In the News: 06/05
New Once-A-Month Osteoporosis Drug Debuts
A new once-a-month oral bisphosphonate called ibandonate, sold under the brand name Boniva, has received Food and Drug Administration approval for the treatment of postmenopausal osteoporosis. Other bisphosphonates currently used in treating osteoporosis—alendronate (Fosamax) and risedronate (Actonel)—must be taken once weekly. FDA approval of the new 150mg formulation was based on the agency’s earlier approval of ibandronate as a once-a-day prescription, where it was shown that the drug not only reduced the risk of spinal fracture but increased bone mineral density as well. The new approval was based on a study of 1,602 women which showed that the once-a-month formulation was at least equivalent to the daily dose in increasing bone mineral density after one year. Caveats: As with other bisphosphonates taken orally, ibandronate may cause gastrointestinal disorders and must be taken with water on an empty stomach after awakening in the morning. A patient must also remain upright and avoid food, drink, and other drugs for at least one hour after taking the medication.
Hyaluronan Injections Delay Need For Knee Surgery
A six-year study of 1,187 patients with extreme osteoarthritis of the knee and in need of total knee replacement (TKR) has shown that injections of hyaluronan, a substance used to supplement the knee joint’s synovial fluid, delayed the need for surgery for nearly four years. The study, whose results were released at a recent meeting of the Academy of Orthopaedic Surgeons (AAOS), reported that the patients, all of whom were candidates for TKR surgery, were injected with one or more courses of hyaluronan (one injection weekly for three weeks). Only 19 percent of those treated ended up having TKR surgery, the highest incidence being among patients who were obese or age 60 or older. Other studies presented at the AAOS meeting reported on the use of hyaluronic products in easing pain in other joints (hip, shoulder, elbow), a practice that is permitted in Europe and Canada but not yet in the U.S., where hyaluronan is currently approved only for use in knee OA.
Back Pain More A Result of Psychological Stress Than Work
According to a U.K. study of 1,366 female nurses recently published in the Journal of Rheumatology, gradual-onset back pain is more related to psychological problems than it is to physical exertion. Of the nurses, who were followed up every three months for two years, 514 (38 percent) reported suffering lower-back pain. Of these, 14 percent reported sudden episodes of pain while at work (lifting patients, etc.), 28 percent reported sudden onset of pain while away from work (sitting, walking, standing), and 59 percent reported the gradual onset of back pain, the latter being associated with such psychological symptoms as fatigue, bad mood, and stress. Researchers said the findings, which were supported by an earlier study of U.K. police officers, may help physicians gain a better understanding of the relationships between the physical and psychological factors that put people at risk for back pain and lead to more effective treatments.
Chondroitin Lessens Joint Narrowing, Pain Reduction Inconclusive
Swiss researchers, reporting in a recent issue of Arthritis & Rheumatism, have found that although chondroitin sulfate, a popular supplement for treating osteoarthritis, significantly reduces the rate of joint-space narrowing in knee osteoarthritis, it does little to reduce pain or increase function. The study included 300 patients with knee OA who were given 800mg of chondroitin sulfate or a placebo each day for two years. At the end of the study, patients taking the supplement had no significant changes in joint-space width, while placebo patients showed major reductions in joint-space width. As for non-reduction in pain, researchers explained that previous studies with chondroitin sulfate and glucosamine, often successfully used in conjunction with one another to treat OA pain, conflicted with their findings. No level of pain was required for entry in the study, which the researchers admitted may have skewed the results.