDA, MD. — Among the many novel technologies cropping up to help analyze bone quality noninvasively, near-infrared spectroscopy may eventually prove to be quite useful, according to results from a preliminary study.

In an investigation that involved mice as subjects, the near-infrared spectroscopy technique has been shown to detect differences in mineralization of those with and without a mutation that models type III osteogenesis imperfecta, Guiyang Li, Ph.D., reported at a meeting on bone quality.

Dual x-ray absorptiometry scans are limited in that they cannot obtain “information on molecular structure of bone and its primary components—hydroxyapatite mineral and collagen,” explained Dr. Li, of the musculoskeletal imaging and spectroscopy laboratory at the Hospital for Special Surgery in New York.

Near-infrared spectroscopy can penetrate millimeters to centimeters through the skin—farther than its close cousin, mid-infrared spectroscopy, which can only penetrate about 10 μm into skin, Dr. Li noted.

Mid-infrared spectroscopy has stronger absorbance bands than near infrared.

The relatively low intensity of near infrared absorbance necessitates the use of special modeling methods to analyze the resulting spectrum, he explained at the meeting, which was sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The meeting was cosponsored by the American Society for Bone and Mineral Research.

BETHESDA, MD. — Among the many novel technologies cropping up to help analyze bone quality noninvasively, near-infrared spectroscopy may eventually prove to be quite useful, according to results from a preliminary study.

In an investigation that involved mice as subjects, the near-infrared spectroscopy technique has been shown to detect differences in mineralization of those with and without a mutation that models type III osteogenesis imperfecta, Guiyang Li, Ph.D., reported at a meeting on bone quality.

Dual x-ray absorptiometry scans are limited in that they cannot obtain “information on molecular structure of bone and its primary components—hydroxyapatite mineral and collagen,” explained Dr. Li, of the musculoskeletal imaging and spectroscopy laboratory at the Hospital for Special Surgery in New York.

Near-infrared spectroscopy can penetrate millimeters to centimeters through the skin—farther than its close cousin, mid-infrared spectroscopy, which can only penetrate about 10 μm into skin, Dr. Li noted.

Mid-infrared spectroscopy has stronger absorbance bands than near infrared.

The relatively low intensity of near infrared absorbance necessitates the use of special modeling methods to analyze the resulting spectrum, he explained at the meeting, which was sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The meeting was cosponsored by the American Society for Bone and Mineral Research.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

BETHESDA, MD. — High-resolution peripheral quantitative CT appears to be a promising technology for identifying osteoporosis-related changes in bone microarchitecture, according to the results of a prospective study.

Data from the noninvasive technique suggest that the imaging procedure will provide new insight into the degradation of bone mineral architecture that occurs in osteoporosis, Stéphanie Boutroy, Ph.D., said at a meeting on bone quality.

Dr. Boutroy of France's National Institute of Health and Medical Research, Lyon, described her findings from an investigation of the scanning technique in 108 healthy premenopausal women (aged 19–45 years), 109 osteopenic, postmenopausal women (aged 52–88 years), and 33 osteoporotic, postmenopausal women (aged 61–84 years). The women were classified as osteopenic or osteoporotic based on bone mineral density (BMD) measures taken by dual x-ray absorptiometry of the femoral neck or spine.

Initially, eight healthy women underwent three separate scanning sessions within 1 month to determine the short-term reproducibility of the density and architecture parameters of the scanning protocol. Between the three sessions, trabecular and cortical volumetric BMD measurements varied by only 0.5%–1.3% in each of those eight patients. Similarly, trabecular architecture values varied by 0.9%–3.1% for each patient between sessions.

When Dr. Boutroy examined the relationship between volumetric BMD and architectural parameters, she found that total density, as expected, was strongly correlated to both trabecular and cortical density. Trabecular and cortical density were strongly correlated to trabecular architecture and cortical thickness, respectively.

At the distal radius, osteoporotic women had significantly lower total volumetric BMD and cortical thickness compared with osteopenic women. Likewise, osteoporotic women also had comparatively lower trabecular density, number, thickness, and separation. No differences could be found in cortical density or the distribution of trabeculae between the two groups, Dr. Boutroy said at the meeting, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Society for Bone and Mineral Research.

At the tibia, osteoporotic women had significantly lower measurements on all parameters (total volumetric BMD, cortical and trabecular density, and trabecular number, thickness, and separation) than osteopenic women. In addition, the osteopenic women had significantly lower values on all parameters compared with healthy, premenopausal women.

Dr. Boutroy has no financial interest in the companies that manufacture high-resolution peripheral quantitative CT devices.

BETHESDA, MD. — High-resolution peripheral quantitative CT appears to be a promising technology for identifying osteoporosis-related changes in bone microarchitecture, according to the results of a prospective study.

Data from the noninvasive technique suggest that the imaging procedure will provide new insight into the degradation of bone mineral architecture that occurs in osteoporosis, Stéphanie Boutroy, Ph.D., said at a meeting on bone quality.

Dr. Boutroy of France's National Institute of Health and Medical Research, Lyon, described her findings from an investigation of the scanning technique in 108 healthy premenopausal women (aged 19–45 years), 109 osteopenic, postmenopausal women (aged 52–88 years), and 33 osteoporotic, postmenopausal women (aged 61–84 years). The women were classified as osteopenic or osteoporotic based on bone mineral density (BMD) measures taken by dual x-ray absorptiometry of the femoral neck or spine.

Initially, eight healthy women underwent three separate scanning sessions within 1 month to determine the short-term reproducibility of the density and architecture parameters of the scanning protocol. Between the three sessions, trabecular and cortical volumetric BMD measurements varied by only 0.5%–1.3% in each of those eight patients. Similarly, trabecular architecture values varied by 0.9%–3.1% for each patient between sessions.

When Dr. Boutroy examined the relationship between volumetric BMD and architectural parameters, she found that total density, as expected, was strongly correlated to both trabecular and cortical density. Trabecular and cortical density were strongly correlated to trabecular architecture and cortical thickness, respectively.

At the distal radius, osteoporotic women had significantly lower total volumetric BMD and cortical thickness compared with osteopenic women. Likewise, osteoporotic women also had comparatively lower trabecular density, number, thickness, and separation. No differences could be found in cortical density or the distribution of trabeculae between the two groups, Dr. Boutroy said at the meeting, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Society for Bone and Mineral Research.

At the tibia, osteoporotic women had significantly lower measurements on all parameters (total volumetric BMD, cortical and trabecular density, and trabecular number, thickness, and separation) than osteopenic women. In addition, the osteopenic women had significantly lower values on all parameters compared with healthy, premenopausal women.

Dr. Boutroy has no financial interest in the companies that manufacture high-resolution peripheral quantitative CT devices.

BETHESDA, MD. — High-resolution peripheral quantitative CT appears to be a promising technology for identifying osteoporosis-related changes in bone microarchitecture, according to the results of a prospective study.

Data from the noninvasive technique suggest that the imaging procedure will provide new insight into the degradation of bone mineral architecture that occurs in osteoporosis, Stéphanie Boutroy, Ph.D., said at a meeting on bone quality.

Dr. Boutroy of France's National Institute of Health and Medical Research, Lyon, described her findings from an investigation of the scanning technique in 108 healthy premenopausal women (aged 19–45 years), 109 osteopenic, postmenopausal women (aged 52–88 years), and 33 osteoporotic, postmenopausal women (aged 61–84 years). The women were classified as osteopenic or osteoporotic based on bone mineral density (BMD) measures taken by dual x-ray absorptiometry of the femoral neck or spine.

Initially, eight healthy women underwent three separate scanning sessions within 1 month to determine the short-term reproducibility of the density and architecture parameters of the scanning protocol. Between the three sessions, trabecular and cortical volumetric BMD measurements varied by only 0.5%–1.3% in each of those eight patients. Similarly, trabecular architecture values varied by 0.9%–3.1% for each patient between sessions.

When Dr. Boutroy examined the relationship between volumetric BMD and architectural parameters, she found that total density, as expected, was strongly correlated to both trabecular and cortical density. Trabecular and cortical density were strongly correlated to trabecular architecture and cortical thickness, respectively.

At the distal radius, osteoporotic women had significantly lower total volumetric BMD and cortical thickness compared with osteopenic women. Likewise, osteoporotic women also had comparatively lower trabecular density, number, thickness, and separation. No differences could be found in cortical density or the distribution of trabeculae between the two groups, Dr. Boutroy said at the meeting, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Society for Bone and Mineral Research.

At the tibia, osteoporotic women had significantly lower measurements on all parameters (total volumetric BMD, cortical and trabecular density, and trabecular number, thickness, and separation) than osteopenic women. In addition, the osteopenic women had significantly lower values on all parameters compared with healthy, premenopausal women.

Dr. Boutroy has no financial interest in the companies that manufacture high-resolution peripheral quantitative CT devices.

A once-monthly formulation of the bisphosphonate ibandronate was recently approved by the Food and Drug Administration for treating postmenopausal osteoporosis, 2 years after a daily formulation of the drug was approved but never marketed.

Ibandronate, which is being marketed as Boniva by Roche, is the third oral bisphosphonate and the first monthly formulation marketed in the United States for osteoporosis. It was approved in late March.

A 2.5-mg daily formulation was approved in 2003, based on a 3-year study that showed a reduction in vertebral fracture risk, but it was never marketed because of the availability of the more convenient, weekly bisphosphonate formulations, alendronate (Fosamax) and risedronate (Actonel).

Approval of the once-monthly 150-mg formulation of ibandronate was based on a 1-year noninferiority study of 1,602 postmenopausal women. The study showed that bone mineral density (BMD) increases in the lumbar spine in patients on monthly ibandronate were significantly higher than in those on 2.5 mg of ibandronate daily (4.85% vs. 3.86%). BMD increases at other skeletal sites also were “consistently higher” among those on the monthly dose, according to the drug's label.

Approval of the daily formulation was based on a 3-year study of almost 3,000 women with postmenopausal osteoporosis; the risk of having a vertebral fracture was 4.7% among those on ibandronate, vs. 9.6% among those on placebo, a highly significant difference.

Over the past decade, several new choices for osteoporosis treatment and prevention have become available, each a little different from the others, providing more opportunities to individualize therapy, said Ethel Siris, M.D., director of the Toni Stabile Osteoporosis Center at New York-Presbyterian Hospital and the Madeline C. Stabile professor of clinical medicine, Columbia University, New York.

The fracture data in the trials of these three drugs are somewhat different, she observed, noting that in the initial 3-year study, daily ibandronate was found to reduce the vertebral fracture risk “quite substantially” but did not reduce the risk of nonvertebral fractures. Alendronate, on the other hand, has been shown to reduce vertebral and hip fractures, and risedronate has been shown to reduce vertebral and nonvertebral fractures, reflected in approved indications, she added in an interview.

In a subgroup of patients with very low T scores in the initial ibandronate study, there was a reduction in nonvertebral fracture risk among those on 2.5 mg, compared with placebo, but that was a post hoc analysis and not a prespecified end point, she said.

Another difference between ibandronate and the other two oral bisphosphonates is that a patient needs to sit or stand for 1 hour after taking ibandronate, compared with only 1/2 hour for the other two agents, she said.

Dr. Siris, a consultant to the manufacturers of alendronate and risedronate, has served on an advisory board for GlaxoSmithKline, which is copromoting ibandronate with Roche.

The recommended dosage of monthly ibandronate is one 150-mg tablet taken on the same day once a month, swallowed with a 6- to 8-ounce glass of water, while standing or sitting. The patient should then wait 60 minutes before lying down or eating, drinking, or taking other medications (to reduce the risk of esophageal irritation). Esophagitis, the main side effect of bisphosphonates, is reduced with less frequent dosing but can still occur.

A once-monthly formulation of the bisphosphonate ibandronate was recently approved by the Food and Drug Administration for treating postmenopausal osteoporosis, 2 years after a daily formulation of the drug was approved but never marketed.

Ibandronate, which is being marketed as Boniva by Roche, is the third oral bisphosphonate and the first monthly formulation marketed in the United States for osteoporosis. It was approved in late March.

A 2.5-mg daily formulation was approved in 2003, based on a 3-year study that showed a reduction in vertebral fracture risk, but it was never marketed because of the availability of the more convenient, weekly bisphosphonate formulations, alendronate (Fosamax) and risedronate (Actonel).

Approval of the once-monthly 150-mg formulation of ibandronate was based on a 1-year noninferiority study of 1,602 postmenopausal women. The study showed that bone mineral density (BMD) increases in the lumbar spine in patients on monthly ibandronate were significantly higher than in those on 2.5 mg of ibandronate daily (4.85% vs. 3.86%). BMD increases at other skeletal sites also were “consistently higher” among those on the monthly dose, according to the drug's label.

Approval of the daily formulation was based on a 3-year study of almost 3,000 women with postmenopausal osteoporosis; the risk of having a vertebral fracture was 4.7% among those on ibandronate, vs. 9.6% among those on placebo, a highly significant difference.

Over the past decade, several new choices for osteoporosis treatment and prevention have become available, each a little different from the others, providing more opportunities to individualize therapy, said Ethel Siris, M.D., director of the Toni Stabile Osteoporosis Center at New York-Presbyterian Hospital and the Madeline C. Stabile professor of clinical medicine, Columbia University, New York.

The fracture data in the trials of these three drugs are somewhat different, she observed, noting that in the initial 3-year study, daily ibandronate was found to reduce the vertebral fracture risk “quite substantially” but did not reduce the risk of nonvertebral fractures. Alendronate, on the other hand, has been shown to reduce vertebral and hip fractures, and risedronate has been shown to reduce vertebral and nonvertebral fractures, reflected in approved indications, she added in an interview.

In a subgroup of patients with very low T scores in the initial ibandronate study, there was a reduction in nonvertebral fracture risk among those on 2.5 mg, compared with placebo, but that was a post hoc analysis and not a prespecified end point, she said.

Another difference between ibandronate and the other two oral bisphosphonates is that a patient needs to sit or stand for 1 hour after taking ibandronate, compared with only 1/2 hour for the other two agents, she said.

Dr. Siris, a consultant to the manufacturers of alendronate and risedronate, has served on an advisory board for GlaxoSmithKline, which is copromoting ibandronate with Roche.

The recommended dosage of monthly ibandronate is one 150-mg tablet taken on the same day once a month, swallowed with a 6- to 8-ounce glass of water, while standing or sitting. The patient should then wait 60 minutes before lying down or eating, drinking, or taking other medications (to reduce the risk of esophageal irritation). Esophagitis, the main side effect of bisphosphonates, is reduced with less frequent dosing but can still occur.

A once-monthly formulation of the bisphosphonate ibandronate was recently approved by the Food and Drug Administration for treating postmenopausal osteoporosis, 2 years after a daily formulation of the drug was approved but never marketed.

Ibandronate, which is being marketed as Boniva by Roche, is the third oral bisphosphonate and the first monthly formulation marketed in the United States for osteoporosis. It was approved in late March.

A 2.5-mg daily formulation was approved in 2003, based on a 3-year study that showed a reduction in vertebral fracture risk, but it was never marketed because of the availability of the more convenient, weekly bisphosphonate formulations, alendronate (Fosamax) and risedronate (Actonel).

Approval of the once-monthly 150-mg formulation of ibandronate was based on a 1-year noninferiority study of 1,602 postmenopausal women. The study showed that bone mineral density (BMD) increases in the lumbar spine in patients on monthly ibandronate were significantly higher than in those on 2.5 mg of ibandronate daily (4.85% vs. 3.86%). BMD increases at other skeletal sites also were “consistently higher” among those on the monthly dose, according to the drug's label.

Approval of the daily formulation was based on a 3-year study of almost 3,000 women with postmenopausal osteoporosis; the risk of having a vertebral fracture was 4.7% among those on ibandronate, vs. 9.6% among those on placebo, a highly significant difference.

Over the past decade, several new choices for osteoporosis treatment and prevention have become available, each a little different from the others, providing more opportunities to individualize therapy, said Ethel Siris, M.D., director of the Toni Stabile Osteoporosis Center at New York-Presbyterian Hospital and the Madeline C. Stabile professor of clinical medicine, Columbia University, New York.

The fracture data in the trials of these three drugs are somewhat different, she observed, noting that in the initial 3-year study, daily ibandronate was found to reduce the vertebral fracture risk “quite substantially” but did not reduce the risk of nonvertebral fractures. Alendronate, on the other hand, has been shown to reduce vertebral and hip fractures, and risedronate has been shown to reduce vertebral and nonvertebral fractures, reflected in approved indications, she added in an interview.

In a subgroup of patients with very low T scores in the initial ibandronate study, there was a reduction in nonvertebral fracture risk among those on 2.5 mg, compared with placebo, but that was a post hoc analysis and not a prespecified end point, she said.

Another difference between ibandronate and the other two oral bisphosphonates is that a patient needs to sit or stand for 1 hour after taking ibandronate, compared with only 1/2 hour for the other two agents, she said.

Dr. Siris, a consultant to the manufacturers of alendronate and risedronate, has served on an advisory board for GlaxoSmithKline, which is copromoting ibandronate with Roche.

The recommended dosage of monthly ibandronate is one 150-mg tablet taken on the same day once a month, swallowed with a 6- to 8-ounce glass of water, while standing or sitting. The patient should then wait 60 minutes before lying down or eating, drinking, or taking other medications (to reduce the risk of esophageal irritation). Esophagitis, the main side effect of bisphosphonates, is reduced with less frequent dosing but can still occur.

PHILADELPHIA — Weaning heart transplant patients aggressively from steroids and prophylactic treatment with alendronate led to a reduced incidence of osteoporosis in a series of 28 patients, compared with a historic control group.

The alendronate regimen was well tolerated by all 28 patients, Gerald Yong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

And survival rates among the patients managed with steroid weaning and alendronate were similar to the historic control group that had been treated with full-dose steroids, suggesting that the regimen designed to prevent bone loss did not compromise immunosuppression, said Dr. Yong, a physician in the cardiac transplant unit at Royal Perth Hospital in Australia.

He and his associates reviewed bone mineral density scores, obtained with dual-energy x-ray absorptiometry (DXA) of the femoral neck and lumbar spine, for 28 heart-transplant patients who were treated at Royal Perth since June 1999, when the bone-preserving regimen was instituted, and compared them with a similar group of 28 patients treated at the same center from 1995 to 1999.

Among the 28 patients in the historic control group, 26 were on prednisolone at the time they underwent bone mineral density studies.

Two patients in this group received treatment with either estrogen or vitamin D to prevent osteoporosis.

The patients in the bone-preserving group were all treated with either 10 mg alendronate daily or 70 mg weekly. Steroid weaning was begun at least 6 months after transplantation, and by the time of their DXA scans 16 of the 28 patients were completely off of prednisolone.

The average z scores and T scores at the femoral neck were 0.4 and −0.7 among the patients in the bone-preserving group, compared with −0.6 and −1.2 in the historic controls. The average scores in the lumbar spine were 0 and −0.6 among patients in the bone-preserving group, and −0.9 and −1.3 in the controls.

On the basis of their average z scores and T scores in the femoral neck, osteoporosis was diagnosed in five of the patients on the bone-preserving regimen (18%), compared with eight patients in the control group (29%).

PHILADELPHIA — Weaning heart transplant patients aggressively from steroids and prophylactic treatment with alendronate led to a reduced incidence of osteoporosis in a series of 28 patients, compared with a historic control group.

The alendronate regimen was well tolerated by all 28 patients, Gerald Yong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

And survival rates among the patients managed with steroid weaning and alendronate were similar to the historic control group that had been treated with full-dose steroids, suggesting that the regimen designed to prevent bone loss did not compromise immunosuppression, said Dr. Yong, a physician in the cardiac transplant unit at Royal Perth Hospital in Australia.

He and his associates reviewed bone mineral density scores, obtained with dual-energy x-ray absorptiometry (DXA) of the femoral neck and lumbar spine, for 28 heart-transplant patients who were treated at Royal Perth since June 1999, when the bone-preserving regimen was instituted, and compared them with a similar group of 28 patients treated at the same center from 1995 to 1999.

Among the 28 patients in the historic control group, 26 were on prednisolone at the time they underwent bone mineral density studies.

Two patients in this group received treatment with either estrogen or vitamin D to prevent osteoporosis.

The patients in the bone-preserving group were all treated with either 10 mg alendronate daily or 70 mg weekly. Steroid weaning was begun at least 6 months after transplantation, and by the time of their DXA scans 16 of the 28 patients were completely off of prednisolone.

The average z scores and T scores at the femoral neck were 0.4 and −0.7 among the patients in the bone-preserving group, compared with −0.6 and −1.2 in the historic controls. The average scores in the lumbar spine were 0 and −0.6 among patients in the bone-preserving group, and −0.9 and −1.3 in the controls.

On the basis of their average z scores and T scores in the femoral neck, osteoporosis was diagnosed in five of the patients on the bone-preserving regimen (18%), compared with eight patients in the control group (29%).

PHILADELPHIA — Weaning heart transplant patients aggressively from steroids and prophylactic treatment with alendronate led to a reduced incidence of osteoporosis in a series of 28 patients, compared with a historic control group.

The alendronate regimen was well tolerated by all 28 patients, Gerald Yong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

And survival rates among the patients managed with steroid weaning and alendronate were similar to the historic control group that had been treated with full-dose steroids, suggesting that the regimen designed to prevent bone loss did not compromise immunosuppression, said Dr. Yong, a physician in the cardiac transplant unit at Royal Perth Hospital in Australia.

He and his associates reviewed bone mineral density scores, obtained with dual-energy x-ray absorptiometry (DXA) of the femoral neck and lumbar spine, for 28 heart-transplant patients who were treated at Royal Perth since June 1999, when the bone-preserving regimen was instituted, and compared them with a similar group of 28 patients treated at the same center from 1995 to 1999.

Among the 28 patients in the historic control group, 26 were on prednisolone at the time they underwent bone mineral density studies.

Two patients in this group received treatment with either estrogen or vitamin D to prevent osteoporosis.

The patients in the bone-preserving group were all treated with either 10 mg alendronate daily or 70 mg weekly. Steroid weaning was begun at least 6 months after transplantation, and by the time of their DXA scans 16 of the 28 patients were completely off of prednisolone.

The average z scores and T scores at the femoral neck were 0.4 and −0.7 among the patients in the bone-preserving group, compared with −0.6 and −1.2 in the historic controls. The average scores in the lumbar spine were 0 and −0.6 among patients in the bone-preserving group, and −0.9 and −1.3 in the controls.

On the basis of their average z scores and T scores in the femoral neck, osteoporosis was diagnosed in five of the patients on the bone-preserving regimen (18%), compared with eight patients in the control group (29%).

WASHINGTON — New imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 100-mcg injections of PTH or a placebo for 18 months.

In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in both the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.

WASHINGTON — New imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 100-mcg injections of PTH or a placebo for 18 months.

In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in both the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.

WASHINGTON — New imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 100-mcg injections of PTH or a placebo for 18 months.

In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in both the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.