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Biomedical subjects

S Rozenberg

Publications and source records attributed to S Rozenberg.

At least 73 records · Page 4Linked to original sources
PubMed1997

Factors influencing the prescription of hormone replacement therapy.

OBJECTIVE: To assess the effects of age, bone mineral density, risk of cardiovascular disease, and of breast cancer on the prevalence of hormone replacement therapy (HRT) prescriptions. METHODS: Seventeen charts of postmenopausal women were summarized. For each chart, we constructed 36 different cases by modifying the age (two levels), the bone mineral density (three levels), the cardiovascular risk (three levels), and the breast cancer risk (two levels). Twelve cases of these 612 files were sent to each Belgian gynecologist (n = 1010). RESULTS: Overall, HRT was prescribed in 67% of the cases. It was prescribed in 54.6% of women who had a normal bone mass, 67.9% of women with a low bone mass, and 79.0% of those with osteoporosis (P < .001). The prescription rate was higher in younger women (mean +/- standard deviation 55 +/- 4 years) than in their peers who were 10 years older (79.3% versus 55.2%; p < .001). No significant variation was observed in relation to the cardiovascular risk profile or to breast cancer risk. CONCLUSION: Osteoporosis is associated with an increased rate and older age with a decreased rate of HRT prescription, whereas no difference is observed in association with cardiovascular or breast cancer risk.

Age Factors↗
PubMed1997

An epidemiological study of diagnostic and therapeutic strategies in office practice patients with subacute or chronic pain in the thoracic or low back. Comparison of practices in primary care and rheumatology settings.

UNLABELLED: There is a paucity of epidemiological data on diagnostic and therapeutic practices in office practice patients with subacute or chronic pain in the thoracic or low back. STUDY OBJECTIVE: to describe diagnostic and therapeutic strategies used in such patients. PATIENTS AND METHODS: descriptive, prospective, two-month epidemiological study in 50 general practitioners and 50 rheumatologists. Each physician was asked to provide data on the demographics, clinical features, history of spinal disease, investigations, prior treatments and treatments prescribed on D0 and D30 in two patients with low back pain and two with thoracic back pain, of one to 12 months' duration. RESULTS: A total of 352 patients were included. In the 217 patients with low back pain, including 107 women and 110 men, duration of the pain was 4.3 +/- 0.2 months and mean age was 49.6 +/- 1 years; 67% of these patients were economically active and 22% were retired; 59% were recruited by rheumatologists. In the thoracic back pain group, there were 135 patients, including 82 women (61%) and 53 men, with a mean duration of pain of 3.8 +/- 0.3 months and a mean age of 47.7 +/- 1.4 years; 60% were economically active and 22% were retired; 49% were recruited by rheumatologists. A history of conservatively-treated low or thoracic back pain was reported for 95.4% of patients in the low back pain group and 94% in the thoracic back pain group. Of the patients with low back pain, 6.3% had had spinal surgery. Investigations were as follows: roentgenograms in 85% of low back pain and 75% of thoracic back pain patients, computed tomography in 11% and 5.8%, magnetic resonance imaging in 2% and 1% and laboratory tests in 14% and 20%. Ninety-one per cent of low back pain and 84% of thoracic back pain patients were already under therapy on D0. Ninety-six per cent of patients overall were given a prescription at the end of the D0 visit, for a nonsteroidal antiinflammatory drug or an analgesic in 80% of low back pain and 63% of thoracic back pain patients, for muscle relaxants in 62% and 69%, for drugs aimed at preventing gastric side effects in 19% and 9.5%, for myotonic agents in 10% and 8% and for sedatives in 5% and 11%. A local steroid injection was given to 20% of low back pain patients. Twenty-four per cent of low back pain and 14% of thoracic back pain patients missed days of work (mean, 11 +/- 1.7 days and 13 +/- 4.6 days, respectively). Physical therapy was prescribed to 36% of low back pain and 27% of thoracic back pain patients and a lumbar support belt to 17% of low back pain patients. On D30, the pain had abated in 86% of low back pain and 89% of thoracic back pain patients and complete freedom from pain was reported by 28% and 32% of patients in these two groups, respectively. Treatments prescribed on D30 were physical therapy (43% and 31%), analgesics (40% and 36%) muscle relaxants (25% and 30%), and nonsteroidal antiinflammatory drugs (23% and 12%). Conclusion. This preliminary study provides data on common practices in subacute and chronic low back and back pain and may prove useful for health care cost estimations.

Acute Disease↗
PubMed1997

Comparison of continuous and sequential transdermal progestogen with sequential oral progestogen in postmenopausal women using continuous transdermal estrogen: vasomotor symptoms, bleeding patterns, and serum lipids.

OBJECTIVE: The efficacy, bleeding patterns, and safety of continuous transdermal and sequential transdermal progestogen therapy were compared with those of oral progestogen therapy in postmenopausal women receiving transdermal estrogen. METHODS: In an open-label, 1-year (13 treatment periods, 28 days each), randomized study, 774 postmenopausal women were assigned to receive 50 micrograms/day of continuous trans dermal estradiol with either continuous or sequential transdermal norethisterone acetate (NETA) in daily doses of 170 or 350 micrograms in a single transdermal patch or sequential oral progestogen (1 mg norethisterone [NET] or 20 mg dydrogesterone/day). RESULTS: The average number of hot flushes/day decreased from prestudy by over 90% (P < .001), and this reduction was unaffected by different progestogen regimens. With sequential progestogen, bleeding incidence and the number of bleeding days did not change over the course of the study but were lower in the low-dose transdermal progestogen group. With continuous progestogen, the incidence of bleeding decreased in both the low- and high-dose groups, from 35% and 45% in treatment period 1 to 25% and 15%, respectively, at the end of treatment. Adverse event incidence was similar in all groups, with 23% to 36% of subjects reporting events possibly or probably related to HRT (excluding vaginal bleeding). Two cases of simple hyperplasia were reported (one in each low-dose progestogen group). Beneficial effects on coronary heart disease risk factors, such as reductions in total cholesterol and low-density lipoprotein cholesterol and increases in high-density lipoprotein-2 cholesterol levels, were measured in all treatment groups. Lipoprotein (a) was reduced in all but the oral progestogen group. CONCLUSIONS: Continuous and sequential transdermal estrogen/progestogen treatments with estradiol/NETA appear to be effective and safe alternatives to continuous transdermal estrogen and oral sequential progestogen for the treatment of menopausal symptoms. Continuous transdermal therapy with estradiol/NETA may be more acceptable for a majority of patients, i.e., those who wish to avoid monthly bleeds, whereas the sequential regimen may be preferable when the clinician and/or patient believes monthly bleeding to be appropriate.

Administration, Cutaneous↗
PubMed1996

Effect of bone density evaluation on hormone replacement therapy prescription.

OBJECTIVES: This study evaluates whether Bone Mineral Density (BMD) results influence HRT prescription. METHODS: Successive charts of 29 postmenopausal women were summarised. For each chart, 3 'simulated cases' were created by modifying the BMD result (based on the Z-score) in order to have 4 groups with the same clinical story but a wide range of BMD values (Group I = Z-score > 0, Group II = Z-score between 0 and -1, Group III = Z-score between -1 and -2 and Group IV = Z-score < -2). The obtained cases were presented to 10 gynaecologists who were asked whether HRT should be prescribed. The gynaecologists were not aware of the above-mentioned manipulation. RESULTS: The overall treatment rate was 74.2%, ranging from 65% for women with the highest BMD (Group I), 73% for Group II, 79% for Group III and 80% for Group IV, i.e. women with the lowest BMD (Friedman analysis of variance; chi-square 17.2; P < 0.001). In approximately a third of the patients (11/29), there was agreement for initiation of therapy, regardless of the BMD. Most of these women presented other indications and no contra-indications for therapy. The prescription frequency of the 10 gynaecologists varied between 63% and 87%; Cochran Q Statistic 39.2; P < 0.0001). For some physicians, a trend to increase prescription was observed in relation to the BMD result, but a statistical difference could only be reached for one physician (P < 0.05). Furthermore, for some physicians no modification whatsoever could be observed. CONCLUSIONS: BMD appears to be a determinant factor for HRT prescription in only a limited proportion of the patients and a small number of the physicians. From an epidemiological point of view, BMD measurements may be useful in order to help deciding women to start HRT, especially those who are reluctant or to those who present relative contra-indications, provided that their physicians are aware of the usefulness of these investigations.

Adult↗
PubMed1996

Cyclical pamidronate infusions in postmenopausal osteoporosis.

OBJECTIVES: Until recently, two bisphosphonates, pamidronate (APD) and etidronate were available for clinical purposes. Contrary to etidronate, pamidronate was not extensively studied in osteoporosis. Therefore, we investigated the effect of cyclic intravenous APD treatment in postmenopausal osteoporosis. METHODS: Parameters of bone remodelling and lumbar spine bone mineral density (BMDL) were assessed in 36 postmenopausal women with osteoporosis (BMDL t-score < -2.5). They received five courses of APD. Intervals between courses were defined according to the fasting urinary calcium excretion (UCa/Cr, mg/mg creatinine) which was measured before each APD course and every 2 weeks after the first treatment. The patients were retreated when UCa/Cr had reached baseline levels. Serum biochemical parameters and urinary hydroxyproline (UOHPro/Cr, mg/mg) were measured before each APD. RESULTS: UCa/Cr decreased during 21-28 days after each course but UCa/Cr measured before APD infusion remained unchanged. UOHPro/Cr significantly fell after the third APD (P = 0.02). Serum calcium was however not modified. Parameters of bone remodelling decreased with time: bone-GLA protein (BGP) started to fall after the first APD (P = 0.0001) and continued to decrease until the fourth APD course, alkaline phosphatase (ALP) significantly decreased after the first APD (P = 0.005); intact PTH significantly increased at the fifth APD (P = 0.02). BMDL significantly increased after 1 year treatment: +2.9% of baseline value. CONCLUSIONS: Cyclical pamidronate treatment of postmenopausal osteoprosis appeared to be effective in reducing bone turnover assessed by BGP, ALP and OHPro/Cr. This effect is followed by an increase in vertebral BMD.

Adult↗
PubMed1996

Diversity of opinions on the management of gout in France. A survey of 750 rheumatologists.

Gout is a common disease. Although effective treatments are available for gout, there is some disagreement as to how they should be used. To study prescription patterns in gout, we conducted a questionnaire survey among 2520 rheumatologists. Seven hundred and fifty completed questionnaires were returned over a two-month period. Among respondents, 35.4% worked in a private office, 21% in a hospital and 43.6% in both. The most widely prescribed treatments in acute gout attack were colchicine alone (63%), colchicine with a nonsteroidal antiinflammatory drug (NSAID) (31.7%) and NSAID alone (5.2%), with significant variations according to the type of practice. Mean duration of treatment in acute gout was 18 +/- 16.8 days (range, 3-180 days). Mean time interval between the attack and initiation of therapy with a xanthine oxidase inhibitor was 21.6 +/- 17.2 days (range 0-180); here also, significant variations were seen according to the type of practice. Concomitant symptomatic therapy was prescribed in 97.3% of cases, for a mean duration of 54 +/- 55.4 days (range 2-365). Thirty per cent of responders never prescribed uricosuric agents. The estimated rate of occurrence of treatment-induced attacks increased with the reported interval between the attack and initiation of urate-lowering therapy. Our data demonstrate that French rheumatologists have widely diverging views on how to treat gout. Whether a waiting period is needed between an acute attack and initiation of urate-lowering therapy, and how long this period should be, are unsettled issues that deserve to be studied.

Adult↗
PubMed1995

[Osteo-articular complications of heart transplantation].

Heart transplantation is an effective means of treating irreversible heart failure in selected patients. Preventing organ rejection requires immunosuppressor treatment with corticosteroids, azathioprine and/or cyclosporine. Bone and joint complications are frequent and increase overall morbidity directly related to anti-rejection therapy. Corticosteroids favour osteopenia which can be detected by measurement of bone density. The risks include spontaneous wedge fractures of the spine and aseptic necrosis. The frequency of complications has been reduced with the use of cyclosporine allowing a reduction in corticosteroids. Raised serum urate levels and increased risk of gout can be induced by cyclosporine. The gout in these patients has a particular course since it appears rapidly after only a few months of hyperuricaemia. Several joints may be involved with production of tophi. Treatment is particularly difficult. Its frequency increases after heart transplantation compared with other organs which can be explained by the more prevalent prescription of diuretics which further aggravate urate secretion. These complications cause further discomfort in transplant recipients.

Bone Diseases↗
PubMed1995

Precision and accuracy of in vivo bone mineral measurement in rats using dual-energy X-ray absorptiometry.

The aim of this study was to evaluate the precision and accuracy of dual-energy X-ray absorptiometry (DXA) for measuring bone mineral content at different sites of the skeleton in rats. In vitro the reproducibility error was very small (< 1%), but in vivo the intra-observer variability ranged from 0.9% to 6.0%. Several factors have been shown to affect in vivo reproducibility: the reproducibility was better when the results were expressed as bone mineral density (BMD) rather than bone mineral content (BMC), intra-observer variability was better than the inter-observer variability, and a higher error was observed for the tibia compared with that for vertebrae and femur. The accuracy of measurement at the femur and tibia was assessed by comparing the values with ash weight and with biochemically determined calcium content. The correlation coefficients (R) between the in vitro BMC and the dry weight or the calcium content were higher than 0.99 for both the femur and the tibia. SEE ranged between 0.0 g (ash weight) and 2.0 mg (Ca content). Using in vitro BMC, ash weight could be estimated with an accuracy error close to 0 and calcium content with an error ranging between 0.82% and 6.80%. The R values obtained between the in vivo and in vitro BMC were 0.98 and 0.97 respectively for femur and tibia, with SEE of 0.04 and 0.02 g respectively. In conclusion, the in vivo precision of the technique was found to be too low. To be of practical use it is important in the design of experimentation to try to reduce the measurement error.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1995

Osteoporosis prevention and treatment with sex hormone replacement therapy.

Oestrogen deficiency is by far the major factor contributing to the high rate of osteoporotic fractures in women. The anti-osteoporotic effect of estrogen may be explained by its property to regulate cytokine secretion and thus balance bone remodeling. In oestrogen deficiency, increased resorption and remodeling will occur leading to osteoporosis. It has been extensively shown that oestrogen replacement therapy (ERT) prevents postmenopausal bone loss and reduces fracture risk by half, provided that an appropriate dose is used. In order to optimize osteoporosis prevention, ERT should be started a early as possible in menopause and be maintained as long as possible. ERT may also be effective in elderly osteoporotic patients in preventing bone loss and, reducing fracture risk. The acceptance of ERT, however, at an older age has not been thoroughly evaluated. A reduction of cardiovascular disease and of climateric symptoms are among other benefits of ERT. So far, only few postmenopausal women are treated with ERT. ERT without progestins has been repeatedly found associated with an increased risk of developing endometrial cancer, but the cyclic addition of progestins protects from endometrial hyperplasia and carcinoma. Combined oestrogen-progestin therapy is as efficient as estrogen therapy alone, but not more so. Since progestins may oppose some of the beneficial effects of estrogens, the lowest dose with the least metabolic impact should be prescribed. Women who have had a hysterectomy, should probably be treated by estrogen replacement therapy only. Meta-analyses concerning breast cancer associated with ERT found a very moderately increased risk (RR = 1.06). Therefore ERT prescription should be discussed openly with women considering all risks and benefits. In women who have suffered from breast cancer, a bone sparing effect of tamoxifen has been shown.

Estrogen Replacement Therapy↗
PubMed1995

Clinical significance of heterogeneity of vertebral mineral density.

Important variations in Z-score per vertebra, which is a common expression of bone mineral density (BMD), are sometimes observed. The present study evaluates the clinical significance of this heterogeneity. Normal and osteoporotic subjects were defined by using strict criteria. For every scan, the minimal Z-score (the vertebra with the lowest Z-score) and the delta Z (highest Z-score--lowest Z-score) was calculated. Of the investigated subjects, 30% presented a delta Z > or = 1. No significant correlation could be found between delta Z and age, BMD, height and weight. There was no difference in delta Z between scans of good, average or poor quality. Osteoporotic subjects had significantly lowered BMD values, whether evaluated through Z-scores for the L2-L4 site (P < 0.001; t = 3.71) or by minimal Z-score (P < 0.001; t = 3.97). Reproducibility calculated for the L2-L4 site on phantoms as well as on patients was excellent (C.V. < 1%). When reproducibility was calculated on each vertebra in vitro or in vivo, an increase in variability was observed. These data show that marked heterogeneity in BMD per vertebra is not infrequent. In some subjects low BMD may be measured at certain vertebrae but not at the total site. Our data suggest that in those cases the lowest BMD should be considered. In follow-up studies however, the BMD should be calculated on the L2-L4 segment, since a loss of precision is observed when only one vertebra is measured.

Absorptiometry, Photon↗