Osteoporosis

DENVER — Significant predictors of receiving a bisphosphonate prescription within 90 days of a fracture for women are a low bone mineral density score after a fracture, being aged 65–74 years, and oral corticosteroid use, according to the results of a study of 2,000 women.

Women with a bone mineral density (BMD) T score of −2.5 or less in the 90 days after a fracture were almost five times as likely to receive a bisphosphonate prescription than women with higher T scores, Carl Asche, Ph.D., said in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

Women who were aged 65–74 years at the time of fracture were almost twice as likely to receive a prescription, compared with woman younger than 65. Similarly, women taking oral corticosteroids also were more likely to receive a bisphosphonate prescription, wrote Dr. Asche of the pharmacotherapy department at the University of Utah, Salt Lake City.

With use of electronic health records from Geisinger Health System from Jan. 1, 2000, to June 30, 2007, women 50 years of age and older who had had a fracture were included. They also had to have continuous electronic health record activity for at least 365 days before and 365 days after the index date (the date of the fracture). Women were excluded if they had a diagnosis of osteoporosis, a bone mineral density score of −2.5 or less at the time of the fracture, a fracture in the 6 months prior to the index date, or a diagnosis of conditions known to impact bone density and quality.

They considered age, race, body mass index (BMI), BMD score 90 days after the fracture, smoking status, Charlson comorbidity index, oral corticosteroid use, and rheumatoid arthritis to be potential predictors of bisphosphonate prescription—alendronate (Fosamax), ibandron-ate (Boniva), or risedronate (Actonel).

A total of 2,000 women met the inclusion criteria, but less than 10% (188) received a prescription for a bisphosphonate within 90 days of fracture. “Very few women aged [over] 50 receive treatment with an oral bisphosphonate after having a fracture, leaving them potentially vulnerable to future fractures,” he noted.

Obese patients (BMI 30–39.9 kg/m

The study was supported by the Alliance for Better Bone Health—Procter & Gamble Pharmaceuticals and Sanofi-Aventis U.S., which co-promote Actonel. Dr. Asche reported that he has a significant financial relationship with Sanofi-Aventis U.S.

DENVER — Significant predictors of receiving a bisphosphonate prescription within 90 days of a fracture for women are a low bone mineral density score after a fracture, being aged 65–74 years, and oral corticosteroid use, according to the results of a study of 2,000 women.

Women with a bone mineral density (BMD) T score of −2.5 or less in the 90 days after a fracture were almost five times as likely to receive a bisphosphonate prescription than women with higher T scores, Carl Asche, Ph.D., said in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

Women who were aged 65–74 years at the time of fracture were almost twice as likely to receive a prescription, compared with woman younger than 65. Similarly, women taking oral corticosteroids also were more likely to receive a bisphosphonate prescription, wrote Dr. Asche of the pharmacotherapy department at the University of Utah, Salt Lake City.

With use of electronic health records from Geisinger Health System from Jan. 1, 2000, to June 30, 2007, women 50 years of age and older who had had a fracture were included. They also had to have continuous electronic health record activity for at least 365 days before and 365 days after the index date (the date of the fracture). Women were excluded if they had a diagnosis of osteoporosis, a bone mineral density score of −2.5 or less at the time of the fracture, a fracture in the 6 months prior to the index date, or a diagnosis of conditions known to impact bone density and quality.

They considered age, race, body mass index (BMI), BMD score 90 days after the fracture, smoking status, Charlson comorbidity index, oral corticosteroid use, and rheumatoid arthritis to be potential predictors of bisphosphonate prescription—alendronate (Fosamax), ibandron-ate (Boniva), or risedronate (Actonel).

A total of 2,000 women met the inclusion criteria, but less than 10% (188) received a prescription for a bisphosphonate within 90 days of fracture. “Very few women aged [over] 50 receive treatment with an oral bisphosphonate after having a fracture, leaving them potentially vulnerable to future fractures,” he noted.

Obese patients (BMI 30–39.9 kg/m

The study was supported by the Alliance for Better Bone Health—Procter & Gamble Pharmaceuticals and Sanofi-Aventis U.S., which co-promote Actonel. Dr. Asche reported that he has a significant financial relationship with Sanofi-Aventis U.S.

DENVER — Significant predictors of receiving a bisphosphonate prescription within 90 days of a fracture for women are a low bone mineral density score after a fracture, being aged 65–74 years, and oral corticosteroid use, according to the results of a study of 2,000 women.

Women with a bone mineral density (BMD) T score of −2.5 or less in the 90 days after a fracture were almost five times as likely to receive a bisphosphonate prescription than women with higher T scores, Carl Asche, Ph.D., said in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

Women who were aged 65–74 years at the time of fracture were almost twice as likely to receive a prescription, compared with woman younger than 65. Similarly, women taking oral corticosteroids also were more likely to receive a bisphosphonate prescription, wrote Dr. Asche of the pharmacotherapy department at the University of Utah, Salt Lake City.

With use of electronic health records from Geisinger Health System from Jan. 1, 2000, to June 30, 2007, women 50 years of age and older who had had a fracture were included. They also had to have continuous electronic health record activity for at least 365 days before and 365 days after the index date (the date of the fracture). Women were excluded if they had a diagnosis of osteoporosis, a bone mineral density score of −2.5 or less at the time of the fracture, a fracture in the 6 months prior to the index date, or a diagnosis of conditions known to impact bone density and quality.

They considered age, race, body mass index (BMI), BMD score 90 days after the fracture, smoking status, Charlson comorbidity index, oral corticosteroid use, and rheumatoid arthritis to be potential predictors of bisphosphonate prescription—alendronate (Fosamax), ibandron-ate (Boniva), or risedronate (Actonel).

A total of 2,000 women met the inclusion criteria, but less than 10% (188) received a prescription for a bisphosphonate within 90 days of fracture. “Very few women aged [over] 50 receive treatment with an oral bisphosphonate after having a fracture, leaving them potentially vulnerable to future fractures,” he noted.

Obese patients (BMI 30–39.9 kg/m

The study was supported by the Alliance for Better Bone Health—Procter & Gamble Pharmaceuticals and Sanofi-Aventis U.S., which co-promote Actonel. Dr. Asche reported that he has a significant financial relationship with Sanofi-Aventis U.S.

The federal government has officially recognized a link between being a prisoner of war (POW) and the development of osteoporosis.

The Department of Veterans Affairs has established a presumption of service connection for osteoporosis in former POWs who were interned for at least 30 days and whose osteoporosis is at least 10% disabling. The VA also established the connection for POWs, regardless of length of imprisonment, who have a diagnosis of posttraumatic stress disorder and osteoporosis that is at least 10% disabling.

Creating a presumption of service connection means that these veterans will not have to prove that their condition was caused by their military service in order to receive VA benefits. The VA said that several studies have shown that POWs have suffered serious bone loss because of dietary deficiencies during their imprisonments.

The federal government has officially recognized a link between being a prisoner of war (POW) and the development of osteoporosis.

The Department of Veterans Affairs has established a presumption of service connection for osteoporosis in former POWs who were interned for at least 30 days and whose osteoporosis is at least 10% disabling. The VA also established the connection for POWs, regardless of length of imprisonment, who have a diagnosis of posttraumatic stress disorder and osteoporosis that is at least 10% disabling.

Creating a presumption of service connection means that these veterans will not have to prove that their condition was caused by their military service in order to receive VA benefits. The VA said that several studies have shown that POWs have suffered serious bone loss because of dietary deficiencies during their imprisonments.

The federal government has officially recognized a link between being a prisoner of war (POW) and the development of osteoporosis.

The Department of Veterans Affairs has established a presumption of service connection for osteoporosis in former POWs who were interned for at least 30 days and whose osteoporosis is at least 10% disabling. The VA also established the connection for POWs, regardless of length of imprisonment, who have a diagnosis of posttraumatic stress disorder and osteoporosis that is at least 10% disabling.

Creating a presumption of service connection means that these veterans will not have to prove that their condition was caused by their military service in order to receive VA benefits. The VA said that several studies have shown that POWs have suffered serious bone loss because of dietary deficiencies during their imprisonments.

DENVER — Women who are encouraged to self-schedule their dual-energy x-ray absorptiometry scans via mailed brochures and letters undergo more scans than do those in usual practice, but it is still not a silver bullet strategy for identifying women who have osteoporosis.

In study of 3,734 women, mailings of an educational osteoporosis brochure and a letter providing the opportunity to self-schedule increased the percentage of women receiving dual-energy x-ray absorptiometry (DXA) scans by 13% versus routine care, Dr. Amy Warriner and her coinvestigators reported in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

The study involved 28 primary care physicians at the University of Alabama at Birmingham. The researchers identified women aged 65 years or older who had not had a DXA scan in the previous 4 years, and were under the care of a university primary care provider.

The participating providers were randomized to provide or not to provide an intervention.

Intervention-group physicians mailed brochures containing information about osteoporosis and fracture risk. The brochures were created using patient feedback from focus groups. Each mailing included a letter providing patients with the opportunity to self-schedule a DXA scan. Two mailings were sent to each woman.

In all, 665 women were randomized into the intervention group and 3,069 into the control group.

A total of 115 women in the intervention group were determined by their primary care providers not to be medically appropriate for DXA testing. Brochures and letters were mailed to the remaining 550 women.

In the intervention group, 19% of women received DXA scans. Half of these were self-scheduled and half were scheduled by the provider.

In comparison, only 6% of women in the control group had DXA scans. DXA scan self-scheduling and receipt was 13% better with a mailing intervention when compared with normal practice, the researchers noted.

“However, more potent strategies will still be needed to further improve DXA screening rates,” wrote Dr. Warriner, professor of medicine in the division of endocrinology and metabolism at the university.

The study was funded in part by Procter & Gamble, which comarkets the osteoporosis drug risedronate (Actonel).

Dr. Warriner reported that she has a significant financial relationship with Amgen Inc., which is developing the osteoporosis drug denosumab.

Her coinvestigators reported significant financial relationships with a number of pharmaceutical companies that make osteoporosis drugs.

DENVER — Women who are encouraged to self-schedule their dual-energy x-ray absorptiometry scans via mailed brochures and letters undergo more scans than do those in usual practice, but it is still not a silver bullet strategy for identifying women who have osteoporosis.

In study of 3,734 women, mailings of an educational osteoporosis brochure and a letter providing the opportunity to self-schedule increased the percentage of women receiving dual-energy x-ray absorptiometry (DXA) scans by 13% versus routine care, Dr. Amy Warriner and her coinvestigators reported in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

The study involved 28 primary care physicians at the University of Alabama at Birmingham. The researchers identified women aged 65 years or older who had not had a DXA scan in the previous 4 years, and were under the care of a university primary care provider.

The participating providers were randomized to provide or not to provide an intervention.

Intervention-group physicians mailed brochures containing information about osteoporosis and fracture risk. The brochures were created using patient feedback from focus groups. Each mailing included a letter providing patients with the opportunity to self-schedule a DXA scan. Two mailings were sent to each woman.

In all, 665 women were randomized into the intervention group and 3,069 into the control group.

A total of 115 women in the intervention group were determined by their primary care providers not to be medically appropriate for DXA testing. Brochures and letters were mailed to the remaining 550 women.

In the intervention group, 19% of women received DXA scans. Half of these were self-scheduled and half were scheduled by the provider.

In comparison, only 6% of women in the control group had DXA scans. DXA scan self-scheduling and receipt was 13% better with a mailing intervention when compared with normal practice, the researchers noted.

“However, more potent strategies will still be needed to further improve DXA screening rates,” wrote Dr. Warriner, professor of medicine in the division of endocrinology and metabolism at the university.

The study was funded in part by Procter & Gamble, which comarkets the osteoporosis drug risedronate (Actonel).

Dr. Warriner reported that she has a significant financial relationship with Amgen Inc., which is developing the osteoporosis drug denosumab.

Her coinvestigators reported significant financial relationships with a number of pharmaceutical companies that make osteoporosis drugs.

DENVER — Women who are encouraged to self-schedule their dual-energy x-ray absorptiometry scans via mailed brochures and letters undergo more scans than do those in usual practice, but it is still not a silver bullet strategy for identifying women who have osteoporosis.

In study of 3,734 women, mailings of an educational osteoporosis brochure and a letter providing the opportunity to self-schedule increased the percentage of women receiving dual-energy x-ray absorptiometry (DXA) scans by 13% versus routine care, Dr. Amy Warriner and her coinvestigators reported in a poster presented at the annual meeting of the American Society for Bone Mineral Research.

The study involved 28 primary care physicians at the University of Alabama at Birmingham. The researchers identified women aged 65 years or older who had not had a DXA scan in the previous 4 years, and were under the care of a university primary care provider.

The participating providers were randomized to provide or not to provide an intervention.

Intervention-group physicians mailed brochures containing information about osteoporosis and fracture risk. The brochures were created using patient feedback from focus groups. Each mailing included a letter providing patients with the opportunity to self-schedule a DXA scan. Two mailings were sent to each woman.

In all, 665 women were randomized into the intervention group and 3,069 into the control group.

A total of 115 women in the intervention group were determined by their primary care providers not to be medically appropriate for DXA testing. Brochures and letters were mailed to the remaining 550 women.

In the intervention group, 19% of women received DXA scans. Half of these were self-scheduled and half were scheduled by the provider.

In comparison, only 6% of women in the control group had DXA scans. DXA scan self-scheduling and receipt was 13% better with a mailing intervention when compared with normal practice, the researchers noted.

“However, more potent strategies will still be needed to further improve DXA screening rates,” wrote Dr. Warriner, professor of medicine in the division of endocrinology and metabolism at the university.

The study was funded in part by Procter & Gamble, which comarkets the osteoporosis drug risedronate (Actonel).

Dr. Warriner reported that she has a significant financial relationship with Amgen Inc., which is developing the osteoporosis drug denosumab.

Her coinvestigators reported significant financial relationships with a number of pharmaceutical companies that make osteoporosis drugs.

Estes Park, Colo. — Poor adherence accounts for more than 90% of all cases of failure to respond to osteoporosis therapy as evidenced by declining bone density or a fracture.

Lack of medication efficacy, on the other hand, is the least likely of the common causes for failure to respond. It ranks behind calcium/vitamin D deficiency, hyperthyroidism and other comorbid conditions, and the use of corticosteroids or other osteoporosis-inducing medications to treat comorbid conditions, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

He singled out failure to respond to treatment as one of the five top challenges in osteoporosis management today. Here are the other challenges highlighted by Dr. McDermott, professor of medicine and director of endocrinology and diabetes practice at University of Colorado Hospital, Denver:

Osteoporosis-inducing medications. Glucocorticoids top the list. They simultaneously reduce bone formation and increase bone resorption, resulting in quick bone loss in patients taking steroids. Serious consideration should be given to prescribing osteoporosis therapy in any patient who has ever been on 5 mg/day or more of prednisone for at least 3 months, he said.

Compelling 18-month data from a randomized trial of teriparatide (Forteo) versus alendronate (Fosamax) for the treatment of glucocorticoid-induced osteoporosis showed teriparatide to be the clear winner, both in terms of increased bone density and fewer vertebral fractures (N. Engl. J. Med. 2007;357:2028-39). The soon-to-be-published 3-year follow-up data confirm this. Both drugs have FDA approval for this indication.

Anticonvulsants are the No. 2 class of medications causing osteoporosis. “Anticonvulsant-induced osteoporosis hasn't been recognized as much, but it's emerging as quite important. It's a much bigger problem with phenobarbital, Dilantin, and Tegretol than with the newer anticonvulsants,” he said.

Atypical fractures of the femoral diaphysis. These fractures are the most recent and worrisome development in the osteoporosis field. Many experts now informally advocate a bisphosphonate therapy holiday after 5 years of use in an effort to avoid these fractures.

Osteonecrosis of the jaw. This condition is marked by nonhealing exposed bone for at least 8 weeks following an invasive dental procedure such as tooth extraction. Dr. McDermott said that he doesn't see it often, but he fields many phone calls about it. The great majority of cases have occurred in patients on high-dose intravenous bisphosphonate therapy for underlying bone cancer; oral bisphosphonates have not been shown to cause the disorder. Nevertheless, when Dr. McDermott is ready to start a patient on a bisphosphonate, he asks if a tooth extraction or dental implant is planned; if so, he'll wait to start the drug until after the procedure.

Osteoporosis medications and renal disease. Citing a lack of safety data, the Food and Drug Administration recommends against using bisphosphonates in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min per 1.73 m

“I do caution against antiresorptive therapy in patients with an eGFR below 15 mL/min—stage 5 chronic kidney disease—because it may predispose to adynamic bone disease,” he added.

Dr. McDermott disclosed serving on the speakers bureaus of several pharmaceutical companies.

Anticonvulsants are the second most common cause of medication-induced osteoporosis.

Source Dr. McDermotT

Estes Park, Colo. — Poor adherence accounts for more than 90% of all cases of failure to respond to osteoporosis therapy as evidenced by declining bone density or a fracture.

Lack of medication efficacy, on the other hand, is the least likely of the common causes for failure to respond. It ranks behind calcium/vitamin D deficiency, hyperthyroidism and other comorbid conditions, and the use of corticosteroids or other osteoporosis-inducing medications to treat comorbid conditions, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

He singled out failure to respond to treatment as one of the five top challenges in osteoporosis management today. Here are the other challenges highlighted by Dr. McDermott, professor of medicine and director of endocrinology and diabetes practice at University of Colorado Hospital, Denver:

Osteoporosis-inducing medications. Glucocorticoids top the list. They simultaneously reduce bone formation and increase bone resorption, resulting in quick bone loss in patients taking steroids. Serious consideration should be given to prescribing osteoporosis therapy in any patient who has ever been on 5 mg/day or more of prednisone for at least 3 months, he said.

Compelling 18-month data from a randomized trial of teriparatide (Forteo) versus alendronate (Fosamax) for the treatment of glucocorticoid-induced osteoporosis showed teriparatide to be the clear winner, both in terms of increased bone density and fewer vertebral fractures (N. Engl. J. Med. 2007;357:2028-39). The soon-to-be-published 3-year follow-up data confirm this. Both drugs have FDA approval for this indication.

Anticonvulsants are the No. 2 class of medications causing osteoporosis. “Anticonvulsant-induced osteoporosis hasn't been recognized as much, but it's emerging as quite important. It's a much bigger problem with phenobarbital, Dilantin, and Tegretol than with the newer anticonvulsants,” he said.

Atypical fractures of the femoral diaphysis. These fractures are the most recent and worrisome development in the osteoporosis field. Many experts now informally advocate a bisphosphonate therapy holiday after 5 years of use in an effort to avoid these fractures.

Osteonecrosis of the jaw. This condition is marked by nonhealing exposed bone for at least 8 weeks following an invasive dental procedure such as tooth extraction. Dr. McDermott said that he doesn't see it often, but he fields many phone calls about it. The great majority of cases have occurred in patients on high-dose intravenous bisphosphonate therapy for underlying bone cancer; oral bisphosphonates have not been shown to cause the disorder. Nevertheless, when Dr. McDermott is ready to start a patient on a bisphosphonate, he asks if a tooth extraction or dental implant is planned; if so, he'll wait to start the drug until after the procedure.

Osteoporosis medications and renal disease. Citing a lack of safety data, the Food and Drug Administration recommends against using bisphosphonates in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min per 1.73 m

“I do caution against antiresorptive therapy in patients with an eGFR below 15 mL/min—stage 5 chronic kidney disease—because it may predispose to adynamic bone disease,” he added.

Dr. McDermott disclosed serving on the speakers bureaus of several pharmaceutical companies.

Anticonvulsants are the second most common cause of medication-induced osteoporosis.

Source Dr. McDermotT

Estes Park, Colo. — Poor adherence accounts for more than 90% of all cases of failure to respond to osteoporosis therapy as evidenced by declining bone density or a fracture.

Lack of medication efficacy, on the other hand, is the least likely of the common causes for failure to respond. It ranks behind calcium/vitamin D deficiency, hyperthyroidism and other comorbid conditions, and the use of corticosteroids or other osteoporosis-inducing medications to treat comorbid conditions, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

He singled out failure to respond to treatment as one of the five top challenges in osteoporosis management today. Here are the other challenges highlighted by Dr. McDermott, professor of medicine and director of endocrinology and diabetes practice at University of Colorado Hospital, Denver:

Osteoporosis-inducing medications. Glucocorticoids top the list. They simultaneously reduce bone formation and increase bone resorption, resulting in quick bone loss in patients taking steroids. Serious consideration should be given to prescribing osteoporosis therapy in any patient who has ever been on 5 mg/day or more of prednisone for at least 3 months, he said.

Compelling 18-month data from a randomized trial of teriparatide (Forteo) versus alendronate (Fosamax) for the treatment of glucocorticoid-induced osteoporosis showed teriparatide to be the clear winner, both in terms of increased bone density and fewer vertebral fractures (N. Engl. J. Med. 2007;357:2028-39). The soon-to-be-published 3-year follow-up data confirm this. Both drugs have FDA approval for this indication.

Anticonvulsants are the No. 2 class of medications causing osteoporosis. “Anticonvulsant-induced osteoporosis hasn't been recognized as much, but it's emerging as quite important. It's a much bigger problem with phenobarbital, Dilantin, and Tegretol than with the newer anticonvulsants,” he said.

Atypical fractures of the femoral diaphysis. These fractures are the most recent and worrisome development in the osteoporosis field. Many experts now informally advocate a bisphosphonate therapy holiday after 5 years of use in an effort to avoid these fractures.

Osteonecrosis of the jaw. This condition is marked by nonhealing exposed bone for at least 8 weeks following an invasive dental procedure such as tooth extraction. Dr. McDermott said that he doesn't see it often, but he fields many phone calls about it. The great majority of cases have occurred in patients on high-dose intravenous bisphosphonate therapy for underlying bone cancer; oral bisphosphonates have not been shown to cause the disorder. Nevertheless, when Dr. McDermott is ready to start a patient on a bisphosphonate, he asks if a tooth extraction or dental implant is planned; if so, he'll wait to start the drug until after the procedure.

Osteoporosis medications and renal disease. Citing a lack of safety data, the Food and Drug Administration recommends against using bisphosphonates in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min per 1.73 m

“I do caution against antiresorptive therapy in patients with an eGFR below 15 mL/min—stage 5 chronic kidney disease—because it may predispose to adynamic bone disease,” he added.

Dr. McDermott disclosed serving on the speakers bureaus of several pharmaceutical companies.

Anticonvulsants are the second most common cause of medication-induced osteoporosis.

Source Dr. McDermotT

Benign positional vertigo appears to strongly correlate with osteopenia and osteoporosis in both men and women, researchers in a case-control study have concluded.

Compared to controls, patients with osteopenia were twice as likely to experience positional vertigo, and those with osteoporosis were three times as likely to experience the disorder, Dr. Ji Sook Kim and colleagues wrote.

“These findings suggest a deranged calcium metabolism in idiopathic benign positional vertigo,” Dr. Kim of the Seoul National University College of Medicine, Korea, said in an interview. “Restoring normal calcium metabolism may prevent recurrences of BPPV.”

The study compared bone mineral density in 209 patients with a diagnosis of idiopathic benign positional vertigo (BPV) and 202 controls. Most (142) were female; their mean age was 60 years.

Among female patients, only 28% had normal bone mineral density, while 47% had osteopenia and 25% had osteoporosis. Among female controls, normal bone mass was found in 57%; 33% had osteopenia and 9% had osteoporosis. (Percentages do not add up to 100% due to rounding.) The differences were significant at all points measured (Neurology 2009;72:1069-76).

In male patients, 48% had normal bone mass, while 40% had osteopenia and 12% had osteoporosis. In male controls, 67% had normal bone mass, 27% had osteopenia, and 6% had osteoporosis. The differences were significant at the femur and first lumbar vertebra, but not at the other lumbar measurements.

Benign positional vertigo appears to strongly correlate with osteopenia and osteoporosis in both men and women, researchers in a case-control study have concluded.

Compared to controls, patients with osteopenia were twice as likely to experience positional vertigo, and those with osteoporosis were three times as likely to experience the disorder, Dr. Ji Sook Kim and colleagues wrote.

“These findings suggest a deranged calcium metabolism in idiopathic benign positional vertigo,” Dr. Kim of the Seoul National University College of Medicine, Korea, said in an interview. “Restoring normal calcium metabolism may prevent recurrences of BPPV.”

The study compared bone mineral density in 209 patients with a diagnosis of idiopathic benign positional vertigo (BPV) and 202 controls. Most (142) were female; their mean age was 60 years.

Among female patients, only 28% had normal bone mineral density, while 47% had osteopenia and 25% had osteoporosis. Among female controls, normal bone mass was found in 57%; 33% had osteopenia and 9% had osteoporosis. (Percentages do not add up to 100% due to rounding.) The differences were significant at all points measured (Neurology 2009;72:1069-76).

In male patients, 48% had normal bone mass, while 40% had osteopenia and 12% had osteoporosis. In male controls, 67% had normal bone mass, 27% had osteopenia, and 6% had osteoporosis. The differences were significant at the femur and first lumbar vertebra, but not at the other lumbar measurements.

Benign positional vertigo appears to strongly correlate with osteopenia and osteoporosis in both men and women, researchers in a case-control study have concluded.

Compared to controls, patients with osteopenia were twice as likely to experience positional vertigo, and those with osteoporosis were three times as likely to experience the disorder, Dr. Ji Sook Kim and colleagues wrote.

“These findings suggest a deranged calcium metabolism in idiopathic benign positional vertigo,” Dr. Kim of the Seoul National University College of Medicine, Korea, said in an interview. “Restoring normal calcium metabolism may prevent recurrences of BPPV.”

The study compared bone mineral density in 209 patients with a diagnosis of idiopathic benign positional vertigo (BPV) and 202 controls. Most (142) were female; their mean age was 60 years.

Among female patients, only 28% had normal bone mineral density, while 47% had osteopenia and 25% had osteoporosis. Among female controls, normal bone mass was found in 57%; 33% had osteopenia and 9% had osteoporosis. (Percentages do not add up to 100% due to rounding.) The differences were significant at all points measured (Neurology 2009;72:1069-76).

In male patients, 48% had normal bone mass, while 40% had osteopenia and 12% had osteoporosis. In male controls, 67% had normal bone mass, 27% had osteopenia, and 6% had osteoporosis. The differences were significant at the femur and first lumbar vertebra, but not at the other lumbar measurements.

Estes Park, Colo. — Many bone disease experts are recommending a 1- to 2-year bisphosphonate holiday after 5 years of treatment in response to a recent spate of reports of atypical fractures of the femoral diaphysis.

There are now more than 70 reports of these atypical transverse fractures of the femoral shaft occurring in patients on bisphosphonates for longer than 5 years. Affected individuals have also had severely suppressed bone turnover markers, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

“This tells us that drugs that turn off a major process like bone remodeling may be very valuable for 3-5 years, but we have to ask, are they good for longer periods of time? We don't know the answer yet,” observed Dr. McDermott, professor of medicine and director of diabetes practice at University of Colorado Hospital, Aurora.

These distinctive fractures have been bilateral in two-thirds of cases. There is no associated history of trauma, just spontaneous thigh pain. Radiographically they look like nonhealing stress fractures that have completed through the bone shaft.

Dr. McDermott has contacted many bone experts, who agree that a bisphosphonate holiday for 1-2 years is reasonable after 5 years of therapy in low-risk patients (those with a T-score greater than −2.5 and no history of fractures). “Treatment holidays are not advised for high-risk patients,” he stressed.

For such patients—those who have a T-score less than −2.5 and/or previous fractures—options include a switch to an anabolic agent such as teriparatide (Forteo) or to a nonbisphosphonate antiresorptive agent such as raloxifene (Evista), estrogen, or calcitonin. Continuing the bisphosphonate in a high-risk patient is also a reasonable strategy.

Regardless, it's now doubly important to monitor bone mineral density and/or bone turnover biomarkers regularly in patients on long-term bisphosphonates, Dr. McDermott emphasized.

Estes Park, Colo. — Many bone disease experts are recommending a 1- to 2-year bisphosphonate holiday after 5 years of treatment in response to a recent spate of reports of atypical fractures of the femoral diaphysis.

There are now more than 70 reports of these atypical transverse fractures of the femoral shaft occurring in patients on bisphosphonates for longer than 5 years. Affected individuals have also had severely suppressed bone turnover markers, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

“This tells us that drugs that turn off a major process like bone remodeling may be very valuable for 3-5 years, but we have to ask, are they good for longer periods of time? We don't know the answer yet,” observed Dr. McDermott, professor of medicine and director of diabetes practice at University of Colorado Hospital, Aurora.

These distinctive fractures have been bilateral in two-thirds of cases. There is no associated history of trauma, just spontaneous thigh pain. Radiographically they look like nonhealing stress fractures that have completed through the bone shaft.

Dr. McDermott has contacted many bone experts, who agree that a bisphosphonate holiday for 1-2 years is reasonable after 5 years of therapy in low-risk patients (those with a T-score greater than −2.5 and no history of fractures). “Treatment holidays are not advised for high-risk patients,” he stressed.

For such patients—those who have a T-score less than −2.5 and/or previous fractures—options include a switch to an anabolic agent such as teriparatide (Forteo) or to a nonbisphosphonate antiresorptive agent such as raloxifene (Evista), estrogen, or calcitonin. Continuing the bisphosphonate in a high-risk patient is also a reasonable strategy.

Regardless, it's now doubly important to monitor bone mineral density and/or bone turnover biomarkers regularly in patients on long-term bisphosphonates, Dr. McDermott emphasized.

Estes Park, Colo. — Many bone disease experts are recommending a 1- to 2-year bisphosphonate holiday after 5 years of treatment in response to a recent spate of reports of atypical fractures of the femoral diaphysis.

There are now more than 70 reports of these atypical transverse fractures of the femoral shaft occurring in patients on bisphosphonates for longer than 5 years. Affected individuals have also had severely suppressed bone turnover markers, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.

“This tells us that drugs that turn off a major process like bone remodeling may be very valuable for 3-5 years, but we have to ask, are they good for longer periods of time? We don't know the answer yet,” observed Dr. McDermott, professor of medicine and director of diabetes practice at University of Colorado Hospital, Aurora.

These distinctive fractures have been bilateral in two-thirds of cases. There is no associated history of trauma, just spontaneous thigh pain. Radiographically they look like nonhealing stress fractures that have completed through the bone shaft.

Dr. McDermott has contacted many bone experts, who agree that a bisphosphonate holiday for 1-2 years is reasonable after 5 years of therapy in low-risk patients (those with a T-score greater than −2.5 and no history of fractures). “Treatment holidays are not advised for high-risk patients,” he stressed.

For such patients—those who have a T-score less than −2.5 and/or previous fractures—options include a switch to an anabolic agent such as teriparatide (Forteo) or to a nonbisphosphonate antiresorptive agent such as raloxifene (Evista), estrogen, or calcitonin. Continuing the bisphosphonate in a high-risk patient is also a reasonable strategy.

Regardless, it's now doubly important to monitor bone mineral density and/or bone turnover biomarkers regularly in patients on long-term bisphosphonates, Dr. McDermott emphasized.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

WASHINGTON — Most women susceptible to fragility fractures fail to appreciate those risks, even if they have been told by a physician that they have osteoporosis, a large international survey-based study has concluded.

“We found a remarkable failure of many women to perceive that these clear-cut factors are putting them at increased risk for a fracture,” said Dr. Ethel Siris, an investigator for GLOW (Global Longitudinal Study of Osteoporosis in Women).

GLOW included more than 60,000 postmenopausal women who were recruited from 706 physician practices in 10 countries. The women completed questionnaires on demographic and medical information, risk factors for fragility fracture, any personal history of and treatment for osteoporosis, and health and functional status.

Comparing themselves with women of the same age, 64% of subjects with risk factors for fracture did not perceive themselves at increased risk, Dr. Siris said in an interview. Even more surprising, she said, 55% of women who had been told by a physician that they had osteoporosis thought that they were not at increased risk.

Women with other risk factors displayed a similar ignorance, Dr. Siris noted. Of women whose mother had experienced a hip fracture, 74% thought they were at a lower fracture risk than their peers or had a similar risk, as did 74% of those with a low body mass index, 80% of current smokers, 77% of those who frequently consumed alcohol, 61% of those taking corticosteroids, and 71% of those with rheumatoid arthritis.

The replies were consistent across countries, she said at an international symposium sponsored by the National Osteoporosis Foundation. “There is apparently a worldwide problem with communicating these ideas to patients.”

The failure to appreciate the implications of fracture risk may help account for the “lousy adherence” to osteoporosis therapy, said Dr. Siris, director of the osteoporosis center at Columbia University, New York.

Dr. Siris disclosed that she has received consulting fees for her time working on GLOW from Sanofi-Aventis and Procter & Gamble Co., which funded the project.

WASHINGTON — Most women susceptible to fragility fractures fail to appreciate those risks, even if they have been told by a physician that they have osteoporosis, a large international survey-based study has concluded.

“We found a remarkable failure of many women to perceive that these clear-cut factors are putting them at increased risk for a fracture,” said Dr. Ethel Siris, an investigator for GLOW (Global Longitudinal Study of Osteoporosis in Women).

GLOW included more than 60,000 postmenopausal women who were recruited from 706 physician practices in 10 countries. The women completed questionnaires on demographic and medical information, risk factors for fragility fracture, any personal history of and treatment for osteoporosis, and health and functional status.

Comparing themselves with women of the same age, 64% of subjects with risk factors for fracture did not perceive themselves at increased risk, Dr. Siris said in an interview. Even more surprising, she said, 55% of women who had been told by a physician that they had osteoporosis thought that they were not at increased risk.

Women with other risk factors displayed a similar ignorance, Dr. Siris noted. Of women whose mother had experienced a hip fracture, 74% thought they were at a lower fracture risk than their peers or had a similar risk, as did 74% of those with a low body mass index, 80% of current smokers, 77% of those who frequently consumed alcohol, 61% of those taking corticosteroids, and 71% of those with rheumatoid arthritis.

The replies were consistent across countries, she said at an international symposium sponsored by the National Osteoporosis Foundation. “There is apparently a worldwide problem with communicating these ideas to patients.”

The failure to appreciate the implications of fracture risk may help account for the “lousy adherence” to osteoporosis therapy, said Dr. Siris, director of the osteoporosis center at Columbia University, New York.

Dr. Siris disclosed that she has received consulting fees for her time working on GLOW from Sanofi-Aventis and Procter & Gamble Co., which funded the project.

WASHINGTON — Most women susceptible to fragility fractures fail to appreciate those risks, even if they have been told by a physician that they have osteoporosis, a large international survey-based study has concluded.

“We found a remarkable failure of many women to perceive that these clear-cut factors are putting them at increased risk for a fracture,” said Dr. Ethel Siris, an investigator for GLOW (Global Longitudinal Study of Osteoporosis in Women).

GLOW included more than 60,000 postmenopausal women who were recruited from 706 physician practices in 10 countries. The women completed questionnaires on demographic and medical information, risk factors for fragility fracture, any personal history of and treatment for osteoporosis, and health and functional status.

Comparing themselves with women of the same age, 64% of subjects with risk factors for fracture did not perceive themselves at increased risk, Dr. Siris said in an interview. Even more surprising, she said, 55% of women who had been told by a physician that they had osteoporosis thought that they were not at increased risk.

Women with other risk factors displayed a similar ignorance, Dr. Siris noted. Of women whose mother had experienced a hip fracture, 74% thought they were at a lower fracture risk than their peers or had a similar risk, as did 74% of those with a low body mass index, 80% of current smokers, 77% of those who frequently consumed alcohol, 61% of those taking corticosteroids, and 71% of those with rheumatoid arthritis.

The replies were consistent across countries, she said at an international symposium sponsored by the National Osteoporosis Foundation. “There is apparently a worldwide problem with communicating these ideas to patients.”

The failure to appreciate the implications of fracture risk may help account for the “lousy adherence” to osteoporosis therapy, said Dr. Siris, director of the osteoporosis center at Columbia University, New York.

Dr. Siris disclosed that she has received consulting fees for her time working on GLOW from Sanofi-Aventis and Procter & Gamble Co., which funded the project.

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

ORLANDO — Bisphosphonate use was linked with an unexpected, increased risk for aortic valve calcification in women aged 55–64 years in an analysis of about 3,700 women.

The analysis also showed the more expected finding that among older women, aged at least 75, bisphosphonate treatment was linked to a significantly reduced risk for aortic valve calcification. This effect probably occurs because bisphosphonate treatment slows calcium loss from bone, thereby preventing the lost calcium from winding up deposited on valves, Dr. Sammy Elmariah said while presenting a poster at the annual meeting of the American College of Cardiology.

The significantly increased risk for aortic valve calcification among younger women treated with a nitrogen-containing bisphosphonate has no clear explanation. “In my opinion it's due to confounding,” Dr. Elmariah said in an interview. Women younger than 65 who go on bisphosphonate treatment often have a special risk for osteoporosis that may somehow relate to a high level of valve calcification.

He and his associates used data collected in the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of about 6,800 men and women aged 45–85 recruited from six U.S. communities and sponsored by the National Heart, Lung, and Blood Institute. Among the 3,710 women in MESA, 214 were treated with a nitrogen-containing bisphosphonate, either an oral or intravenous formulation, and the other 3,496 were not receiving a bisphosphonate. The bisphosphonate group included 100 women aged younger than 65.

Cardiovascular calcification was evaluated by electron-beam CT (in three communities) or multidetector row helical CT (at three communities). Aortic-valve calcification was defined as any calcified lesion on an aortic-valve leaflet.

Among women younger than 65, imaging showed aortic valve calcification in 18% of those on a bisphosphonate and in 4% of those not on the drug. In women aged 65 or older, imaging showed a rate of 13% with calcification in the bisphosphonate group and 20% in those not on the drug, reported Dr. Elmariah, a cardiologist at Mount Sinai Medical Center in New York.

In a model that adjusted for age, body mass index, ethnicity, study site, education, income, health insurance, treatment for hypertension or lipid lowering, diabetes, smoking, blood pressure, and cholesterol level, bisphosphonate use was linked with a 3.9-fold increased risk for aortic valve calcification in women younger than 65, a statistically significant association. The vast majority of these women were aged 55–64.

In contrast, among women aged 65 or older, bisphosphonate use was associated with a nonsignificant, 30% reduction in valve calcification. In the subgroup of women aged 75 or older, bisphosphonate use was linked with a significant reduction in the prevalence of valve calcification, a roughly 50% relative risk reduction compared with women not on a bisphosphonate.

The finding warrants further investigation in other groups of women taking bisphosphonates, Dr. Elmariah said. He reported no financial relationships for this study.

ORLANDO — Bisphosphonate use was linked with an unexpected, increased risk for aortic valve calcification in women aged 55–64 years in an analysis of about 3,700 women.

The analysis also showed the more expected finding that among older women, aged at least 75, bisphosphonate treatment was linked to a significantly reduced risk for aortic valve calcification. This effect probably occurs because bisphosphonate treatment slows calcium loss from bone, thereby preventing the lost calcium from winding up deposited on valves, Dr. Sammy Elmariah said while presenting a poster at the annual meeting of the American College of Cardiology.

The significantly increased risk for aortic valve calcification among younger women treated with a nitrogen-containing bisphosphonate has no clear explanation. “In my opinion it's due to confounding,” Dr. Elmariah said in an interview. Women younger than 65 who go on bisphosphonate treatment often have a special risk for osteoporosis that may somehow relate to a high level of valve calcification.

He and his associates used data collected in the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of about 6,800 men and women aged 45–85 recruited from six U.S. communities and sponsored by the National Heart, Lung, and Blood Institute. Among the 3,710 women in MESA, 214 were treated with a nitrogen-containing bisphosphonate, either an oral or intravenous formulation, and the other 3,496 were not receiving a bisphosphonate. The bisphosphonate group included 100 women aged younger than 65.

Cardiovascular calcification was evaluated by electron-beam CT (in three communities) or multidetector row helical CT (at three communities). Aortic-valve calcification was defined as any calcified lesion on an aortic-valve leaflet.

Among women younger than 65, imaging showed aortic valve calcification in 18% of those on a bisphosphonate and in 4% of those not on the drug. In women aged 65 or older, imaging showed a rate of 13% with calcification in the bisphosphonate group and 20% in those not on the drug, reported Dr. Elmariah, a cardiologist at Mount Sinai Medical Center in New York.

In a model that adjusted for age, body mass index, ethnicity, study site, education, income, health insurance, treatment for hypertension or lipid lowering, diabetes, smoking, blood pressure, and cholesterol level, bisphosphonate use was linked with a 3.9-fold increased risk for aortic valve calcification in women younger than 65, a statistically significant association. The vast majority of these women were aged 55–64.

In contrast, among women aged 65 or older, bisphosphonate use was associated with a nonsignificant, 30% reduction in valve calcification. In the subgroup of women aged 75 or older, bisphosphonate use was linked with a significant reduction in the prevalence of valve calcification, a roughly 50% relative risk reduction compared with women not on a bisphosphonate.

The finding warrants further investigation in other groups of women taking bisphosphonates, Dr. Elmariah said. He reported no financial relationships for this study.

ORLANDO — Bisphosphonate use was linked with an unexpected, increased risk for aortic valve calcification in women aged 55–64 years in an analysis of about 3,700 women.

The analysis also showed the more expected finding that among older women, aged at least 75, bisphosphonate treatment was linked to a significantly reduced risk for aortic valve calcification. This effect probably occurs because bisphosphonate treatment slows calcium loss from bone, thereby preventing the lost calcium from winding up deposited on valves, Dr. Sammy Elmariah said while presenting a poster at the annual meeting of the American College of Cardiology.

The significantly increased risk for aortic valve calcification among younger women treated with a nitrogen-containing bisphosphonate has no clear explanation. “In my opinion it's due to confounding,” Dr. Elmariah said in an interview. Women younger than 65 who go on bisphosphonate treatment often have a special risk for osteoporosis that may somehow relate to a high level of valve calcification.

He and his associates used data collected in the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of about 6,800 men and women aged 45–85 recruited from six U.S. communities and sponsored by the National Heart, Lung, and Blood Institute. Among the 3,710 women in MESA, 214 were treated with a nitrogen-containing bisphosphonate, either an oral or intravenous formulation, and the other 3,496 were not receiving a bisphosphonate. The bisphosphonate group included 100 women aged younger than 65.

Cardiovascular calcification was evaluated by electron-beam CT (in three communities) or multidetector row helical CT (at three communities). Aortic-valve calcification was defined as any calcified lesion on an aortic-valve leaflet.

Among women younger than 65, imaging showed aortic valve calcification in 18% of those on a bisphosphonate and in 4% of those not on the drug. In women aged 65 or older, imaging showed a rate of 13% with calcification in the bisphosphonate group and 20% in those not on the drug, reported Dr. Elmariah, a cardiologist at Mount Sinai Medical Center in New York.

In a model that adjusted for age, body mass index, ethnicity, study site, education, income, health insurance, treatment for hypertension or lipid lowering, diabetes, smoking, blood pressure, and cholesterol level, bisphosphonate use was linked with a 3.9-fold increased risk for aortic valve calcification in women younger than 65, a statistically significant association. The vast majority of these women were aged 55–64.

In contrast, among women aged 65 or older, bisphosphonate use was associated with a nonsignificant, 30% reduction in valve calcification. In the subgroup of women aged 75 or older, bisphosphonate use was linked with a significant reduction in the prevalence of valve calcification, a roughly 50% relative risk reduction compared with women not on a bisphosphonate.

The finding warrants further investigation in other groups of women taking bisphosphonates, Dr. Elmariah said. He reported no financial relationships for this study.