Jewish World Review March 1, 2002 /17 Adar, 5762

Osteoporosis prevention with a once-a-year injection?

By Robert A. Wascher, M.D., F.A.C.S. -- 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.


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.

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....


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.

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 healthy!

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.


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© 2002, Dr. Robert A. Wascher