Jewish World Review March 1, 2002 /17 Adar, 5762
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com --
THIS week's New England Journal of Medicine reports on a promising
development in the prevention and treatment of osteoporosis. As we age, we
slowly lose the mineralized portion of the bone that gives it its strength.
The problem is particularly severe in women, as this process is accelerated
following menopause.
In severe cases of osteoporosis, relatively minor
trauma can give rise to debilitating fractures of the vertebrae, hips, and
other bones.
A recently developed class of anti-osteoporosis drugs, called
bisphosphonates, are the only FDA-approved medications available that not
only arrest the progressive loss of bone density, but can also increase bone
density (though only to a modest degree). However, they are not easily
absorbed after being swallowed, requiring frequent doses. At the higher
range of approved dosages, the bisphosphonates often cause gastrointestinal
upset, often resulting in poor patient compliance.
A total of 351 postmenopausal women were enrolled in a multicenter
bisphosphonate therapy trial. All volunteers had documented low bone
mineral density, and were studied for a period of one year. Varying doses
of zoledronic acid, a potent bisphosphonate, were given to volunteers
intravenously at the following intervals: 3 months, 6 months and 12 months.
Another group of women received an injection of a placebo (saline) only. As
this was a double-blinded study, none of the volunteers or their physicians
knew whether they were receiving the drug or the placebo. At the end of one
year, lumbar spine bone mineral density was tested again.
Surprisingly, ALL groups of study participants receiving zoledronic acid had
similar increases in bone density when compared to the group receiving the
placebo injections. Increases of 4 to 5 percent in lumbar spine density
occurred in the women who received the drug every three months as well as in
the group of women who received only a single 4 milligram injection during
the year-long study.
This is quite a remarkable-and unexpected-finding.
The drug is metabolized rather quickly following intravenous injection, but
its bone density effects nonetheless appear to persist for at least 12
months. The possibility that one could obtain similar bone-building effects
from a once-a-year injection of a single drug is quite an extraordinary
concept.
As this is a novel finding, additional and larger studies would be
prudent. More important than this study's finding of increased bone mineral
density would be evidence that an annual injection of zoledronic acid
actually reduced the incidence of spine and hip fractures compared to women
not taking any anti-osteoporotic drug. Demonstrating a clinical benefit
with this new dosing regimen will be an important next step.
LIFETIME RISK OF DEVELOPING HIGH BLOOD PRESSURE
However, the actual lifetime risk of
developing high blood pressure has never been specifically assessed. In
this week's Journal of the American Medical Association, this risk appears
to have been quantified in a group of 1298 participants in the famous
Framingham Heart Study. These 1298 volunteers, aged 55 to 65 years, were
carefully studied between 1976 and 1998, and were free of high blood
pressure at the beginning of the study. The findings were rather shocking:
90% of the participants developed at least mild high blood pressure (at
least 140/90 mm Hg).
Approximately 60% of this group eventually required
medication to control their elevated blood pressure. When this current
group of volunteers were compared to an earlier study group (involving a
different group of volunteers between 1952 and 1975), the risk of developing
high blood pressure was unchanged for women but was 60% higher among the men
in the current group. For all of this bad news, there was some good news as
well. The risk of developing moderately high blood pressure (at least
160/100 mm Hg) was significantly lower among the current group of study
patients when compared to the earlier group. This is most likely due to
improved screening and treatment for high blood pressure.
Clearly, if 90% of us are at risk of eventually developing at least mild
high blood pressure, there is much more work to be done in the areas of
hypertension prevention and treatment....
DIET & THE RISK OF OVARIAN CANCER
In a nutshell, women with a high intake of vegetables had one-fourth the
risk of developing ovarian cancer when compared with the women who consumed
few vegetables. The story for high fruit intake was similar, with the heavy
fruit eaters experiencing one-third the risk of ovarian cancer when compared
to women who rarely ate fruit. Conversely, diets high in animal fat were
associated with a more than three-fold increase in the risk of ovarian
cancer.
In general, women with high dietary intakes of fatty, cured or
smoked foods had a significantly increased risk of developing ovarian
cancer. A similar correlation between dietary habits and other cancers have
been found, most notably with colon cancer. Although the evidence is
somewhat weaker, cancers of the stomach, breast and prostate may also occur
more commonly in people with a low intake of fruits and vegetables and/or
with high intake levels of animal-based foods and dietary fat. Once again,
Mom's wisdom is validated-- you really should eat all of your fruit and
vegetables so that you will grow up to be
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
Comment by clicking here.
Osteoporosis prevention with a once-a-year injection?
Untreated high blood pressure increases the risk of heart attack and stroke.
As we age, changes in the elasticity of our arteries tend to cause our blood
pressure to gradually increase.
The British Journal of Cancer is reporting on a study from China that
evaluates the impact of diet on the incidence of ovarian cancer. In a
recent column, I discussed a new protein-based blood test that shows promise
as a tool for early detection of ovarian cancer, which is often silent
during its early stages. A total of 254 women with ovarian cancer and 652
women without cancer were assessed for their dietary habits using a diet
questionnaire. Although this method of research can provide rather
subjective results (as it is both retrospective and based solely upon
patient recollections), the results are certainly consistent with other
studies of dietary influence on the incidence of certain cancers.
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