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S19 The new definition of osteoporosis and its implications for bone mass measurement in women
SIDE EFFECTS
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THE NEW DEFINITION OF OSTEOPOROSIS AND ITS IMPLICATIONS FOR BONE MASS MEASUREMENT IN WOMEN.
Vivienne O’Connor
One hundredand forty six (26%) womenwithdrew from the initial 548 intention-to-treatsubjects. The reasonsfor withdrawalwere administrative(69) and medical (77). Administrative reasons included 19 protocol violations; 11 non-compliance;25 who no longerwishedto participate;and 10lostto follow-up. Thereforethe reasonsfor the womennot wishingto continuethe protocol are unknown for the latter two groups,consistingof 35 women (6%). Medical reasonswere divided into 14 serious (including 4 women with breast cancer; one with endometrial cancer;and one with thromboembolism) and 63 non-serious(of which the main reasonswere: vaginal bleeding; sore breasts; headache andmigraine;premenstrual tension;andweightgain). Irrespectiveof provera-dosegroup, womenwithdrawingfrom the study were more likely to have reporteda bleedingproblemthan those who remainedin the study (p
P D Delmas
ClaudeBernardUniversity of Lyon, INSERM ResearchUnit 403, Lyon, France Osteoporosis is one of the mostprevalentdiseases associated with agingandbecauseof its morbidity andcost, it is viewed asa major healthproblemin the westernand asianworld. Thus, the lifetime risk of any osteoporoticfracture (including the hip, spine and forearm)is almost40% in white womenfrom the age 50 years onwards.A low bonemassis by far the mostimportantdeterminant of bone fragility. Amongst the various methods capable of measuringbonemassand/ordensity, singleand dual energyXray absorptiometry(SXA and DXA) are the mostaccurate,preciseand convenienttechniques.A decreasein bone massmeasuredat the lumbar spine, hip, forearm or heel with these techniquesis associatedwith a significant increasein the risk of osteoporotic fractures. Specifically,a decrease of onestandarddeviation(SD) of bone massinducesa 1.5 to 3 fold increasein the risk of hip, vertebral or forearmfractures. A recent WHO report hasdefined osteoporosis asa diseasecharacterizedby a decreaseof bone mass greaterthan2.5 SD belowthe peakbonemass,i.e. the meanlevel of bonemassachievedin young healthywomen. Womenwith a bone masscomprisedbetween1 and 2.5 SD belowthe peak bonemass (low bonemass)haveanintermediate risk of fracture. Continued
S19 (cant)
s20 PREVENTION OF OSTEOPOROSIS WITH ESTROGENS, ITS ANALOGUES AND PROGESTOGENS: WHAT IS NEW?
This operationaldefinition of osteoporosis providesa rationalbasis for the therapeuticdecisionwhich is also basedon other clinical narameterssuch as age, menopausalstatus, associateddisease, history of previous fractures and the be&t/risk ratio of the treatment.An interestingalternativeto DXA is the measurement of ultrasoundvelocity and broadbandattenuationat the calcaneum,a radiationfreemethodthat correlateswith bonemassandpredictsthe risk of hip fracture in the elderly. Finally, recentdatasuggestthat evaluationof bone turnover with new sensitivemarkersof bone resorptionand/orformationprovideusefuladditionalinformationin the clinical evaluationof osteoporoticpatients. Indeed,a high rate of boneresorptionis associated with an increasedrate of fracture, independentlyof the level of bone mass. In conclusion,recent advancesin medicaltechnologyallowsto makean early diagnostic of osteoporosis andto target effective treatmentto the subgroupof postmenopausal women which is at highest risk of sustaining fractures.
28
D WPurdie
Centre for Metabolic Bone Disease,Hull Royal Intinnary HULL HU3 2RW, UK The estrogens, andmorespecificallyestradiol,arefirmly established as the prime therapeutic intervention for the prevention of osteoporosis in postmenopausal women. Recentdevelopmentsin the useof estrogens may be groupedunder3 broadheadings:The physiologicalrelationshipbetweenthe estrogensand the skeleton; new estrogendelivery systems;and the long-termsafety of HRT, particularlyin respectof breastcancer. The complexmechanism involving both cytokines and calcitrophic hormones- whereby estrogenrestrainsboneturnoverandhencemaintainsthe couplingof boneformation/resorption is slowly beingclarified. With regard to delivery systems,the past 2 years have seen significantadvancesdesignedto melt the two central concernsof patientsofferedHRT - simplicity of regimeand avoidanceof cyclic bleeding. The advent of the matrix patch has helpedin termsof adhesion,reliability of delivery and absenceof epidermalirritation. Howeverthe 3 day/4 day applicationpattern is not optimaland the adventof the 7 daypatchwith a unitary applicationtime eachweek, will aid continuation. Similarly, the increasinguseof the calendar monthratherthanthe cycle “month” for the progestogencomponent i.e. that it betakenfrom January1-12et seq is helpful. The problem of bleedinghasbeenaddressed with the adventof tri-monthly cyclic HRT regimeandthe continuouscombinedapproach.
- COMPLIANCE
THE NEW DEFINITION OF OSTEOPOROSIS AND ITS IMPLICATIONS FOR BONE MASS MEASUREMENT IN WOMEN.
Vivienne O’Connor
One hundredand forty six (26%) womenwithdrew from the initial 548 intention-to-treatsubjects. The reasonsfor withdrawalwere administrative(69) and medical (77). Administrative reasons included 19 protocol violations; 11 non-compliance;25 who no longerwishedto participate;and 10lostto follow-up. Thereforethe reasonsfor the womennot wishingto continuethe protocol are unknown for the latter two groups,consistingof 35 women (6%). Medical reasonswere divided into 14 serious (including 4 women with breast cancer; one with endometrial cancer;and one with thromboembolism) and 63 non-serious(of which the main reasonswere: vaginal bleeding; sore breasts; headache andmigraine;premenstrual tension;andweightgain). Irrespectiveof provera-dosegroup, womenwithdrawingfrom the study were more likely to have reporteda bleedingproblemthan those who remainedin the study (p
P D Delmas
ClaudeBernardUniversity of Lyon, INSERM ResearchUnit 403, Lyon, France Osteoporosis is one of the mostprevalentdiseases associated with agingandbecauseof its morbidity andcost, it is viewed asa major healthproblemin the westernand asianworld. Thus, the lifetime risk of any osteoporoticfracture (including the hip, spine and forearm)is almost40% in white womenfrom the age 50 years onwards.A low bonemassis by far the mostimportantdeterminant of bone fragility. Amongst the various methods capable of measuringbonemassand/ordensity, singleand dual energyXray absorptiometry(SXA and DXA) are the mostaccurate,preciseand convenienttechniques.A decreasein bone massmeasuredat the lumbar spine, hip, forearm or heel with these techniquesis associatedwith a significant increasein the risk of osteoporotic fractures. Specifically,a decrease of onestandarddeviation(SD) of bone massinducesa 1.5 to 3 fold increasein the risk of hip, vertebral or forearmfractures. A recent WHO report hasdefined osteoporosis asa diseasecharacterizedby a decreaseof bone mass greaterthan2.5 SD belowthe peakbonemass,i.e. the meanlevel of bonemassachievedin young healthywomen. Womenwith a bone masscomprisedbetween1 and 2.5 SD belowthe peak bonemass (low bonemass)haveanintermediate risk of fracture. Continued
S19 (cant)
s20 PREVENTION OF OSTEOPOROSIS WITH ESTROGENS, ITS ANALOGUES AND PROGESTOGENS: WHAT IS NEW?
This operationaldefinition of osteoporosis providesa rationalbasis for the therapeuticdecisionwhich is also basedon other clinical narameterssuch as age, menopausalstatus, associateddisease, history of previous fractures and the be&t/risk ratio of the treatment.An interestingalternativeto DXA is the measurement of ultrasoundvelocity and broadbandattenuationat the calcaneum,a radiationfreemethodthat correlateswith bonemassandpredictsthe risk of hip fracture in the elderly. Finally, recentdatasuggestthat evaluationof bone turnover with new sensitivemarkersof bone resorptionand/orformationprovideusefuladditionalinformationin the clinical evaluationof osteoporoticpatients. Indeed,a high rate of boneresorptionis associated with an increasedrate of fracture, independentlyof the level of bone mass. In conclusion,recent advancesin medicaltechnologyallowsto makean early diagnostic of osteoporosis andto target effective treatmentto the subgroupof postmenopausal women which is at highest risk of sustaining fractures.
28
D WPurdie
Centre for Metabolic Bone Disease,Hull Royal Intinnary HULL HU3 2RW, UK The estrogens, andmorespecificallyestradiol,arefirmly established as the prime therapeutic intervention for the prevention of osteoporosis in postmenopausal women. Recentdevelopmentsin the useof estrogens may be groupedunder3 broadheadings:The physiologicalrelationshipbetweenthe estrogensand the skeleton; new estrogendelivery systems;and the long-termsafety of HRT, particularlyin respectof breastcancer. The complexmechanism involving both cytokines and calcitrophic hormones- whereby estrogenrestrainsboneturnoverandhencemaintainsthe couplingof boneformation/resorption is slowly beingclarified. With regard to delivery systems,the past 2 years have seen significantadvancesdesignedto melt the two central concernsof patientsofferedHRT - simplicity of regimeand avoidanceof cyclic bleeding. The advent of the matrix patch has helpedin termsof adhesion,reliability of delivery and absenceof epidermalirritation. Howeverthe 3 day/4 day applicationpattern is not optimaland the adventof the 7 daypatchwith a unitary applicationtime eachweek, will aid continuation. Similarly, the increasinguseof the calendar monthratherthanthe cycle “month” for the progestogencomponent i.e. that it betakenfrom January1-12et seq is helpful. The problem of bleedinghasbeenaddressed with the adventof tri-monthly cyclic HRT regimeandthe continuouscombinedapproach.