Discontinuous calcitonin treatment of established osteoporosis - effects of withdrawal of treatment

Article Abstract:

Calcitonin is a peptide hormone produced in the thyroid gland, and is involved in the control of bone and calcium metabolism. It prevents the resorption, or dissolution, and decreases bone formation and the number of osteoclast cells. Calcitonin has been used to treat Paget's disease (which affects the elderly and is characterized by chronic inflammation of the bones) and conditions associated with increased blood calcium levels. In the United States, injectable calcitonin has been approved for treating bone loss (osteoporosis). A new dosage form of calcitonin derived from salmon, which is administered through the nose, may be useful in treating osteoporosis. Calcitonin may be administered daily, a few times per week, or every three weeks. A discontinuous regimen consists of administering calcitonin for a year, followed by a year of withdrawal, and resumption of calcitonin therapy in the third year. The effects of discontinuous therapy with intranasal salmon calcitonin on bone and calcium metabolism were assessed in 26 women who had reached menopause, the cessation of menstruation. In addition, the effects of withdrawing calcitonin therapy were also examined. At the end of three years, women who were not treated with calcitonin lost more bone in the forearm and spine than women treated with calcitonin for one or two years. Bone loss was greater in women treated with calcitonin for one year than in women treated with the hormone for two years. The rate of bone loss was similar among all women during the withdrawal period. Calcitonin was most effective in women with high bone turnover, or metabolism, and with low levels of bone mass. Bone changes in the spine were determined based on bone turnover. The results show that calcitonin increases the gain in amount of bone in the periphery, head, and trunk in women with osteoporosis, and response to calcitonin treatment can be monitored by changes in bone turnover. (Consumer Summary produced by Reliance Medical Information, Inc.)

Osteoporosis, Calcitonin

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Biochemical markers of bone turnover in diagnosis and assessment of therapy

Article Abstract:

Osteoporosis is more common in women than in men. Although some bone loss occurs as a natural part of aging, the rate of bone loss increases during menopause when the ovaries stop making estrogen. Low bone mass prior to menopause and a fast rate of bone loss afterwards are risk factors associated with osteoporosis. Bone densitometry has been used to measure bone mineral density in postmenopausal women to determine the risk of osteoporosis. Current research is focusing on the development of blood tests and urine tests that can be used to determine the risk of osteoporosis. Serum alkaline phosphatase (sAP) is an enzyme that is made in bone and it has been used as a marker of bone formation. However, it is not specific for bone metabolism. The amount of calcium and hydroxyproline in the urine has been used as a marker of bone resorption (loss). Osteocalcin (BGP; bone Gla protein) is a protein that is made in certain bone cells (osteoblasts) and is present in the blood. Several studies have reported that blood levels of BGP provide an estimate of bone formation. PICP (a small protein that comes from a protein called collagen during the formation of bone) may be a marker of bone formation. Pyridinoline (PYR) and deoxypyridinoline (D-PYR) are released from the bone and are present in the urine during bone resorption. Studies have shown that postmenopausal women have higher blood levels of sAP, BGP and PICP, and higher urinary levels of calcium, hydroxyproline, PYR and D-PYR than premenopausal women. Hormone replacement therapy with estrogen has been shown to reduce the blood and urinary levels of these markers. The degree of postmenopausal bone loss was related to the concentrations of these markers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Diagnosis, Blood chemical analysis, Alkaline phosphatase, Urine, Urinalysis, blood

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Serum lipids, lipoproteins, and apolipoproteins during postmenopausal estrogen replacement therapy combined with either 19-nortestosterone derivatives or 17-hydroxyprogesterone derivatives

Article Abstract:

Hormone therapy with estrogen replacement is used to relieve symptoms of menopause, the cessation of the menstrual cycle, and to prevent bone loss after menopause. Estrogen therapy has also been shown to have beneficial effects on blood lipids, and thereby may reduce the risk of cardiovascular disease. Progestogen hormones help to regulate menstrual periods, and prevent the risk of estrogen-related endometrial hyperplasia (the excessive proliferation of endometrial tissue lining the uterus) and cancer. Some studies suggest that 19-nortestosterone derivatives have adverse effects on blood lipids. The effect of combined hormone treatment on blood lipids, lipoproteins, and apolipoproteins was assessed in 139 postmenopausal women, aged 45 to 55 years. The women were divided into groups, and given estradiol valerate (E) combined with: (1) levonorgestrel; (2) medroxyprogesterone acetate; (3) desogestrel; or (4) cyproterone acetate. All treatments reduced low-density lipoprotein cholesterol, and caused similar but smaller changes in total cholesterol and apolipoprotein B. The drug regimens did not change high-density lipoprotein cholesterol (HDL-C) or apolipoprotein A1 (Apo A1). Combined hormone treatment resulted in large variations in the HDL-C levels, which increased with estrogen alone and decreased with combined hormone treatment. When progestogens and estrogens were administered together continuously, HDL-C levels did not show cyclical changes. Changes in Apo A1 levels were similar to those observed for HDL-C. The findings show that all treatment regimens produce changes in blood lipids, lipoproteins, and apolipoproteins that are beneficial in preventing cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Prevention, Physiological aspects, Hormone therapy, Menopause, Blood lipids, Estrogen, Estrogens

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