European Guidance For Osteoporosis Diagnosis And Management

The International Osteoporosis Foundation (IOF) has welcomed the recently published paper European guidance for the diagnosis and management of osteoporosis in postmenopausal women(1) from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).



This paper constitutes a roadmap for European countries to practically implement the new FRAX™ tool based on the WHO technical report, Assessment of osteoporosis at the primary health care level(2,3). The European guidance, published in Osteoporosis International, is a critical review of diagnostic methods, treatments and their monitoring options. It also shows case-finding strategies supported by health economic data.



IOF sees the ESCEO guidance as a positive move towards using the FRAX™ algorithm in daily practice. The WHO report and FRAX™ tool, released on February 21, 2008, help health practitioners to better understand the new paradigm for diagnosis and management of people at risk of developing fragility fractures.



In this regard, there will be a FRAX™ exhibition booth at the forthcoming ECCEO 8 Congress in Istanbul, Turkey, to be held at the Grand Cevahir Hotel & Convention Center. Participants will have the opportunity to have their 10-year fracture risk calculated, based on their geographic origin and individual risk factors. As a next step, the ESCEO paper can contribute with guidance on how to manage or monitor their condition, in the most rationale and cost-effective way.



Professor Jean-Yves Reginster, President of ESCEO, noted, "The ESCEO European guidance is convergent with the WHO report on how to assess and treat postmenopausal women with or at risk from osteoporosis. Moreover, cost-effectiveness analyses which illustrate scenarios based on a UK setting provide a starting point for health policy makers and health care providers to develop national guidelines on diagnosis and intervention thresholds."



The ESCEO guidance is very timely, as across Europe, osteoporosis is a major public health problem with serious medical and economic impact. In 2000, throughout the region, there were an estimated 620,000 new hip fractures, 574,000 forearm fractures, 250,000 shoulder fractures, and 620,000 spinal fractures in men and women aged 50 years or over, accounting for 34.8% of such fractures worldwide(4). There are more than 2.7 million osteoporotic fractures in men and women in Europe at a direct cost of 36 billion euros(5). It is estimated that by 2050, direct costs related to hip fractures will increase to 76.7 billion euros(6).







Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster, JY, Borgstr?¶m F, Rizzoli R, on behalf of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2008 Feb 12; [Epub ahead of print]
















Kanis JA on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases. University of Sheffield, UK.



World Health Organization. Assessment of osteoporosis at the primary health care level. Summary Report of a WHO Scientific Group. WHO, Geneva. who.int/chp/topics/rheumatic/en/index.html



Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726-1733



Kanis JA, Johnell O, on behalf of the Committee of Scientific Advisors of the International Osteoporosis Foundation (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:220-238



Kanis JA et al. Requirements for DXA for the management of Osteoporosis in Europe. Osteoporosis Int. 2005;16:229-38)



Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men (7,8,9).



Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.



The International Osteoporosis Foundation (IOF) is the only worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners.



Working with its 184 member societies in 89 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.



Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis" Journal of Bone Mineral Research, 1992; 7:1005-10



Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674



Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915



For more information on osteoporosis and IOF please visit: iofbonehealth/



Source: janice blondeau


International Osteoporosis Foundation

Bionovo Completes Enrollment Of MF101 Phase 2 Trial To Evaluate A Safer, New Therapy For Menopausal Symptoms

Bionovo, Inc.
(OTC Bulletin Board: BNVI) provided an update on its Phase 2 clinical trial
of MF101, a novel, oral treatment for hot flashes and other symptoms of
menopause. The Company has fully enrolled its FDA-approved trial with 184
women volunteers. Dr. Deborah Grady at the University of California, San
Francisco is serving as the Principal Investigator and the multi-center
trial is being conducted at six clinical sites across the country. The
trial will evaluate the efficacy of MF101 on actual and perceived relief
from menopausal symptoms. The women enrolled in the trial are aged 40-60
and experiencing greater than 7 moderate-to-severe hot flashes each day.



MF101 is an estrogen receptor beta (ER-beta) selective drug developed
as an alternative to those products currently on the market that have been
shown to increase the risk for breast and uterine cancers. Bionovo
recognized the opportunity to commercialize a product that would be equally
effective, with an improved safety profile to hormone therapy, and began
the clinical development of MF101. The drug candidate has been evaluated by
an independent Data and Safety Monitoring Board and has passed through a
standard two-round examination for safety. The Phase 2 study is expected to
run for an additional four months with results anticipated in early April
2007.



"For too long women had to face the choice between quality of life and
their long-term health," said Isaac Cohen, President and CEO, Bionovo. "The
market for menopausal products is enormous and growing, and we believe
there is great opportunity for a product that offers both efficacy and
safety."



The Phase 2 trial is a double-blind, randomized, placebo-controlled
trial. Women volunteers were randomized to groups of 60 receiving 2 doses
of MF101 or placebo. The trial is being conducted at the following sites:
University of California, San Francisco, University of Pittsburgh,
University of Minnesota, University of Tennessee, University of Alabama and
the San Diego Medical Center for Clinical Research.



About MF101



MF101, an ER-beta selective agonist, is designed for the treatment of
vasomotor symptoms such as hot flashes and night sweats in postmenopausal
women. In animal studies, MF101 has been shown to prevent tumor formation
in the breast and uterus, suggesting that Bionovo's lead drug will not
increase the risk of either breast or uterine cancer. In Phase 1 clinical
testing of MF101, the drug was found to be safe, well tolerated and taken
with high compliance. A multi-center, Phase 2, double-blind,
placebo-controlled, randomized clinical trial of MF101 has completed full
enrollment of 180 patients.



About Bionovo, Inc.



Bionovo is a drug development company focusing on the discovery of
novel pharmaceutical agents for cancer and women's health. The company has
one drug in Phase 2 clinical testing to treat conditions associated with
menopause and a second drug, BZL101, for breast cancer that will enter
Phase 2 clinical testing later this year. The company is developing its
products in close collaboration with leading U.S. academic research
centers, including the University of California, San Francisco, University
of Colorado Health Sciences Center, University of California, Berkeley, and
the University of Texas, Southwestern. For further information please
visit: bionovo/.


Bionovo, Inc

bionovo/

How Predictable Are Urinary Tract Infections?

It is expected that women will experience urinary tract infections (UTIs) at least twice during their lifetime. If a test existed that could predict UTIs, health care providers and patients would benefit. In the February 2008 issue of Urologic Nursing, Deborah Kuklinski and Sumana Koduri explore using urine dipsticks, an in-office test, to predict UTI.


Kuklinski and Koduri say a urine dipstick positive for nitrites (produced by bacteria in a UTI) implies UTI, but the urine culture, which takes longer and is more expensive, is the gold standard for a positive diagnosis. If the urine dipstick could be used to diagnose a UTI, say the authors, treatment could begin immediately. They found that despite associating urine dipsticks and urine cultures positive for nitrites, 40%-50% of the UTIs would have been missed without the urine culture due to the sensitivity of the bacteria.


Although Kuklinski and Koduri couldn't conclude the urine dipstick accurately diagnosed UTI, their study indicates the urine culture is still important for diagnosis and treatment. They recommend practitioners continue to use the urine culture and offer patient education on UTI symptoms.


Predicting Urinary Tract Infections in a Urogynecology Population

Deborah Kuklinski, MS, RNC, WHNP; Sumana Koduri, MD

Urologic Nursing; February 2008

suna


The Society of Urologic Nurses and Associates is a national, non-profit professional membership association with over 3,000 members and annual revenues of $1.5 million. SUNA derives its income from membership dues (only $60), conference registration fees, exhibits, advertising, grants, and the sale of educational products.


SUNA publishes a professional, peer-reviewed bi-monthly journal (Urologic Nursing Journal) and a bi-monthly newsletter (Uro-Gram). SUNA establishes the scope and standards of urologic nursing practice and the scope and standards of advanced urologic nursing practice. SUNA provides scholarships, grants and awards to deserving nurses and other health care professionals.


SUNA supports and promotes the certification of urologic nurses and associates by providing educational preparation for the examinations offered which lead to certification in three areas.


SUNA provides a variety of opportunities for participation including local chapters, task forces and Special Interest Groups (SIGS) in five major subspecialty areas.


suna

Family Lifespan Boosted By Late Motherhood

Women who have babies naturally in their 40s or 50s tend to live longer than other women. Now, a new study shows their brothers also live longer, but the brothers' wives do not, suggesting the same genes prolong lifespan and female fertility, and may be more important than social and environmental factors.



"If women in your family give birth at older ages, you may well have a chance of living longer than you would otherwise," says the study's lead author, demographer Ken R. Smith, a professor of family and consumer studies at the University of Utah. "If you have a female relative who had children after age 45, then there may be some genetic benefit in your family that will enhance your longevity."



For descendants of the Utah and Quebec pioneers studied, "you may be able to look at the ages when your female ancestors gave birth - rather than just their longevity - in estimating how long you may live," says Smith, whose study will be published online May 4 and in the June 10 print issue of the Journal of Gerontology: Biological Sciences.



The researchers examined high-quality genealogical records from the Utah Population Database at the University of Utah with its records of 1.6 million Utah Mormon pioneers and their descendants. They also used the University of Montreal's Program on Demographic History Research, which has records on 400,000 people who lived in heavily Catholic Quebec between 1608 and 1850.



Specifically, the study involved the records of 11,604 Utah men who were born between 1800 and 1869 and who had at least one sister who lived at least to age 50; and the records of 6,206 Quebec men who lived between 1670 and 1750, and had at least one sister who lived to 50 or older. The key findings:
Women who had "late fertility" - a birth at age 45 or older - were 14 percent to 17 percent less likely to die during any year after age 50 than women who did not deliver a child after age 40. That confirmed earlier studies. But those studies did not determine if the women gave birth later and lived longer because of genes or because of social and environmental factors such as good nutrition or healthy living.


Brothers who had at least three sisters, including at least one sister who gave birth at age 45 or later, were 20 percent to 22 percent less likely to die during any year after age 50 than brothers who had no "late fertile" sisters. That indicates what earlier studies did not, namely, the same genes may influence the lifespan of both sexes and women's ability to give birth at older ages.


The brothers' wives didn't have longer lives, suggesting any environmental or social factors that influence lifespan had only a weak influence, and that genes may explain why brothers lived longer when they had a sister who gave birth in her 40s.

The study didn't address how much longevity is due to genetics, but Smith says scientists believe genes account for up to 25 percent of differences in longevity.
















Smith conducted the study with two other University of Utah researchers: Richard Cawthon, a research associate professor of human genetics, and demographer Geraldine Mineau, a research professor and director of population sciences at the university's Huntsman Cancer Institute, where Smith also is an investigator. Other coauthors were demographer Alain Gagnon and sociologist Ryan Mazan of the University of Western Ontario, and demographer Bertrand Desjardins, of the University of Montreal.



Good Genes Versus a Good Environment



Smith says that during the last decade, "there have been several studies that show a number of species, including humans, are able to reproduce late without medical intervention - and those females live longer." Other studies found that late menopause also is associated with women having prolonged fertility and longevity.



"There is a genetic component to longevity, especially for living to very old ages," Smith says. "The new thing here is what most evolutionary biologists long have argued: that survival and reproduction are intrinsically linked to one another. So the novel finding in this paper is discovering this link in humans before modern contraception."



But he says the link between late motherhood and longevity "could be something that is not inherited. It could be good nutrition or really good living, suggesting that if you are a healthier mom you live longer."



That is why the researchers looked at the lifespan of the brothers of women who had babies late, and of those brothers' wives. The wives are not blood relatives, so genetic factors shared by sisters and brothers wouldn't be the same in the brothers' wives.



Smith says the study focused on the longevity of brothers rather than sisters of late-fertile women because "men's own reproductive history doesn't get in the way of assessing the role of their female relatives' fertility."



The study focused on the two pioneer groups not only because of the quality of the data but because of the absence of modern birth control and an unfavorable attitude toward natural family planning methods by Mormons and Catholics. Also, a link between late fertility and lifespan is easier to observe in large families with more sisters.



Since all of those studied are now dead, the researchers could look at the full length of their fertile periods and lives. "Not many data sets could do this," Smith says.



The researchers controlled for various factors that could skew the results. For example, they excluded any individuals who did not live to at least 50 because a husband's death at a younger age would influence his wife's child-bearing.



Late Babies Linked to Longer Life for Moms and Blood Uncles
The study confirmed earlier research showing that women who have babies late tend to live longer.



Compared with women who had their last baby before age 41, Utah pioneer women who had their last baby at age 41 to 44 were 6 percent less likely to die during any given year past age 50, and Utah pioneer women who had their final birth at age 45 or older were 14 percent less likely to die during any given year after age 50.



In other words, imagine woman A had her last baby at age 35, woman B had her last baby at 42 and woman C had her last baby at 46. Then at age 52 - or any other age past 50 - woman B would be 6 percent less likely to die than woman A, and woman C would be 14 percent less likely to die than woman A.



In Quebec, slightly different age groups were analyzed. Compared with younger mothers, women who had their last child between ages 42 and 44?? were 6 percent less likely to die during any given year past age 50, and women who had their last child at age 44?? or older were 17 percent less likely to die during any given year past age 50.


By looking at the brothers of women who had children late, the study suggests the same age-slowing genes may be responsible for both prolonged fertility in women and longer lifespan in both sexes. The effects of late fertility were strongest for brothers with at least three sisters because the larger the number of sisters, the more likely it is at least one will give birth in middle age.



So in the Utah group, brothers with three or more sisters - at least one of whom gave birth at age 45 or older - were 20 percent less likely to die during any given year after age 50 than men without late-fertile sisters.



In Quebec, brothers with three or more sisters - at least one of whom gave birth at age 44?? or older - were almost 23 percent less likely to die during any single year after age 50 than men without sisters who gave birth late.


It is possible social and environmental reasons - good water, good nutrition, a healthy environment - could explain why the brothers and their late-birthing sisters had longer lives. So the researchers also examined the longevity of the brothers' wives.

They found no increase in lifespan, indicating that heredity - far more than environmental factors - played a role in the prolonged fertility and longer lives of the women, and the longer lives of their brothers.



Smith says the new findings do not conflict with one of his earlier studies finding that having larger families reduced parents' lifespan. Both findings can operate together.



Source:
Lee Siegel


University of Utah