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Asthma may lead to bone loss

AsthmaPeople suffering from asthma may be more prone to bone loss as researchers have now discovered links between asthma and a decrease in bone mineral density.

“We know prolonged use of corticosteroids in the treatment of asthma is a risk factor of osteoporosis, but we have not had definite data showing the relationship between asthma itself and bone loss,” explained Jae-Woo Jung of Seoul National University Medical Research Centre in South Korea.

“This study has shown a meaningful association between the two conditions even in the absence of previous oral corticosteroid use,” Jung added.

For the study, researchers examined more than 7,000 patients, 433 of which had airway hyper-responsiveness (AHR) or asthma.

Lumber spine and femur bone density was significantly lower in those with AHR or asthma, than those without the conditions, showed the findings of the research.

“Reasons can include corticosteroid use, low levels of vitamin D or even race,” said John Oppenheimer, an associate editor of the journal Annals of Allergy, Asthma & Immunology that published the study.


Romosozumab ‘Potential Breakthrough’ in Osteoporosis investigational humanized monoclonal antibody romosozumab (Amgen and UCB Pharma) increases bone mineral density (BMD) and bone formation and reduces bone resorption in postmenopausal women with low bone mineral density, a phase 2, multicenter, randomized, placebo-controlled study suggests.

The findings were published online January 1, 2014, in the New England Journal of Medicine by Michael R. McClung, MD, from the Oregon Osteoporosis Center, Portland, and colleagues.

“Romosozumab, administered subcutaneously at intervals of 1 month or 3 months over a period of 12 months, was associated with prompt, transitory increases in markers of bone formation; moderate, sustained decreases in markers of bone resorption; and rapid, large increases in bone mineral density in the spine and hip regions,” Dr. McClung and colleagues write.

Romosozumab increases bone formation by binding to sclerostin, an osteocyte-derived inhibitor of osteoblast activity. Sclerostin inhibition is an attractive drug mechanism of action because the gene that encodes sclerostin is expressed only in skeletal tissue and, therefore, off-target effects would be limited, the authors explain.

Indeed, in an editorial accompanying the report, Carolyn B. Becker, MD, an endocrinologist at Brigham and Women’s Hospital, Boston, Massachusetts, calls the new study results “a potential breakthrough in osteoporosis therapeutics,” as current antiresorptive drugs do not restore bone architecture, and the anabolic agent teriparatide is limited by inconvenient dosing, high cost, and a black box warning about osteosarcoma.

In contrast, she cautions that questions remain about romosozumab, including whether its effect on BMD will translate into antifracture efficacy and whether it will be safe for long-term use. In addition, Dr. Becker suggests, there may be a way to replicate the bone-remodeling effects of romosozumab by combining currently available osteoporosis therapies.

“Impressive” Results

The 12-month study randomly assigned a total of 419 postmenopausal women aged 55 to 85 years from 28 centers worldwide, including 367 who received 1 of 5 dosing regimens of subcutaneous romosozumab injections (70, 140, or 210 mg once a month or 140 or 210 mg every 3 months) or to 1 of 2 open-label comparators (70 mg oral alendronate weekly or 20 μg daily subcutaneous teriparatide). The other 52 participants received placebo injections either monthly or every 3 weeks.

The women all had low BMD that was not severe enough to be diagnosed as osteoporosis (T score of −2.0 or less at the lumbar spine, total hip, or femoral neck and −3.5 or more at every one of the 3 sites).

The primary endpoint was the percentage change from baseline in BMD at the lumbar spine at month 12. Of the total of 383 women who completed the 12-month visit, those receiving romosozumab had significant increases in BMD at the lumbar spine compared with placebo, regardless of dose frequency and dose level (P < .001).

Increases in BMD from baseline at the lumbar spine at month 12 were significant at all dosing levels, ranging from 5.4% with 140 mg every 3 months and 70 mg monthly to 11.3% for 210 mg monthly. The placebo group saw no increase in BMD, whereas BMD increased by 4.1% in the alendronate group and 7.1% with teriparatide.

There were similarly significant increases in BMD at the total hip and femoral neck, Dr. McClung and colleagues report.

The increases in BMD seen at 12 months with the 210-mg monthly romosozumab dose (11.3% in the lumber spine, 4.1% in total hip, and 3.7% in femoral neck) were all significantly greater than those seen with alendronate and teriparatide (P < .001) for all 3 comparisons.

“The results were impressive,” Dr. Becker comments.

In contrast, no differences in BMD at 12 months were seen among the groups at the distal third of the radius, the authors note.

Increases in bone formation markers occurred at 1 week after the initial dose in all romosozumab groups, peaked at month 1, and then returned to baseline levels or fell below between months 2 and 9, despite continued administration of the drug.

In all romosozumab groups, the level of the bone-resorption marker serum β-CTX decreased initially from baseline, primarily in the first week. In the patients receiving monthly 210-mg romosozumab doses, β-CTX remained below baseline at month 12.

“The effects of romosozumab on bone turnover reflect a rapid, marked, and transitory increase in bone formation and a moderate but more sustained decrease in bone resorption,” Dr. McClung and colleagues write, adding that “[t]he reason for the transitory nature of the effect on bone formation is unclear.”

Indeed, Dr. Becker says this finding is unexpected and should be explored further. “If the changes in BMD for a presumed anabolic agent were predictable, the changes in bone-turnover markers were not.”

Reductions in serum calcium of 1.30% to 2.68% from baseline, in a dose–response pattern, were seen at month 1 but returned to baseline thereafter.


Serious event rates were 7% for the pooled romosozumab group and 10% among those receiving the 210-mg monthly dose. These rates did not differ from the rates seen among the patients taking placebo (14%), alendronate (8%), or teriparatide (9%). None were considered treatment-related.

Mild injection site reactions were more common with romosozumab than placebo, but there was no dose–response relationship, Dr. McClung and colleagues say.

Binding antibodies were seen in 20% of the romosozumab group, and antibodies with in vitro neutralizing activity in 3%. In contrast, no binding antibodies were seen in any of the other treatment groups. However, the development of antibodies appeared to have no effect on adverse events, pharmacokinetics, or pharmacodynamics, the investigators note.

New Approach

According to the editorial, romosozumab’s “pattern of brief anabolic stimulation coupled with chronic suppression of bone resorption…is unprecedented among current therapies for osteoporosis.”

However, Dr. Becker also points out that small studies suggest it may be possible to reproduce the same effect on bone remodeling by combining teriparatide, which increases bone formation markers but also stimulates bone resorption markers with antiresorptive agents such as zoledronic acid or denosumab.

Remaining questions about romosozumab may be forthcoming from a phase 3 clinical trial of romosozumab currently underway in postmenopausal women with osteoporosis, Dr. Becker notes.

The study was supported by Amgen and UCB Pharma. Dr. McClung reports receiving research grants from Amgen and Regeneron, and serving on speakers bureaus for Amgen and Vivus. Dr. Becker has no relevant disclosures.

N Engl J Med. Published online January 1, 2014.

Don’t waste time on fad diets says study diets, which lead to short-term weight loss, can often be a waste of time, according to a new study.

Whether you’re following the Atkins and Dukan The Fast Diet, The Alkaline Diet to The Baby Food Diet, The Blood-Type Diet, The French Woman Diet, The Paleo Diet and the new 5:2 regime, these often turn out to be passing fancies, reveals a study conducted on 2,000 adults by Alpro, a manufacturer of soy-based food and drink products.

Alpro dietician Kate Arthur said, ‘More and more dieters are realising that the fad diet promises of shedding huge amounts of weight in just a few weeks are either hollow, or that the diets are impossible to follow.

‘The reality is that the majority of these diets are so impractical, and indeed so little fun that we often give up within just a few days.’ (Read: Fad is bad)

Says nutritionist Neha Chandna, ‘You haven’t put on all the weight overnight, so how can you expect to lose it at a lightning speed? These days, everyone wants to lose weight in the blink of an eye and to achieve their dream body, they resort to fad diets which definitely work but for a short period of time. They help you lose weight from your muscles and bones leaving you feeling weak and ill. And once you go back to your normal routine, you gain all the weight or even more in no time. You do the math and see what’s the whole point of following some diet regime which is short-lived, deprives you of nutrients and has many hazardous effects on your body?’

Out of half of the respondents who regularly diet, Alpro found that two out of five dieters quit within the first seven days.

One out of five people are able to sustain it for a month, and the same number make it to the three-month mark, while the remainder stay dedicated for at least six months.

However, only one in 20 is likely to still be following their new healthy eating regime after one year.

Most people begin their diets on a Monday, indictes the survey. Over four out of 10 regular dieters see Mondays as the logical starting point for it usually following a weekend of excess either at home or by eating and drinking out with friends.

However, it’s often in vain as only five days later, by Friday the same week, many people are likely to have already given up the latest new dieting craze. (Read: Look perfect on your wedding with these weight loss tips)

Neha lists out a few ill-effects of following a fad diet:

  •  Causes constipation
  •  Leads to weakness
  •  Loss of concentration
  •  Nausea
  •  Headache
  •  Depression
  •  Muscle loss
  •  Health risks like osteoporosis and many more

The research also found that an increasing number of people are realising the benefits of regular healthy eating.

‘There has never been any secret to sustaining a healthy diet. It always has been, and always will be, about eating the right foods as part of a balanced diet, and exercising, while allowing yourself a treat now and again,’ said Arthur.

October 20 is World Osteoporosis Day: Not just women; men too get affected by bone diseases

OsteoporosisOsteoporosis occurs when there is a loss in the peak bone mass and loss of calcium, leading to hip, knee and shoulder fractures.

Bone diseases among women are a common occurrence, but of late these problems, especially osteoporosis, are fast affecting men, mostly after they turn 60, experts say.

“Osteoporosis, which was earlier associated with women, has now risen among men as well. The problem affects them mostly after they reach the age of 60 years and above,” Hemant Gopal, consultant (Rheumatology) at the Max Super Specialty Hospital in Shalimar Bagh, said.

Osteoporosis occurs when there is a loss in the peak bone mass and loss of calcium, leading to hip, knee and shoulder fractures.

Osteoporosis is ranked as the second most common health-related risk in the world after coronary heart disease. Around 93 % of women are aware of it, but of them, only 8 to 10 % know they have it.

It is estimated that there would be around 36 million people suffering from the disease by the end of 2013.

“The development of the bone mass occurs between the age of 15 to 25 years. However, these days, with changes in lifestyle, less physical activity leads to bone problems at a later age,” Gopal added.

Experts feel physical exercise should be done in the right manner, with focus on activities like jumping, running and walking.

“When one is jumping, the load falls on the body and it is useful in developing bone mass. The load should fall on the hand, knees, joints so that they grow stronger,” Dhananjay Gupta, of the orthopedics department at Fortis Hospital, said.

A deficiency of vitamin D and lack of mineral-rich food are the other causes of calcium loss in the bones. For this, doctors advise exposure to sun.

Similarly, people suffering from arthritis, liver diseases or who sweat excessively too are prone to bone diseases, doctors said.

“The patients who are on steroids should stop this if they are diagnosed with osteoporosis. Patients who are on long-term medication for conditions like epilepsy should also immediately consult doctors as the steroids for these diseases lead to tremendous calcium loss in the bones,” Gupta added.

Ironically, the symptoms of osteoporosis are present in the body long before one gets to know about the problem. And the realization comes when the bones start fracturing.

“Some fractures may escape detection for years. The patients may not be aware of their osteoporosis problem until they suffer painful fractures so we strictly advise people above the age of 35 years to go for a routine bone density check up, ” said Rajeev K. Sharma, senior orthopedic and joint replacement surgeon, Apollo Hospital.

Doctors said as part of the aging process, both men and women lose their bone density by 0.3 to 0.5 % after the age of 35.

“People who consume alcohol and smoke cigarettes (which are high calcium stealers) run a higher risk of acquiring bone diseases. Quitting is the best option than to suffer from fractures later in life,” Sharma added.

With physiotherapy being the treatment for osteoporosis, many rehabilitation centres have come up in the capital to provide effective treatment.

“The services that we offer are orthopedic rehabilitation, back-and-neck pain therapy, pain management, medical fitness and osteoporosis program,” said Gerd Mueller, managing director, AktivOrtho, which has introduced state-of-the-art, German designed rehabilitation equipment together with a team of experienced and certified medical professionals.

In sum, doctors said that both men and women should exercise and eat healthy to avoid bone diseases at a later stage.

Astrocal Update: Lack of exercise makes Indian bones weaker

BonesIndian bones are conventionally weaker, deformed and more osteoporosis-prone compared to Americans or Britons, say leading knee replacement surgeons who participated in a knowledge-sharing exercise here on replacement surgeries.

The exercise also threw up insights about how Africa could also emerge as a major resource pool for tapping patients in India’s quest for medical tourism.

Speaking to us on the sidelines of the event, Erik Zeegan, a leading Las Vegas-based orthopaedic surgeon, said that knee replacement surgeries in India tended to be a lot different from those in the US owing to the more deformities of the bones found in the sub-continent.

“The deformities here are significant. The knees are more worn out. We do not see such deformities in the US,” Zeegan said, adding that knee sizes of patients in the US also tended to be larger than those found here.

One of the reasons for this, according to Ameya Velingker, a Goa-based specialist, is that Indian patients tend to take their osteo-arthritic knees to the very terminal stages before choosing the surgical option to overcome a bad knee situation.

One of the reasons why over 700,000 knee replacement surgeries are conducted in the US every year as compared to 70,000 in India, is because the procedure is considered a natural extension of knee treatment there, Velingkar said.

“In India, a lot of people still give it a lot of thought because of a few failed cases of knee replacement surgeries which have happened because of bad medical advice,” Velingker said, adding that there were instances in the past when knee replacement surgery was relatively new and doctors in some cases recommended the surgery even when it was not required.

He further said that a distinct lack of a physical regimen in India had largely contributed to the “bad bones” phenomenon here.

“Indian bones are of poor quality, plus lack of exercise further deteriorates their growth in most cases in India,” Velingker said, adding that the more the exercise the better the quality of bones.

Obsession with fitness in Western countries has resulted in better quality and denser bones there, he said.

“Most people hit the gym or go running in the West which ensures that they have much better bones than most of us,” he said.

Giving a practical example, Velingkar said that while one surgical saw blade suffices for three to four knee replacement surgeries for Indian patients, the scenario was much different when it comes to operating upon patients from Britain.

“For UK patients I need to use one new saw every time,” he said.

Velingker said that Europe and North America apart, Africa was emerging as a great potential market to tap patients for knee replacement surgeries.

“There is a lot of potential to get patients from countries like Nigeria and Kenya. The medical facilities available there are poor and the governments in these countries facilitate treatment abroad,” he said, adding that a bilateral approach with these African nations could help India’s medical tourism.

He also pointed out that knee replacement surgery in India cost around Rs.2 lakh ($3,400) as compared to the Rs.9-10 lakh which is required for a similar surgery in the US.

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