Biophysical study of bone mineral in biopsies of osteoporotic patients before and after long-term treatment with fluoride

252 cancer would occur. The advent of oral contraceptives. the trend toward childbearing later in life, and the dpmonstration of the protectire va!ae of menopausal estrogen replacement therapy against osteoporosis and czrdiovascuiar disease requires that this issue be reexamined. New information bearing on this subject includes the recognition of estrogen receptors, the isolation of youth rather than pregnancy as the factor resulting in poor prognosis, epidemiologic studies showing no increased risk of breast cancer in women using oral contraceptives or taking hormonal replacement therapy, the benefi--d breast cancer, and the absence of an cial effect of pregnancy subsequent to successfuiiy man+.. adverse effect of oral con+Jaceptives upon estabiisbd breast camzer. !r. view of the lack of evidence relating estrogen to exacerbation of existing breast cancer, it may he in the best interest of our patients to liberalize our &t!itude to renewed hormonal exposure in patients with successfully n,anaged breast cancer.

Biophysicnl study of bone mineral in biopsies of ~steoporutic patknts

befote

and after long-term

treatment with fluoride

Baud CA; Very JM; Courvoisier B Institut de Morphologie, Centre Medical U+ersitaire, 1211 Geneve 4: Switzerland Bone; 916 (361-365)/1988/ Crystallographic characteristics of bone mineral were examined in a group of 60 Jsteoporotic patients before and after 3 to 6 years of fluoride therapy. The age of the mineral was evaluated by means of X-ray absorption, as degree of mineralization of bone tissue (MDBT). Crystallinity was evaluated by measuring both X-ray diffraction line broadening, beta (31.0) and beta (00.2). and the crystaliinity index (CI) by infrared spectrometry. The a arId c unit-cell parameters were determined by powder Xray diffraction. Bone fluoride contem was measured by specific electrode. Patients were divided in two groups according to MDBT before treatment: one group with MDBT values less thsn or equal tu mean value; another group with MDBT value. greater than mean value. in The first group, trabecuiar bone volume (TBV) did not change sigmficantiy during therapy. In the second group, an increase of TBV was observed. Osteoporoses can then be distinguished, on MDBT criterion, between osteoporosis with hypermaturated mineral an9 osteoporosis with hypomaturated mineral. The MDBT before treaunent permits one to predict the effect of fluoride therapy on TBV. In the two groups there was a significant increase in bone fluoride content between the onset and the end of treatment. Bone fluoride content increased linearly during therapy without any plateau effect. Crystallographic modifications iuduced by fluoride explain mechanical and chemical improvement of bone.

A model tor e~:!n~~i~?gthe poteotiat costs aod savfogs of osteopurosis

prevention

strategies

Ross PD, ‘Yasnich RD, Maciean CJ; Hagino P: Vogel JM Kuakini Gs:etipmxk Study, Kuakini Medical Center, Honolulu, HI; U.S.A. Bone; 916 (337-347)/1988/ A model was developed which estimates thL cost of osteoporosis ,isk evaluation and treatment, arid the resulting savings in terms of reduced fracture frequency, for the adult female population of the United States. In the absence of treatment, tk e model predicts 1.44 million fractures will occur annually from non-violent causes. Treatmerit of all women beginning at age 50 with an agent that slows hone 1~s by 50% would reduce the number of these fractures by 0.59 million. Selective treatment of the 47% of women at the greutcbt fracture -isk would reduce the number of fractures by 0.45 million. but would only cost 47010as much ah treating all women. Additional data are required before 6.emodel can be used to evaluate specific treatment regime;;. H~=.v;vcr, ‘t ++tars that selective treatment uf those at high& risk w&d yieid the gr:?cest benefit to cost ratio, if OII!~benefits related to reduced fracture frequency are considered.