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Table of Contents
image Calcium regulation of androgen receptor expression in the human prostate cancer cell line LNCaP
image The role of calcium, pH, and cell proliferation in the programmed (apoptotic) death of androgen-independent prostatic cancer cells induced by thapsigarin
image Programmed cell death as a new target for prostatic cancer therapy
image Hypercalcemia in carcinoma of the prostate: Case report and review of the literature
image Calcium excretion in metastatic prostatic carcinoma
image Chemoprevention of colorectal tumors: role of lactulose and of other agents.
image [Overview--suppression effect of essential trace elements on arteriosclerotic development and it's mechanism]
image Different effects of PTH on erythrocyte calcium influx
image Hypercalcemia due to constitutive activity of the parathyroid hormone (PTH)/PTH-related peptide receptor: Comparison with primary hyperparathyroidism
image Osteoclast cytomorphometry in patients with femoral neck fracture
image The PTH-calcium relationship curve in secondary hyperparathyroidism, an index of sensitivity and suppressibility of parathyroid glands
image Role of parathyroid hormone-related peptide (PTHrP) in hypercalcemia of malignancy and the development of osteolytic metastases
image Experimental study of glucocorticoid-induced rabbit osteoporosis
image 24,25 dihydroxyvitamin D supplementation corrects Intradialytic calcium balances with different calcium dialysate levels. Effects on cardiovascular stability and parathyroid function
image Biochemical effects of calcium and vitamin D supplementation in elderly, institutionalized, vitamin D-deficient patients
image Calcium, phosphate, vitamin D, and the parathyroid
image The BsmI vitamin D receptor restriction fragment length polymorphism (bb) influences the effect of calcium intake on bone mineral density
image Bone mineral density changes during lactation: Maternal, dietary, and biochemical correlates
image Postprandial parathyroid hormone response to four calcium-rich foodstuffs
image Complementary medical treatment for Colles' fracture: A comparative, randomized, longitudinal study
image Treatment of postmenopausal osteoporosis: Spoilt for choice? Part 1 - Foundations for an individually adapted management concept
image Calcium and vitamin D in the prevention and treatment of osteoporosis
image Calcium intake and fracture risk: Results from the study of osteoporotic fractures
image Bone loss and turnover after cardiac transplantation
image What's hip in diet and osteoporosis?
image A high dietary calcium intake is needed for a positive effect on bone density in Swedish postmenopausal women
image Amelioration of hemiplegia-associated osteopenia more than 4 years after stroke by 1alpha-hydroxyvitamin D3 and calcium supplementation
image The usefulness of bone turnover in predicting the response to transdermal estrogen therapy in postmenopausal osteoporosis
image Osteoporotic vertebral fractures in postmenopausal women
image Proteins and bone health
image Osteoporosis: Prevention, diagnosis, and management
image Connections between phospho-calcium metabolism and bone turnover. Epidemiologic study on osteoporosis (second part)
image Calcium regulation and bone mass loss after total gastrectomy in pigs
image Management of osteoporosis in the elderly
image Effect of measuring bone mineral density on calcium intake
image Osteoporosis: Its pediatric causes and prevention opportunities
image Estimated dietary calcium intake and food sources for adolescent females: 1980-92
image The pathogenesis of age-related osteoporotic fracture: Effects of dietary calcium deprivation
image Osteoporosis prevention and treatment. Pharmacological management and treatment implications
image Calcium metabolism in the elderly
image Therapy of osteoporosis: Calcium, vitamin D, and exercise
image Pathophysiology of osteoporosis
image Risk for osteoporosis in black women
image Age considerations in nutrient needs for bone health: Older adults
image Dietary calcium intake and its relation to bone mineral density in patients with inflammatory bowel disease
image Harmonization of clinical practice guidelines for the prevention and treatment of osteoporosis and osteopenia in Europe: A difficult challenge
image Clinical practice guidelines for the diagnosis and management of osteoporosis
image Current and potential future drug treatments for osteoporosis
image Calcium nutrition and osteoporosis
image Osteoporosis of Crohn's disease: A critical review
image The preparation and stability of compound active calcium tablets
image Immunosuppression: Tightrope walk between iatrogenic side effects and therapy
image Secondary osteoporosis in rheumatic diseases
image Does lactose intolerance predispose to low bone density? A population-based study of perimenopausal Finnish women
image Glucocorticoid-induced osteoporosis
image Current treatment options for osteoporosis
image Treatments for oestoporosis
image Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: A preliminary report
image The effect of calcium supplementation and Tanner Stage on bone density, content and area in teenage women
image Osteoporosis
image Osteoporosis and calcium ingest
image Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: A 3 year followup
image Novelties and issues in the drug market 1995
image Influence of life style in the MEDOS study
image Roles of diet and physical activity in the prevention of osteoporosis
image The problem: Health impact of osteoporosis
image Prophylaxis of osteoporosis with calcium, estrogens and/or eelcatonin: Comparative longitudinal study of bone mass
image Nutritional prevention of aging osteoporosis
image Osteoporotic fractures: Background and prevention strategies
image Energy and nutrient intake in patients with CF
image Current and future nonhormonal approaches to the treatment of osteoporosis
image Transient osteoporosis of the hip. Case report and review of the literature
image Osteomalacia and osteoporosis in a woman with ankylosing spondylitis
image Calcium and vitamin D nutritional needs of elderly women
image Heated oyster shell-seaweed calcium (AAA Ca) on osteoporosis
image Calcium deficiency in fluoride-treated osteoporotic patients despite calcium supplementation
image Endocrinology
image Axial bone mass in older women
image Bone mineral density in mother-daughter pairs: Relations to lifetime exercise, lifetime milk consumption, and calcium supplements
image Reduced bone mass in women with premenstrual syndrome
image Calcium-regulating hormones across the menstrual cycle: Evidence of a secondary hyperparathyroidism in women with PMS
image Calcium supplementation in premenstrual syndrome: A randomized crossover trial
image Multiple sclerosis: vitamin D and calcium as environmental determinants of prevalence (a viewpoint). I.: Sunlight, dietary factors and epidemiology
image Calcium, phosphorus and magnesium intakes correlate with bone mineral content in postmenopausal women
image Effect of glucocorticoids and calcium intake on bone density and bone, liver and plasma minerals in guinea pigs
image Relationship between liver cirrhosis death rate and nutritional factors in 38 countries
image Prophylaxis of recurring urinary stones: hard or soft mineral water
image Prospective study of nutritional factors, blood pressure, and hypertension among US women.
image Association of macronutrients and energy intake with hypertension.
image Relations between magnesium, calcium, and plasma renin activity in black and white hypertensive patients
image Effect of renal perfusion pressure on excretion of calcium, magnesium, and phosphate in the rat.
image Nonpharmacologic treatment of hypertension.
image Micronutrient effects on blood pressure regulation.
image Role of magnesium and calcium in alcohol-induced hypertension and strokes as probed by in vivo television microscopy, digital image microscopy, optical spectroscopy, 31P-NMR, spectroscopy and a unique magnesium ion-selective electrode.
image Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review).
image Effect of dietary magnesium supplementation on intralymphocytic free calcium and magnesium in stroke-prone spontaneously hypertensive rats.
image Impact of increasing calcium in the diet on nutrient consumption, plasma lipids, and lipoproteins in humans
image Electrolytes and hypertension: results from recent studies.
image Augmentation of the renal tubular dopaminergic activity by oral calcium supplementation in patients with essential hypertension.
image The pathogenesis of eclampsia: the 'magnesium ischaemia' hypothesis.
image Intracellular Mg2+, Ca2+, Na2+ and K+ in platelets and erythrocytes of essential hypertension patients: relation to blood pressure.
image A prospective study of nutritional factors and hypertension among US men
image Electrolytes in the epidemiology, pathophysiology, and treatment of hypertension.
image Minerals and blood pressure.
image The effect of Ca and Mg supplementation and the role of the opioidergic system on the development of DOCA-salt hypertension.
image Dietary modulators of blood pressure in hypertension
image Daily intake of macro and trace elements in the diet. 4. Sodium, potassium, calcium, and magnesium
image Calcium intake: covariates and confounders
image Nutrition and the elderly: a general overview.
image Blood pressure and nutrient intake in the United States.
image Serum calcium, magnesium, copper and zinc and risk of cardiovascular death.
image Endothelial function in deoxycorticosterone-NaCl hypertension: effect of calcium supplementation.
image Prevention of preeclampsia with calcium supplementation and its relation with the L-arginine:nitric oxide pathway.
image [Guidelines on treatment of hypertension in the elderly, 1995--a tentative plan for comprehensive research projects on aging and health-- Members of the Research Group for "Guidelines on Treatment of Hypertension in the Elderly", Comprehensive Research Projects on Aging and Health, the Ministry of Health and Welfare of Japan]
image Management of acute myocardial infarction in the elderly
image Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables
image The effects of calcium channel blockers on blood fluidity.
image Concentrations of magnesium, calcium, potassium, and sodium in human heart muscle after acute myocardial infarction.
image Nutrient intake and food use in an Ojibwa-Cree community in Northern Ontario assessed by 24h dietary recall
image Mgsup 2sup +-Casup 2sup + interaction in contractility of vascular smooth muscle: Mgsup 2sup + versus organic calcium channel blockers on myogenic tone and agonist-induced responsiveness of blood vessels
image Antacids drugs: Multiple but too often unknown pharmacological properties
image Trace elements in prognosis of myocardial infarction and sudden coronary death
image Intakes of vitamins and minerals by pregnant women with selected clinical symptoms.
image [Amyotrophic lateral sclerosis--causative role of trace elements]
image Aluminum Deposition in Central Nervous System of Patients with Amyotrophic Lateral Sclerosis From the Kii Peninsula of Japan
image [Deficiency of certain trace elements in children with hyperactivity]
image Augmented Ca2+ in-flux is involved in the mechanism of enhanced proliferation of cultured vascular smooth muscle cells from spontaneously diabetic Goto-Kakizaki rats
image The central role of calcium in the pathogenesis of cardiovascular disease
image Dietary calcium, vitamin D, and the risk of colorectal cancer in Stockholm, Sweden
image Natural products and their derivatives as cancer chemopreventive agents
image New agents for cancer chemoprevention
image Frequently nebulized beta-agonists for asthma: effects on serum electrolytes.
image Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease.
image Long-term treatment with calcium-alpha-ketoglutarate corrects secondary hyperparathyroidism
image Oral vitamin D or calcium carbonate in the prevention of renal bone disease?
image Comparison of effects of calcitriol and calcium carbonate on secretion of interleukin-1beta and tumour necrosis factor-alpha by uraemic peripheral blood mononuclear cells
image Effect of dietary calcium on urinary oxalate excretion after oxalate loads
image The lack of influence of long-term potassium citrate and calcium citrate treatment in total body aluminum burden in patients with functioning kidneys


Calcium regulation and bone mass loss after total gastrectomy in pigs

Annals of Surgery (USA), 1997, 225/2 (181-192)

Objective: Total gastrectomy often results in postgastrectomy bone disease with decreased bone mass and increased fracture risk. To further elucidate the mechanisms of postgastrectomy bone disease, the authors investigated calcium metabolism and bone mineral density after total gastrectomy in pigs. Summary Background Data: Postgastrectomy bone disease can present as osteomalacia, osteoporosis in excess of normal aging, or a combination of both. The underlying mechanisms are insufficiently understood and need further investigation. Methods: Growing minipigs were gastrectomized and compared with fed matched, sham-operated control pigs for 1 year. Calcium absorption, serum calcium, parathyroid hormone, 25-(OH)-vitamin D, 1,25- (OH)2-vitamin D, alkaline phosphatase, and computed tomography bone mineral density were measured in three monthly intervals. Results: Total gastrectomy resulted in impaired calcium absorption, reduced serum calcium and 25-(OH)- vitamin D, increased parathyroid hormone and 1,25-(OH)2-vitamin, and reduced bone mineral density compared with fed matched, sham-operated control pigs. Conclusions: The authors data indicate that a reduced serum calcium activates counter-regulatory mechanisms, resulting in calcium mobilization from the bone. Possibly, calcium and vitamin D supplementation after total gastrectomy might prevent postgastrectomy bone mass loss.

Management of osteoporosis in the elderly

Journal of Geriatric Drug Therapy (USA), 1996, 11/1 (5-16)

Osteoporosis is the most common skeletal disorder of the elderly. This crippling disease causes 1.5 million fractures each year, with annual costs to the United States health care system of $10 billion. Osteoporotic fractures cause pain, disability, and, in some cases, death. Early diagnosis of osteoporosis is possible with accurate and non-invasive measurements of bone density, targeting those at greatest risk of developing osteoporotic fractures. Treatment with calcium, estrogen, calcitonin, or a bisphosphonate stabilizes bone density in the elderly and may reduce the risk of fractures. This article reviews the current strategies for evaluation, diagnosis, and management of osteoporosis.

Effect of measuring bone mineral density on calcium intake

Japanese Journal of Geriatrics (Japan), 1996, 33/11 (840-846)

The diet in Japan has improved, but calcium intake has not increased for the past ten years, and it remains insufficient. To prevent osteoporosis, instruction in nutrition is directed at increasing calcium intake. We studied the effect of measuring bone mineral density on calcium intake in people receiving nutrition education. Intake of other nutrients was also measured. The subjects were 87 healthy women living in an agricultural region (Yamanashi Prefecture). They were members of a group formed to improve the diet of people in their area. For three days in October 1992 and in August 1994 food-weight records were obtained. A total of 76 of the 87 women chose to have their bone mineral density measured. The measurements before the first nutrition assessment in 1992. The intake of almost all nutrients tended to be greater in 1994 than in 1992. Calcium intake exceeded the minimum daily requirement (600mg). Calcium intake increased between 1992 and 1994 only in the subjects whose bone mineral density had been measured. Calcium intake decreased in the other subjects. Therefore, nutrition education programs aimed at preventing osteoporosis may be more effective if bone mineral density is measured. In addition, an appropriate balance of other nutrients can be maintained as the intake of calcium is increased.

Osteoporosis: Its pediatric causes and prevention opportunities

Primary Care Update for Ob/Gyns (USA), 1997, 4/1 (15-20)

Osteoporosis is the most common metabolic bone disease in western societies, and is characterized by a reduction of bone mass leading to the increased susceptibility to fractures. With increases in life expectancy and in the number of elderly people, bone loss and fractures are becoming more common in the United States and throughout the world. As a consequence, an epidemic of bone fractures among the elderly is expected. In this respect, it is obvious that the emphasis should be on the development of strategies for maximizing bone gain and preventing bone loss and subsequent osteoporosis. This paper discusses the concepts that are the foundation for primary prevention of osteoporosis: the measures that should be implemented during childhood and adolescence, with the goal of optimizing bone mass in young adulthood. Some important concepts, such as peak bone mass and calcium intake threshold, as well as the original studies of adolescent females and their bone mass acquisition are presented. It becomes clear that osteoporosis could have its roots during growth, and it should be treated as such. Teenagers should therefore be targeted as a population at risk, and preventive measures should be implemented by means of adequate calcium intake, proper diet, and exercise programs aimed at increasing peak bone mass.

Estimated dietary calcium intake and food sources for adolescent females: 1980-92

Journal of Adolescent Health (USA), 1997, 20/1 (20-26)

Purpose: To estimate dietary calcium intake of three groups of adolescent females ages 11-12 years, 13-14 years, and 15-18 years during four separate 2-year time periods from the years 1980-92; and to identify their food sources of calcium. Methods: Nutrient intake survey based on 14-day food consumption records collected from four national representative samples of 4,000 United States households. Results: Dietary calcium consumption declined significantly (p < .01) over the 10-year period for the 15-18 year olds. Calcium intake was significantly lower for 13-14 year olds compared to the youngest age group, and for 15-18 year olds when compared to the two younger age groups for all four study periods (p < .01). Over 90% of all adolescent females consumed < 100% of the RDA for calcium during all data collection periods. The percentage of adolescent females who consumed less than two- thirds of the RDA increased with age. Seventy-seven percent of 15-18 year olds consumed below this level from 1990-92. Milk and milk products were the best food sources of calcium contributing over one-half of the calcium to the diet. This percentage declined over time and with age to 44% for the 15-18 year old females in 1990. This drop can be attributed to a 7-12% decline in fluid milk consumption for the 11-12 year olds and 15-18 year olds, respectively. Conclusions: Estimates indicate that dietary calcium intakes fall far short of both the Recommended Dietary Allowance (RDA) and National Institutes of Health (NIH) recommendations. Intakes have declined over time, with age, and appear to be related to a decline in fluid milk consumption. Efforts to increase calcium consumption among adolescent females appear critical. Clear recommendations to consume a minimum of three servings everyday of lowfat or nonfat dairy products such as milk and yogurt are needed to help this population meet daily calcium requirements.

The pathogenesis of age-related osteoporotic fracture: Effects of dietary calcium deprivation

Journal of Clinical Endocrinology and Metabolism (USA), 1997, 82/1 (260-264)

The pathogenesis of osteoporotic fracture after the menopause is uncertain. We studied the effects of a 4-day low calcium diet on 17 subjects with vertebral osteoporotic fracture and 17 age-matched controls with a bone density within the young normal range and without fracture. At baseline, the osteoporotic patients were well matched to normal subjects in terms of calcium intake and absorption and renal function, but had higher bone turnover and relative secondary hyperparathyroidism. After the low calcium diet, the rise in calcitriol was deficient in the osteoporotic subjects. These data are consistent with the suggested pathogenesis of type II or age- related osteoporosis and show that in these subjects with osteoporotic fracture there was a primary defect in calcitriol production that resulted in secondary hyperparathyroidism. This defect may be the cause of the high bone turnover and may play an important role in the development of bone loss in these subjects.

Osteoporosis prevention and treatment. Pharmacological management and treatment implications

Drugs and Aging (New Zealand), 1996, 9/6 (472-477)

In the current economic climate, osteoporosis is a major public health issue because of the high rate of fractures associated with the disease. Prevention of osteoporosis is a cost-effective approach, especially in aging populations. Encouraging moderate exercise and dietary supplementation with calcium and vitamin D, especially in institutionalised elderly people, are the major nonpharmacological management measures used to prevent and treat osteoporosis. Pharmacological measures have been developed in the last few years and extensive research is under way. Hormone replacement therapy results in increased bone mass, especially in postmenopausal patients, and its effect is currently being investigated in the elderly population. The bisphosphonates, especially alendronate, are promising and have few adverse effects, but the issue of cost needs to be addressed. Pharmacological agents that stimulate bone formation, such as sodium fluoride, growth hormone and other trophic factors, are being researched.

Calcium metabolism in the elderly

Giornale di Gerontologia (Italy), 1996, 44/2 (91-96)

The aging process is characterized by several alterations in calcium metabolism and by a negative calcium balance. Total body calcium is reduced in the elderly. Since 99% of total body calcium is localized in the bone this reduction is associated with a reduction in progressive bone mass, increased fragility of the skeleton, and with increased risk of fractures. The reduction in calcium with aging is paradoxically associated with an accumulation of calcium within the cells and soft tissues. From a metabolic point of view, the aging process is associated with several alterations in calcium homeostasis. Calcium intake, calcium absorption, and renal calcium conservation are all reduced in the aged. Calciotropic hormone levels undergo alterations with age. 25(OH)2 levels tend to decrease with age due to reduced vitamin D intake and as a result of a reduction in exposure to the sun. PTH levels in response to the status of calcium deprivation and the reduction of serum ionized calcium progressively tend to increase with age. Aging is also associated with an increase in bone turnover, as documented by the increased levels of the serum and urinary markers of bone formation and bone reabsorption. This increase in bone remodeling is directly related to the reduction in bone mass and the increased risk of fractures. Calcium supplements together with drugs able to reduce bone turnover, may contribute to the normalizing of the calcium balance, and reducing the risk of fractures in the elderly.

Therapy of osteoporosis: Calcium, vitamin D, and exercise

American Journal of the Medical Sciences (USA), 1996, 312/6 (278-286)

Calcium supplementation has long been regarded as a fundamental part of the prevention and treatment of postmenopausal osteoporosis, but it is only in recent years that clear evidence has emerged demonstrating its impact on bone mass. Calcium supplementation does not completely arrest postmenopausal bone loss but slows the rate of decline by 30 to 50%. The effect of calcium supplementation on fracture incidence in postmenopausal women has not been established. Vitamin D deficiency is common in the frail elderly, particularly in countries where fortification or food with this vitamin is not practiced. Treatment of vitamin D deficiency has been associated with significant reductions in the number of hip fractures. The role of the potent vitamin D metabolites, calcitriol and alphacalcidol, in the management of postmenopausal osteoporosis is not clear. Although some studies show substantial benefits in bone density or fracture rate from the use of these compounds, the published data are inconsistent. In general, hormone replacement therapy and the potent bisphosphonates produce greater effects on bone density and there is a greater consistency among the results of the published studies of these other interventions. Controlled trials of exercise interventions in postmenopausal women show that exercise can positively influence bone density by a few percent. Exercise interventions in the elderly have been reported to decrease fall frequency by 10%. This latter effect may have a greater impact on fracture frequency than the modest benefits of exercise on bone density.

Pathophysiology of osteoporosis

American Journal of the Medical Sciences (USA), 1996, 312/6 (251-256)

As with many chronic diseases that express themselves late in life, osteoporosis is distinctly multifactorial both in etiology and in pathophysiology. Osteoporotic fractures occur because of a combination of injury and intrinsic bony fragility. The injury comes most often from a combination of falls, poor postural reflexes that fail to protect bony parts from impact, and reduced soft tissue padding over bony prominences. The bony fragility itself is a composite of geometry, low mass density, severance of microarchitectural connections in trabecular structures, and accumulated fatigue damage. Reduced bone mass, in turn, is caused by varying combinations of gonadal hormone deficiency, inadequate intakes of calcium and vitamin D, decreased physical activity, comorbidity, and the effects of drugs used to treat various unrelated medical conditions. Finally, the often poor outcome from hip fracture in the elderly is partly caused by associated protein- calorie malnutrition. An adequate preventive program for osteoporotic fracture must address as many of these factors as possible, ie, it must be as multifaceted as the disease is multifactorial.

Risk for osteoporosis in black women

Calcified Tissue International (USA), 1996, 59/6 (415-423)

Models of involutional bone loss and strategies for the prevention of osteoporosis have been developed for white women. Black women have higher bone densities than white women, but as the black population ages there will be an increasingly higher population of black women with osteoporosis. Strategies should be developed to reduce the risk of black women for fragility fractures. Dual energy X-ray absorptiometry measurements of the total body, femur, spine, and radius were performed on 503 healthy black and white women aged 20-80 years. Indices of bone turnover, the calcitrophic hormones, and radioisotope calcium absorption efficiency were also measured to compare the mechanisms of bone loss. The black women had higher BMD values at every site tested than the white women throughout the adult life cycle. Black women have a higher peak bone mass and a slightly slower rate of adult bone loss from the femur and spine, which are skeletal sites comprised predominantly of trabecular bone. Indices of bone turnover are lower in black women as are serum calcidiol levels and urinary calcium excretion. Serum calcitriol and parathyroid hormone levels are higher in black women and calcium absorption efficiency is the same in black and white women, but dietary calcium intake is lower in black women. Black and white women have a similar pattern of bone loss, with substantial bone loss from the femur and spine prior to menopause and an accelerated bone loss from the total skeleton and radius after menopause. The higher values for bone density in black women as compared with white women are caused by a higher peak bone mass and a slower rate of loss from skeletal sites comprised predominantly of trabecular bone. Low-risk strategies to enhance peak bone mass and to lower bone loss, such as calcium and vitamin D augmentation of the diet, should be examined for black women. The risk vs. benefits of hormonal replacement therapy should be determined, especially in older women.

Age considerations in nutrient needs for bone health: Older adults

Journal of the American College of Nutrition (USA), 1996, 15/6 (575-578)

Current knowledge of the relation between nutrition and bone health in the elderly is sufficient, if applied, to lead to a reduction in fractures in the aged of from 30-60%. The critical nutrients are calcium and vitamin D, and possibly phosphate as well. Additionally, nutritional measures, especially protein repletion, dramatically improve outcomes from hip fracture. Fortunately the indicated interventions have a favorable cost- benefit relationship, especially when skim milk is used as the source of the needed nutrients.

Dietary calcium intake and its relation to bone mineral density in patients with inflammatory bowel disease

Journal of Internal Medicine (United Kingdom), 1996, 240/5 (285-292)

Objectives. To investigate calcium intake and its association with bone mineral density (BMD) and the type and extent of the disease in patients with inflammatory bowel disease (IBD). Setting. University hospital clinic, Subjects. A total of 152 unselected IBD patients and 73 healthy controls. Measurements. Dietary calcium intake was assessed with a food frequency questionnaire and BMD of the lumbar spina and proximal femur was measured. Results. The IBD patients had lower dietary calcium intake (1034 (SD 493) mg) than the controls (1334 (514) mg, P < 0.001). The difference was significant in the males (1047 (552) mg and 1575 (586) mg, respectively, P < 0.001), but not in the females (1020 (422) mg and 1112 (303) mg). The dietary daily calcium intake was below 1000 mg in 53% of the patients and 27% of the controls (P = 0.0004) and below 400 mg in 9.2% of the patients and none of the controls (P = 0.007). The calcium intake was not associated with the severity or the type of IBD. Seventy-one (47%) patients and eight (11%) controls avoided lactose in their diet (P < 0.001). In the IBD patients, no association between the calcium intake and BMD was detected, whereas in the controls a positive correlation between the calcium intake and the BMD of the proximal femur was found. Conclusions, Calcium intakes below the recommendations are seen more often in the IBD patients than in the healthy controls, but in the IBD patients the calcium intake is not associated with BMD in a cross-sectional study. A low-lactose diet is common among IBD patients. To reduce the risk of inadequate calcium intake, unnecessary dietary restrictions concerning, e.g. milk products, should be avoided for these patients.

Harmonization of clinical practice guidelines for the prevention and treatment of osteoporosis and osteopenia in Europe: A difficult challenge

Calcified Tissue International (USA), 1996, 59/SUPPL. 1 (S24-S29)

Europe is a patchwork of various medical cultures and financial resources. Variations abound with respect to financing accessibility to public health systems, health expenditures, drug registration and reimbursement, the prescription of drugs, and clinical applications, as well as the perception of osteoporosis itself. However, there are possibilities for the harmonization of medical services among the various countries within Europe. The European Agency for the Evaluation of Medicinal Products (EAEMP) is attending to the centralized or decentralized procedures for the registration of drugs. The Group for the Respect of Ethics and Excellence in Science (GREES) is investigating guidelines for drug registration as well as gathering and making available medical references. The European Foundation for Osteoporosis and Bone Diseases (EFFO) is increasing awareness of the prevalence of the disease and the need for prevention and treatment. Finally, the International Federation of Societies on Skeletal Diseases (IFSSD) is coordinating epidemiologic, clinical, and social research. There is a need for increased awareness of osteoporosis throughout Europe. Health authorities are in need of cost/benefit reports leading to the registration and reimbursement of agents. Primary care physicians need information about osteoporosis and need to become involved in the diagnosis and science of the disease. Awareness needs to be generated among specialists: they need to be educated in the latest techniques for diagnosis and treatment. Finally, the general population needs to become aware of osteoporosis and to be encouraged to participate in the prevention and treatment of this disease. Current screening and detection in Europe is being done by densitometry. However, other techniques on the horizon include ultrasound and biochemical markers. Primary prevention, i.e., maximizing peak bone mass, includes examining the genetics of osteoporosis to determine the high-risk population and promoting reasonable physical exercise and dietary/lie-style habits (e.g., increased calcium and avoidance of tobacco). Secondary prevention includes the identification of high-risk groups through risk factors, biochemical markers, and densitometry and adherence to the World Health Organization definition of osteopenia-osteoporosis (adapted to financial concerns by GREES guidelines). Other therapies include hormone replacement agents (although there are risks for cancer and concerns about durability), calcium and other inhibitors of bone resorption, physical activity, and vitamin D prophylaxis in the elderly. Treatment of established or severe osteoporosis includes drugs upon availability (inhibitors of bone resorption and stimulators of bone formation), surgery, and experimental approaches.

Clinical practice guidelines for the diagnosis and management of osteoporosis

Canadian Medical Association Journal (Canada), 1996, 155/8 (1113-1129)

Objective: To recommend clinical practice guidelines for the assessment of people at risk for osteoporosis, and for effective diagnosis and management of the condition. Options: Screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations. Prophylactic and corrective therapies: calcium and vitamin D nutritional supplementation, physical activity and fall-avoidance techniques, ovarian hormone therapy, bisphosphonate drugs, other drug therapies. Pain-management medications and techniques. Outcomes: Prevention of loss of bone mineral density and fracture; increased bone mass; and improved quality of life. Evidence: Epidemiologic and clinical studies and reports were examined, with emphasis on recent randomized controlled trials. Clinical practice in Canada and elsewhere was surveyed. Availability of treatment products and diagnostic equipment in Canada was considered. Values: Cost-effective methods and products that can be adopted across Canada were considered. A high value was given to accurate assessment of fracture risk and osteoporosis, and to increasing bone mineral density, reducing fractures: and fracture risk and minimizing side effects of diagnosis and treatment. Benefits, harms and costs: Proper diagnosis and management of osteoporosis minimize injury and disability, improve quality of life for patients and reduce costs to society. Rationally targeted methods of screening and diagnosis are safe and cost effective. Harmful side effects and costs of recommended therapies are minimal compared with the harms and costs of untreated osteoporosis. Alternative therapies provide a range of choices for physicians and patients. Recommendations: Population sets at high risk should be identified and then the diagnosis confirmed through bone densitometry. Dual-energy x-ray absorptiometry is the preferred measurement technique. Radiography can be an adjunct when indicated. Calcium and vitamin D nutritional supplementation should be at currenly recommended levels. Patients should be counselled in fall-avoidance techniques and exercises. Immobilization should be avoided. Guidelines for management of acute pain are listed. Ovarian hormone therapy is the therapy of choice for osteoporosis prevention and treatment in post menopausal women. Bisphosphonates are an alternative therapy for women with established osteoporosis who cannot or prefer not to take ovarian hormone therapy. Validation: These guidelines were reviewed and approved by the Scientific Advisory Board of the Osteoporosis Society of Canada, in consultation with individual family and general practitioners.

Current and potential future drug treatments for osteoporosis

Annals of the Rheumatic Diseases (United Kingdom), 1996, 55/10 (700-714)

There has been a major interest in the drug treatment of osteoporosis and an increase in the number of drugs available in most countries. The ideal drug (one which increases or restores bone density and trabecular connectivity) is still not available. However, in patients with relatively preserved trabecular connectivity and moderately reduced bone density, several agents have shown substantial clinical benefit. Oestrogens are still the mainstay of drug treatment, but the risks of breast cancer versus the cardiovascular and skeletal benefits with long term use have to be assessed in the individual. Newer tissue specific oestrogens show some promise in this respect. The bisphosphonates and possibly fluoride are likely to be the major alternatives to oestrogens in the medium term. The newer bisphosphonates, alendronate and in the future risedronate, are likely to supersede etidronate. Calcitriol probably has a limited role, confined to those patients in whom HRT or bisphosphonates are not appropriate. Calcium supplementation, or an increase in dietary intake if deficient, irrespective of which agent is used, is also of benefit. In older patients there is considerable support for using a combination of calcium and vitamin D. Whether combination treatment, for example oestrogens, bisphosphonates, and calcium together, will result in greater efficacy remains to be conclusively shown, but may be an attractive option in younger patients with higher bone turnover. Apart from fluoride, bone formation stimulators are unlikely to have a major role until the next century, although it may be possible to use growth factors as part of an ADFR regimen (A = activate remodelling, D depress resorption, F = free formation, and R = repeat). This is still an important theoretical approach and needs further work with newer agents to see if increased efficacy can be found. In addition sequential treatment may be necessary in view of the limited time periods over which particular agents, such as intermittent fluoride (four years), have ben examined, and this will have to be individually tailored.

Calcium nutrition and osteoporosis

Canadian Medical Association Journal (Canada), 1996, 155/7 (935-939)

Objective: To recommend appropriate levels of calcium intake in light of the most recent studies. Options: Dietary calcium intake, calcium supplementation, calcium and vitamin D supplementation; ovarian hormone therapy in postmenopausal women. Outcomes: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with osteoporosis prevention. Evidence: Relevant clinical studies and reports were examined, in particular those published since the 1988 Osteoporosis Society of Canada position paper on calcium nutrition. Only studies in humans were considered, including controlled, randomized trials and prospective studies, using bone mass and fractures as end-points. Studies in early and later phases of skeletal growth were noted. The analysis was designed to eliminate menopause as a confounding variable. Values: Preventing osteoporosis and maximizing quality of life were given a high value. Benefits, harms and costs: Adequate calcium nutrition increases bone mineral density during skeletal growth and prevents bone loss and osteoporotic fractures in the elderly. Risks associated with high dietary calcium intake are low, and a recent study extends this conclusion to the risk of kidney stones. Lactase-deficient patients may substitute yogurt and lactase-treated milk for cow's milk. True milk allergy is probably rare; its promotion of diabetes mellitus in susceptible people is being studied. Recommendations: Current recommended intakes of calcium are too low. Revised intake guidelines designed to reduce bone loss and protect against osteoporotic fractures are suggested. Canadians should attempt to meet their calcium requirements principally through food sources. Pharmaceutical calcium supplements and a dietician's advice should be considered where dietary preferences or lactase deficiency restrict consumption of dairy foods. Further research is necessary before recommending the general use of calcium supplements by adolescents. Calcium suplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fractures. Adequate amounts of vitamin D are necessary for optimal calcium absorption and bone health. Elderly people and those who use heavy sun screens should have a dietary intake of 400 to 800 IU of vitamin D per day.

Osteoporosis of Crohn's disease: A critical review

Canadian Journal of Gastroenterology (Canada), 1996, 10/5 (317-321)

Osteoporosis has long been a recognized complication of Crohn's disease (CD), with a documented incidence ranging from 31% to 65%. The cause of osteoporosis in Crohn's patients is likely multifactorial; corticosteroids, inflammatory cytokines, small bowel resection and the resultant calcium and vitamin D deficiencies, hypogonadism, malnutrition and the cachexia of inflammation all play a role. However, the mechanism responsible for osteoporosis associated with CD remains unclear. Treatment of decreased bone density in CD patients has been limited to calcium and vitamin D replacement. The present understanding of the pathophysiology, mechanism and treatment of osteoporosis in CD is reviewed, with the focus on the role of steroid-induced osteoporosis and the use of bisphosphonates.

The preparation and stability of compound active calcium tablets

Chinese Pharmaceutical Journal (China), 1996, 31/8 (474-477)

Objective: To prepare compound active calcium tablets and evaluate their stability. Method: The optimal formulation of the tablets was found with orthogonal experiment design. The stability of the tablets was investigated by shelf-life and accelerated experiment. Results: The prepared tablets rapidly disentigrated in 15 min, and showed good stability under various experimental conditions. Conclusion: The compound active calcium tablets will play an important part in prevention and treatment of late middle age or older osteoporosis.

Immunosuppression: Tightrope walk between iatrogenic side effects and therapy

Schweizerische Medizinische Wochenschrift (Switzerland), 1996, 126/38 (1603-1609)

The therapeutic effect of most immunosuppressive agents is inspecific and therefore often limited by an increased risk of infection by viral, bacterial or fungal organisms as well as by an increased incidence of malignant neoplasms. This short review includes the most commonly used immunosuppressants such as corticosteroids, azathioprine, methotrexate, cyclophosphamide and cyclosporine. The most common risks of long-term corticosteroids treatment are Cushing-like changes, decreased glucose tolerance and the usually benign steroid diabetes. Also clinically important is osteoporosis, since it can be prevented by physical training, calcium supplementation and treatment with vitamin D if necessary. Although there is still no proof of a significantly increased risk of peptic ulcer during steroid therapy, patients may develop gastrointestinal hemorrhage and even perforation without producing pain while being treated with corticosteroids. Mineralocorticoid effects, such as salt and water retention, are seen only with hydrocortisone and prednisone, whereas with synthetic steroids such as dexamethasone, sodium retention is absent despite their strong antiphlogistic activity. The most important side effect of the cytotoxic agents azathioprine, methotrexate and cyclophosphamide is marrow suppression. Due to the high turnover of neutrophils, patients most frequently suffer neutropenia rather than thrombocytopenia or anemia. Neutropenia, as well as impaired humoral and cellular immune mechanisms, are responsible for increased susceptibility to bacterial, viral or parasitic diseases during immunosuppressive therapy. Hepatotoxicity has been reported among patients receiving azathioprine (cholestatic hepatitis) and methotrexate (elevated AST levels and, rarely, liver fibrosis or cirrhosis). Cyclophosphamide causes hemorrhagic cystitis in a substantial proportion of patients, as well as an increased incidence of urothelial neoplasms. Both these side effects may be prevented by Mesna. The most important side effects of cyclosporin are acute and chronic nephrotoxicity usually associated with significantly elevated plasma levels of the drug. It must be borne in mind that severe nephrotoxicity may occur in patients receiving cyclosporine and ketoconazole together, since the latter may inappropriately increase the plasma cyclosporine level.

Secondary osteoporosis in rheumatic diseases

Ceska Revmatologie (Czech Republic), 1996, 4/2 (51-57)

In the introduction the authors submit the contemporary definition of osteoporosis (OP) and an account on the causes of secondary osteoporosis. In rheumatoid arthritis (RA) (and other inflammatory types of rheumatism), juxtraarticular and diffuse osteoporosis is encountered. The presence of diffuse OP in patients with RA, never treated with steroids, was confirmed in an investigation of monozygotic pairs of twins by Sambrook et al. The causes of diffuse OP in patients with RA include: a) systemic effect of inflammatory mediators (IL-1, IL-6 and TNFalpha), changes in the circulating hormone levels, changes in calcium metabolism and reduced physical activity. A frequent cause of OP is the administration of steroids (CS-induced OP). In the mechanism of development of CS-OP in particular reduced new formation of bone is involved, while bone reabsorption is usually normal. It can be, however, increased in secondary parathyroid hyperfunction as a result of hypocalcaemia in CS-induced reduced calcium absorption. In the conclusion the authors discuss the principles of prevention and treatment of CS-induced osteoporosis.

Does lactose intolerance predispose to low bone density? A population-based study of perimenopausal Finnish women

Bone (USA), 1996, 19/1 (23-28)

The relationship of lactase malabsorption to osteoporosis is unclear. We examined the relationship of self-reported lactose intolerance (LI) to bone mineral density (BMD) in perimenopausal Finnish women. A random population sample of 2025 women aged 48-59, who underwent spinal and femoral BMD measurement with dual X-ray absorptiometry in Kuopio, Finland during 1989-1991 formed the study population. Out of these women, 162 women reported LI. The mean dairy calcium intake was 558 mg/day in women with LI and 828 mg/day in other women (p < 0.0001). The mean spinal BMDs were 1.097 and 1.129 g/cm2 (-2.8%) (p = 0.016) and the mean femoral BMDs were 0.906 and 0.932 g/cm2 (-2.8%) (p = 0.012) for the LI and other women, respectively. After adjusting for weight, age, years since menopause, and the history of hormone replacement therapy, these differences changed to -2.7% (p = 0.016) for the spinal and -2.4% (p = 0.012) for the femoral BMD, respectively. Dairy calcium intake was an independent determinant of femoral BMD. The addition of calcium intake variables into the multivariate model did not affect the spinal BMD difference, but weakened the femoral BMD difference to -1.9% (p = 0.075). Our results suggest that LI slightly reduces perimenopausal BMD, possibly through reduced calcium intake.

Glucocorticoid-induced osteoporosis

Medecine et Hygiene (Switzerland), 1996, 54/2127 (1490-1495)

Corticosteroids induce mainly trabecular bone loss leading to osteoporosis responsible for fractures and a high rate of morbidity. Thus patients starting a long-term treatment with corticosteroids should be assessed for bone density and biochemical markers. All will benefit from preventive measures with calcium and vitamin D supplements as well as hormonal treatment if necessary. In patients with low bone mass and even more for those with fractures, remineralising treatments with fluoride or bisphosphonates will belp reduce the bone loss and may even increase bone mass.

Current treatment options for osteoporosis

Journal of Rheumatology (Canada), 1996, 23/SUPPL. 45 (11-14)

The goals of treatment for patients with osteoporosis are to maintain normal bone and to prevent the deterioration of normal bone to osteoporotic bone. Achievement of these goals, combined with a successful approach to prevention of falls, may substantially decrease the incidence and risk of fractures. Strategies for osteoporosis therapy include patient strategies (e.g., administration of calcium, exercise), drug therapy to stimulate bone formation (e.g., fluoride, anabolic steroids), and drugs to inhibit bone resorption (e.g., estrogen replacement therapy, calcitonin, bisphosphonates).

Treatments for oestoporosis

Revue Francaise de Gynecologie et d'Obstetrique (France), 1996, 91/6 (329-334)

Preventive therapy for osteoporosis should theoretically be recommended to women at cessation of menses and to elderly individuals of either sex. However, therapeutic decisions depend heavily on individual factors, primarily bone mass assessed using absorptiometry or other means. Hormone replacement therapy (HRT) with estrogen-progestogen combinations is the most effective treatment for women at menopause but is contraindicated in some patients; the results of some studies that found a small increase in the breast cancer risk in patients receiving HRT are open to criticism. Fluoride therapy has generated considerable controversy but can continue to be used according to reasonable rules. Prophylactic calcitonin therapy is expensive and requires treatment modalities that patients are reluctant to accept. Supplemental calcium and vitamin D therapy is undeniably effective, at least in very elderly subjects. Other treatments are also discussed. Current views held by patients, and perhaps by some physicians, regarding the value of preventive treatment for osteoporosis need to be changed.

Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: A preliminary report

Osteoporosis International (United Kingdom), 1996, 6/4 (329-333)

Parathyroid surgery is indicated in patients presenting with primary hyperparathyroidism (PHPT) and osteoporosis (defined as bone mineral density more than 2 standard deviations below normal). Many are elderly women with complex medical problems, either unwilling or considered unfit for surgery. Estrogen replacement therapy (ERT) may potentially be an alternative form of therapy in this group. We studied 15 consecutive postmenopausal women presenting with PHPT and osteoporosis. Group 1 comprised 5 women who elected to be treated with ERT (conjugated equine estrogen, 0.3-0.625 mg/day). The other 10 women underwent successful parathyroidectomy. These 10 patients were randomly subdivided into group 2 (5 patients who received calcitriol 0.25 microg b.i.d. for 12 months following surgery) and group 3 (5 patients who received elemental calcium 1 g/day for 12 months following surgery). Lumbar spine and femoral neck bone mineral density (BMD) were measured prior to and after 12 months of therapy, using a dual-energy X-ray absorptiometer (Lunar DPX-L). The three groups did not differ with respect to their ages (group mean 71.8 years), or baseline serum calcium (group mean 2.77 mmol/l), serum parathyroid hormone (group mean 11.0 pmol/l), lumbar spine BMD (group mean 0.93 g/cm2) and femoral neck BMD (group mean 0.73 g/cm2). Serum calcium normalized in all patients who underwent surgery and none developed hypoparathyroidism. A non-significant decrease in serum calcium was seen in patients treated with ERT only. Lumbar spine (+5.3% per year; 95% CI, 1.1% to 9.6%) and femoral neck BMD (+5.5% per year; 95% CI, -2.1% to 13.2%) increased significantly after 12 months of ERT (p < 0.001 compared with pre-therapy values). These increases in BMD did not differ significantly from those in patients who underwent successful parathyroidectomy followed by either calcitriol therapy or calcium replacement (lumbar spine BMD increase of +6.2% per year, 95% CI 3.1% to 9.4%; and femoral neck BMD increase of +3% per year, 95% CI 0 to 6%). In sumary, increases in lumbar spine and femoral neck BMD occur following treatment of PHPT. ERT appeared as effective as parathyroidectomy (combined with either calcitriol or calcium supplements) for the treatment of osteoporosis in elderly postmenopausal women presenting with PHPT

The effect of calcium supplementation and Tanner Stage on bone density, content and area in teenage women

Osteoporosis International (United Kingdom), 1996, 6/4 (276-283)

One hundred and twelve Caucasian girls, 11.9 + or - 0.5 years of age at entry, were randomized into a 24-month, double-masked, placebo-controlled trial to determine the effect of calcium supplementation on bone mineral content, bone area and bone density. Supplementation was 500 mg calcium as calcium citrate malate (CCM) per day. Controls received placebo pills, and compliance of both groups averaged 72%. Bone mineral content, bone mineral area and bone mineral density of the lumbar spine and total body were measured by dual energy X-ray absorptiometry (DXA). Calcium intake from dietary sources averaged 983 mg/day for the entire study group. The supplemented group received, on average, an additional 360 mg calcium/day from CCM. At baseline and after 24 months, the two groups did not differ with respect to anthropometric measurements, urinary reproductive hormone levels or any measurement of pubertal progression. The supplemented group had greater increases of total body bone measures: content 39.9% versus 35.7% (p = 0.01), area 24.2% versus 22.5% (p = 0.15) and density 12.2% versus 10.1% (p = 0.005). Region-of-interest analyses showed that the supplemented group had greater gains compared with the control group for bone mineral density, content and area. In particular, in the lumbar spine and pelvis, the gains made by the supplemented group were 12%-24% greater than the increases made by the control group. Bone acquisition rates in the two study groups were further compared by subdividing the groups into those with below- or above-median values for Tanner score and dietary calcium intake. In subjects with below-median Tanner scores, bone acquisition was not affected by calcium supplementation or dietary calcium level. However, the calcium supplemented subjects with above-median Tanner had higher bone acqusition rates than the placebo group with above-median Tanner scores. Relative to the placebo group, the supplemented group had increased yearly gains of bone content, area and density which represented about 1.5% of adult female values. Such increases, if held toadult skeletal maturity, could provide protection against future risk of osteoporotic fractures.


Physical Medicine and Rehabilitation Clinics of North America (USA), 1996, 7/3 (583-599)

The management of osteoporosis is challenging. Physicians can look forward to a growing number of medications for treatment and prevention. Rehabilitation management includes the amelioration of pain, prescription of physical activity, and exercise as well as the appropriate use of modalities and orthotics. It is also essential to counsel the patient on diet, including the needs for calcium and vitamin D. Assessment and treatment of emotional and psychosocial factors is also necessary. The prevention of disability with particular emphasis on fall prevention will help reduce the incidence of fractures. Rehabilitation intervention can help improve quality of life for the many patients with osteoporosis.

Osteoporosis and calcium ingest

Progresos en Obstetricia y Ginecologia (Spain), 1996, 39/4 (289-292)

Bone mineral content related to calcium ingest is analyzed in 200 women through a case-control design. 75 were diagnosed of osteoporosis and the remaining 125 had normal bone mineral content. The age ranged between 48 and 55 years old, with climateric period lower than 18 months. Bone mass determination was carried out with double fotonic absortion densitomerty. The calcium ingest study was fulfilled through 24 hours before remind, with personal interview. It was repeated 4 times in a one year period. There were significant differences and also a positive correlation in bone mass related to calcium ingest even in trabecular or cortical bone.

Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: A 3 year followup

Journal of Rheumatology (Canada), 1996, 23/6 (995-1000)

Objective. To determine the efficacy and safety of vitamin D 50,000 units/week and calcium 1,000 mg/day in the prevention of corticosteroid induced osteoporosis. Methods. A minimized double blind, placebo controlled trial in corticosteroid treated subjects in a tertiary care university affiliated hospital. The sample was 62 subjects with polymyalgia rheumatica, temporal arteritis, asthma, vasculitis, or systemic lupus erythematosus. The primary outcome measure was the percentage change in bone mineral density (BMD) of the lumbar spine in the 2 treatment groups from baseline to 36 mo followup. Results. BMD of the lumbar spine in the vitamin D and calcium treated group decreased by a mean (SD) of 2.6% (4.1%) at 12 mo, 3.7% (4.5%) at 24 mo, and 2.2% (5.8%) at 36 mo. In the placebo group there was a decrease of 4.1% (4.1%) at 12 mo, 3.8% (5.6%) at 24 mo, and 1.5% (8.8%) at 36 mo. The observed differences between groups were not statistically significant. The difference at 36 mo was -0.693% (95% CI -5.34, 3.95). Conclusion. Vitamin D and calcium may help prevent the early loss of bone seen in the lumbar spine as measured by densitometry of the lumbar spine. Longterm vitamin D and calcium in those undergoing extended therapy with corticosteroids does not appear to be beneficial.

Novelties and issues in the drug market 1995

Ricerca e Pratica (Italy), 1996, 12/68 (63-71)

Undoubtly the most relevant data produced in this period regard the treatment of hypercholesterolemia. The S4 study has in fact conclusively demonstrated the efficacy of statins in the secondary prevention of coronary events. The West of Scotland Coronary Prevention Study Group has strongly shown a role for statins also in primary prevention, although with a less favourable benefit/risk and benfit/cost profile. Alendronate is the fourth drug shown effective in reducing bone fractures in post-menopausal women, after estrogens, calcitonin, and calcium plus Vitamin D. While estrogens remain first choice when therapy is considered in the immediate post-menopause-because of their higher protective effect and their added cardiovascular benefits - available data are not sufficient to chose among alternatives for older women or for those unwilling to take estrogens. Calcium plus Vitamin D remains the cheapest choice. Formoterol is the first long acting beta-2-agonist to come on the market after the success of salmeterol. Its quick onset of action has been considered a good reason to advise it also for the relief of asthma attacks. It is our opinion that the use of a short acting alternative (like salbutamol) is still to be preferred for safety reasons. Interferon beta has been studied in patients with relapsing-remitting multiple sclerosis. Although it seems able to reduce recurrences, the drug has no demonstrable effect on disability. Methodological issues, and strong vested interests, advise caution with reguard to an uncritical acceptance of this therapeutic option.

Influence of life style in the MEDOS study

Scandinavian Journal of Rheumatology, Supplement (Norway), 1996, 25/103 (112)

MEDOS is a case-control study where 9,000 persons were interviewed with an extensive questionnaire, either at time of fracture or in age-matched controls. Both men and ium intake in the diet, urinary excretion of calcium, serum calcium, serum phosphate, serum parathormone and calcitonin. In children (10-14 years) with lactase deficiency and osteoporosis the mean value of calcium intake was smaller (540-670 mg per day) than in patients of the lactase-normal group (on average 820 mg per day). In children osteoporosis has developed 2-10 years after the hypolactasia diagnosis. In the group of postmenopausal women (50-60 years) calcium intake was smaller in the lactase-deficient group with osteoporosis (average 630 mg per day), in the lactase-normal group in postmenopausal women calcium intake was normal (about 1200 mg per day). Urinary excretion of calcium (per 24 h) and other laboratory analyses did not differ in patients with hypolactasia from patients of the lactase-normal group. Lactase deficiency appears to be one of several factors that predispose the development of osteoporosis, probably through diminished calcium intake.

Roles of diet and physical activity in the prevention of osteoporosis

Scandinavian Journal of Rheumatology, Supplement (Norway), 1996, 25/103 (65-74)

In recent years, much attention has been directed toward the prevention of osteoporosis, since this disease has become a leading cause of morbidity and mortality in elderly women. Research has demonstrated that the prevention of osteoporosis and osteoporosis-related fractures may best be achieved by initiating sound health behaviors early in life and continuing them throughout life. Evidence suggests that osteoporosis is easier to prevent than to treat. In fact, healthy early life practices, including the adequate consumption of most nutrients, regular physical activity, and other healthy behaviors, contribute to greater bone mineral measurements and optimal peak bone mass by the fourth decade of life of females, and, perhaps, also of males. Several reports have shown that the adequate consumption of nutrients, calcium in particular, during the pre-pubertal and early post-pubertal years of females contribute to increased peak bone mass. Indeed, skeletal benefits from long-term calcium supplementation have been reported for females at practically every period of the life cycle. Vitamin D, which may be either consumed or produced endogenously through the action of sunlight, promotes calcium absorption and thereby enhances bone mineralization. Thus, the adequate consumption of calcium, in conjunction with vitamin D, in early life will likely optimize peak bone mass, and adequate intakes of these two nutrients should continue through the remainder of life to help maintain bone mass. On the other hand, excess phosphorus consumption may deter bone mineral accrual because of the resultant elevation of serum parathyroid hormone levels. Additionally, high intakes of protein, sodium, and caffeine may decrease bone mineral mass through increased urinary excretion of calcium. Vitamin K may also have an important positive effect on the development and maintenance of bone through its role in promoting carboxylations of the matrix protein, osteocalcin. In conclusion, the prevention of osteoporosis needs to begin during the pre-ubertal years and it should be continued throughout life. Bone mass can better be maintained later in life through adequate consumption of several nutrients with specific roles in calcium and bone metabolism, regular physical activity, and the practice of a healthy lifestyle. Mechanisms through which the nutrients and exercise affect bone mass will be explored.