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See detailStrategies for the prevention of hip fracture
Gourlay, M.; Richy, F.; Reginster, Jean-Yves ULg

in American Journal of Medicine (2003), 115(4), 309-317

Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip ... [more ▼]

Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip fracture after the age of 50 years. Despite the availability of evidence-based guidelines for hip fracture prevention, routine screening and preventive measures have not been incorporated into standard primary care practice. Many physicians lack adequate knowledge to initiate bone mineral density testing and treatment with preventive medications to decrease the incidence of osteoporosis and fractures. Furthermore, patients are less likely to request information about bone health than about diseases for which systematic screening and prevention protocols have been established. This review describes preventive measures to decrease hip fracture in postmenopausal women, including screening by bone mineral density testing, risk factor assessment, and chemoprevention. Existing guidelines are summarized, and dilemmas regarding their implementation are discussed. (C) 2003 by Excerpta Medica Inc. [less ▲]

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See detailA Double-Blind, Placebo-Controlled, Dose-Finding Trial of Intermittent Nasal Salmon Calcitonin for Prevention of Postmenopausal Lumbar Spine Bone Loss
Reginster, Jean-Yves ULg; Deroisy, Rita ULg; Lecart, M. P. et al

in American Journal of Medicine (1995), 98(5), 452-8

PURPOSE: Nasal administration of salmon calcitonin (SCT) has been suggested for preventing trabecular bone loss during the first years following the menopause, but no conclusive evidence has appeared ... [more ▼]

PURPOSE: Nasal administration of salmon calcitonin (SCT) has been suggested for preventing trabecular bone loss during the first years following the menopause, but no conclusive evidence has appeared about the minimal effective dose. Since nasal calcitonin is highly expensive, it makes sense to define this dose. PATIENTS AND METHODS: We performed a double-blind, placebo-controlled, randomized, single-center study with a 3-arm parallel-group design. The subjects were 251 healthy women who had experienced natural menopause within the past 6 to 72 months and were not affected by any diseases or treatments that interfere with calcium metabolism. They were randomly allocated in groups of 6 to receive intranasal SCT 50 IU (n = 84), SCT 200 IU (n = 84), or placebo (n = 83). All treatments were given on 5 consecutive days per week. Statistical analysis was based on two populations: intention-to-treat (IT) and valid completers (VC). The main assessments performed were bone mineral density of the lumbar spine (LSBMD) and biochemical parameters reflecting bone turnover (serum alkaline phosphatase, urinary calcium/creatinine, and hydroxyproline/creatinine ratios). RESULTS: Changes over the treatment period were comparable in the IT and VC populations. In the group receiving the placebo, LSBMD decreased from baseline to end point by a mean of 6.28% (95% confidence interval [CI] -7.69 to -4.89) in the IT population and 6.98% (95% CI -8.86 to -5.11) in the VC population (P = 0.0001, end LSBMD versus baseline LSBMD). LSBMD increased slightly with the 50-IU/d dose of SCT, by 0.82% (95% CI -0.26 to 1.89) in the IT population, and 0.51% (95% CI -0.69 to 1.72) in the VC (P = NS, versus baseline). Subjects who received SCT 200 IU/d experienced significant increases of 2.03% (95% CI 0.92 to 3.15) in the IT population and 2.26% (95% CI 1.01 to 3.51) in the VC (both P = 0.001). The difference between the evolution of the combined groups receiving nasal SCT and the group treated with the placebo was highly significant (P = 0.0001). No significant changes were recorded in biochemical parameters reflecting bone turnover. CONCLUSIONS: SCT 50 IU/d administered nasally and intermittently appears to prevent lumbar bone loss in nonobese early postmenopausal women. [less ▲]

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See detailCalcitonin for Prevention and Treatment of Osteoporosis
Reginster, Jean-Yves ULg

in American Journal of Medicine (1993), 95(5A), 44-47

There appears to be a consensus that 100 IU/day of nasally administered salmon calcitonin may prevent trabecular bone loss during the first year of the menopause. Strong evidence exists that half that ... [more ▼]

There appears to be a consensus that 100 IU/day of nasally administered salmon calcitonin may prevent trabecular bone loss during the first year of the menopause. Strong evidence exists that half that dose may also be sufficient to prevent trabecular bone loss and that higher doses (> or = 200 IU/day) induce a significant increase in spinal bone mineral content. Calcium supplements should be systemically administered when calcitonin is given, particularly at high doses. Rectal calcitonin seems also to be an efficient alternative in prevention of trabecular bone loss. Further studies are required to evaluate the effect of calcitonin in prevention of cortical bone loss. In established osteoporosis calcitonin may prevent further bone loss at trabecular and cortical sites. A similar benefit is obtained following parenteral or nasal administration of the drug. Long-term administration of nasal salmon calcitonin induces a significant dose-dependent gain of bone at the lumbar spine, whereas discontinuous therapy with a ratio of 1:2 or 2:3 between the treatment and nontreatment periods is the best regimen for cortical bone. Epidemiological, retrospective, and prospective studies provide a convergent network of evidence that calcitonin administration in osteoporosis contributes to reduce significantly the frequency of subsequent fractures, both in the spine and in the hip. Finally, in established osteoporosis, nasal calcitonin possesses a potent analgesic effect, reduces the duration of bed confinement, and decreases the number of concomitant analgesic medications. The well-demonstrated effects of nasal calcitonin permit it to be considered as a highly rational solution for the prevention and the treatment of postmenopausal osteoporosis. [less ▲]

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See detailEffect of Calcitonin on Bone Mass and Fracture Rates
Reginster, Jean-Yves ULg

in American Journal of Medicine (1991), 91(5B), 19-22

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