In the News: 07/05
Calcium, Vitamin D Still Vital Allies In Osteoporosis War
Although previous studies have shown vitamin D and calcium to be effective in preventing bone fractures, two recent studies did not demonstrate a reduction in fractures with this therapy. The first study, entitled Randomized Evaluation of Calcium or Vitamin D (RECORD) and appearing in the Lancet, surveyed 5,200 people over the age of 70 who had suffered a recent bone fracture. Subjects were given a daily dose of 1000mg of calcium, 800 IU of vitamin D, a combination of both, or a placebo, and were tracked for 24 to 62 months. Investigators found that, regardless of treatment, 13 percent of the participants had suffered a new fracture.
One problem with the study, however, was that it measured the level of existing calcium and vitamin D in only a small sample—60 subjects, or 1.1 percent of the study population. Another potential problem was the drop-out rate—46 percent—which created problems for randomization of the study. Since only 1.1 percent of patients had vitamin D measured, it was unknown whether the subjects were vitamin D replete or deficient. “If the patient is vitamin D-deficient,” says Chad Deal, M.D., director of the Center for Osteoporosis and Metabolic Bone Disease at The Cleveland Clinic, “800mg of vitamin D is inadequate to correct the deficiency. If the patient is vitamin D-replete, taking more calcium and vitamin D isn’t going to make much of a difference. The recommended daily dose of vitamin D is 400-600 IU and 1,200mg of calcium. Any more than this is unnecessary.”
A similar study, published in BMJ (British Medical Journal), examined more than 3,300 women over age 70 who exhibited one or more risk factors for hip fracture. In this study, researchers divided the subjects into a “supplement” group and a control group, which was encouraged to use calcium in their diet. After a 25-month follow-up, fracture rates did not differ significantly between the two groups. It appears that vitamin D and calcium from commercial supplements or from your diet are equally effective. Calcium and vitamin D are essential as a base of therapy, but if you have established osteoporosis additional therapy is needed. Investigate the drugs we recommend in our cover story this issue, in addition to getting a daily dose of calcium and vitamin D.
High Blood Pressure = Less Pain?
If you suffer from high blood pressure, you may also suffer from less musculoskeletal pain. That’s the conclusion of Norwegian investigators following a large-scale study that found strong evidence of interaction between a person’s cardiovascular and pain regulatory systems. The report, published in the Archives of Internal Medicine, analyzed the results of two Norwegian studies involving 46,901 adults. It concluded that high systolic or diastolic blood pressure was associated with a 10 to 60 percent lower prevalence of musculoskeletal pain. Additionally, it was discovered that pain decreased as blood pressure increased.
Why such a relationship exists, researchers admit, is unknown, since there is no obvious pathogenetic link between blood pressure and musculoskeletal pain. The study’s authors also caution that their findings should not change traditional approaches to treating musculoskeletal complaints, since their research includes no implications for the clinical treatment of patients.
Herbal Remedies And RA Drugs Don’t Mix
Gingko biloba, devil’s claw, ginger, garlic, and other herbal remedies may deliver a feel-better promise for people suffering from rheumatological disorders, but many who take them are unaware of the ways these remedies may interact with drugs prescribed to treat their disorders. This was the conclusion of a recent survey, reported in the Annals of Rheumatic Diseases, of 238 rheumatology patients in the UK, 44 percent of whom said they used an herbal remedy within the past six months. Researchers claimed that some so-called herbal “cures” may have antiplatelet or anticoagulant effects that may worsen the gastrointestinal bleeding risk of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). The herb echinacea (purple coneflower), researchers noted, may be hepatotoxic (liver-damaging) when used in combination with disease-modifying antirheumatic drugs (DMARDs). Investigators concluded that some physicians are unaware of the adverse effects brought on by drug/herbal interactivity and that many patients are hesitant about telling their doctors that they are using them.