Thursday, July 22, 2010

The osteoporosis folly continues

We know that HRT works well and has minimal side effects but it is TOO popular so all sorts of unlikely alternatives are being tried

A hormone which regulates our internal bodyclock may also help treat osteoporosis. Now a pill form of the hormone, melatonin, is being given to women over 45 as part of a clinical trial to test the benefits.

Osteoporosis is a condition affecting the bones, causing them to become weak and fragile and increasing the risk of fractures. There are around 300,000 osteoporosis-related fractures each a year as a result. The condition affects both women and men of all ages, although it's most commonly associated with postmenopausal women.

Traditional treatment includes drugs called bisphosphonates, which work by blocking the breakdown of bone; strontium ranelate, a drug which stimulates new bone growth, and vitamin D, which makes bones stronger. HRT, which raises levels of oestrogen in the body, has been used, too, but long-term use over a number of years has been shown to increase the risk of stroke.

In the new study at the University of Pittsburgh in the U. S. , researchers are looking at melatonin as an alternative treatment.

Melatonin is a hormone which is secreted by the pineal gland in the brain. It is produced in the hours of darkness and maintains the body's internal 24-hour body clock. It also helps control the timing and release of female reproductive hormones.

Previous studies have pointed to a connection between melatonin and osteoporosis. In one American study, women who worked nightshifts for more than 20 years were more likely to suffer wrist or hip fractures. Night-shift workers have lower night- time melatonin levels, possibly because they're exposed to light at night. (Bright lights in the evening or too little light during the day can disrupt the body's normal melatonin cycle.)

In the new trial in Pittsburgh, which is due to last six months, 20 women aged 45 to 52 will take a synthetic version of the hormone in pill form before bed. They will have their bone density tested before and after the treatment. They will also be monitored to see whether improved hormone levels have an effect on their general well-being.

British experts remain circumspect about the new approach. 'We're always glad to see new research into osteoporosis, and look forward to the results of this initial trial,' says Rob Dawson, of the National Osteoporosis Society. 'However, much more work is needed before any benefits of melatonin can be assessed.

'Melatonin has cropped up in clinical research about bone health, but as yet there have been no proven connections to warrant large trials.'


Another "miracle" drug

Sounds too good to be true. If it's like many other wonder drugs, long-term side-effects will eventually be discovered which will knock it on the head. There are few exceptions to the general rule that the wonder drug of today is the iatrogenic disaster of tomorrow

A four-in-one diet drug that can help a woman drop two dress sizes in six months has been developed by scientists. The jab, which could be available in three years, also lowers blood pressure, raises 'good' cholesterol, and can prevent and even cure diabetes. If that's not enough, it also appears to have a 'feel-good' factor.

Similar in structure to a gut hormone that helps regulate appetite, liraglutide tricks the brain into thinking we are full despite eating 20 per cent less food. Taken for six months, it helped men and women who have struggled with their weight for years shed a stone and a half on average, making it more than twice as good as anything already on the market.

Free of the side-effects that have led some other diet 'wonder drugs' to be banned, it could also cut the need for gastric banding, stomach stapling and other expensive and potentially dangerous operations.

There are, however, likely to be concerns about a drug being used as a 'quick fix' to a problem which can in many cases be tackled with diet and exercise.

Researchers in the UK and abroad tested liraglutide on more than 550 obese men and women. Some of those taking part were given liraglutide daily. Others were given a supply of dummy pills or of orlistat, the 'gold standard' obesity treatment prescribed by GPs around the country.

Those who took liraglutide lost an average of a stone and a half over six months - more than twice as much as those on orlistat, the International Congress on Obesity heard.

When they continued to take the drug for another 18 months, the weight stayed off. However, those on orlistat started to pile the pounds back on.

The benefits of liraglutide, which like insulin comes in an injectable pen, did not end there. Blood pressure dropped to such an extent that patients could throw away the drugs they were taking to keep it under control. There was also an improvement in blood fats, including cholesterol. The body's ability to deal with sugar changed so much that diabetes was staved off in those at risk.

Liraglutide, which is also known as Victoza, can also improve the processing of sugar in those who already have the condition - removing the need for some to inject themselves with insulin.

Professor Mike Lean, of Glasgow University, who treated some of the Britons in the trial, said: 'The weight loss was very striking. 'One of the things we looked at was pre-diabetes, where you have one foot on the slippery slope towards diabetes and heart disease, and it more or less abolished it. 'That doesn't mean that it has gone forever but at least you have turned the clock back.'

He added: 'The drug is very effective and most obese people would like to lose one and a half stone or more. The difficulty is what then? Can people adapt their eating habits and start to become thin people? 'We don't know. But we do know with absolute certainty that when you stop a drug and the effects have gone, people's weight starts going up again.'

Liraglutide is expected to cost around £1,000 a year, or almost £3 a day, making it slightly more expensive than existing drugs.

Dr Ian Campbell, a GP and medical director of charity Weight Concern, gave the drug a cautious welcome. He said: 'We are badly in need of safe and effective weight-loss medicines but many have promised great results but have not delivered.

'Obesity is too complex to be solved with a drug. 'Drugs should only ever be used as a support to lifestyle changes such as healthy eating and exercise.'


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