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Biomedical subjects

Paul D Miller

Publications and source records attributed to Paul D Miller.

13 recordsLinked to original sources
PubMed2003

Cooled thermotherapy for the treatment of benign prostatic hyperplasia: durability of results obtained with the Targis System.

OBJECTIVES: To evaluate the durability of benefit associated with cooled high-energy thermotherapy (cooled thermotherapy) using the Targis System with data extending to 5 years after treatment. METHODS: At three centers in Canada and the United Kingdom, 150 patients with benign prostatic hyperplasia underwent cooled thermotherapy with the Targis System. This was an outpatient procedure performed without general or regional anesthesia. Patients were followed up at 1 and 6 weeks, 3, 6, and 12 months, and yearly to 5 years. RESULTS: Patients were evaluated at 1, 2, 3, 4, and 5 years after treatment (n = 132, 111, 90, 77, and 59, respectively). At these intervals, the American Urological Association symptom scores improved by 11.7 (57%), 12.1 (58%), 11.5 (53%), 10.1 (47%), and 10.6 (47%) points (P <0.0001 for each), the peak flow rates improved by a mean of 4.0 (57%), 4.0 (56%), 3.4 (48%), 3.3 (47%) and 2.4 (37%) mL/s (P <0.0001 for each), and quality-of-life scores improved by 2.6, 2.6, 2.5, 2.3, and 2.3 points (P <0.0001 for each). At least a 50% improvement in the American Urological Association symptom score was observed in 63% to 68% of patients available for follow-up at years 1, 2, and 3 and 50% and 51% of patients available for follow-up at years 4 and 5, respectively. Four patients required repeated microwave thermotherapy, 27 required subsequent invasive treatments, 1 permanent catheterization, 11 required alpha-blockers, and 1 antiandrogen therapy. CONCLUSIONS: Cooled thermotherapy with the Targis System produces durable improvements in symptoms, quality of life, and flow rates to at least 5 years after treatment.

Aged↗
PubMed2003

Bone mass measurements.

The clinical application of bone densitometry is one of the advances in the field of osteoporosis that has led to the increased patient awareness of this increasingly prevalent disease. Bone densitometry has made it possible for clinicians to diagnose osteoporosis before the first fracture has occurred; predict risk for fracture in postmenopausal women, men, and in patients who are receiving glucocorticoids; and can be used as a surrogate marker to follow the efficacy of therapies and to examine those patients that might be osteoporosis-specific therapeutic nonresponders.

Absorptiometry, Photon↗
PubMed2003

Bone mineral density--clinical use and application.

Clinical application of bone densitometry has led to increased patient awareness of this increasingly prevalent disease. With bone densitometry, it is possible for clinicians to diagnose osteoporosis before the first fracture has occurred; predict risk for fracture in men, postmenopausal women, and in patients receiving glucocorticoids; and can be used as a surrogate marker to follow the efficacy of therapies and to examine those patients who might be osteoporosis-specific therapeutic non-responders.

Aging↗
PubMed2003

Position Development Conference.

In a series of three published articles, the International Society for Clinical Densitometry has recorded the findings reached by an expert panel at the ISCD Position Development Conference held in July 2001. The key elements of those papers have been reviewed in this executive summary. It should be emphasized that the ISCD recommendations are not meant to serve as rigid guidelines or to replace clinical judgment. The recommendations will be reviewed and updated periodically as more data become available. A second Position Development Conference will be held in July 2003 in Cincinnati, OH. For information, visit the ISCD web site: http://www.iscd.org/.

Absorptiometry, Photon↗
PubMed2002

Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Many elderly female residents of long-term care facilities have osteoporosis and could benefit from intervention to increase bone density. OBJECTIVE: To examine the efficacy and safety of alendronate for treatment of osteoporosis in elderly female residents of long-term care facilities. DESIGN: Multicenter, randomized, double-blind, placebo-controlled 2-year study. SETTING: 25 long-term care facilities. PATIENTS: 327 elderly women with osteoporosis. INTERVENTION: Patients were randomly assigned to receive alendronate, 10 mg/d, or placebo. All patients also received vitamin D, 400 IU/d, and some patients received supplemental calcium (total intake, approximately 1500 mg/d). MEASUREMENTS: Bone mineral density (BMD) of the spine and hip and biochemical markers of bone turnover. RESULTS: Alendronate produced significantly greater increases in BMD than did placebo (24-month differences: spine, 4.4% [95% CI, 3.3% to 5.5%]; femoral neck, 3.4% [CI, 2.3% to 4.4%]). Alendronate produced greater decreases from baseline in biochemical markers of bone turnover than did placebo (P < 0.001). CONCLUSION: Alendronate increased BMD at both the spine and hip in elderly female residents of long-term care facilities.

Aged↗
PubMed2002

A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis.

Teriparatide (rDNA origin) injection [recombinant human PTH (1-34)] stimulates bone formation, increases bone mineral density (BMD), and restores bone architecture and integrity. In contrast, bisphosphonates reduce bone resorption and increase BMD. We compared the effects of teriparatide and alendronate sodium on BMD, nonvertebral fracture incidence, and bone turnover in 146 postmenopausal women with osteoporosis. Women were randomized to either once-daily sc injections of teriparatide 40 micro g plus oral placebo (n = 73) or oral alendronate 10 mg plus placebo injection (n = 73). Median duration of treatment was 14 months. At 3 months, teriparatide increased lumbar spine BMD significantly more than did alendronate (P < 0.001). Lumbar spine-BMD increased by 12.2% in the teriparatide group and 5.6% in the alendronate group (P < 0.001 teriparatide vs. alendronate). Teriparatide increased femoral neck BMD and total body bone mineral significantly more than did alendronate, but BMD at the one third distal radius decreased, compared with alendronate (P < or = 0.05). Nonvertebral fracture incidence was significantly lower in the teriparatide group than in the alendronate group (P < 0.05). Both treatments were well tolerated despite transient mild asymptomatic hypercalcemia with teriparatide treatment. In conclusion, teriparatide, a bone formation agent, increased BMD at most sites and decreased nonvertebral fractures more than alendronate.

Adult↗
PubMed2002

Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment.

Low bone mineral density (BMD) is a risk factor for fracture. Although the current "gold standard" test is DXA of the hip and spine, this method is not universally available. No large studies have evaluated the ability of new, less expensive peripheral technologies to predict fracture. We studied the association between BMD measurements at peripheral sites and subsequent fracture risk at the hip, wrist/forearm, spine, and rib in 149,524 postmenopausal white women, without prior diagnosis of osteoporosis. At enrollment, each participant completed a risk assessment questionnaire and had BMD testing at the heel, forearm, or finger. Main outcomes were new fractures of the hip, wrist/forearm, spine, or rib within the first 12 months after testing. After 1 year, 2259 women reported 2340 new fractures. Based on manufacturers' normative data and multivariable adjusted analyses, women who had T scores < or = -2.5 SD were 2.15 (finger) to 3.94 (heel ultrasound [US]) times more likely to fracture than women with normal BMD. All measurement sites/devices predicted fracture equally well, and risk prediction was similar whether calculated from the manufacturers' young normal values (T scores) or using SDs from the mean age of the National Osteoporosis Risk Assessment (NORA) population. The areas under receiver operating characteristic (ROC) curves for hip fracture were comparable with those published using measurements at hip sites. We conclude that low BMD found by peripheral technologies, regardless of the site measured, is associated with at least a twofold increased risk of fracture within 1 year, even at skeletal sites other than the one measured.

Absorptiometry, Photon↗
PubMed2002

Executive summary International Society for Clinical Densitometry position development conference Denver, Colorado July 20-22, 2001.

Bone densitometry is routinely used to assess the skeleton in patients who have diseases or conditions that can cause low bone mass. However, there are some areas of controversy related to the interpretation of bone densitometry results. To address these issues, the International Society for Clinical Densitometry (ISCD) convened a Position Development Conference in Denver, Colorado, July 20-22, 2001. The ISCD is a not-for-profit multidisciplinary society whose main mission is to promote quality in the performance and interpretation of bone densitometry examinations.

Bone Density↗
PubMed2002

What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis?

Measurement of bone mineral density (BMD) at central skeletal sites with dual X-ray absorptiometry is the "gold standard" both for the diagnosis of osteoporosis using the criteria of the World Health Organization (WHO) and for monitoring individuals receiving antiresorptive treatment for osteoporosis. Measurement of BMD at peripheral sites (peripheral BMD) can be used to assess fracture risk, but application of the WHO criteria gives different prevalence values for "osteoporosis" with peripheral devices, and different risks for fracture at the same cut points. The International Society for Clinical Densitometry Position Development Conference panelists reached the following conclusions about peripheral BMD testing: First, WHO T-score criteria should not be used with peripheral devices. Second, for the identification of a level for peripheral BMD measurements above which osteoporosis is unlikely, device-specific cut points for peripheral BMD should be identified that have 90% sensitivity for identifying patients who have osteoporosis (T-score of -2.5 or below) based on measurements of the spine and hip. If central BMD testing is available, patients who have peripheral BMD below the 90% sensitivity level should have a central BMD measurement. If central BMD testing is not available, peripheral BMD might be used for identification of patients who are likely to have osteoporosis. Risk-based cut points were preferred to prevalence based cut points, and, again, device-specific cut points are needed. For patients tested only with a peripheral BMD device whose result is intermediate, clinical judgment would be needed. Third, peripheral BMD testing should not be used for monitoring patients who are taking antiresorptive therapy for osteoporosis. Fourth, peripheral BMD testing performs best when used for postmenopausal women. Further research on all these issues is needed.

Absorptiometry, Photon↗