Volume 194 - Issue 6
In Other Journals
Author: Peter Lavelle
Med J Aust 2011; 194 (6): 323. || doi: 10.5694/j.1326-5377.2011.tb02987.x
Published online: 21 March 2011
Published online: 21 March 2011
Nitro for bones?
Cheap and widely available, nitroglycerin is known to stimulate bone formation and inhibit bone resorption. Might it have a role to play in the treatment of bone loss? Jamal and colleagues from the University of Toronto and other centres did a double-blind, placebo-controlled trial of 243 postmenopausal women with lumbar spine T scores of between 0 and - 2.0.1 The women were randomised to receive either nitroglycerin ointment (15 mg/d) or placebo applied every night at bedtime, over a 2-year period. After 2 years, those who used nitroglycerin had a modest but significant improvement in bone density in the lumbar spine, femoral neck, and total hip compared with placebo. Hence, nitroglycerin might be useful in preventing fractures, say the authors. A larger study of the effects of nitroglycerin in preventing fractures is needed, writes Dr Sundeep Khosla from Mayo Clinic in an accompanying editorial.2
1. JAMA 2011; 305: 800-807
2. JAMA 2011; 305: 826-827
Stress and infertility
Many infertile women believe that emotional distress such as tension or worry may be the cause of either their failure to become pregnant naturally, or their lack of success with fertility treatment. They’re wrong, at least on the last count, say Boivin, from the Cardiff Fertility Studies Research Group in the UK, and colleagues. The researchers conducted a meta-analysis of links between stress and the success of the fertility treatment, reviewing 14 studies of 3 583 infertile women who were undergoing a cycle of fertility treatment. The women were assessed prior to their treatment for anxiety and stress; the researchers then compared those women who achieved success in infertility treatment with those who didn’t. Emotional distress was not associated with either success or failure; thus emotional distress won’t jeopardise a woman’s chances of falling pregnant, the authors concluded.
BMJ 2011; 342: d223
Fractured bisphosphonates
Oral bisphosphonates are a mainstay of treatment for osteoporosis; but have also been associated with “atypical” fractures of the subtrochanteric or shaft regions of the femur. The nature of the risk has been unclear in the past; small observational studies have shown conflicting results, say Laura Park-Wyllie from St Michael’s Hospital, Toronto, and colleagues. They conducted a large, population-based, case-control study of 205 466 women aged 68 years or older who took bisphosphonate therapy, comparing those who developed a fracture with those of the same age who did not. The risk of atypical fractures was about 2.7 times greater in those women who had taken bisphosphonates for more than 5 years. But there was no increased risk when the drugs were used for less than 5 years. Moreover, the absolute risk of atypical fractures is low, and bisphosphonates reduce the risk of standard osteoporotic fractures (of the femoral head and intertrochanteric region) by about 25 % say the researchers, which more than offsets the risk of atypical fractures. They say women with osteoporosis should not stop taking bisphosphonates because of the small risk of atypical fractures.
JAMA 2011; 305: 783-789
Deafness dementia link
Hearing loss appears to be a risk factor for dementia. And the greater the degree of hearing loss, the greater the risk. So say Lin and colleagues from Johns Hopkins School of Medicine and affiliated institutions. They studied 639 individuals aged 36 to 90 years, of whom 125 had hearing loss of varying severity (as measured by audiometry) at the start of the study, but none of whom had dementia. Over a median follow-up period of 11.9 years, 58 people were diagnosed with dementia. The researchers found that the risk of dementia from any cause increased with the severity of the hearing loss; for every 10 decibels of hearing loss, the risk increased by 27%. But further studies are needed to determine if hearing loss is a marker for dementia, or a causative factor in itself. If it is the latter, treatment — for example, with digital hearing aids and cochlear implants — might reduce the risk of dementia, say the researchers.
Arch Neurol 2011; 68: 214-220
Back surgery wins out
Is surgery effective for discogenic low back pain? Past trials comparing surgical with non-surgical treatments give conflicting results, say Ohtori and colleagues from the Graduate School of Medicine at Chiba University, Japan. In a small randomised trial, they compared the effectiveness of various treatments in 41 patients with discogenic low back pain. A control group of 20 received minimal exercise-based treatment; 15 received anterior interbody fusion (ABF); and, six received posterolateral fusion (PLF) with pedicle screws. Before surgery, there was no difference between the groups in pain and disability scores; but 2 years after surgery, both ABF and PLF groups had less pain and disability than those in the minimal treatment group. Provided it is correctly diagnosed to start with, discogenic low back pain responds to surgical treatment, the researchers concluded.
Spine 2011; 36: 347-354