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Important new advance in osteoporosis treatment.


One of the most inconvenient--and potentially most dangerous--aspects of aging is osteoporosis. Although sometimes erroneously defined as "bone loss," osteoporosis is actually an imbalance of the body's complex process of breaking down old bone and rebuilding new; with osteoporosis, breakdown exceeds formation. No one seems to know what causes this imbalance, yet 15 million Americans suffer from this disease, which produces no symptoms until bones become so brittle that they break. Such deformities as "dowager's hump" may then occur, in which spinal vertebrae collapse. Oftentimes, the osteoporosis patient ends up significantly shorter than he or she had been in younger years. Broken hips are another problem; resulting complications are a major cause of illness and death among elderly women.

Because most osteoporosis patients are postmenopausal females (perhaps due to the fact that much calcium is lost during a woman's "change"), seven U.S. medical centers recently completed a two-year study of more than 400 such individuals to determine if an osteoporosis treatment that's more efficient and less expensive than the two currently approved methods could be established. Doctors treated each patient in eight 91-day cycles; during each cycle, the patient received either 1 g of phosphate or a placebo during the first three days, followed by 14 days of treatment with either a placebo or 400 mg of oral etidronate, a drug currently licensed only for the treatment of Paget's disease (bone inflammation). The remaining days of each cycle found everyone taking calcium either in supplements or as part of their diets. The researchers found that those who were given the etidronate, especially those with the lowest spinal bone density, experienced significant increases in spinal bone mass, as well as reduced incidences of new vertebral fractures without significant adverse effects. Those who were given placebos did not experience such significant changes. Also, the use of 1 g of phosphate had no apparent benefit and, in fact, gave 39 percent of the women diarrhea.

Thus far, only two therapies have been approved for osteoporosis in the U.S.: oral estrogen and parenteral synthetic salmon calcitonin, both hormones. A pair of experimental treatments, sodium fluoride and intranasal calcitonin, have not panned out thus far because: (a) although sodium fluoride does build bone mass, it tends to weaken bones and make them more structurally flawed, and (b) intranasal calcitonin is expensive (about $2,500 is the average annual cost of the treatment). As the study's researchers point out, hormones only prevent bone loss; etidronate goes one step further by actually enabling the already-weakened bone to add to itself. Plus, etidronate costs only about an average $300 a year.

Dr. Nelson B. Watts of Emory University in Atlanta, who headed the study, reports in the New England Journal of Medicine (NEJM) that "intermittent cyclical therapy with etidronate should be a welcome addition to the therapeutic options for osteoporosis." He also told a New York Times reporter that, although his study did not include male osteoporosis patients, they should benefit as well from etidronate treatment. Although the drug's manufacturer, Norwich Eaton Pharmaceuticals of Norwich, N.Y., can thus far market the drug only for Paget's disease, doctors are free to prescribe the drug for osteoporosis if they wish. Dr. B. Lawrence Riggs of the Mayo Clinic and Foundation in Rochester, Minn., writing in a related NEJM editorial, expects that doctors will most likely continue to prescribe estrogen and calcitonin according to each osteoporosis patient's needs.
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Title Annotation:oral etidronate
Publication:Medical Update
Date:Oct 1, 1990
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