1. The skeletal effects of simple bed rest and re-ambulation were studied in a consecutive series of 34 patients (aged 18-60 years) hospitalized with low backache due to protrusion of a lumbar intervertebral disc. The bone mineral content of the second, third and fourth lumbar vertebrae was determined by dual-photon (153Gd) absorptiometry immediately after admission to the hospital, at the end of the bed-rest period (mean 27 days, range 11-61 days) and approximately 15 weeks later (range 11-24 weeks). 2. During recumbency a mean decrease in lumbar spine bone mineral content of 0.9% per week was observed. 3. Re-ambulation resulted in bone mineral gain, and restoration of lumbar spine bone mineral content was nearly complete after 4 months. 4. The findings suggest that the simple therapeutic bed-rest regimen leads to excessive vertebral bone loss. Recurrent bed-rest periods may predispose to spinal osteoporosis.

1. The skeletal effects of physical training were studied in a controlled trial involving 31 healthy women (aged 50-73 years) with previous Colles' fracture of the forearm. The bone mineral content of the lumbar spine and both distal forearms was measured by dual-photon (153Gd) absorptiometry. 2. The participants were allocated to either a physical exercise group or a control group. The former group followed a standardized exercise programme, exercising for 1 h twice weekly during 8 months. 3. Twenty-seven women completed the study. Lumbar spine bone mineral content of the exercise group increased by 3.5%, whereas that of the control group decreased by 2.7%. The rate of bone loss in the control group equalled that of age-matched normal women. 4. The changes in forearm bone mineral content appeared to be independent of the exercise. The bone mineral content of the previously fractured forearm remained nearly unchanged. The bone mineral content of the uninjured forearm decreased on average by 3.5%. 5. The data suggest that physical exercise can inhibit or reverse the involutional bone loss from the lumbar vertebrae in normal women. Physical exercise may prevent spinal osteoporosis.

The aim of this investigation was to elucidate whether Colles' fractures in middle-aged women were indicative of generalized bone loss (osteopenia) and whether bone mass of the axial and the appendicular skeleton was related to the extent of daily physical activity. Thirty-six patients (aged 50-73 years) with previous Colles' fracture were studied. The median time elapse after the injury was 18 months (range 9-20.5 months). Bone mineral content of the 2nd, 3rd, and 4th lumbar vertebrae (lumbar BMC) and both distal forearms (forearm BMC) were determined to dual-photon (153Gd) absorptiometry. The physical activity level was graded according to a standard interview and a bicycle ergometer test. Mean lumbar BMC was reduced by 9% compared to age-matched normal women (p less than 0.05), mean forearm BMC was reduced by 5% (NS). Twenty patients showed spinal osteopenia by either conventional radiography or absorptiometry (95% confidence limits 38-72%). The fracture-related bone loss from the forearms was most prominent when the fracture had occurred in the dominant forearm, suggesting that the loss of 'dominant' forearm activity per se results in bone loss. No relation between working capacity and forearm BMC was found. However, the working capacity was positively related to lumbar BMC (P less than 0.01), even if the common relationship to age was eliminated (P less than 0.05). The data suggest that the bone mass of the axial skeleton reflects the extent of daily physical activity. Patients with Colles' fractures represent an easily definable population which might benefit from prophylactic measures against vertebral bone loss and compression fractures. One of these could be physical exercise.

A double-blind, crossover study was carried out to assess the efficacy and tolerance of a sustained-release tablet formulation of ketoprofen given as a single daily 200 mg dose compared with 2 X 50 mg normal formulation capsules of ketoprofen twice daily. Eighty-four patients with osteoarthritis of the hip and/or knee were admitted and received treatment for periods of 3 weeks, preceded by a 1-week placebo wash-out period, with each of the two formulations, in random order. Patients were seen after each study period and clinical objective and subjective assessments made of signs and symptoms of the disease, consumption of rescue analgesic and unwanted effects. Forty-eight of the patients continued, mainly on the sustained-release formulation, in an open long-term tolerance study lasting 3 months. The results were analyzed for 68 patients who completed the double-blind phase and for 33 who completed the open phase of the study. The patients who were withdrawn did so mainly for non-drug related reasons; 19 patients did so because of gastric disorders during the first phase. The incidence of side-effects was low and similar in frequency and nature with both formulations; those that were reported were mild and principally gastro-intestinal. Both active treatment periods afforded similar symptomatic relief and were preferred to placebo by all but 2 patients. No significant differences were found between active treatments, although there was a trend in favour of the sustained-release formulation for most of the parameters studied as there was in patient preference.