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Osteoporosis: studies show promise for stronger bones.

ERT for Established Osteoporosis: It has long been known that estrogen replacement therapy -- when it is begun at menopause or soon after -- can slow the rate of postmenopausal bone loss and decrease the occurrence of fractures due to osteoporosis. However, estrogen has not generally been considered an effective treatment for older women who already have the disease.

Now, promising new research data offers hope for women already experiencing thinning, brittle bones. In a controlled study at the Mayo Clinic, Dr. Edward G. Lufkin and his colleagues administered estrogen by skin patch to a group of women aged 54 to 72 with established osteoporosis. After one year of treatment, bone mineral density was found to have increased significantly in the lumbar spine and to a lesser extent in the thigh bone and at the midpoint of the forearm.

Most significantly, this bone-strengthening had cut the rate of vertebral fractures in the experimental subjects by one-half, the researchers documented. Subsequently analyzing three-year data from that same population, the researchers found that the bone gain continued to the level of about 15 percent and then started to level out.

Based on these findings, Dr. Lufkin recommends that older women with established osteoporosis be evaluated as possible candidates for estrogen replacement therapy.

Reversing Osteoporotic Changes with PTH. A recent study by researchers in New York suggests that treatment with parathyroid hormone (PTH) might actually be capable of reversing osteoporotic changes in women with the disease.

Dr. Robert Lindsay, chief of internal medicine at Helen Hayes Hospital in West Haverstraw, N.Y., and his colleagues treated laboratory animals with PTH, a hormone made by the parathyroid -- two pairs of endocrine glands within the thyroid -- that controls the distribution of calcium and phosphate in the body. They found a reversal in osteoporotic changes associated with artificially induced menopause. The research team now has a clinical trial under way evaluating the effects of PTH in post-menopausal women with osteoporosis.

"There are a lot of uncontrolled data supporting the idea that, if you have PTH or an analogue of PTH, you can produce an increase in bone mass, especially in the vertebrae," says Dr. Lindsay, who is also a clinical professor of medicine at Columbia University. "Whether that will turn out to be useful in terms of reducing fracture risk in patients with osteoporosis remains to be seen."

Dr. Lindsay points out that researchers have been able to increase bone mass with fluoride treatments. But there was no reduction in vertebral fracture rates, because new bone formed under the influence of fluoride may not be as strong as normal adult bone. "That does not happen with PTH as far as we know," he says.

Weight-Bearing Exercise and Bone Mass: If you want to achieve or maintain bone strength, exercise. That is the message of a long-term study conducted by researchers at the University of California San Francisco (UCSF) Medical Center and the Stanford Arthritis Center. In the study of middle-aged to older runners, researchers from the two medical centers found that men and women who run have more spinal bone mineral density than those who do not. "And we find, also, that when you stop running and decrease the weight-bearing exercise by even 20 percent, you lose some of that bone density," says Dr. Nancy Lane of UCSF, who headed the study.

Dr. Lane explains that the stress on the skeletal structure from weight-bearing exercise builds up or maintains bone to match that stress. That holds true both for women, who experience a dramatic drop-off in bone mineral density after menopause, and men, whose bones thin out more gradually.

She acknowledges that as people grow older, it becomes more difficult to run significant distances. "If you're going to exercise, decide on a form of it you'll stay with, because it's the continuous stresses that will help the bones. Brisk walking is very good," she says.
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Author:Briley, Michael
Publication:Arthritis Today
Date:Jul 1, 1993
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