No abstract

The efficacy and safety of oral pamidronate was examined in a double-blind, placebo-controlled trial in women and men with established osteoporosis. Seventy-eight postmenopausal women and 23 men with at least one prevalent vertebral fracture were randomized separately to 150 mg/day of pamidronate or placebo for 3 years followed by 150 mg/day of pamidronate for an additional 2 years. In addition, all patients received 400 U/day of cholecalciferol and 500 mg/day of elemental calcium. Pamidronate increased significantly bone mineral density of the lumbar spine (LS-BMD) and of the femoral neck (FN-BMD)

No abstract

Bisphosphonates are used with increasing frequency in the treatment of patients with osteoporosis. Continuous administration of low doses of nitrogen-containing bisphosphonates by mouth is the preferred mode of therapy. The skeletal half-life of bisphosphonates is long, however, and little is known about their long term effects on skeletal metabolism. We examined the changes in biochemical parameters of bone turnover [serum alkaline phosphatase and urinary hydroxyproline (OHP)], in bone mineral density, and in fracture frequency after discontinuation of long term (mean, 6.5 yr, range, 5-9 yr) therapy with oral pamidronate (150 mg/day) in 30 patients with osteoporosis and vertebral fractures. Serum alkaline phosphatase and urinary OHP were significantly lower at the end of long term treatment (90% and 72% of basal values, respectively). Serum alkaline phosphatase had increased to basal values within 6 months of stopping treatment, whereas OHP increased significantly to a maximum average of 92% of pretreatment values. There was no change in the every 6-month bone mineral density measurements of the lumbar spine and the femoral neck during the 2 yr after stopping treatment. Spine fracture index, calculated by the method of Raymakers and co-workers, was 0.83 +/- 0.12 before treatment, 0.85 +/- 0.12 at the end of treatment, and 0.85 +/- 0.13 2 yr after stopping treatment (nonsignificant). There was also no significant change in the rate of new vertebral fractures on or up to 2 yr after stopping treatment (48.5 of 1000 and 46.5 of 1000 patient yr, respectively). Our data demonstrate that the sustained suppression of bone turnover induced by long term treatment with pamidronate is readily reversible on stopping treatment. The beneficial effect of this treatment regimen on the skeleton, however, appears to be maintained for at least 2 yr after discontinuation of treatment.

Single enerlly photon absorptiometry is a reliable technique for assess@ the bone mineral content (BMC) of cortical bone in the forearm. It can also be used for BMC measurement in the ultradistal part of the forearm, where there is a considerable proportion of trabecular bone. The results of a BMC survey at both sites in healthy Dutch women, aged 26-75 yr, are reported, and the differences and changes with age are discussed. The techuique offers possibiities for a rational screening programme in post-menopausal women, because of its high precision, low radiation dose, speed and low cost. The validity of the ultradistal measurement for the detection of abnormally fast bone mineral loss from trabecular bone in the individual patient has yet to be proven. IntroduetlooOsteoporosis is a matter of great concern in terms of health care and cost. On the basis of the rise in the number of hospital admissions due to osteoporosis or osteoporosis-related fractures in The Netherlands during the period 1972-1982, it is forecast that this figure will triple by the year 2010, taking into account expected population trends (11. A rational prevention strategy requires the proper identification of women at risk and the availability of preventive measures.Oestrogen substitution is an effective method of preventing post-menopausal bone loss [2], while adequate calcium intake and appropriate exercise are also recommended. Oestrogens should be prescribed selectively to women at risk for post-menopausal osteoporosis 131. Risk assessment ultimately relies on the detection of an excessive loss of bone mass or an existing abnormally low bone mass. Several techniques areavailable for this purpose [4], but only single photon absorptiometry (SPA) is suitable for the screening of bone mineral mass on a CO~?SPW&IKX to: