Osteoporosis in the News


Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.

Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR.

Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand.

OBJECTIVE: To investigate whether calcium supplements increase the risk of cardiovascular events.

CONCLUSIONS: Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.

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Osteoporosis

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Taking A Break From Osteoporosis Drugs Can Protect Bones

19 Nov 2010 - 5:00 PST


Taking time off from certain osteoporosis drugs may be beneficial to bone health, according to a study conducted at Loyola University Health System. Researchers found that bone density remained stable for three years in patients who took a drug holiday from bisphosphonates, a popular class of osteoporosis drugs that can cause fractures in the thigh bones and tissue decay in the jaw bone. 

"These drugs are potentially harmful when taken for long durations, yet little has been known until now about the length of time osteoporosis patients should go without treatment for this debilitating condition," said Pauline Camacho, MD, study investigator and director of the Loyola University Osteoporosis and Metabolic Bone Disease Center. "Our study demonstrated that bones can remain stable for a number of years after these drugs are discontinued." 

Doctors recommend that patients take drug holidays from bisphosphonates after four to five years. These drugs continue to stabilize bones and reduce the risk for bone loss after treatment ceases. 

The study's goal was to identify the optimal drug holiday length after prolonged use of bisphosphonates based on changes in bone mineral density and bone loss. The study evaluated 139 patients (123 females, 16 males) with osteoporosis and osteopenia, the precursor to the disease. Patients took a bisphosphonate an average of 6.8 years before beginning a drug holiday from 2005 to 2010. Over three years, five fractures occurred, but bone mineral density did not change significantly. However, bone loss did start to increase at six months. The type of bisphosphonate and the duration of treatment did not affect bone mineral density. 

"While further research is needed to adequately assess the optimal duration of the drug holiday, we do know that patients can relatively safely discontinue their treatment for at least three years," Dr. Camacho said. "However, patients who fracture during their drug holiday should notify their physician right away so osteoporosis therapy can be resumed. Patients also should continue to see their physician to regularly monitor their bone health." 

Lauren Myers, a second-year medical student at Loyola University Chicago Stritch School of Medicine, and Jim Sinacore, PhD, associate professor of preventive medicine and epidemiology at Stritch, also were study investigators.

NICE Opens Consultation On Hip Fracture Draft Guideline

11 Nov 2010 

The National Institute for Health and Clinical Excellence (NICE) today (10 November) opens the public consultation on its draft guideline on the management of hip fracture in adults. The draft guideline sets out preliminary recommendations on what treatment and care the NHS should offer to people who have had a hip fracture, from the point at which they are admitted to hospital, to their return home, and then final discharge from follow-up care. 

Around 70-75,000 hip fractures occur each year in the UK, with figures projected to rise as a result of the ageing population. The average age of a person with hip fracture is 77 years, and most are women. Although most hip fractures occur in later life, they can happen at any age in people who have the bone-thinning conditions osteoporosis or osteopenia. Currently, the cost of medical and social care for the UK's hip fracture cases is an estimated £2 billion each year. A high number of deaths occur after a hip fracture, with around one in three people with a fracture dying within 12 months. Although fewer than half of these deaths are related to the hip fracture itself, it's an indication of the high level of pre-existing illnesses in many patients with hip fracture. 

Dr Fergus Macbeth, NICE Clinical Practice Centre Director, said: "Hip fracture is a major health problem which can have a devastating impact on people who suffer one, as well as requiring a carefully coordinated approach from a range of health disciplines including care after leaving hospital. Evidence indicates that there is considerable variation in clinical practice, which can affect the quality of care that hip fracture patients of all ages receive. For example, prompt surgery has been generally recognised as important, but it's sometimes delayed for administrative or clinical reasons. When the final NICE guideline is published, it will help health professionals manage hip fracture in the most effective way. We look forward to receiving comments from groups representing patients and clinicians as part of this public consultation to help inform the development of this important guideline." 

Draft recommendations for consultation include: 

- Timing of surgery: Offer patients who require surgery an operation to be carried out on the day of, or the day after, admission, and identify and treat specified correctable co-morbidities immediately so that surgery is not delayed 

- Surgical procedures: recommendations on when to offer arthroplasty (joint reconstruction or realignment) and total hip replacements depending on the specific type of hip fracture and patient's individual circumstances 

- Mobilisation strategies: Offer patients physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery, and offer patients mobilisation at least once a day and ensure regular physiotherapy review 

- Multidisciplinary management: From admission, offer all hip fracture patients a formal, acute orthogeriatric or orthopaedic ward-based Hip Fracture Programme that incorporates aspects including: 
- early identification of individual goals for multidisciplinary rehabilitation to help patients regain their mobility and independence as quickly as possible, continued regular orthogeriatric and multidisciplinary review 
- continued regular orthogeriatric (joint orthopaedic and geriatric care service) and multidisciplinary review 
- comprehensive information exchange with the patient's primary care team 

The consultation on the draft guideline on the management of hip fracture in adults closes on 12 January 2011, and comments from registered stakeholders are welcome via the NICE website. 

Notes 

About the guidance 

1. The consultation on the draft guideline is available from Weds 10 November 2010 to 12 January 2011. 

2. Read the NICE guidance on primary and secondary prevention of osteoporotic fractures athttp://www.nice.org.uk/TA160, http://www.nice.org.uk/TA161 and http://www.nice.org.uk/TA204. 

Source: 
NICE

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