Two steps forward in field of osteoporosis
February 22nd, 2011
05:27 PM ET

Two steps forward in field of osteoporosis

Osteoporosis, a condition where the bones become weak, affects 10 million people in the U.S. Two studies released Tuesday in the Journal of the American Medical Association looked at osteoporosis prevention and treatment. One found a nitroglycerin ointment may someday be an inexpensive, widely available means of prevention. The other found a small increase in the risk of atypical fractures associated with the long-term use of the class of drugs known as bisphosphonates.

The nitroglycerin ointment, applied to one part of the skin, was shown to have effects all over the body.

"It differs from current drugs, which either inhibit the breakdown of bone or stimulate the formation of new bone," said Dr. Sundeep Khosla of the Mayo Clinic, who wrote an accompanying editorial. "Nitroglycerin tends to do a little bit of both, which would put it in a unique class by itself."

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Researchers at the Women's College Research Institute and University of Toronto, Canada, studied 243 women for two years. They were postmenopausal and aged 50 or older. They applied either a placebo or the ointment once daily.

At the end of the study, researchers found its use was associated with a modest rise  in density and a decrease in bone loss.

But Khosla says he wouldn't recommend people rush out to buy nitroglycerin ointment, a current treatment for some heart conditions.

"About a quarter of the people (in the study) developed significant headaches," he said.

"It offers a new direction for drug development," he added. "Maybe the pharmaceutical industry will become interested in this and start developing other compounds that work like nitroglycerin does, but maybe doesn't have the side effect of headache and so forth. Those are questions for the future."

The second study looked at long-term use of bisphosphonates, a class of drugs used commonly to treat osteoporosis. They're sold under such brand names as Fosamax, Actonel, Boniva and Reclast.

The researchers looked at the records of all women in Ontario who were age 68 or older with a thigh bone fracture and compared them with women who didn't have those fractures. They also studied the length of time that the women of these two groups had been on the oral bisphosphonate drugs.

"We found a small increase in the risk of thigh bone fractures in women who took these drugs for five years or more," said study author Laura Y. Park-Wyllie of St. Michael's Hospital in Toronto, Ontario. "The risk-benefit for women who have osteoporosis and are at high-risk of fractures favors continuing treatment because, on average, the benefit will outweigh the risk."

For women taking the drugs less than five years, researchers did not see an increase.

In October 2010, the Food and Drug Administration said it's continuing its safety review on the drugs. The atypical fractures involved the femoral shaft (bone in the leg extending from the hip to the knee) or subtrochanteric (fractures in the bone just below the hip joint.)

Park-Wyllie said that a typical hip fracture normally seen with osteoporosis would occur in the upper part of the thigh bone, or femur, which is close to the hip joint.

"Long-term use of the drugs may warrant reconsideration, especially for patients who are at relatively low risk of fracture," she added. "So women taking these drugs, who are not considered to be at high risk for fracture [from osteoporosis], can talk to their doctors about whether they should continue or stop taking the drug."

Park-Wyllie noted that a doctor can assess risk by looking at a patient's history of fracture, age, whether she is postmenopausal,  family history, medical conditions and medications. The research noted that bisphosphonate use was effective in reducing the risk of typical osteoporosis fractures.

"Why these thigh bone fractures could be occurring, there isn't a good understanding of, or how they're occurring," Park-Wyllie said. "It's an important question that future research should direct their efforts at."

soundoff (23 Responses)
  1. Bill - Upper NYS

    The osteoporosis studies are interesting, but why almost all the studies related to women? Granted, women are four times more likely to have osteoporosis, but that still means millions of men may have the problem. Because of all the advertising, men just assume it is a women's disease and don't have bone density studies. If 68% of the 44 million people who have osteoporosis are women, that means over 14 million men are effected! I assume that is only an estimate.

    February 23, 2011 at 14:21 | Report abuse | Reply
    • Diane

      Bill, yes, there are plenty of men with this disease. However, being more prevelant in women, there is a larger population base with which to conduct these studies. There could also be other reasons that are not gone into with these articles on CNN and other sites, that of how hormones affect the diseases. Just because these studies are looking at mainly women does not mean there is nothing being done for men, but that the researchers are using a larger population base with which to study the disease and, hopefully, come to some conclusions about causes and treatments that may then be available for men as well. As one who is starting the journey down the long road of arthritis at 45, I personally don't care if they study men or women more, as long as they are able to find treatments that work, and hopefully a cure.

      February 23, 2011 at 18:06 | Report abuse |
    • LLK

      Valid viewpoint. One of the very few conditions that affect both genders where male subjects are no the focus group.

      February 24, 2011 at 10:40 | Report abuse |
  2. Lane

    Rates of osteoporosis are highest in countries where dairy and meat consumption are highest and lowest in countries where dairy and meat consumption are lowest. Consumption of animal products creates an acidic condition resulting in calcium carbonate being taken from the bones in order to buffer the acidity. The easiest, most cost-effective way to avoid getting osteoporosis is to refrain from consuming dairy and meat.

    February 23, 2011 at 15:06 | Report abuse | Reply
    • Kim

      Exactly! Anyone interested in understanding more about the link between dairy and osteoporosis (as well as other diseases) should read Whitewash by Joseph Keon. To understand more about the link between both dairy and animal protein and osteoporosis (and again, other diseases) should read the China Study by T. Colin Campbell. I'm thoroughly amazed (and horrified) at the number of doctors who push dairy as a cure to osteoporosis. Obviously, it's not working.

      February 23, 2011 at 15:59 | Report abuse |
  3. Wanna-be Vegan

    I have tried to follow a vegan diet and would really like to maintain it but end up feeling hungry, despite eating plenty of potatoes, brown rice, whole grain breads and cereals, beans, vegetables of all kinds, fruit, and organic nut butters. Still feel something is lacking, including Omega-3, and without dairy how do you get enough protein during pregnancy? Are eggs acid-forming?

    February 24, 2011 at 04:42 | Report abuse | Reply
    • Kim

      You might consider logging all of your food into nutritiondata.com. It breaks out even the micronutrients you're eating such as omega-3, as well as the amino acids so that you can see if you're eating the complete spectrum of protein. You're probably getting more protein and nutrients than you think if you're eating all the stuff you mention. A good source of omega-3 is ground flax seed (the whole ones just pass through your body) – just add it to your cereal or salad or smoothies. As for protein, all veggies and fruits have some protein, and beans and nuts are great sources. A non-pregnant person needs about 5-10% of their diet from protein (on 2000 calorie diet, that's 25-50 grams). Pregnant women are advised to eat 25g more than they would otherwise. Yes, eggs are acid-forming. As for hunger, perhaps you should eat more often? I'll say that as a vegan, I rarely, if ever, feel stuffed, but rather just comfortable. I eat about 5-6 times a day as I get hungry. If you're looking to feel the same level of full as you did non-vegan, I'm just not sure that you can. I know this was wordy, but hope it helps.

      February 24, 2011 at 08:50 | Report abuse |
  4. Sunshine

    While I find this all interesting I am now wondering if this series of mentioned diseases is peculiar to North America/Europe?

    Do these exist in the Congo for example, or Lithuania or Sri Lanka?

    February 24, 2011 at 09:20 | Report abuse | Reply
  5. LLK

    My understanding, as a layperson, is that the meds mentioned in the article do nothing to maintain or enhance bone flexibility, only strength. Full bone health requires both. I've heard of some herbs that can help, but am not an expert. May be worth looking into, however.

    Thanks to Kim for the info.

    February 24, 2011 at 10:44 | Report abuse | Reply
  6. Nancy

    Regarding countries with high consumptions of dairy and meat...do they correlate to countries with higher consumptions of wine or alcohol? Is dairy and meat worse than having a glass or two of wine a day?

    February 24, 2011 at 13:14 | Report abuse | Reply
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