Men's Osteoporosis Support GroupMonthly ibandronate in men; bisphosphonates and chronic kidney disease; excess male mortality after hip fracture Bone. 2010 Jan 6. [Epub ahead of print]. Efficacy and safety of monthly ibandronate in men with low bone density. Orwoll ES and others. PMID: 20060082. This is another study showing the effectiveness and safety of once-monthly bisphosphonates, this one being 150 mg/month Ibandronate (Boniva), with the study involving only men. It included132 men; 47 received placebo and 85 received monthly ibandronate. Results compared percentage increase in bone mineral density (BMD) at various sites after one year of treatment. Also changes in bone turnover markers (BTMs) for bone formation and resorption were analyzed. The ibandronate group had greater changes in BMD at all sites measured than the placebo group, and had greater reductions in BTMs. The authors concluded, "In men with low BMD, 1 year of treatment with oral once-monthly 150 mg ibandronate significantly increased BMD at the LS and hip (TH, TR, and FN), significantly reduced BTM levels in the PP population, and was generally well tolerated." Editor's comments. This is one more bisphosphonate to add to the the list of those found effective with once-monthly dosing. There is an Update showing that risedronate (Actonel) works this way. And presumably Fosamax would, but to my knowledge no studies have confirmed that yet. All the once-monthly doses are simply four times the once-weekly dose of the medication. Presumably this would be an off-label prescription for men at this time, but I would expect FDA approval of ibandronate once-monthly for men eventually. So if the once-monthly dosing regimen would be more convenient for you, ask your physician about ibandronate or Actonel, both have been shown effective. Of interest in the results is that the placebo group did increase spinal BMD using twice-daily 500-mg calcium and once-daily 400-IU vitamin D. However, two of three hip areas measured lost BMD in the placebo group during the study. Another indication that calcium and vitamin D supplements are inadequate to treat osteoporosis or osteopenia. Yet perhaps also showing that the twice-daily calcium regimen was more effective than once-daily calcium dosing used in previous research. Perhaps other studies will bear this out. Blood Purif. 2010 Jan 21;29(3):293-299. [Epub ahead of print]. Bisphosphonate Use in Chronic Kidney Disease: Association with Adynamic Bone Disease in a Bone Histology Series. Amerling R and others. PMID: 20090316. I won't go into all the details of this study, read the abstract if you are interested. Basically the authors found that those with chronic kidney disease (CKD), and who were or had been taking bisphosphonates for osteoporosis, had defective bone mineralization, known as adynamic bone disease. The authors concluded: "Based on these observations, the use of bisphosphonates in CKD cannot be recommended." Note that participants in the study had stage II-IV CKD (scroll down to get to the explanation for the various stages of CKD). Editor's comments. Those with CDK, and/or their care providers, need to be aware of this research and its implications. Unfortunately it isn't known if other FDA-approved medications such as Forteo, Miacalcin, etc., would be safe to give to stage II-IV CKD patients. At the very least, whatever FDA-approved medication CKD patients are getting, they should be followed by careful and frequent follow up of bone mineralization to verify there is no adynamic bone disease occurring. Age Ageing. 2010 Jan 14. [Epub ahead of print]. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Kannegaard PN, and others. PMID: 20075035. This research involved a more than 41,000-person database of individuals in Denmark who had hip fractures from 1999 to 2002, and who were followed until 2005. The authors found, ". . . a substantially higher mortality among male hip fracture patients than female hip fracture patients despite men being 4 years younger at the time of fracture. Both male and female hip fracture patients were found to have an excess mortality rate compared to the general population." It was found that age, number of comedications and presence of different specific Charlson index components and medications increased the risk of death in men and women. But more so in men. Editor's comments. I fear this study may not offer a lot in terms of how to avoid this excess mortality for men that it shows exists. It sounds like the cause is related to items that are mostly uncontrollable, like age, medications and other medical conditions. Perhaps many of these conditions and the need for medication for them were brought on by poor lifestyle choices. If so, they would have been preventable with wiser choices. Other than that, if you are elderly, be very careful not to fall and break a hip, especially if you are male. And, if you have been diagnosed with osteoporosis, be sure to take your medications as directed to maintain BMD.
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