Nondrug therapies for osteoporosis

nations as to why endogenous estrogens were not protective against cardiovascular disease and conclude that estrogen concentrations in postmenopausal women may be less than that required to prevent disease, and thus only premenopausal concentrations are cardioprotective. The average levels ofestradiol in their patients was 54 to 56 pmollL for those who had cardiovascular disease death and ischemic heart disease as the cause of death. Although this hormone level may have been present initially, we have no idea what the level was in the

years immediately preceding death. Was it the same or lower? The data now being reported regarding the protective effects of postmenopausal estrogens show this effect when the level is maintained, but a loss of protection when estrogens are stopped. Although it is difficult to reach a conclusion on anything based on the limited data, this study would appear to support the conclusion that in postmenopausal women endogenous levels of estrogen are inadequate. External estrogens, if appropriate, are needed. Pli 11081·6862(96)00001·5

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OB/GYNS

LITERATURE ON THE CAUSES OF CEREBRAL PALSY To the Editor: I am impressed with your new publication. About "Cerebral Palsy in Australia:" Two perinatologists from down-under have written me that the aurhors of that consensus statement were selected for their viewpoints. The consensus statement Achilles heel, I believe, is the suggestion that intrapartum insults hardly ever cause «5%) cerebral palsy. An article by a plaintiffs attorney (Tilson JL. Exposing manufactured scientific literature. MLTA Quartery 1994 Summer) aruges with AGOG Technical Bulletin #163. I presume that your staff is aware of this publication, but I have had a difficult time obtaining a copy. It seems to me that this should likewise be read by any physician who has been sued regarding cerebral palsy. Bob Goodlin, MD Denver, Colorado PlI51085·6862(96)00007·6

NONDRUG THERAPIES FOR OSTEOPOROSIS To the Editor: I have received the first volume of ACOG Clinic Review and think it

1111111111111111111111111111111111 1085-6862(199603/04)1:2i1-N

is a nice change in format. I would like to comment, however, on some of your recommendations for "Osteoporosis: A New Treatment Modality." What's wrong with exercise? All we seem to do is want to drug the population. I see nothing in your recommendations regarding exercise, diet, etc. Certainly, it has been shown that exercise can retard osteoporosis, and in fact, patients can improve and lay down bone with the proper exercise. Also, there are some homeopathic remedies that seem to work quite well. The new drug, alendronate, is not inexpensive. What has not been done is a good study to compare alendronate sodium versus a good diet and exercise with weight bearing. Why not? It is one heck of a lot cheaper to recommend exercise and a good diet than to drug up the population. Unfortunately, the comments that I have suggested will not have the same impact upon the medical community, and also unfortunately, our failure to be leaders in exercise and diet, etc, will continue to force the population to spend extraordinarily large amounts of money to take care ofproblems that can be remedied by a better health life style. Duane E. Townsend, MD Salt Lake City, Utah

16 • ACOG CLINICAL REVIEW. March/April 1996

Published in cooperation with The American College of Obstetricians and Gynecologists Editor-in-Chief: Vicki L. Seltzer, MD New Hyde Park, NY

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©1996 by the American College of Obstetricians and Gynecologists Published byElsevier Science Inc. 1085,6862196/$15.00