In The News: 04/08
Study Finds Little Evidence that Antidepressants Ease Back Pain
Australian researchers have found only minimal evidence that antidepressants relieve pain or depression in patients with chronic lower back pain (LBP). They did note, however, that "severely" depressed patients with LBP may still benefit from antidepressants. The findings involved a review of 10 studies published in the 2008 Cochrane Database of Systemic Reviews. The review compared antidepressants with placebo among patients with LBP who were taking one of several types of antidepressants, including selective serotonin reuptake inhibitors, tricylic antidepressants, and atypical antidepressants such as aminoketone. Some medical experts who reviewed the study did not agree with the findings, claiming evidence still supports the belief that tricyclics are "moderately" effective for decreasing chronic LBP and calling for larger studies, longer-term follow-up, and an examination of the cost-effectiveness of antidepressants in treating chronic lower back pain.
Alendronate Effective for Prevention of Secondary Fractures
Alendronate (Fosamax) can reduce the risk of vertebral, nonvertebral, hip, and wrist fractures among postmenopausal women with low bone density or previous fractures, according to a study in the 2008 Cochrane Database of Systemic Reviews. Researchers analyzed 11 trials that included 12,068 women and found that, at 10 mg a day, alendronate was effective (45 percent risk reduction) at preventing primary and secondary vertebral fractures. The drug also provided significant protection (16 percent risk reduction) against secondary fractures in other bones, including those in the hip and wrist. Alendronate was also found to be safe, with no incidence of adverse side effects detected.
Calcium Supplements Help Build Bone, but May Raise Heart Risk
Older women who take calcium supplements to maintain bone strength may be at increased risk for a heart attack, according to a Jan. 16 report in the British Medical Journal. Researchers in New Zealand studied 1,471 postmenopausal women, average age 74, who were divided into two groups (732 received a daily calcium supplement, 739 were given a placebo) and followed for five years. Heart attacks were more common in those on the calcium supplement, with 31 women experiencing a heart attack vs. 21 women on the placebo. Researchers said because calcium supplements raise blood calcium levels, this could accelerate the formation of deposits in the arteries that could lead to a heart attack. The study’s authors admitted that the results were "not conclusive," and recommended that the potentially detrimental effect of calcium supplementation be weighed against the benefits of calcium on bone, particularly in older women.
Soft Drinks Increase Gout Risk, but Diet Soft Drinks Do Not
Soft drinks can significantly increase the risk for gout, according to a 12-year study of 46,393 Canadian men published in the January issue of Arthritis Care & Research. Those who consumed just one soft drink each day increased their gout risk by 45 percent, while two or more drinks increased it by 85 percent. The culprit is high-fructose corn syrup, which is found in most carbonated soft drinks—but not in diet soft drinks. Unlike glucose, the sugar our bodies uses for fuel, fructose raises uric acid levels, and high levels of uric acid are linked to gout.
Women Urged Not to Postpone Knee Replacement
By postponing knee replacement, women with knee osteoarthritis (OA) may risk putting their post-surgical mobility at risk. According to a study reported in January’s Journal of Bone and Joint Surgery, women typically postpone knee surgery until they can no longer withstand the pain. A group of 229 OA knee-replacement candidates (95 men, 126 women) took part in standard physical tests. While the men had reduced knee function, the women showed a much greater level of disability. Researchers concluded that women postpone knee surgery until their OA is more advanced than in men. This difference, they maintain, is likely to lead to worse surgical outcomes for women. The researchers warn that the level of an individual’s function going into surgery generally dictates the level of function after surgery, and say that earlier intervention can help preserve an individual’s mobility and quality of life.