If your pants feel tighter than usual, you might begin to suspect that you’ve gained a couple of pounds. But at what point should you begin to worry that the weight gain is serious? Could you be one of the approximately two-thirds of American adults who are either overweight or obese, with an increased risk for conditions like diabetes and heart disease? While no single measurement is perfect, here are a few ways to size yourself up.
Continue Reading January 2nd, 2009
Jan. 2, 2009 — After having teeth pulled, 4% of patients in a study who were taking Fosamax developed a dangerous condition called osteonecrosis of the jaw, USC researchers report. None of the tooth extraction patients not taking Fosamax developed osteonecrosis.
The condition, sometimes called jawbone death, occurs when bone in the jaw fails to heal after a minor trauma. It results in pain, swelling, infection, and exposed bone.
Merck says the study has numerous flaws. But study researchers Parish P. Sedghizadeh, DDS, and colleagues say Fosamax and other bisphosphonate drugs may be riskier than previously thought.
“Here at the USC School of Dentistry, we’re getting two or three new patients a week that have bisphosphonate-related osteonecrosis of the jaw — and I know we’re not the only ones seeing it,” Sedghizadeh says in a news release.
Just last month, an expert panel for the American Dental Association concluded that the risk of jaw osteonecrosis “apparently remains low” for people taking bisphosphonates. In addition to Fosamax, other oral bisphosphonate drugs include Zometa, Aredia, and Actonel, and Boniva.
Even so, it’s not the first time questions have been raised about bisphosphonates and jawbone death. A 2005 paper in the Journal of the American Dental Association reviewed the risk, as did a 2005 study in the Journal of Endodontics and a 2006 editorial in the New England Journal of Medicine.
Injection versions of the drugs appear to carry a higher risk. The risk of osteonecrosis is generally thought to be quite low for oral bisphosphonates.
“We’ve been told that the risk with oral bisphosphonates is negligible, but 4% is not negligible,” Sedghizadeh says.
The Fosamax label and the labels of other bisphosphonate drugs note that jaw osteonecrosis has been reported in patients taking bisphosphonates, including some patients taking the drugs for postmenopausal osteoporosis. But jaw osteonecrosis patient Lydia Macwilliams says nobody warned her during her three years of Fosamax use.
“My doctor who prescribed Fosamax didn’t tell me about any possible problems with my teeth,” Macwilliams, one of Sedghizadeh’s patients, says in a USC news release.
In their study, Sedghizadeh and colleagues combed through their records and identified 208 patients who took Fosamax. Sixty-six of these patients had teeth extracted; nine of these patients developed jaw osteonecrosis — four at the site of the extraction and five after denture-related ulceration.
Among 4,384 tooth extraction patients not on Fosamax, none developed jaw osteonecrosis.
However, patients who developed osteonecrosis had other factors, including chemotherapy, type 2 diabetes, high blood pressure, high cholesterol, and steroid therapy. Some of these conditions are risk factors for osteonecrosis.
Nevertheless, Sedghizadeh notes that USC now warns all dental patients taking Fosamax and other bisphosphonates that “you may be at risk of developing osteonecrosis (bone death) of the jaw, and certain dental treatments may increase that risk.”
continued…
Merck notes in a statement that the Sedghizadeh study contains methodological flaws and that the findings cannot be used to reach “valid scientific conclusions regarding the prevalence of osteonecrosis of the jaw” in patients taking Fosamax.
“Data from randomized, prospective clinical trials are the gold standard and are more reliable than data from studies like the [Sedghizadeh study],” the statement reads. “In controlled clinical trials involving more than 17,000 patients, contributing as much as 10 years’ data with [Fosamax], there have been no reports of osteonecrosis of the jaw. This includes approximately 3,000 osteoporosis patients taking [Fosamax] for three to five years and approximately 800 patients taking [Fosamax] for eight to 10 years.”
Sedghizadeh and colleagues call for other institutions to go through their own records to establish whether patients on Fosamax and other bisphosphonates have a higher risk of jawbone death after dental procedures.
The Sedghizadeh study appears in the January issue of the Journal of the American Dental Association.
View Article Sources
SOURCES:
Sedghizadeh, P.P. Journal of the American Dental Association, January 2009; vol 140, manuscript received ahead of publication.
News release, University of Southern California.
Fosamax prescribing information for medical professionals.
American Dental Association, “Dental Management of Patients Receiving Oral Bisphosphonate Therapy — Expert Panel Recommendations: Report of the Council on Scientific Affairs,” July 2008.
Edwards, B.J. Journal of the American Dental Association, December 2008; vol 139: pp 1674-1677.
Markiewicz, M.R. Journal of the American Dental Association, December 2005; vol 136: pp 1669-1674.
Goodell, G.G. Journal of Endodontics, October 2005, online edition.
Bilezikian, J.P. New England Journal of Medicine, Nov. 30, 2006; vol 355: pp 2278-2281.
© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore…
Continue Reading January 2nd, 2009
Jan. 2, 2009 — Women who don’t try to eat less more than double their risk of substantial weight gain in middle age, a three-year study shows.
If you’re a 40-something woman, it doesn’t matter whether you’re thin or overweight — odds are, you’ll gain weight over time if you don’t make an effort to cut back on what you eat.
The finding comes from a study of 192 women with an average age of 40 by Brigham Young University researchers Larry A. Tucker, PhD, and Laura Bates. The women were not obese, had not yet reached menopause, and did not smoke.
At the start of the study the women underwent detailed physical exams, including measures of weight and body fat. They also underwent a seven-day analysis of the food they ate, in which they weighed and recorded every bit of food they put into their mouths.
Three years later, the women underwent another round of physical exams and food-intake analysis. The bottom line was no surprise: Women tend to gain weight and body fat as they age and become less physically active.
But not all women gained weight. Even if they didn’t exercise more, women who made an effort to eat less were 69% less likely to gain more than 2.2 pounds and were 2.4 times less likely to gain 6.6 pounds or more.
It’s never too soon, or too late, to watch what you eat, Tucker and Bates suggest.
“It matters little at what point women are regarding restricted eating. What matters most is that they increase their dietary restraint over time or they will likely gain weight,” they conclude.
Women who increased their “emotional eating” — that is, eating as a way of coping with feeling depressed, lonely, bored, anxious, worried, or other emotional states — were also more likely to gain weight than women who did not increase this kind of eating behavior.
“To avoid weight gain, these women have to learn to control their food consumption during emotionally challenging situations,” Tucker and Bates note.
Some earlier studies suggested that women who try to eat less actually end up gaining weight because their feelings of deprivation lead them to cycles of bingeing. But Tucker and Bates saw no evidence of this, even though they acknowledge that binge eating usually does occur in people trying to eat less.
“Tight regulation of food intake may lead to bingeing from time to time, but over the long term, fewer calories are consumed and the risk of weight gain is much less in women who practice restricted eating,” they suggest. “In fact, women have to increase restraint over time to keep from gaining weight and body fat.”
The study appears in the January/February issue of the American Journal of Health Promotion.
View Article Sources
SOURCE:
Tucker, L.A. and Bates, L. American Journal of Health Promotion, January/February 2009; vol 22: manuscript received ahead of print.
© 2008 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore…
Continue Reading January 2nd, 2009
Jan. 1, 2009 — Medication helps depressed kids, but only those whose symptoms are severe enough to warrant treatment with antidepressants, analysis of clinical trial data suggests.
The study is a careful analysis of data from 12 published and unpublished clinical trials in which newer antidepressant drugs were studied in children aged 6 to 18 with major depression.
There was a big problem with these studies: A placebo — fake pills — helped nearly half of depressed kids get better. Antidepressant drugs did only a little better, resulting in substantial improvement for 59% of kids vs. 48% for placebo.
Does this mean the drugs don’t work very well? Or is something else going on? That’s what Jeffrey A. Bridge, PhD, of Nationwide Children’s Hospital in Columbus, Ohio, and colleagues tried to find out.
The researchers analyzed all the data collected in the various studies. They found that kids enrolled in multicenter clinical trials were much more likely to respond to placebo than were kids in smaller trials. They also found that kids in larger trials tended to have less severe depression than kids in smaller trials.
This, they suggest, may mean that antidepressants are most helpful to kids with at least moderately severe depression. For kids with milder depression, the drugs’ benefits may not outweigh their risks.
“If confirmed, these findings raise questions about the benefit-to-risk profile of antidepressants in treating depressed pediatric patients with mild functional impairment,” Bridge and colleagues conclude.
Doctors who treat children for depression should pay close attention to this finding, suggests an editorial by Graham J. Emslie, MD, of the University of Texas Southwestern Medical Center in Dallas.
The study “emphasizes the importance of a careful and extended evaluation prior to initiating medication to make sure that the depression is of sufficient severity to warrant medication treatment,” Emslie says.
Emslie makes another major point: The large placebo effect seen in these studies does not mean there’s no such thing as child depression — nor does it mean that these children don’t need “vigorous treatment.”
Bridge and colleagues suggest that kids with milder depression may benefit more from specialized psychotherapy than from antidepressants as an initial treatment option.
Just how severe must a child’s depression be before antidepressant therapy is indicated? Unfortunately, the study can’t answer that question. Emslie suggests that future trials be designed to find out which children are most likely to need antidepressant treatment.
The Bridge study and the Emslie editorial appear in the January issue of the American Journal of Psychiatry.
The Bridge study was funded by a grant from the National Institute of Mental Health. Bridge and one of his co-authors have presented at a conference supported by pharmaceutical companies; that co-author has also participated in drug company-sponsored forums. Emslie receives research support from and is a consultant for several drug companies; a reviewer for the American Journal of Psychiatry found no evidence of company influence in his editorial.
View Article Sources
SOURCES:
Bridge, J.A. American Journal of Psychiatry, January 2009; vol 166: pp 42-49.
Emslie, G.J. American Journal of Psychiatry, January 2009; vol 166: pp 1-3.
© 2009 WebMD, LLC. All rights reserved. SHARE What is this? del.icio.usMore…
Continue Reading January 2nd, 2009
Implementing smoke-free policies can lead to a fewer hospitalizations resulting from heart attacks, according to a new study published by the Centers for Disease Control and Prevention.
Continue Reading January 2nd, 2009
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