Diana Mahoney

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All of the participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” Ms. Finigan said.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. Analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age. As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” she said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All of the participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” Ms. Finigan said.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. Analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age. As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” she said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All of the participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” Ms. Finigan said.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. Analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age. As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” she said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Age and frailty should not deter physicians from offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy.”

The three studies each looked at 3-year fracture end points and included women aged 80–100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” Dr. Boonen said.

The rates of nonvertebral fractures were not significantly different between the two groups, he said. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, Dr. Boonen said. The treatment was well tolerated, even among the oldest women in the study population, “despite the fact that evaluation of baseline characteristics showed these patients to have a higher prevalence of gastrointestinal diseases than younger patients.”

The findings are of particular relevance, considering the aging of the population. “The prevalence of vertebral deformities in women increases markedly between the ages of 50 and 90, and epidemiological data suggest that half or more of women aged 80 and older have vertebral fractures,” he said. “Our findings suggest that adding [bisphosphonate] treatment to calcium and vitamin D could significantly decrease the incidence of vertebral fractures in elderly women with osteoporosis and thus reduce the public health burden associated with these fractures.”

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Because each of the antiresorptive therapies used to treat osteoporosis has unique characteristics and side-effect profiles, the observations made in this study cannot be generalized to include other bisphosphonates, he cautioned.

Dr. Boonen disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

HARROGATE, ENGLAND — Age and frailty should not deter physicians from offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy.”

The three studies each looked at 3-year fracture end points and included women aged 80–100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” Dr. Boonen said.

The rates of nonvertebral fractures were not significantly different between the two groups, he said. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, Dr. Boonen said. The treatment was well tolerated, even among the oldest women in the study population, “despite the fact that evaluation of baseline characteristics showed these patients to have a higher prevalence of gastrointestinal diseases than younger patients.”

The findings are of particular relevance, considering the aging of the population. “The prevalence of vertebral deformities in women increases markedly between the ages of 50 and 90, and epidemiological data suggest that half or more of women aged 80 and older have vertebral fractures,” he said. “Our findings suggest that adding [bisphosphonate] treatment to calcium and vitamin D could significantly decrease the incidence of vertebral fractures in elderly women with osteoporosis and thus reduce the public health burden associated with these fractures.”

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Because each of the antiresorptive therapies used to treat osteoporosis has unique characteristics and side-effect profiles, the observations made in this study cannot be generalized to include other bisphosphonates, he cautioned.

Dr. Boonen disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

HARROGATE, ENGLAND — Age and frailty should not deter physicians from offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy.”

The three studies each looked at 3-year fracture end points and included women aged 80–100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” Dr. Boonen said.

The rates of nonvertebral fractures were not significantly different between the two groups, he said. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, Dr. Boonen said. The treatment was well tolerated, even among the oldest women in the study population, “despite the fact that evaluation of baseline characteristics showed these patients to have a higher prevalence of gastrointestinal diseases than younger patients.”

The findings are of particular relevance, considering the aging of the population. “The prevalence of vertebral deformities in women increases markedly between the ages of 50 and 90, and epidemiological data suggest that half or more of women aged 80 and older have vertebral fractures,” he said. “Our findings suggest that adding [bisphosphonate] treatment to calcium and vitamin D could significantly decrease the incidence of vertebral fractures in elderly women with osteoporosis and thus reduce the public health burden associated with these fractures.”

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Because each of the antiresorptive therapies used to treat osteoporosis has unique characteristics and side-effect profiles, the observations made in this study cannot be generalized to include other bisphosphonates, he cautioned.

Dr. Boonen disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

BOSTON — Many physicians do not follow recommended guidelines for the diagnosis and management of children with pharyngitis, according to results of a Centers for Disease Control and Prevention survey.

Although pharyngitis is one of the most common reasons for prescribing antibiotics for children, only 15%-30% of pediatric episodes are caused by group A streptococci and helped by antibiotics, CDC epidemiologist Sarah Y. Park, M.D., said in a presentation at the annual meeting of the Infectious Disease Society of America.

Numerous studies have demonstrated that it is not possible on clinical grounds to differentiate streptococcal from viral pharyngitis, yet 278 of 505 (55%) eligible pediatricians and family physicians who completed the CDC survey said they did not wait for laboratory confirmation of bacterial pharyngitis before initiating antibiotic therapy.

In addition, 64 (13%) of the respondents said they prescribed antibiotics based on clinical findings alone.

Diagnostic recommendations for pharyngitis are throat culture alone or a rapid antigen-detection test with throat culture backup, in conjunction with clinical and epidemiologic findings, said Dr. Park. “Diagnosis based on clinical findings alone is not recommended. Most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination, which leads to antibiotic abuse,” she said.

Dr. Park and her colleagues sent surveys to a total of 2,000 randomly selected members of the American Academy of Family Physicians (1,000 recipients) and the American Academy of Pediatrics (1,000 recipients).

The surveys included questions about demographics, management strategies for acute pharyngitis, understanding of the appropriate use of throat cultures and rapid testing, and the approach to a clinical scenario with clinical findings consistent with group A streptococci pharyngitis.

The preliminary results are based on the responses from 260 pediatricians and 245 family physicians.

Approximately 94% of the physicians cited prevention of acute rheumatic fever as a reason to treat bacterial pharyngitis, and 54% cited prevention of acute glomerulonephritis. Rapid antigen detection tests were available to 89% of respondents, and throat culture was available to 93%. Of the 441 physicians who reported using any test, 39 said they continued with antibiotic therapy despite a negative test, “which is why presumptively starting therapy pending results of a culture is discouraged; treatment often continues regardless of the result,” said Dr. Park.

In addition, 52 (13%) of the 388 physicians who reported using the rapid antigen test said they did not confirm a negative result with throat culture, as the clinical guidelines recommend.

The findings are disappointing in light of the growing awareness of the risks of antibiotic overuse and resistance, said Dr. Park. “Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. But following recommended guidelines is just as important.”

Toward this end, efforts need to target physician understanding of the appropriate use of throat culture and rapid antigen-detection testing to promote reasonable antibiotic prescribing, she concluded.

BOSTON — Many physicians do not follow recommended guidelines for the diagnosis and management of children with pharyngitis, according to results of a Centers for Disease Control and Prevention survey.

Although pharyngitis is one of the most common reasons for prescribing antibiotics for children, only 15%-30% of pediatric episodes are caused by group A streptococci and helped by antibiotics, CDC epidemiologist Sarah Y. Park, M.D., said in a presentation at the annual meeting of the Infectious Disease Society of America.

Numerous studies have demonstrated that it is not possible on clinical grounds to differentiate streptococcal from viral pharyngitis, yet 278 of 505 (55%) eligible pediatricians and family physicians who completed the CDC survey said they did not wait for laboratory confirmation of bacterial pharyngitis before initiating antibiotic therapy.

In addition, 64 (13%) of the respondents said they prescribed antibiotics based on clinical findings alone.

Diagnostic recommendations for pharyngitis are throat culture alone or a rapid antigen-detection test with throat culture backup, in conjunction with clinical and epidemiologic findings, said Dr. Park. “Diagnosis based on clinical findings alone is not recommended. Most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination, which leads to antibiotic abuse,” she said.

Dr. Park and her colleagues sent surveys to a total of 2,000 randomly selected members of the American Academy of Family Physicians (1,000 recipients) and the American Academy of Pediatrics (1,000 recipients).

The surveys included questions about demographics, management strategies for acute pharyngitis, understanding of the appropriate use of throat cultures and rapid testing, and the approach to a clinical scenario with clinical findings consistent with group A streptococci pharyngitis.

The preliminary results are based on the responses from 260 pediatricians and 245 family physicians.

Approximately 94% of the physicians cited prevention of acute rheumatic fever as a reason to treat bacterial pharyngitis, and 54% cited prevention of acute glomerulonephritis. Rapid antigen detection tests were available to 89% of respondents, and throat culture was available to 93%. Of the 441 physicians who reported using any test, 39 said they continued with antibiotic therapy despite a negative test, “which is why presumptively starting therapy pending results of a culture is discouraged; treatment often continues regardless of the result,” said Dr. Park.

In addition, 52 (13%) of the 388 physicians who reported using the rapid antigen test said they did not confirm a negative result with throat culture, as the clinical guidelines recommend.

The findings are disappointing in light of the growing awareness of the risks of antibiotic overuse and resistance, said Dr. Park. “Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. But following recommended guidelines is just as important.”

Toward this end, efforts need to target physician understanding of the appropriate use of throat culture and rapid antigen-detection testing to promote reasonable antibiotic prescribing, she concluded.

BOSTON — Many physicians do not follow recommended guidelines for the diagnosis and management of children with pharyngitis, according to results of a Centers for Disease Control and Prevention survey.

Although pharyngitis is one of the most common reasons for prescribing antibiotics for children, only 15%-30% of pediatric episodes are caused by group A streptococci and helped by antibiotics, CDC epidemiologist Sarah Y. Park, M.D., said in a presentation at the annual meeting of the Infectious Disease Society of America.

Numerous studies have demonstrated that it is not possible on clinical grounds to differentiate streptococcal from viral pharyngitis, yet 278 of 505 (55%) eligible pediatricians and family physicians who completed the CDC survey said they did not wait for laboratory confirmation of bacterial pharyngitis before initiating antibiotic therapy.

In addition, 64 (13%) of the respondents said they prescribed antibiotics based on clinical findings alone.

Diagnostic recommendations for pharyngitis are throat culture alone or a rapid antigen-detection test with throat culture backup, in conjunction with clinical and epidemiologic findings, said Dr. Park. “Diagnosis based on clinical findings alone is not recommended. Most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination, which leads to antibiotic abuse,” she said.

Dr. Park and her colleagues sent surveys to a total of 2,000 randomly selected members of the American Academy of Family Physicians (1,000 recipients) and the American Academy of Pediatrics (1,000 recipients).

The surveys included questions about demographics, management strategies for acute pharyngitis, understanding of the appropriate use of throat cultures and rapid testing, and the approach to a clinical scenario with clinical findings consistent with group A streptococci pharyngitis.

The preliminary results are based on the responses from 260 pediatricians and 245 family physicians.

Approximately 94% of the physicians cited prevention of acute rheumatic fever as a reason to treat bacterial pharyngitis, and 54% cited prevention of acute glomerulonephritis. Rapid antigen detection tests were available to 89% of respondents, and throat culture was available to 93%. Of the 441 physicians who reported using any test, 39 said they continued with antibiotic therapy despite a negative test, “which is why presumptively starting therapy pending results of a culture is discouraged; treatment often continues regardless of the result,” said Dr. Park.

In addition, 52 (13%) of the 388 physicians who reported using the rapid antigen test said they did not confirm a negative result with throat culture, as the clinical guidelines recommend.

The findings are disappointing in light of the growing awareness of the risks of antibiotic overuse and resistance, said Dr. Park. “Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. But following recommended guidelines is just as important.”

Toward this end, efforts need to target physician understanding of the appropriate use of throat culture and rapid antigen-detection testing to promote reasonable antibiotic prescribing, she concluded.

BOSTON — Daptomycin may effectively treat gram-positive bone and joint infections and may be less likely than standard antimicrobials to cause drug resistance as a consequence of long-term therapy, Michael S. Finney, M.D., said at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, daptomycin (Cubicin) eradicated infections in 9 of 10 patients with gram-positive osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia. The patients were treated at two medical centers between November 2003 and April 2004.

“Eight of the patients were infected with methicillin-resistant Staphylococcus aureus [MRSA], and enterococcus and streptococcus were isolated from two patients,” said Dr. Finney of Fountain Valley (Calif.) Regional Hospital, where six of the patients were treated. The remaining four patients were treated at Rush University Medical Center in Chicago.

Daptomycin was effective in seven of the eight MRSA-infected patients and both of the non-MRSA patients. Of the 10 patients, 4 had osteomyelitis only and 6 had some combination of osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia.

Nine had undergone prior unsuccessful treatment with one or more antibiotics: Eight received vancomycin, three received linezolid, and three received quinupristin/dalfopristin. Among the patients successfully treated with daptomycin were seven who had failed or could not tolerate vancomycin, which is often a first-line treatment for osteomyelitis.

The daptomycin treatment duration averaged 30 days, with a range from 21 to 42 days. “In general, the therapy was well tolerated, even for the longer treatment durations,” he said.

The one patient in the case series whose infection was not resolved had a relapse during daptomycin therapy, “possibly as a result of underdosing,” he said. Because of renal insufficiency, the septic arthritis patient was started on alternate-day vs. daily dosing and was not adjusted to daily dosing once renal function improved. During treatment, the patient developed an epidural abscess from MRSA with reduced susceptibility to daptomycin.

Bone and joint infections are notoriously difficult to resolve, require prolonged treatment, and are associated with a high risk of recurrence. “Effective treatment requires the antibiotic to penetrate the site of infection at an adequate concentration to effectively kill the causative pathogen,” Dr. Finney noted. Because gram-positive organisms, particularly S. aureus, are the predominant cause of these infections, the possibility of drug resistance further complicates treatment.

Vancomycin, a standard treatment for bone and joint infections, is not highly active against some gram-positive organisms, including S. aureus. In fact, he said, “studies have shown an increased risk of recurrence with vancomycin treatment for S. aureus osteomyelitis.” Bacteriostatic antimicrobials such as vancomycin, which merely inhibit the growth of bacteria, may have a higher risk of causing drug resistance during therapy than do bactericidal agents such as daptomycin.

Daptomycin is approved for treating complicated skin and skin structure infections. The findings suggest that further studies are warranted to determine the agent's role in treating gram-positive bone and joint infections, and to determine optimal dosing, Dr. Finney said.

He and his colleagues in the study reported having no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

BOSTON — Daptomycin may effectively treat gram-positive bone and joint infections and may be less likely than standard antimicrobials to cause drug resistance as a consequence of long-term therapy, Michael S. Finney, M.D., said at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, daptomycin (Cubicin) eradicated infections in 9 of 10 patients with gram-positive osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia. The patients were treated at two medical centers between November 2003 and April 2004.

“Eight of the patients were infected with methicillin-resistant Staphylococcus aureus [MRSA], and enterococcus and streptococcus were isolated from two patients,” said Dr. Finney of Fountain Valley (Calif.) Regional Hospital, where six of the patients were treated. The remaining four patients were treated at Rush University Medical Center in Chicago.

Daptomycin was effective in seven of the eight MRSA-infected patients and both of the non-MRSA patients. Of the 10 patients, 4 had osteomyelitis only and 6 had some combination of osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia.

Nine had undergone prior unsuccessful treatment with one or more antibiotics: Eight received vancomycin, three received linezolid, and three received quinupristin/dalfopristin. Among the patients successfully treated with daptomycin were seven who had failed or could not tolerate vancomycin, which is often a first-line treatment for osteomyelitis.

The daptomycin treatment duration averaged 30 days, with a range from 21 to 42 days. “In general, the therapy was well tolerated, even for the longer treatment durations,” he said.

The one patient in the case series whose infection was not resolved had a relapse during daptomycin therapy, “possibly as a result of underdosing,” he said. Because of renal insufficiency, the septic arthritis patient was started on alternate-day vs. daily dosing and was not adjusted to daily dosing once renal function improved. During treatment, the patient developed an epidural abscess from MRSA with reduced susceptibility to daptomycin.

Bone and joint infections are notoriously difficult to resolve, require prolonged treatment, and are associated with a high risk of recurrence. “Effective treatment requires the antibiotic to penetrate the site of infection at an adequate concentration to effectively kill the causative pathogen,” Dr. Finney noted. Because gram-positive organisms, particularly S. aureus, are the predominant cause of these infections, the possibility of drug resistance further complicates treatment.

Vancomycin, a standard treatment for bone and joint infections, is not highly active against some gram-positive organisms, including S. aureus. In fact, he said, “studies have shown an increased risk of recurrence with vancomycin treatment for S. aureus osteomyelitis.” Bacteriostatic antimicrobials such as vancomycin, which merely inhibit the growth of bacteria, may have a higher risk of causing drug resistance during therapy than do bactericidal agents such as daptomycin.

Daptomycin is approved for treating complicated skin and skin structure infections. The findings suggest that further studies are warranted to determine the agent's role in treating gram-positive bone and joint infections, and to determine optimal dosing, Dr. Finney said.

He and his colleagues in the study reported having no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

BOSTON — Daptomycin may effectively treat gram-positive bone and joint infections and may be less likely than standard antimicrobials to cause drug resistance as a consequence of long-term therapy, Michael S. Finney, M.D., said at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, daptomycin (Cubicin) eradicated infections in 9 of 10 patients with gram-positive osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia. The patients were treated at two medical centers between November 2003 and April 2004.

“Eight of the patients were infected with methicillin-resistant Staphylococcus aureus [MRSA], and enterococcus and streptococcus were isolated from two patients,” said Dr. Finney of Fountain Valley (Calif.) Regional Hospital, where six of the patients were treated. The remaining four patients were treated at Rush University Medical Center in Chicago.

Daptomycin was effective in seven of the eight MRSA-infected patients and both of the non-MRSA patients. Of the 10 patients, 4 had osteomyelitis only and 6 had some combination of osteomyelitis, septic joint infection, septic arthritis infection, and/or bacteremia.

Nine had undergone prior unsuccessful treatment with one or more antibiotics: Eight received vancomycin, three received linezolid, and three received quinupristin/dalfopristin. Among the patients successfully treated with daptomycin were seven who had failed or could not tolerate vancomycin, which is often a first-line treatment for osteomyelitis.

The daptomycin treatment duration averaged 30 days, with a range from 21 to 42 days. “In general, the therapy was well tolerated, even for the longer treatment durations,” he said.

The one patient in the case series whose infection was not resolved had a relapse during daptomycin therapy, “possibly as a result of underdosing,” he said. Because of renal insufficiency, the septic arthritis patient was started on alternate-day vs. daily dosing and was not adjusted to daily dosing once renal function improved. During treatment, the patient developed an epidural abscess from MRSA with reduced susceptibility to daptomycin.

Bone and joint infections are notoriously difficult to resolve, require prolonged treatment, and are associated with a high risk of recurrence. “Effective treatment requires the antibiotic to penetrate the site of infection at an adequate concentration to effectively kill the causative pathogen,” Dr. Finney noted. Because gram-positive organisms, particularly S. aureus, are the predominant cause of these infections, the possibility of drug resistance further complicates treatment.

Vancomycin, a standard treatment for bone and joint infections, is not highly active against some gram-positive organisms, including S. aureus. In fact, he said, “studies have shown an increased risk of recurrence with vancomycin treatment for S. aureus osteomyelitis.” Bacteriostatic antimicrobials such as vancomycin, which merely inhibit the growth of bacteria, may have a higher risk of causing drug resistance during therapy than do bactericidal agents such as daptomycin.

Daptomycin is approved for treating complicated skin and skin structure infections. The findings suggest that further studies are warranted to determine the agent's role in treating gram-positive bone and joint infections, and to determine optimal dosing, Dr. Finney said.

He and his colleagues in the study reported having no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

BOSTON — Daptomycin may be an effective option for difficult-to-treat gram-positive bloodstream infections, John Segreti, M.D., reported at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, 31 patients were treated with daptomycin (Cubicin) for bacteremia and/or infective endocarditis at two medical centers. Of these, 24 achieved clinical resolution of the life-threatening conditions, including all 11 with methicillin-resistant Staphylococcus aureus (MRSA) infection, 6 of 7 with methicillin-susceptible Staphylococcus aureus (MSSA) infection, and 5 of 11 with vancomycin-resistant enterococci (VRE).

These findings are particularly important in light of the increasing prevalence of serious infections involving gram-positive cocci and the increasing concern about antimicrobial resistance, especially in hospital intensive care units, said Dr. Segreti of Rush Medical College in Chicago. “Unfortunately, the gold standard for many serious gram-positive infections—vancomycin—is threatened. Its increased use for S. aureus infections leads to an increased risk for recurrent bacteremia and mortality.

“This may be a consequence of inadequate bactericidal activity of vancomycin, especially when treating some strains of S. aureus.” Daptomycin is a more rapidly bactericidal agent than vancomycin, “which is critical when treating bloodstream infections, especially in eradicating the vegetative mass associated with infective endocarditis,” he explained.

Between November 2003 and July 2004, 31 patients at Rush University Medical Center in Chicago and Fountain Valley (Calif.) Regional Hospital received 6 mg/kg daptomycin daily or every other day for bloodstream infections. Overall, 22 of the patients had been diagnosed with bacteremia only, 8 had culture-positive infective endocarditis, and 1 had culture-negative endocarditis.

In 24 cases, the patients had received prior antibiotic therapy for their infections, including vancomycin in 18 patients and linezolid in 4, but they required a change in treatment because of limited success of the initial therapy or because of intolerable adverse effects.

The pathogens identified in the study population included MRSA in 11 patients, VRE in 11, MSSA in 7, and coagulase-negative staphylococcus in 1; 1 other patient had an infection of unknown etiology. An analysis of the patient records showed that daptomycin was effective for 18 of the 22 bacteremic patients without endocarditis and for 6 of the 9 patients with infective endocarditis. The seven patients for whom treatment was not successful died during hospitalization.

In general, daptomycin was safe and well tolerated, even for extended durations of therapy, Dr. Segreti said.

Currently, daptomycin is approved for the treatment of complicated skin and skin structure infections. A clinical trial is underway to assess higher dosages of the drug as well as the optimal dosage and duration of treatment and the long-term efficacy for these infections, he said.

The results suggest that daptomycin “may provide an additional option for the treatment of bloodstream infections, not only for patients who fail prior antimicrobial therapy but also as initial therapy for patients at risk for drug-resistant gram-positive infections,” he concluded.

Dr. Segreti and his colleagues in this investigation reported no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

BOSTON — Daptomycin may be an effective option for difficult-to-treat gram-positive bloodstream infections, John Segreti, M.D., reported at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, 31 patients were treated with daptomycin (Cubicin) for bacteremia and/or infective endocarditis at two medical centers. Of these, 24 achieved clinical resolution of the life-threatening conditions, including all 11 with methicillin-resistant Staphylococcus aureus (MRSA) infection, 6 of 7 with methicillin-susceptible Staphylococcus aureus (MSSA) infection, and 5 of 11 with vancomycin-resistant enterococci (VRE).

These findings are particularly important in light of the increasing prevalence of serious infections involving gram-positive cocci and the increasing concern about antimicrobial resistance, especially in hospital intensive care units, said Dr. Segreti of Rush Medical College in Chicago. “Unfortunately, the gold standard for many serious gram-positive infections—vancomycin—is threatened. Its increased use for S. aureus infections leads to an increased risk for recurrent bacteremia and mortality.

“This may be a consequence of inadequate bactericidal activity of vancomycin, especially when treating some strains of S. aureus.” Daptomycin is a more rapidly bactericidal agent than vancomycin, “which is critical when treating bloodstream infections, especially in eradicating the vegetative mass associated with infective endocarditis,” he explained.

Between November 2003 and July 2004, 31 patients at Rush University Medical Center in Chicago and Fountain Valley (Calif.) Regional Hospital received 6 mg/kg daptomycin daily or every other day for bloodstream infections. Overall, 22 of the patients had been diagnosed with bacteremia only, 8 had culture-positive infective endocarditis, and 1 had culture-negative endocarditis.

In 24 cases, the patients had received prior antibiotic therapy for their infections, including vancomycin in 18 patients and linezolid in 4, but they required a change in treatment because of limited success of the initial therapy or because of intolerable adverse effects.

The pathogens identified in the study population included MRSA in 11 patients, VRE in 11, MSSA in 7, and coagulase-negative staphylococcus in 1; 1 other patient had an infection of unknown etiology. An analysis of the patient records showed that daptomycin was effective for 18 of the 22 bacteremic patients without endocarditis and for 6 of the 9 patients with infective endocarditis. The seven patients for whom treatment was not successful died during hospitalization.

In general, daptomycin was safe and well tolerated, even for extended durations of therapy, Dr. Segreti said.

Currently, daptomycin is approved for the treatment of complicated skin and skin structure infections. A clinical trial is underway to assess higher dosages of the drug as well as the optimal dosage and duration of treatment and the long-term efficacy for these infections, he said.

The results suggest that daptomycin “may provide an additional option for the treatment of bloodstream infections, not only for patients who fail prior antimicrobial therapy but also as initial therapy for patients at risk for drug-resistant gram-positive infections,” he concluded.

Dr. Segreti and his colleagues in this investigation reported no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

BOSTON — Daptomycin may be an effective option for difficult-to-treat gram-positive bloodstream infections, John Segreti, M.D., reported at the annual meeting of the Infectious Diseases Society of America.

In a retrospective study, 31 patients were treated with daptomycin (Cubicin) for bacteremia and/or infective endocarditis at two medical centers. Of these, 24 achieved clinical resolution of the life-threatening conditions, including all 11 with methicillin-resistant Staphylococcus aureus (MRSA) infection, 6 of 7 with methicillin-susceptible Staphylococcus aureus (MSSA) infection, and 5 of 11 with vancomycin-resistant enterococci (VRE).

These findings are particularly important in light of the increasing prevalence of serious infections involving gram-positive cocci and the increasing concern about antimicrobial resistance, especially in hospital intensive care units, said Dr. Segreti of Rush Medical College in Chicago. “Unfortunately, the gold standard for many serious gram-positive infections—vancomycin—is threatened. Its increased use for S. aureus infections leads to an increased risk for recurrent bacteremia and mortality.

“This may be a consequence of inadequate bactericidal activity of vancomycin, especially when treating some strains of S. aureus.” Daptomycin is a more rapidly bactericidal agent than vancomycin, “which is critical when treating bloodstream infections, especially in eradicating the vegetative mass associated with infective endocarditis,” he explained.

Between November 2003 and July 2004, 31 patients at Rush University Medical Center in Chicago and Fountain Valley (Calif.) Regional Hospital received 6 mg/kg daptomycin daily or every other day for bloodstream infections. Overall, 22 of the patients had been diagnosed with bacteremia only, 8 had culture-positive infective endocarditis, and 1 had culture-negative endocarditis.

In 24 cases, the patients had received prior antibiotic therapy for their infections, including vancomycin in 18 patients and linezolid in 4, but they required a change in treatment because of limited success of the initial therapy or because of intolerable adverse effects.

The pathogens identified in the study population included MRSA in 11 patients, VRE in 11, MSSA in 7, and coagulase-negative staphylococcus in 1; 1 other patient had an infection of unknown etiology. An analysis of the patient records showed that daptomycin was effective for 18 of the 22 bacteremic patients without endocarditis and for 6 of the 9 patients with infective endocarditis. The seven patients for whom treatment was not successful died during hospitalization.

In general, daptomycin was safe and well tolerated, even for extended durations of therapy, Dr. Segreti said.

Currently, daptomycin is approved for the treatment of complicated skin and skin structure infections. A clinical trial is underway to assess higher dosages of the drug as well as the optimal dosage and duration of treatment and the long-term efficacy for these infections, he said.

The results suggest that daptomycin “may provide an additional option for the treatment of bloodstream infections, not only for patients who fail prior antimicrobial therapy but also as initial therapy for patients at risk for drug-resistant gram-positive infections,” he concluded.

Dr. Segreti and his colleagues in this investigation reported no financial interest in the manufacturer of daptomycin, Cubist Pharmaceuticals Inc.

HARROGATE, ENGLAND — Calcium and vitamin D supplementation do not reduce the risk of clinical fracture among women identified as having one or more risk factors for hip fracture, a randomized controlled trial has shown.

Investigators at the University of York (England), in collaboration with community primary care providers, recruited 3,322 women aged 70 years and older, who had at least one of the following risk factors for hip fracture: previous fracture, low body weight, maternal history of hip fracture, a fall in the previous 12 months, or older age (per year increase).

Approximately half of the women were randomized to receive daily oral supplementation of 1,000 mg of calcium and 800 IU vitamin D, along with a patient information leaflet on dietary calcium intake and fall prevention. The remaining patients were randomized to a control group and received only the patient information leaflet, reported York University research fellow Jill Porthouse in a presentation at the annual conference of the National Osteoporosis Society.

After a median follow-up of 25 months, there were no significant differences between the two groups in the rates of all clinical fractures or hip fractures.

The odds ratio for all fractures in the supplement group compared with the control group was 1.03. For hip fractures specifically, the odds ratio was 0.82, according to the study findings.

These results are disappointing, noted Ms. Porthouse.

“Fall-related low-trauma fractures represent a significant burden of illness in older people. Calcium and vitamin D supplementation is a relatively inexpensive intervention, but it does not appear to reduce fracture rates in women at risk,” she noted.

HARROGATE, ENGLAND — Calcium and vitamin D supplementation do not reduce the risk of clinical fracture among women identified as having one or more risk factors for hip fracture, a randomized controlled trial has shown.

Investigators at the University of York (England), in collaboration with community primary care providers, recruited 3,322 women aged 70 years and older, who had at least one of the following risk factors for hip fracture: previous fracture, low body weight, maternal history of hip fracture, a fall in the previous 12 months, or older age (per year increase).

Approximately half of the women were randomized to receive daily oral supplementation of 1,000 mg of calcium and 800 IU vitamin D, along with a patient information leaflet on dietary calcium intake and fall prevention. The remaining patients were randomized to a control group and received only the patient information leaflet, reported York University research fellow Jill Porthouse in a presentation at the annual conference of the National Osteoporosis Society.

After a median follow-up of 25 months, there were no significant differences between the two groups in the rates of all clinical fractures or hip fractures.

The odds ratio for all fractures in the supplement group compared with the control group was 1.03. For hip fractures specifically, the odds ratio was 0.82, according to the study findings.

These results are disappointing, noted Ms. Porthouse.

“Fall-related low-trauma fractures represent a significant burden of illness in older people. Calcium and vitamin D supplementation is a relatively inexpensive intervention, but it does not appear to reduce fracture rates in women at risk,” she noted.

HARROGATE, ENGLAND — Calcium and vitamin D supplementation do not reduce the risk of clinical fracture among women identified as having one or more risk factors for hip fracture, a randomized controlled trial has shown.

Investigators at the University of York (England), in collaboration with community primary care providers, recruited 3,322 women aged 70 years and older, who had at least one of the following risk factors for hip fracture: previous fracture, low body weight, maternal history of hip fracture, a fall in the previous 12 months, or older age (per year increase).

Approximately half of the women were randomized to receive daily oral supplementation of 1,000 mg of calcium and 800 IU vitamin D, along with a patient information leaflet on dietary calcium intake and fall prevention. The remaining patients were randomized to a control group and received only the patient information leaflet, reported York University research fellow Jill Porthouse in a presentation at the annual conference of the National Osteoporosis Society.

After a median follow-up of 25 months, there were no significant differences between the two groups in the rates of all clinical fractures or hip fractures.

The odds ratio for all fractures in the supplement group compared with the control group was 1.03. For hip fractures specifically, the odds ratio was 0.82, according to the study findings.

These results are disappointing, noted Ms. Porthouse.

“Fall-related low-trauma fractures represent a significant burden of illness in older people. Calcium and vitamin D supplementation is a relatively inexpensive intervention, but it does not appear to reduce fracture rates in women at risk,” she noted.

HARROGATE, ENGLAND — A single injection of zoledronic acid can help counteract the loss of bone mass associated with acute stroke and reduce the likelihood of osteoporotic fractures if given soon after the event, a study has shown.

Patients injected with the long-acting, highly potent bisphosphonate within 35 days after suffering a stroke lost significantly less hip bone mineral density than matched control patients who received a placebo, reported Kenneth Poole, B.M., in a presentation at the annual conference of the National Osteoporosis Society.

The findings suggest that taking measures to prevent bone loss as a routine part of stroke management could significantly reduce the high rate of hip fractures among stroke survivors, Dr. Poole said.

“We know that osteoporosis is a significant complication of stroke, particularly when patients become fully or partly immobilized,” said Dr. Poole. “When someone is put to bed and has an immobilized limb, the cells that break down bone are overactive.” The risks are exacerbated by stroke-related lower-limb and vision problems, which lead to more falls and fractures.

Previous studies have shown that stroke survivors are more than four times as likely to suffer hip fractures than individuals in an age-matched reference population.

Most victims of stroke are already at risk for osteoporosis because of their age—more than half of all strokes occur in people older than 70—thus “they can ill afford to lose further bone, said Dr. Poole, who conducted the study with colleagues from the University of Cambridge, England.

The investigators randomly assigned 16 patients to receive 4 mg of zoledronic acid (Zometa) or placebo by intravenous injection within 35 days of acute stroke. All patients also received daily oral calcium and vitamin D supplementation. Bone mineral density (BMD) measurements were obtained in the hemiplegic and unaffected total hip region of all participants at baseline and at months 6 and 12.

At 1 year, patients in the placebo group had a significantly greater reduction of BMD in both hips, compared with those in the zoledronic acid group. The mean percentage decrease in BMD at the hemiplegic and unaffected hips, respectively, of the control patients was 10.2% and 6.0%. By contrast, the patients treated with zoledronic acid group had no decrease in BMD at either site. Zoledronic acid was well tolerated and associated with no serious adverse events. Dr. Poole reported no financial interests relating to zoledronic acid or its manufacturer, Novartis.

HARROGATE, ENGLAND — A single injection of zoledronic acid can help counteract the loss of bone mass associated with acute stroke and reduce the likelihood of osteoporotic fractures if given soon after the event, a study has shown.

Patients injected with the long-acting, highly potent bisphosphonate within 35 days after suffering a stroke lost significantly less hip bone mineral density than matched control patients who received a placebo, reported Kenneth Poole, B.M., in a presentation at the annual conference of the National Osteoporosis Society.

The findings suggest that taking measures to prevent bone loss as a routine part of stroke management could significantly reduce the high rate of hip fractures among stroke survivors, Dr. Poole said.

“We know that osteoporosis is a significant complication of stroke, particularly when patients become fully or partly immobilized,” said Dr. Poole. “When someone is put to bed and has an immobilized limb, the cells that break down bone are overactive.” The risks are exacerbated by stroke-related lower-limb and vision problems, which lead to more falls and fractures.

Previous studies have shown that stroke survivors are more than four times as likely to suffer hip fractures than individuals in an age-matched reference population.

Most victims of stroke are already at risk for osteoporosis because of their age—more than half of all strokes occur in people older than 70—thus “they can ill afford to lose further bone, said Dr. Poole, who conducted the study with colleagues from the University of Cambridge, England.

The investigators randomly assigned 16 patients to receive 4 mg of zoledronic acid (Zometa) or placebo by intravenous injection within 35 days of acute stroke. All patients also received daily oral calcium and vitamin D supplementation. Bone mineral density (BMD) measurements were obtained in the hemiplegic and unaffected total hip region of all participants at baseline and at months 6 and 12.

At 1 year, patients in the placebo group had a significantly greater reduction of BMD in both hips, compared with those in the zoledronic acid group. The mean percentage decrease in BMD at the hemiplegic and unaffected hips, respectively, of the control patients was 10.2% and 6.0%. By contrast, the patients treated with zoledronic acid group had no decrease in BMD at either site. Zoledronic acid was well tolerated and associated with no serious adverse events. Dr. Poole reported no financial interests relating to zoledronic acid or its manufacturer, Novartis.

HARROGATE, ENGLAND — A single injection of zoledronic acid can help counteract the loss of bone mass associated with acute stroke and reduce the likelihood of osteoporotic fractures if given soon after the event, a study has shown.

Patients injected with the long-acting, highly potent bisphosphonate within 35 days after suffering a stroke lost significantly less hip bone mineral density than matched control patients who received a placebo, reported Kenneth Poole, B.M., in a presentation at the annual conference of the National Osteoporosis Society.

The findings suggest that taking measures to prevent bone loss as a routine part of stroke management could significantly reduce the high rate of hip fractures among stroke survivors, Dr. Poole said.

“We know that osteoporosis is a significant complication of stroke, particularly when patients become fully or partly immobilized,” said Dr. Poole. “When someone is put to bed and has an immobilized limb, the cells that break down bone are overactive.” The risks are exacerbated by stroke-related lower-limb and vision problems, which lead to more falls and fractures.

Previous studies have shown that stroke survivors are more than four times as likely to suffer hip fractures than individuals in an age-matched reference population.

Most victims of stroke are already at risk for osteoporosis because of their age—more than half of all strokes occur in people older than 70—thus “they can ill afford to lose further bone, said Dr. Poole, who conducted the study with colleagues from the University of Cambridge, England.

The investigators randomly assigned 16 patients to receive 4 mg of zoledronic acid (Zometa) or placebo by intravenous injection within 35 days of acute stroke. All patients also received daily oral calcium and vitamin D supplementation. Bone mineral density (BMD) measurements were obtained in the hemiplegic and unaffected total hip region of all participants at baseline and at months 6 and 12.

At 1 year, patients in the placebo group had a significantly greater reduction of BMD in both hips, compared with those in the zoledronic acid group. The mean percentage decrease in BMD at the hemiplegic and unaffected hips, respectively, of the control patients was 10.2% and 6.0%. By contrast, the patients treated with zoledronic acid group had no decrease in BMD at either site. Zoledronic acid was well tolerated and associated with no serious adverse events. Dr. Poole reported no financial interests relating to zoledronic acid or its manufacturer, Novartis.

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” said Ms. Finigan.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. A multiple stepwise logistic regression analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age.

As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” Ms. Finigan said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” said Ms. Finigan.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. A multiple stepwise logistic regression analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age.

As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” Ms. Finigan said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Low serum albumin and T3 levels are independently predictive of vertebral fractures in women older than 50 years, a 10-year prospective study has shown.

Because albumin and T3 deficiencies are considered markers of frailty and sickness, the findings suggest that chronic poor health may itself be a risk factor for vertebral fracture, said Judith Finigan, principal investigator and research nurse in the bone metabolism group at the University of Sheffield (England).

To identify predictors of fracture in women between ages 50 and 85, the Sheffield investigators acquired baseline bone mineral density (BMD) measures and medical and lifestyle information from a population-based group of 375 women. They also collected fasting blood samples for measuring serum calcium, alkaline phosphatase, parathyroid hormone, creatinine, phosphate, albumin, and thyroid hormones.

All participants had spinal radiographs taken at baseline and at years 2, 5, 7, and 10, which were reviewed for incident vertebral fractures by a single radiologist. Nonvertebral fractures were confirmed by radiologist reports.

Cox regression analysis showed that numerous risk factors—including age; BMD at the lumbar spine, hip, or total body; years of estrogen exposure; and prevalent vertebral fracture—predicted fractures overall.

Low serum T3, low serum albumin, and low body fat were specifically predictive of vertebral fractures but not nonvertebral fractures. These measures remained significantly predictive, even after adjusting for age, Ms. Finigan reported at the annual conference of the National Osteoporosis Society. Neither TSH nor T4 predicted fracture, she noted.

The age-adjusted relative risks per standard deviation decrease for T3, albumin, and body fat were 1.71, 1.74, and 1.55, respectively. “T3 and albumin also predicted vertebral fracture independently of spine or hip BMD,” said Ms. Finigan.

In a separate analysis of a larger cohort, the investigators examined the relationship between serum albumin and vertebral fractures in postmenopausal women from the placebo arms of the Hip Intervention Program (HIP) trial and the Vertebral Efficacy with Risedronate Therapy (VERT) trial.

At 3 years, 381 of 2,720 subjects had experienced one or more incident vertebral fractures. A multiple stepwise logistic regression analysis showed a 1.23 relative risk of vertebral fracture for each standard deviation decrease in serum albumin, after adjusting for femoral neck BMD, weight, and age.

As in the smaller study, low serum albumin was not associated with an increased risk of incident nonvertebral fractures in the larger population.

The findings of the second analysis “confirm the association between low baseline albumin levels and incident vertebral fractures,” Ms. Finigan said.

Serum albumin and thyroid hormone measurements are recommended as part of a routine evaluation for osteoporosis in postmenopausal women. Patients with deficiencies in these may be candidates for antiresorptive treatment to reduce their risk of vertebral fractures, Ms. Finigan concluded.

HARROGATE, ENGLAND — Age and frailty should not deter offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age-and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy,” he said.

The three studies each looked at 3-year fracture end points and included women aged 80-100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” said Dr. Boonen.

The rates of nonvertebral fractures were not significantly different between the two groups, Dr. Boonen stated. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, said Dr. Boonen. The treatment was well tolerated, even among the oldest women in the study population.

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Each of the antiresorptive therapies has unique characteristics and side-effect profiles. The observations made in this study cannot be generalized to include other bisphosphonates, Dr. Boonen cautioned.

He disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

HARROGATE, ENGLAND — Age and frailty should not deter offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age-and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy,” he said.

The three studies each looked at 3-year fracture end points and included women aged 80-100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” said Dr. Boonen.

The rates of nonvertebral fractures were not significantly different between the two groups, Dr. Boonen stated. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, said Dr. Boonen. The treatment was well tolerated, even among the oldest women in the study population.

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Each of the antiresorptive therapies has unique characteristics and side-effect profiles. The observations made in this study cannot be generalized to include other bisphosphonates, Dr. Boonen cautioned.

He disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

HARROGATE, ENGLAND — Age and frailty should not deter offering very elderly osteoporotic patients antiresorptive therapy, despite age-associated increases in comorbid conditions, said Steven Boonen, M.D.

The results of a pooled analysis from three randomized, double-blind controlled trials showed a significantly reduced risk of new vertebral fractures among 704 osteoporotic women aged 80 and older who received bisphosphonate therapy, compared with age-and disease-matched patients randomized to placebo treatment, Dr. Boonen reported in a presentation at the annual conference of the National Osteoporosis Society.

“To the best of our knowledge, this study is the first to document a benefit of antiresorptive treatment in addition to that afforded by calcium and vitamin D in a population of women aged 80 and older with osteoporosis,” said Dr. Boonen of Leuven (Belgium) University Center for Metabolic Bone Disease, the study's principal investigator. “The findings tell us that, even in the very old, reducing bone resorption rates remains an effective treatment strategy,” he said.

The three studies each looked at 3-year fracture end points and included women aged 80-100 years with documented osteoporosis. In each study, the women randomized to bisphosphonate therapy were prescribed 5 mg/day of risedronate (Actonel) for up to 3 years, and control group patients were given a placebo pill for the same duration. All participants received 1,000 mg calcium supplementation per day and, if baseline levels were low, up to 500 U of vitamin D per day.

At 1 year, the risedronate groups had a new vertebral fracture rate of 2.5%, compared with 10.9% for the control groups. At 3 years, the new vertebral fracture rates for the bisphosphonate and placebo groups were 18.2% and 24.6%, respectively, “representing a 44% reduction in risk for the women who took risedronate,” said Dr. Boonen.

The rates of nonvertebral fractures were not significantly different between the two groups, Dr. Boonen stated. At 3 years, the risedronate patients had a 14% risk, compared with the placebo group's 16.2% risk. The studies also showed risedronate to have a safety profile similar to that of placebo.

The early efficacy of the risedronate therapy was consistent across the three trials, said Dr. Boonen. The treatment was well tolerated, even among the oldest women in the study population.

The hope is that these data will help increase the number of “very old” patients with osteoporotic fractures who are deemed eligible for and who receive treatment. “Despite the debilitating effects of osteoporotic fractures and the availability of therapies to reduce fracture recurrence, only a small percentage of women with osteoporotic fractures receive treatment, and this percentage decreases with age,” Dr. Boonen said. “Clinicians may presume that it is too late to alter the course of disease in its late stage, but these results tell us that is not so.”

Each of the antiresorptive therapies has unique characteristics and side-effect profiles. The observations made in this study cannot be generalized to include other bisphosphonates, Dr. Boonen cautioned.

He disclosed that he has received research grants from Procter and Gamble Pharmaceuticals but has no other financial relationship with it or any other company that markets bisphosphonates.

HARROGATE, ENGLAND — A single bone mineral density measurement early in menopause is a strong predictor of future bone status in women not considered at risk for osteoporosis, a study has shown.

Despite various rates of bone mineral loss among individuals and measurement sites, baseline bone mineral density measures of 766 women from the Danish Osteoporosis Prevention Study predicted 75% of the variation in lumbar spine bone mineral density and 74% of femoral neck bone minderal density variation over 10 years, reported Bo Abrahamsen, M.D., at the annual conference of the National Osteoporosis Society.

None of the women in the investigation were receiving hormone therapy or treatment with antiresorptive drugs.

The baseline scans were acquired within 2 years of menopause.

Baseline lumbar spine T-scores greater than -1.2 were associated with a 90% negative predictive value for developing osteoporosis over the course of 10 years.

However, a lumbar spine T-score greater than 0.5 had a negative predictive value of 100%.

A baseline femoral neck T-score greater than -1.7 had a 90% negative predictive value for femoral neck osteoporosis.

“No women developed femoral neck osteoporosis in the absence of baseline femoral neck osteopenia,” said Dr. Abrahamsen of Odense (Denmark) University Hospital.

At baseline, having a lumbar spine T-score greater than -1.0 or a femoral neck T-score greater than -0.5 was associated with a 90% negative predictive value for osteoporosis of the lumbar spine and/or the femoral neck.

“Women with lumbar spine osteopenia at baseline had a 46% risk for developing osteoporosis of the femoral neck or lumbar spine,” explained Dr. Abrahamsen.

At the same time, fewer than 10% of women whose T-scores of the spine or femoral neck dipped below -2.5 within 10 years had spinal osteopenia at their initial visit, he said.

The findings support the role of bone density measurements in the first years after menopause, Dr. Abrahamsen said.

“There is an increasing demand for [bone density measurement] with the onset of menopause due to concerns about the safety of hormone replacement therapy and a possible need for considering other treatment,” he said.

“We know that, despite the fact that the average rate of bone mineral loss is only a few percent per year, there is much individual variation in those rates,” Dr. Abrahamsen said.

“These results tell us that much of the variation in future bone mineral density can be predicted by baseline bone mineral density,” Dr. Abrahamsen added.

As such, baseline measures should be considered for long-term treatment planning, Dr. Abrahamsen concluded.

HARROGATE, ENGLAND — A single bone mineral density measurement early in menopause is a strong predictor of future bone status in women not considered at risk for osteoporosis, a study has shown.

Despite various rates of bone mineral loss among individuals and measurement sites, baseline bone mineral density measures of 766 women from the Danish Osteoporosis Prevention Study predicted 75% of the variation in lumbar spine bone mineral density and 74% of femoral neck bone minderal density variation over 10 years, reported Bo Abrahamsen, M.D., at the annual conference of the National Osteoporosis Society.

None of the women in the investigation were receiving hormone therapy or treatment with antiresorptive drugs.

The baseline scans were acquired within 2 years of menopause.

Baseline lumbar spine T-scores greater than -1.2 were associated with a 90% negative predictive value for developing osteoporosis over the course of 10 years.

However, a lumbar spine T-score greater than 0.5 had a negative predictive value of 100%.

A baseline femoral neck T-score greater than -1.7 had a 90% negative predictive value for femoral neck osteoporosis.

“No women developed femoral neck osteoporosis in the absence of baseline femoral neck osteopenia,” said Dr. Abrahamsen of Odense (Denmark) University Hospital.

At baseline, having a lumbar spine T-score greater than -1.0 or a femoral neck T-score greater than -0.5 was associated with a 90% negative predictive value for osteoporosis of the lumbar spine and/or the femoral neck.

“Women with lumbar spine osteopenia at baseline had a 46% risk for developing osteoporosis of the femoral neck or lumbar spine,” explained Dr. Abrahamsen.

At the same time, fewer than 10% of women whose T-scores of the spine or femoral neck dipped below -2.5 within 10 years had spinal osteopenia at their initial visit, he said.

The findings support the role of bone density measurements in the first years after menopause, Dr. Abrahamsen said.

“There is an increasing demand for [bone density measurement] with the onset of menopause due to concerns about the safety of hormone replacement therapy and a possible need for considering other treatment,” he said.

“We know that, despite the fact that the average rate of bone mineral loss is only a few percent per year, there is much individual variation in those rates,” Dr. Abrahamsen said.

“These results tell us that much of the variation in future bone mineral density can be predicted by baseline bone mineral density,” Dr. Abrahamsen added.

As such, baseline measures should be considered for long-term treatment planning, Dr. Abrahamsen concluded.

HARROGATE, ENGLAND — A single bone mineral density measurement early in menopause is a strong predictor of future bone status in women not considered at risk for osteoporosis, a study has shown.

Despite various rates of bone mineral loss among individuals and measurement sites, baseline bone mineral density measures of 766 women from the Danish Osteoporosis Prevention Study predicted 75% of the variation in lumbar spine bone mineral density and 74% of femoral neck bone minderal density variation over 10 years, reported Bo Abrahamsen, M.D., at the annual conference of the National Osteoporosis Society.

None of the women in the investigation were receiving hormone therapy or treatment with antiresorptive drugs.

The baseline scans were acquired within 2 years of menopause.

Baseline lumbar spine T-scores greater than -1.2 were associated with a 90% negative predictive value for developing osteoporosis over the course of 10 years.

However, a lumbar spine T-score greater than 0.5 had a negative predictive value of 100%.

A baseline femoral neck T-score greater than -1.7 had a 90% negative predictive value for femoral neck osteoporosis.

“No women developed femoral neck osteoporosis in the absence of baseline femoral neck osteopenia,” said Dr. Abrahamsen of Odense (Denmark) University Hospital.

At baseline, having a lumbar spine T-score greater than -1.0 or a femoral neck T-score greater than -0.5 was associated with a 90% negative predictive value for osteoporosis of the lumbar spine and/or the femoral neck.

“Women with lumbar spine osteopenia at baseline had a 46% risk for developing osteoporosis of the femoral neck or lumbar spine,” explained Dr. Abrahamsen.

At the same time, fewer than 10% of women whose T-scores of the spine or femoral neck dipped below -2.5 within 10 years had spinal osteopenia at their initial visit, he said.

The findings support the role of bone density measurements in the first years after menopause, Dr. Abrahamsen said.

“There is an increasing demand for [bone density measurement] with the onset of menopause due to concerns about the safety of hormone replacement therapy and a possible need for considering other treatment,” he said.

“We know that, despite the fact that the average rate of bone mineral loss is only a few percent per year, there is much individual variation in those rates,” Dr. Abrahamsen said.

“These results tell us that much of the variation in future bone mineral density can be predicted by baseline bone mineral density,” Dr. Abrahamsen added.

As such, baseline measures should be considered for long-term treatment planning, Dr. Abrahamsen concluded.