Gallium nitrate for advanced Paget disease of bone: effectiveness and dose-response analysis

Article Abstract:

Paget disease of bone (osteitis deformans) is a condition in which bone is continuously remodeled and replaced in a disorganized, deformed fashion, leading to pain, fracture, and neurologic complications. Since gallium nitrate (used to treat some cancer complications) slows bone resorption, which occurs at a rapid rate in Paget disease, it is possible the drug would slow the course of that disease. To evaluate this, 10 patients were studied at three doses/administration routes (high intravenous, intermediate and low subcutaneous). Measurements were made of biochemical parameters that reflect bone resorption: urinary hydroxyproline and blood alkaline phosphatase activity (both increase when resorption increases). Results showed that hydroxyproline excretion decreased in all patients at all dose levels, with similar decreases for the high, intravenously administered and the moderate, subcutaneously administered doses. Gallium nitrate also led to a reduction in alkaline phosphatase activity, at all dose levels, but here, the intravenous route was considerably more effective than the two subcutaneous routes. Pain was reduced during 6 of 13 treatment courses, according to patient evaluation. A brief review of current treatments for Paget disease is presented. Patients with this disorder are quite heterogeneous, and extrapolations cannot yet be made from this small study group to the group of Paget disease patients as a whole. Nonetheless, gallium nitrate is encouraging as a potential therapeutic agent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, Drug therapy, Gallium nitrate, Osteitis deformans

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Osteoporosis and the primary care physician: time to bone up

Article Abstract:

Primary care physicians need to educate themselves on the prevention, diagnosis, and treatment of osteoporosis as the treatment trend for patients with osteoporosis is likely to shift from specialists to general practitioners. A decrease in bone mass density is an important factor in predicting risk for bone damage. However, the only currently reliable way to measure bone mass density is with an expensive instrument called a dual-energy x-ray absorptiometer. The only drugs currently approved for preventing osteoporosis are calcitonin injections and estrogen. However, a recent study has shown that early intervention with low-dose sodium fluoride in women with nearly normal bone mass density may be a promising preventive treatment for osteoporosis. General practitioners can help prevent osteoporosis by encouraging their patients to exercise regularly, supplement a healthy diet with calcium, and exercise care around the home and in the workplace.

Care and treatment, Editorial, Methods, Usage, Patient education, Osteoporosis, Health risk communication

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Cost-Effectiveness of Alternative Test Strategies for the Diagnosis of Coronary Artery Disease

Article Abstract:

Several non-invasive diagnostic tests are a cost-effective alternative to coronary angiography. During coronary angiography, a dye is injected into the patient to detect atherosclerosis in the coronary arteries. Based on a review of the literature, researchers estimated that echocardiography was more cost-effective than other noninvasive techniques such as stress testing, single-photon emission computed tomography (SPECT), and positron emission tomography (PET). The best diagnostic test only added seven more days of life compared to the worst test.

Diagnosis, Coronary heart disease, Diagnosis, Noninvasive, Noninvasive diagnosis

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