Predicting Injury Of Military Personnel And Athletes

MILITARY personnel and sporting professionals could soon be ensuring a far longer period of career success, thanks to a landmark study commissioned in Suffolk.


The first ever randomised trial of its kind* has proven that injury rate among military professionals can be predicted and reduced, as a result of special technology.


A total of 400 new entry trainees were assessed at the Britannia Royal Naval College, Dartmouth in a study led by Dr Andrew Franklyn-Miller. Over 3 years, he researched the trainee population using state-of-the-art equipment supplied by Suffolk-based Footfunction Centre.


The RSscan footscan system, devised by RSscan Lab Ltd and used at the Centre, works by measuring vertical force over a number of sensors and then enables a D3D orthotic to be created. Figures collated this month now show that prescription of this specialist orthotic can reduce injury rate by as much as 31 per cent in those at high and medium risk of injury - but as much as 78 pc in the high risk category.


The finding is a significant one for the military, in which many trainees are lost from duty and ongoing time-dependent training due to injury (particularly lower limb injury). It typically costs ┬г2,000 per week for a trainee to be out with injury.


It will also be music to the ears of those in the sporting profession, proving that injury can be predicted and prevented.


This was an independent study by the Military of Defense where Andrew Franklin Miller led the study.


"We are delighted with the results of the trial," said Ms Smith-Rewse of the Foot Function Centre. "Our work at the Centre has long been confirming that the technology really can predict and reduce injury, but now it has formed part of one of the largest randomized orthotic studies in the world.


"On a daily basis we see athletes, members of the military, and recreational sportsmen and women whose lives can be dramatically improved as a result of this kind of facility.


"We are delighted that now we can confidently share our success with the wider world on the basis of these exciting findings."


Chic Wilkinson, Clinical Team Manager at RAF Honington, has been using the orthotics produced by the Suffolk team and their technology.


He said: "The D3D Performance Orthotic is proving to be very successful in the treatment and management of many of the prevalent lower limb injuries seen in military recruit training.


"This research is a massive step forward and potentially means a saving of many thousands of pounds for the military.


"It typically costs ┬г2000 per week to have a person out of training through injury. We needed proof that the right technology could help us predict and prevent that - and we now seem to have that evidence."


The clinical trial consisted of 400 male participants walked across a 18metre track with a 1m footscan® system, pressure measure system, in-bedded within. Only five tests were taken of each recruit and only 6 minutes were given to each participant. Analysis of taken data and three risk groups were formed of likelihood of injury: LOW, MEDIUM and HIGH.

The conclusions were that the Right Stride D3D™ orthotics reduced injury rate by 31% in those categorised as High and Medium risk groups combined and in the high risk group by as much of 78%!

The D3D™ orthotics are patented and are manufactured to very high standard and are supplied by RSscan Lab Ltd, UK.


*The author of the report believes this to be the first trial of its kind, ever.


The Footfunction™ Centre have dedicated health specialists in podiatry and biomechanics. Bespoke orthotics are manufactured on site, enabling quick and professional service.

Ultrasound-Guided Cortisone Injections May Help Treat Severe Hip Pain

Ultrasound-guided cortisone injections may be an effective treatment method for gluteus medius tendinopathy, a common, painful condition caused by an injury to the tendons in the buttocks that typically affects middle-aged to elderly women and young active individuals, according to a study published in the January issue of the American Journal of Roentgenology.



Gluteus medius tendinopathy can cause severe hip pain. "The underlying causes remain unclear but probably are multi-factorial and involve mechanical and degenerative processes," said Etienne Cardinal, MD, lead author of the study. Medical treatment usually includes physiotherapy, nonsteroidal anti-inflammatory medication, and local injections of corticosteroids.



The study, performed at the University of Montreal's Hospital Center, included 54 patients with gluteus medius tendinopathy. Ultrasound-guided cortisone injections were performed on all patients. "One month after treatment, 72 percent of the patients showed a clinically significant improvement in pain level. Seventy percent of patients were satisfied with the results of the intervention," said Cardinal.



"The use of ultrasound for guiding musculoskeletal procedures has increased over the past several years. Advantages of ultrasound over fluoroscopy include its soft-tissue imaging capabilities that allow a diagnostic study to be performed before cortisone injection," he said.



"This noninvasive, nonionizing imaging technique allows continuous monitoring of the needle position, which facilitates the performance of safe and precise cortisone injections," said Cardinal.



This study appears in the January issue of the American Journal of Roentgenology.



Source:

Heather Curry

American College of Radiology / American Roentgen Ray Society

Lower Back And Foot Pain Associated With More Severe Knee Osteoarthritis Symptoms

A new study found that patients with osteoarthritis (OA) of the knee who also have pain in other joints were more likely to experience greater knee pain. Specifically, pain in the lower back as well as foot pain and elbow pain on the same side as the affected knee were associated with more severe knee pain. Full details appear in the December issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.


Knee OA is the leading cause of disability in the U.S., with nearly 4.3 million adults over age 60 having the symptomatic form of the disease according to the Centers for Disease Control and Prevention (CDC). A study by Helmick et al. published in Arthritis & Rheumatism reported 59 million people have low back pain, which is the most common cause of lost work time among individuals less than 45 years of age and the third most common cause among those 45 to 65 years of age.


The current study team led by Pradeep Suri, M.D., from Harvard Medical School, New England Baptist Hospital, and Spaulding Rehabilitation Hospital in Boston, Massachusetts used data provided by individuals from the Osteoarthritis Initiative a multicenter population-based observational cohort study of knee OA. A subgroup of 1,389 participants, ages 45-79 years who had symptomatic knee OA in at least one knee were included, with patients also asked to identify pain in the lower back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle or foot. Researchers used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to measure the level of pain of patients in the study on a scale of 0 to 20 with lower scores representing less pain and stiffness.


Results indicate that 57.4% of participants reported having pain in their lower back. Participants with low back pain had a mean WOMAC pain score of 6.5, while those without pain in their lower back scored 5.2. Researchers found that low back pain was significantly associated with an increase in the WOMAC knee pain score, with similar associations demonstrated in all other individual joint locations that were studied. Those models analyzing pain locations simultaneously show only low back pain, and ipsilateral foot pain and elbow pain were significantly associated with a higher knee pain score.


Additionally, researchers determined that having more than one pain location, regardless of the site, was associated with greater WOMAC knee pain score. In participants with four or five pain locations the severity of knee pain was even higher. "Our findings show that pain in the low back, foot and elbow may be associated with greater knee pain, confirming that symptomatic knee OA rarely occurs in isolation. Future studies are needed to determine whether treatment of pain occurring elsewhere in the body will improve therapy outcomes for knee OA," Dr. Suri concluded.


Sources: Wiley - Blackwell, AlphaGalileo Foundation.

European Edition Of SAGE's 'Foot & Ankle Specialist' To Launch

SAGE is to launch Foot & Ankle Specialist - European Edition from February 2011. The journal will be an international edition of Foot & Ankle Specialist (FAS), a bimonthly controlled circulation journal launched in 2008 publishing peer-reviewed clinical information for foot and ankle caregivers.



Written and edited by podiatrists and orthopaedic surgeons, FAS offers the latest techniques and advancements in foot and ankle treatment through research reports and reviews, technical perspectives, case studies, and other evidence-based articles. FAS enables practitioners to address a broad range of disorders and provide their patients with the best current diagnosis and therapy.



Topics covered in the journal include ankle instability & arthritis; sports podiatry or orthopaedics; diabetic foot & wound care; heel pain, plantar fasciitis and heel spurs; dermatology and skin care; surgeries and infection. It is of interest to all those involved in foot and ankle specialisms, including surgery, nerve and wound specialists, physicians, nurses, and physical therapists.



Content in the European edition of FAS will be the same as the existing journal, and the website for both will be fas.sagepub. All content published is free to access.



"We have been delighted with the response from health professionals to FAS in the US market and see real potential for the forthcoming European edition," said Tessa Picknett, Associate Director, STM Journals, SAGE. "FAS has both a truly outstanding Editor and Editorial board, and equally has attracted a list of incredibly strong contributors making this a high-quality journal that is valued by caregivers from across the foot and ankle specialisms."



The first edition of Foot & Ankle Specialist - European Edition will be vol. 4, issue 1, year 2011. Foot & Ankle Specialist is published six times a year in February, April, June, August, October, and December.



Source:

Jayne Fairley


SAGE Publications UK

First Asia-Wide Osteoporosis Awareness Campaign Launched

International Osteoporosis Foundation's first TV ad encourages women to take the One Minute Risk Test, materials aimed at
physicians to help them treat patients effectively


The first Asia-wide advertising campaign promoting action against osteoporosis was launched today in Hong Kong.


The campaign, prepared by International Osteoporosis Foundation and its 24 member societies in Asia, urges women to take
control of their bone health by taking the "IOF One Minute Osteoporosis Risk Test".


The advertising will appear on television and in print. In addition, IOF has prepared a special campaign aimed at physicians,
to enable them to do an even better job of diagnosing and treating patients with osteoporosis.


The campaign is spearheaded by a TV spot that urges women to take responsibility for their bone health.


In the 30-second public service announcement, the form of one mannequin, representing the one in three women over 50 who will
get osteoporosis, suffers the three most common osteoporosis fractures - wrist, spine and hip.


Leading TV stations throughout the region have agreed to broadcast the TV spot without charge. They include CNBC, CNN, Star
TV, Discovery Health Channel, National Geographic Channel, MediaCorp News, in print, the International Herald Tribune, and in
outdoor media, Clear Channel. In addition, numerous corporate sponsors* will support the campaign in order to generate
maximum reach. This donated airtime and sponsorship is valued at around US$ 200,000.


The film, shot in Mumbai, India, was directed by Naren Multani, one of India's leading film makers - he won a One Show Pencil
(Silver) in 2002, was a Clio Finalist in 2001, and his first independent film, "Mindgame" has been shown at the New York
Short Film Festival and San Francisco Film Festival.


Osteoporosis, when the bones become brittle and break easily, is one of the world's most widespread and debilitating
diseases.


In Europe and the United States together, the lifetime risk of hip fracture in women is larger that sum of lifetime risks of
having breast, endometrial and ovarian cancer. The lifetime risk of hip fracture in men is greater than that of prostate
cancer.


Speaking at the advertising launch, Daniel Navid, IOF chief executive officer, warned, "Osteoporosis is already a huge health
problem in Asia, and getting more serious every day. It is a time bomb ticking -- Asian women and men must take immediate
action to protect themselves from fractures and disability."


Osteoporotic fractures are expensive both in terms of human stress and in cost of care. By 2050, 6.4 million people worldwide
will suffer a hip fracture annually, with 51% of these fractures occurring in Asia. In China, one in six men have one or more
vertebral fractures.















Prof. Edith Lau, president of Hong Kong Osteoporosis Foundation and an IOF Board member said, "Asians are at high risk of
osteoporosis. We have a lower bone density, we don't get a calcium-rich diet as children and we increasingly lead a sedentary
lifestyle." She noted that in Hong Kong, 45% of women aged 65 and above have osteoporosis, while 42% of them have low bone
mass (osteopenia). A total of 300,000 women and 70,000 men who are 50 years and older suffer from osteoporosis, as defined by
the WHO criteria. In 2001, 8 in every 1000 women and 3 per 1000 men fractured their hip. The death rate for hip fractures is
10 percent and 50 percent become disabled due to the hip fracture.


Yet about half of hip and vertebral fractures can be prevented, if the disease is treated promptly and adequately, Dr. Lau
said. Both diagnosis and treatments of osteoporosis are painless, simple and easy, but doctors need to be informed, which is
one of the objectives of the part of the campaign aimed at health professionals.


Prof. Annie Kung, president of Osteoporosis Society Hong Kong, urged people to take responsibility for their bone health by
taking the IOF One Minute Risk Test. She said, "Osteoporotic fractures often result in a loss of productivity and mobility.
Only by regularly checking our bone density can we Asian women be sure we will be able to retain our independence. The TV
spot will alert women throughout Asia that they can easily find out if they are at risk of osteoporosis by taking the risk
test."


Similar launches are planned in other Asian countries.


The film and the campaign's coordination and launch were realized through services donated by agencies within the Interpublic
Group of Companies. Torre Lazur-McCann Healthcare Worldwide, a member of the IOF's Committee of Corporate Advisors, provided
coordination support and connected their affiliates with IOF member osteoporosis societies throughout Asia to initiate the
campaign in local markets. McCann Healthcare also developed the creative concept and produced the television commercial. The
launch event and media relations were undertaken by Weber Shandwick, the world's largest public relation agency.


ENDS


Notes to Editors:


For more information about IOF contact : Paul Sochaczewski:

psochaczewskiosteofound


For more information about the advertising campaign contact: Caroline Brivoal

McCann Healthcare (Singapore)

Tel: +65 6737-9911

caroline.brivoalap.mccann


For media enquiries in Asia: Pamela So

Weber Shandwick Worldwide

Tel: 852 2533 9916 / 852 8109 8166

psowebershandwick


Winnie Hui

Weber Shandwick Worldwide

Tel: 852 2533 9920 / 852 9345 3657

whuiwebershandwick


* Corporate sponsors to date include: Aventis, Bright Milk, GSK, Lilly, MSD, Nestle, NZDB, Novartis, Sohu, Subway, Tetra Pak,
Ultronics, Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and
debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One
out of three women over 50 will experience osteoporotic fractures, as will one out of five men (1,2,3).


Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be
prevented, it can be easily diagnosed and effective treatments are available.


1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992;
7:1005-10


2 Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674


3. Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It
brings together scientists, physicians, patient societies and corporate partners. Working with its 167 member societies in 85
locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early
detection and improved treatment of osteoporosis.


osteofound

Muscles And Bones In Cahoots

Traditionally, doctors and clinicians thought diseases that affect muscles or bones affected those areas specifically. For example, bone diseases only affect bones, or muscle diseases only concerned muscles. But recent evidence supports the notion that bones and muscles are more interconnected than previously thought. It seems that bones and muscles can release signals that directly affect one another's function or disease state. Even more remarkable is that these systems seem to produce secreting factors that communicate to distant parts of the body.


Dr. Marco Brotto, the director of the Muscle Biology Group at the Schools of Nursing and Medicine, University of Missouri-Kansas City (UMKC) will be discussing the latest findings about the shared communication and dependence between muscles and bones at the annual 2010 Experimental Biology conference in Anaheim, CA being held April 24-28 Brotto will deliver his presentation, "Evidence for Pathophysiological Crosstalk Between Bones, Cardiac, Skeletal and Smooth Muscles," on behalf of his team, which includes Leticia Brotto, Todd Hall and Michael Loghry, Sandra Romero, and collaborations between two other principle investigators from the University of Missouri-Kansas City, Kansas City, MO, Jon Bonewald and Mark Johnson; and Thomas Nosek, J. Shen and C-K Qu of Case Western Reserve University, Cleveland, OH.


The Cost of Aging


With new revolutions in medicine, the average lifespan in developed countries continues to increase. As a result, the incidence and cost of treating age-related diseases has skyrocketed, particularly those that result from years of wear and tear of muscles and bones.


Every year, the cost alone in the United States of treating osteoporosis an aging disease predominantly found in women that causes fragile bones is $14 billion, according to The National Institutes of Health website. Other diseases, like sarcopenia a muscle wasting disease affects every individual over the age of 50 resulting in the loss of one to two percent of muscle mass each year. As the baby boomers get older, the trend in rising costs continues.


This is why Brotto's findings that muscle and bone diseases affect one another may have an astronomical impact when considering the long-term effects of designing new preventatives and treating age-related muscle and bone disorders.


The Lines of Communication


Brotto's collaborative group observed that mutations or defects in specific genes important for muscle function, also created changes in bones. The reciprocal effect happens when mutations are made that affect bone function. These observations led to the search for signaling components that could affect both organs, but the group has also encountered some intriguing surprises along the way.


Brotto researcher's discovered that bones act like glands to secrete hormones that are detected by muscles. Reciprocally, muscles are releasing factors, known as myokines that are detected by bones affecting bone mass and strength. And the separate muscle types, heart (cardiac), skeletal and smooth muscle (like that of the stomach and blood vessels) secrete different signals for different reasons.















The group identified multiple components of signaling systems involved in muscle and bone communication. Specifically, they distinguished a certain type of prostaglandin released from bone cells (osteocytes). Other findings revealed that the Wnt pathway, which is important for normal development, could be linked to wasting diseases in both muscles and bones.


One area Brotto's group focused on was the regulation of calcium metabolism. Calcium is needed both to build strong bones and to make muscles contract. Researchers focused on a muscle specific phosphatase called MIP that decreases naturally as we age that may be involved the regulation of calcium levels in the body. Researchers removed the MIP protein from mice by knocking out the gene that codes for the protein. These mice had muscle weakness and faster aging, as well as reductions in bone densities. The mutant mice also had weakness in smooth muscle function of the contracting arteries and vessels. Interestingly enough, some of these results seemed to be gender specific. The female mice developed osteoporosis, but the males did not. And there was female bias for weakness in heart muscle function that was not seen in the male subjects. This data supports that calcium regulation is different between the two sexes, which may explain why women are more likely to get osteoporosis than men.


A New Approach to Bone Fractures: A Breakdown in Communication Between Muscle and Bone?
For the many diseases that target muscles diet, exercise and hormone therapy are the only treatments. Unfortunately, many patients have health conditions that prevent them from exercising limiting their treatment options. Brotto is hopeful that following the new line of research studying the communication between muscles and bones will identify novel therapies and potentially help millions of people.


When a bone is fractured, it is typically thought to be a defect in the strength of the bone. But the Bone-Muscle team at UMKC hypothesizes that it may be caused from a breakdown in communication between muscles and bones. Muscles put force on bones as they contract, which is known as mechanical loading. Perhaps the muscles put too much force on the bones at the wrong time, which results in a break.


"We would like to discover chemical factors that can bypass the issue of loading and could patch communication on the muscle side or the bone side to make the unity stronger," Brotto said.


Source: Federation of American Societies for Experimental Biology (FASEB)

Disability Transitions And Osteoarthritis In High Functioning Older Women

Osteoarthritis, common among older adults, is strongly linked to late-life disability, but the process by which this happens has not been well studied. A recent study published in the April 2006 issue of Arthritis Care & Research (interscience.wiley/journal/arthritiscare) examined the impact of osteoarthritis in the lower extremities and found that women with this condition have a greater risk of developing decreased mobility, a risk which is further increased by being overweight.



Led by Shari M. Ling of Intramural Research Program, National Institute on Aging/NIH together with investigators in the Center on Aging and Health at the Johns Hopkins Medical Institutions in Baltimore, MD, researchers used data obtained from participants in the Women's Health and Aging Study II (WHAS II) to determine whether patients with osteoarthritis in their lower extremities were more prone to developing mobility limitations than women who did not have the disease. They also looked at whether limitations in mobility tended to develop before difficulty in activities of daily living. Their analysis included 199 women with lower extremity osteoarthritis who had no difficulty with mobility tasks at the beginning of the study and 140 women without osteoarthritis in the knee or hip, all of whom were between 70 and 79 years old. Patients were evaluated as to their osteoarthritis status, the presence of pain, knee strength, knee torque, and their level of mobility 18, 36 and 72 months following the initial evaluation.



The results showed that even though more women with osteoarthritis reported using arthritis medications, a greater proportion reported having pain most days and greater pain severity while walking and climbing stairs compared to women with no OA. In addition, 26% of the women with osteoarthritis were obese compared to 11% of the women without the disease, and an additional 40% were overweight. The two groups were similar, however, with regard to knee strength and torque. Overall, women with osteoarthritis were about 2.5 times more likely to develop difficulty in both lower extremity mobility and activities of daily living than those who did not have osteoarthritis. Greater knee strength reduced the risk of developing difficulty performing daily activities whether or not the woman had osteoarthritis, and greater knee torque had the same effect, although it did not reduce the risk for lower extremity difficulty.



"Despite numerous cross-sectional reports of the associations between OA [osteoarthritis], painful symptoms, low strength and obesity, existing studies have not been able to discern the relative contributions of these closely related factors to the development of specific mobility difficulty characteristics," the authors note. The current study demonstrates that lower extremity osteoarthritis is associated with painful symptoms, excess weight and obesity and that women with painful osteoarthritis are more likely to develop lower extremity limitations combined with limitations on their daily activities. The fact that this is affected by higher body mass is what lends novelty to the current study, according to the authors.



"Longitudinal observations of well-functioning women living in the community who are at risk of functional decline provide a unique perspective from which OA can be examined," the authors state. The findings of the current study are particularly relevant given the increase in the number of older Americans and the trend to higher rates of obesity among Americans in all age groups. The authors conclude: "The trends towards earlier onset of obesity observed between 1991 and 1998 would predictably translate into a higher proportion of adults who could develop painful symptoms and mobility difficulty at an earlier age."







Article: "Transitions to Mobility Difficulty Associated With Lower Extremity Osteoarthritis in High Functioning Older Women: Longitudinal Data from the Women's Health and Aging Study II," Shari M. Ling, Qian Li Xue, Eleanor M. Simonsick, Jing Tian, Karen Bandeen-Roche, Linda P. Fried, Joan M. Bathon, Arthritis Care & Research, April 2006; 55:2; pp.



Contact: Amy Molnar

amolnarwiley

John Wiley & Sons, Inc.

Why Women's Feet Hurt More In Autumn

Fall is not a fun time of year for women like Elaine Powers.


In the summer months, "like everybody else, I like to wear flip-flop sandals, open-toed shoes, a nice pedicure with good nail polish," she says.


But as autumn arrives, the 49-year-old South Carolina hospice nurse is making the annual changeover to closed-in shoe styles more appropriate to the cooler weather. It's a transition many women are making in their wardrobes. But it's more painful for women like Powers, and not because she's a slave to foot fashion. Powers has bunions.


"Even after you take your shoes off, or put your feet up, it's just a throbbing… It's almost like every time your heart beats, that bunion throbs," she says.


Women with bunions are a common sight in the waiting rooms of many foot and ankle surgeons during this time of year, according to the 6,000-member American College of Foot and Ankle Surgeons (ACFAS).


St. Louis foot and ankle surgeon Karl Collins, DPM, FACFAS, gives two additional reasons for this annual trend. One is financial. Women are closer to meeting insurance deductibles near the end of the year.


"The other thing is, people are very active in the summer," Collins says. "They're always outdoors, they're always at the pool or whatever, so they will decide to get their bunion fixed in the winter, because in their mind, they're not missing anything fun."


Powers has suffered with bunion pain for nearly 25 years. However, many women never experience pain from their bunions, even when the deformity looks severe. Shoes do not cause bunions, but they may cause bunion pain. That's why foot and ankle surgeons recommend shoe modifications to new patients. Avoiding high heeled shoes and styles that crowd the toes together can help. Collins says proper shoe selection and adjustment can go a long way.


"If they have a shoe that fits well everywhere else, but there's just a little bit of irritation at just that one spot, we may recommend that they have the shoe modified (by a shoe repair shop)," he says.


South Carolina foot and ankle surgeon Michelle L. Butterworth, DPM, FACFAS, treats a lot of teachers with back to school bunion pain. She says many women don't understand what doctors mean about shoe width: It's the front of the shoe that needs to be wide.


"Anything that's real pointy is going to put more pressure on that (bunion) bump," she explains.


In addition to recommending shoe changes, foot and ankle surgeons may also prescribe foam- or gel-filled padding, orthotics, anti-inflammatory medications, and injections for bursitis, nerve irritation and joint irritation. While these techniques address pain, they do not stop the bunion from getting worse. Only surgery can correct the deformity.


Bunion surgery boasts a high success rate. But surgeons agree that patients need to understand what their procedure and recovery will involve.















"Probably the biggest thing is, they think surgery's not going to work and (the bunion is) going to come back," says Butterworth. "It's probably the biggest myth I dispel."


Powers is one of her patients.


"That's one of the reasons why I haven't had this surgery before now," Powers says. "A lot of people tell me once you have (bunions), you are always prone to have them, they'll come back."


Following the surgeon's instructions for recovery can significantly reduce the chances of a bunion returning.


"If wearing four-inch heels and working on your feet all day wasn't good for you before the surgery, it's certainly not going to be good for you after the surgery," notes Michael Loshigian, DPM, FACFAS, a New York City foot and ankle surgeon.


Powers hasn't made up her mind about bunion surgery. She's already tried prescription pain medication, and struggles to find comfortable shoes. This fall, Butterworth will perform bunion surgery on Powers' 19-year-old daughter, who inherited her mother's feet. Powers wants to see how that turns out. She also has to worry about finding someone to cover her 12-hour work shifts for several weeks.


But if she does choose surgery, she already knows how she'll celebrate after her recovery.


"I'm buying a pair of stiletto heels and I'm wearing them everywhere I go," she jokes.


The ACFAS provides a list of answers to frequently asked questions about bunion surgery on FootPhysicians.


The American College of Foot and Ankle Surgeons is a professional society of more than 6,000 foot and ankle surgeons. Founded in 1942, the College's mission is to promote research and provide continuing education for the foot and ankle surgical specialty, and to educate the general public on foot health and conditions of the foot and ankle through its consumer Web site, FootPhysicians.


American College of Foot and Ankle Surgeons

8725 W Higgins Rd., #555

Chicago, IL 60631

United States

acfas

Androgen's role in bone loss

An extensive, Oregon Health & Science University-led research effort examining the role of the male sex hormone androgen
in bone formation has piqued the interest of the United States military.


The U.S. Army Medical Research and Materiel Command, looking to reduce stress fractures and preserve bone health among its
young recruits, is funding a four-year, $1.72 million project through the Department of Defense Peer Reviewed Medical
Research Program that scientists hope will lead to a better understanding of the molecular and cellular events by which
androgen influences the skeleton.


"It turns out that one of the most common injuries sustained in basic training in both men and women is stress fracture in
long bones. In this population, there's also anabolic steroid abuse," said the study's lead investigator, Kristine Wiren,
Ph.D., associate professor of medicine (endocrinology, diabetes and clinical nutrition) and behavioral neuroscience, OHSU
School of Medicine, and research biologist, Portland Veterans Affairs Medical Center.


"The goal of the Army in funding this grant is to identify factors that promote a healthy skeleton, that influence stress
fractures, and to treat and prevent bone-weakening osteoporosis in the aging population."


Of the 1.3 million bone fractures attributed to osteoporosis each year, 150,000 are hip fractures that occur in men with a 15
percent lifetime risk for the development of fracture. Hip fractures tend to occur over the age of 70; nearly a fourth of the
patients who suffer a hip fracture die within the first year; half of patients are unable to walk without assistance; and a
third are totally dependent.


Osteoporosis is characterized by a relative decrease in bone formation, mediated by osteoblast cells, versus bone resorption,
mediated by osteoclast cells. Androgen - testosterone is best-known type - and estrogen both contribute to adult bone mass
maintenance: Androgen is an anabolic agent that stimulates bone formation, and estrogen is thought to have a protective
effect on bone by inhibiting resorption.


"In osteoporosis, you have more resorption than formation," Wiren said.


Aging, glucocorticoid therapy for asthma, alcoholism, chronic smoking and bone marrow malignancies are believed to cause
androgen deficiency. All - in addition to reduced hormone secretion from the testes, a condition called hypogonadism - are
associated with osteoporosis development in men.















The disease also is a side effect of androgen deprivation therapy, a common treatment for prostate cancer that wipes out most
male hormones found in the body.


"Women and estrogen have been targets for a lot of osteoporosis research because estrogen is effective at stopping bone
loss," Wiren said. "We understand a lot more about estrogen than we do androgen. But both genders have androgen and both
genders have estrogen and both are at risk for the development of osteoporosis. It's also clear in intervention studies that
you can effectively treat osteoporotic women with androgen."


One option being studied for treating osteoporosis in men and women is androgen therapy, either through androgen replacement
using hormone drugs, or androgen replacement combined with estrogen replacement.


"You get a better response with combined treatment than with either steroid alone, which suggests they're doing different
things," Wiren said.


Selective androgen receptor modulators, or SARMs, are among a class of drugs that also are being studied as an alternative to
androgen therapy. Like selective estrogen receptor modulators, SARMs activate the hormone's signaling pathway, but only in a
tissue-specific manner. By targeting androgen receptors in bone, SARMs are thought to curb potential risks for prostate
cancer progression and other side effects that can result from androgen replacement.


The Army grant, which began in November, comes on the heels of a study Wiren published in July in the journal Endocrinology.
In it, she describes her research team's development of a transgenic mouse group with overexpressed androgen receptors in
bone-forming osteoblast cells.


"There's a whole superfamily of receptors for steroid hormones; steroids require a receptor for biologic actions," Wiren
said. "By overexpressing the receptor, we get a more sensitive response to androgen."


Using collagen DNA cloned from rats as a promoter, Wiren was able to drive overexpression of the androgen receptor DNA in the
skeleton and at a high level. "When we characterized how much of the receptor was present, it was four-fold higher. It's
higher than what you usually have in bone, but at a level you'd find in the prostate or other androgen target tissues," she
said.


The result was a mouse group with enhanced androgen responsiveness in bone, particularly among males. Their skulls were
thicker, they had increased formation on the outside of long bones, such as the femur, decreased formation on the marrow
surface inside the bone, reduced bone loss and low bone "turnover." Biomechanical analysis showed that the bones were not
stronger, however, with reduced load capability and different material properties.


The study also demonstrated that androgen receptors are important to the development of the sexually distinct skeletons of
men and women.


"There are receptors everywhere, but these mice demonstrate proof of concept that the androgen receptor in bone is
responsible for sexually dimorphic skeletons. In other words, that male bones are wider than female," she said. "This is an
important model to look at the influence of gender on bone development and skeletal maintenance."


To access all OHSU news releases, visit ohsu/news.



Contact: Jonathan Modie

modiejohsu

503-494-8231

Oregon Health & Science University

Researchers Win Award For Best Clinical Paper In Orthopedic Physical Therapy

University of Delaware researchers have won the American Physical Therapy Association's award for the best clinical paper in orthopedics published in 2008.



Their study focused on one of the most controversial topics in sports medicine-the management of anterior cruciate ligament (ACL) injuries.



Each year, nearly 250,000 Americans, particularly athletes, rupture their ACL, which is one of the major ligaments of the knee.



The authors included Wendy Hurd, a Ph.D. graduate of the UD Biomechanics and Movement Science Program, Michael Axe, clinical professor of physical therapy at UD and an orthopedic surgeon at First State Orthopedics in Newark, Del., and Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy.



The team received the 2009 Steven J. Rose Excellence in Research Award from APTA's Orthopaedic Section on Feb. 11 at the association's meeting in Las Vegas.



Their article, "A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals with Anterior Cruciate Ligament Injury: Part 2: Determinants of Dynamic Knee Stability," was published in the January 2008 issue of the American Journal of Sports Medicine.



It was one of three papers from the team that reported on a 10-year sample of patients.



Should a patient with an ACL injury undergo surgery or not? Although ACL reconstruction is the answer for most patients, a small percentage can make a full recovery without surgery.



Building on past University of Delaware research, the clinical team devised a screening method to identify patients who are the best candidates for rehabilitation through physical therapy.



The approach is based on the stability of the patient's knee while doing a series of simple hop tests.



The tool, which has been tested on 10 years of data, will aid physicians and patients in making the decision about whether safe return to activity is possible without ACL reconstructive surgery.







Source: Tracey Bryant


University of Delaware

IOF Launches New Osteoporosis Website

Major features include enhanced interactivity; new database-driven architecture; expanded, latest information for patients, the public, health care professionals and the media; new section on nutrition and bone health.


The International Osteoporosis Foundation (IOF) today introduced an extensive, newly designed website in Hong Kong as part of the global launch of World Osteoporosis Day.


The new website - iofbonehealth - replaces the previous site - osteofound - although the old address will continue to link to the new one.


The new website contains some 1,200 pages and is expected to continue building on the popularity of the existing website, which at present registers some 1.6 million hits per month.


"In spite of the success of the current site, it was time for a change," noted IOF Chief Executive Officer Daniel Navid. "Our original website was created in 1998 and obviously much has changed in the amount of information available in the field of osteoporosis, and also in website design and the way people use the internet to obtain information. The new website makes use of the latest technologies to provide targeted and comprehensive information for a variety of users."


Some highlights of the new website include:


Access to national osteoporosis societies worldwide?


The IOF website continues to be the only source for contact information and links to the IOF's 173 national osteoporosis member societies in 86 locations, representing some 82% of the world's population.


Nutrition section


This new section is particularly timely since it provides information related to the World Osteoporosis Day 2006 theme "Bone Appйtit: The role of nutrition in building and maintaining strong bones". Special features include an overview of nutrition and bone health; a global recipe database featuring bone-friendly recipes provided by the IOF's member societies and renowned master chefs; a novel calcium calculator which is based on weekly calcium intake; and tables of foods rich in calcium and vitamin D.


Health Professionals?


Designed to provide doctors, nurses, and allied health specialists with detailed information on osteoporosis, this section includes special topics such as: bone biology; secondary osteoporosis; diagnosis, treatment and care; osteoporosis in men; the role of exercise for bone health; and other osteoporosis-related issues.


What is Osteoporosis??


This well-illustrated section is now available for both the public and, in more detail, for health professionals. It offers a succinct, easy-to-read overview of osteoporosis, and its prevention, diagnosis and treatment.















Advocacy/Policy


Newly revised and expanded, this section will feature news on worldwide policy and lobbying initiatives, key facts and statistics, and national osteoporosis guidelines and other key resource documents, grouped by region of the world.


VIP quotes


In this new section, entertainers, athletes, chefs and osteoporosis advocates will offer personal messages to inspire people with osteoporosis and help raise awareness of issues important to patients and health care providers alike.


Technical innovations?


The new website makes extensive use of the most popular web technologies, PHP (programming language) and MySQL (database). It features an object-oriented, extensible architecture that forms a solid foundation for the further development of the website. An innovative approach to content classification and linking was developed to make the wealth of information accessible to different interest groups.


Sponsors?


Various sponsors, who are members of IOF Committee of Corporate Advisors, have provided unrestricted educational grants for the development of this website, particularly Schering AG, Amgen, Tetra Pak, MSD, Novartis, and Fonterra Brands.


The new website was developed by Zephir, based in Basel, Switzerland.


For complete details on World Osteoporosis Day 2006 activities today, please click here.


Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men1, 2, 3. Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.


The International Osteoporosis Foundation (IOF) is the only worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 173 member societies in 86 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.


1 - Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

2 - Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674

3 - Melton LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915


iofbonehealth

PAC Looks At Risks Associated With Osteoporosis Medications, Australia

Osteoporosis is such a major health problem that it is estimated someone is admitted to an
Australian hospital with an osteoporotic fracture every five to six minutes.


And by 2021 it is suggested the frequency of hospital admissions will have increased to one
admission every three to four minutes as the population ages and osteoporosis becomes
more prevalence.


The importance of pharmacists understanding and better managing osteoporosis will be the
subject of a key presentation in the Advanced Clinical Practice stream at this year's
Pharmacy Australia Congress in Sydney being held at the Sydney Hilton from 15-18
October under the overarching theme of Securing Your Practice Advantage.


Osteoporosis treatments - what are the risks? will be presented by Professor Jeff Hughes,
Head, School of Pharmacy, Curtin University of Technology, who will examine the number
of pharmacological and non-pharmacological measures which may be employed to prevent
and manage osteoporosis, in particular to reduce the risk of bone fracture.


"These inventions have varying clinical efficacies and associated toxicities," Professor
Hughes said.
"The decision to commence a person on drug treatment for their osteoporosis should
always be based on the estimated benefit of treatment (that is, the potential to prevent bone
fracture) balanced against the potential risks (that is, adverse effects)."


Professor Hughes says the past decade has seen the emergence of evidence that can
better inform physicians in the choice of osteoporosis management.
"In this presentation the array of adverse effects which need to be considered in selecting
the appropriate drug therapy for an individual patient will be discussed," he says.
"These will include gastrointestinal disorders, cancer, hypercalcaemia, cardiac arrhythmias ,
thromboembolic disorders , musculoskeletal disorders, osteonecrosis of the jaw, and bone
fractures."


As well as being Head of the School of Pharmacy at Curtin University of Technology.,
Professor Hughes is recognised as a leader in clinical pharmacy education and practice in
Australia.


In 2004 his efforts in the areas of clinical pharmacy education and pharmacy research were
acknowledged when he was named the Pharmaceutical Society of Australia's Pharmacist of
the Year.

Source
Pharmaceutical Society of Australia

Diagnosing Brittle Bones Before They Break

With an Australian admitted to hospital every eight minutes suffering from the brittle bone condition osteoporosis, a QUT researcher is using a Smart State PhD Scholarship to further our understanding of how bone fractures.


Queensland University of Technology medical engineer and PhD researcher Victoria Toal said osteoporosis typically went undiagnosed until a fracture occurred which dramatically increased the risk of further damage.


Ms Toal, from the Faculty of Built Environment and Engineering, has received $21,000 to finance the research under the latest round of State Government Smart State PhD Scholarships.


"There's currently limited knowledge about how bone damage occurs in conditions such as osteoporosis," Ms Toal said.


"I'll be using high resolution medical imaging, computer models and experimental tests to study how high loading events cause damage to osteoporotic trabecular bone which is the porous network in the middle of most bones.


"The laboratory testing will involve placing bone samples through carefully controlled stress, compression and tension tests and studying how they behave.


"The experimental results will be used to develop a computer model that will provide a tool to aid diagnosis and treatment of bone disorders.


"This will help predict how human bones will cope during different loading conditions like when walking or during a fall.


"This research is particularly relevant in helping our ageing population to continue to live healthy and active lives."


One in every two women and one in three men over the age of 60 will experience an osteoporotic fracture and thereafter have an increased risk of further similar bone damage.


The Smart State PhD Scholarships program is part of the Government's $200 million Smart State Innovation Funds, which are designed to help build world-class research facilities, attract top quality scientists and stimulate cutting-edge research projects in Queensland.



Queensland University of Technology

New Study Finds Blacks Still Lag In Obtaining Total Knee Replacements

A new study released today found blacks remain less likely than whites to undergo total knee replacement, an important intervention for reducing pain and improving physical function among those with disabling knee osteoarthritis. The study also found total knee replacements are increasing substantially in both populations. According to the Arthritis Foundation, the research underscores the need for healthcare providers and people of all races to take proactive measures in preventing and managing the disease.


The Morbidity and Mortality Weekly Report study released by the Centers for Disease Control and Prevention, used Medicare claims data from 2000 to 2006 to estimate the national and state-specific total knee replacements for blacks and whites among U.S. adults aged 65 and older.


The study found that among Medicare enrollees, the prevalence of total knee replacements increased by 58 percent overall. Despite the substantial increase in the rates of total knee replacements for both populations, total knee replacements among blacks was 37 percent lower than for whites in 2000, and remained virtually unchanged in 2006. In addition, the rates for total knee replacements were lowest among black men and highest among white women.


The Importance of Taking Action


According to the Arthritis Foundation, most Americans are unaware of the seriousness of arthritis and the impact it can have on their lives. Arthritis is the nation's most common cause of disability and costs the U.S. economy more than $128 billion annually. Knee osteoarthritis, the most frequent form of lower extremity arthritis, contributes to 418,000 knee replacement procedures annually and in 2006 accounted for 496,000 hospital discharges and $19 billion in hospital costs.


"Nearly one in two adults may develop knee osteoarthritis over their lifetime, with an equal risk among blacks and whites," said Patience White, MD, MA, chief public health officer for the Arthritis Foundation. "There are steps Americans can take now to prevent increasing disability from knee osteoarthritis and, if surgery becomes necessary, to better prepare themselves."


Tips for Reducing Knee Pain


To reduce the pain and disability of arthritis, the Arthritis Foundation recommends the following:


- Understand the myth about physical activity and arthritis. Many people think that physical activity can worsen arthritis pain. Nothing could be farther from the truth. Done appropriately, physical activity can help decrease symptoms of knee osteoarthritis. In addition, physical activity is an important component of weight control and helps maintain healthy bones, muscles and joints. For joint-safe exercise programs, try the Arthritis Foundation's Life Improvement Series land or water exercise programs offered at more than 1,700 locations nationwide.















- Control weight. For those already living with symptoms, losing 15 pounds can cut knee pain in half. Maintaining a healthy weight also can lower a person's risk of osteoarthritis. In fact, one study showed that women who lost as little as 11 pounds halved their risk of developing knee osteoarthritis and its accompanying joint pain.1


- Discover techniques to manage your arthritis. Participate in the Arthritis Foundation Self-Help Program, a self-management course that teaches people with arthritis how to manage the pain and challenges that arthritis imposes. The course has been shown to lead to a 40 percent reduction in pain.


- Learn more. Contact your local local Arthritis Foundation office or visit arthritis to learn about programs offered in your area and to order free educational materials, including literature on arthritis in African Americans. For more actions you can take, visit take control of osteoarthritis (arthritis/prevent-osteoarthritis.php) to get started.


About the Arthritis Foundation


The Arthritis Foundation is the leading health organization addressing the needs of some 46 million Americans living with arthritis, the nation's most common cause of disability. Founded in 1948, with headquarters in Atlanta, the Arthritis Foundation has multiple service points located throughout the country.


The Arthritis Foundation is the largest private, not-for-profit contributor to arthritis research in the world, funding more than $400 million in research grants since 1948. The foundation helps individuals take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis. Information is available 24 hours a day, seven days a week at 1-800-283-7800 or arthritis.


1 "Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women," David T. Felson, MD, MPH; Yuqing Zhang, MB, MPH; John M. Anthony, BA, BS; Allen Naimark, MD; and Jennifer J. Anderson, PhD, Annals of Internal Medicine, 1992; 116:535 539.

The Arthritis Foundation

The Mammalian System For Controlling Bone Remodelling Also Regulates Fever

The so-called RANK protein and the molecule that binds to it, the RANK ligand or RANKL, form a focus of the work of Josef Penninger, director of the Institute of Molecular Biotechnology (IMBA) in Vienna. In 1999 his group deleted the RANKL gene from mice and showed that the RANK/RANKL system was the "master regulator" governing bone loss (Kong et al. 1999 Nature 402, 304-309). The work provided the fist genetic proof for a completely new and rational treatment for osteoporosis, one of the most serious public health problems for older women. The results of phase III clinical trials for a human antibody to RANKL have recently been published (see Cummings et al. 2009, New Eng. J. Med. 361, 756-765) and, pending approval by the authorities, it is conceivable that this antibody will soon be made widely available for osteoporosis treatment.



Considering that such treatments might be of potential benefit to millions of patients, it is important to understand any possible side-effects and in this regard the old observation (see Kartsogiannis et al. 1999, Bone 25, 525-534) that RANKL is also expressed in the brain is highly interesting. The function of RANK and RANKL in the brain was completely unknown and forms the basis of Penninger's latest work. To investigate it, Reiko Hanada - an endocrinologist and Postdoc in Penninger's group - injected RANKL into mice and rats, intending to look for effects on behaviour. As Penninger says, "in principle the injections could have resulted in changes to the animals' intelligence or memory or in subtle behavioural alterations that we could never have detected. But we were lucky. The results were dramatic and obvious - the animals stopped moving and developed really high temperatures."



That this was not mere coincidence was suggested by the observation that RANK and RANKL are not present in all areas of the brain. Rather, the proteins were found to be restricted to areas that other groups had previously implicated in the control of body temperature. And Penninger's group showed further that injections of RANKL triggered changes in areas of the brain known to be involved in the fever response, through which mammals increase their body temperature to fight infection. Unlike normal mice, mice that had been engineered to lack RANK in the brain did not respond to simulated infections by raising their body temperature although they appeared otherwise normal. Taken together, these results show that RANK and its ligand are involved in the regulation of the body's fever response to fight infections.



Because Penninger's group had previously shown that RANK and RANKL control the production of milk during pregnancy, it seemed possible that the system might also have an effect on the body temperature of females. Penninger freely concedes that "this was a hunch but one that seemed worth checking." And his speculation turned out to be correct: female - but not male - mice lacking RANK in the brain show a significant increase in body temperature compared with their littermates, at least during daylight hours. As a result, such female mice have much lower differences in body temperature between day and night. In a final experiment, this effect was revealed to be at least partially the result of sex hormones released from the ovaries.
















Because the experimental work was performed in mice and rats, it seemed extremely likely that the results would be relevant to other mammals, including man. Proof that this is the case arose from a chance lunchtime meeting at a conference, during which Penninger learned of a family whose children had defects in the RANK gene. As predicted by Penninger's work, these children showed much lower fever responses to infection. Even when they contracted pneumonia, their body temperatures scarcely rose.



Penninger's data link bone metabolism to the control of temperature during infection and, even less expectedly, to the gender-specific control of body temperature. Although any explanation for the difference between males and females is still speculation, Penninger notes that "the RANK/RANKL system is intricately involved with reproductive biology, transferring calcium from mothers' bones to their children. Perhaps the changes in female body temperature controlled by RANK and its ligand are also related in some way to reproduction or to human fertility." As an example, it is conceivable that the RANK/RANKL system may be responsible for the sudden bursts of high temperature associated with hormonal changes - and with osteoporosis - in older women.



The elegant experiments reported in the present paper were performed at the IMBA in close collaboration with groups at the Medical University of Vienna as well as in Berlin and in Japan - Penninger acknowledges in particular the contribution of Shuh Narumiya, "whose expertise on fever was crucial to our understanding". The work also demonstrates the importance of mouse genetics: the findings could not have arisen from work on isolated cell lines. Penninger himself retains a childlike sense of wonder that "one little mouse" - the RANKL deletion his group published a decade ago - "should have given rise both to a scientifically based treatment for osteoporosis and to new and exciting speculations on human reproductive biology, with all their potential therapeutic implications."



The paper "Central control of fever and female body temperature by RANKL/RANK was published in Nature on November 26, 2009 (doi:10.1038/nature08596).



Source: Heidemarie Hurtl


Research Institute of Molecular Pathology

Scientific Research Highlights Of The American Academy Of Pain Medicine Annual Meeting

Pain medicine investigators presented preliminary research findings at poster sessions held during the 23rd annual meeting of the American Academy of Pain Medicine at the Hilton New Orleans Riverside Hotel/Morial Convention Center, February 7-10, 2007. The highlights are as follows:



*
Internet not Primary Source for Illegally Obtained Prescription Analgesics By Addicts Seeking Methadone Treatment



Despite media reports suggesting that the Internet is the primary source for illegally obtained prescription opioids, only a small percentage of opioid analgesic addicts who are seeking methadone maintenance treatment reported this as a direct source of their drug supply.



Illegally obtained opioid medications present an ongoing and challenging dilemma to society at large, while also impacting the legitimate prescribing of opioids for those individuals with moderate to severe chronic pain conditions. The researchers analyzed questionnaires filled out by 3,294 persons seeking treatment for addiction at 73 methadone treatment programs who indicated that a prescription opioid analgesic was the primary drug they abused to learn how opioid analgesic abusers reportedly obtained their drug. The most commonly reported sources for obtaining opioid analgesics included: dealers (79.96%), friends or relatives (51.3%), physician prescription (30.17%), emergency room visits (13.53%), theft (6.48%), forged prescription (2.48%), Internet (2.9%), and other (not specified) (2.7%).



Investigators: Ann T. Kline, MS, Purdue Pharma L.P., Stamford, CT; Meredith Y. Smith, MPA, PhD, Purdue Pharma L.P., Stamford, CT; J. David Haddox, DDS, MD, Purdue Pharma L.P., Stamford, CT; John P. Fitzgerald, MS, LPC, CAS, Purdue Pharma L.P., Stamford, CT; Andrew Rosenblum, PhD, National Development and Research Institutes (NDRI), New York, NY; Chunki Fong, MS, NDRI, New York, NY; Mark Parrino, MPA, American Association for the Treatment of Opioid Dependence (AATOD), New York, NY; and Carleen Maxwell, MPH, AATOD, New York, NY.



*
Report Characterizes Opioid Analgesic Abuse



Opioid analgesic abuse is more prevalent in rural areas and is growing in popularity among teenagers.



Although numerous US surveillance systems currently report on opioid analgesic abuse, there is a need for additional descriptive and interpretive data, not only to confirm and characterize the cases, but to guide targeted intervention efforts. The researchers conducted 258 telephone interviews in 40 states with a wide range of contacts, including law enforcement officers, physicians, pharmacists, and drug abuse treatment staff. The reports from the local sources indicated that hydrocodone and oxycodone (immediate-release and extended-release) were reported to be the most frequently abused and diverted opioid analgesics; opioid analgesic abuse is not confined to rural areas; opioid analgesic abuse appears to be rising among teenagers; and abusers often perceive prescription drugs to be safer to use than illicit drugs.
















Other key findings include the abuse of antidepressants to reduce the side effects of methamphetamine; abuse of prescription drugs rising in Mormon communities and on Native American reservations; and local government officials are being forced to redirect resources from diversion and abuse of prescription drugs to combat a rising methamphetamine problem. Interpretation of quantitative reports of opioid analgesic abuse and diversion are substantially enriched by the addition of detailed, descriptive field-based inquiries.



Investigators: John P. Fitzgerald, MS, LPC, CAS, Meredith Y. Smith, Ann T. Kline, and J. David Haddox, DDS, MD, Purdue Pharma L.P., Stamford, CT.



*
Spinal Cord Stimulation Can Relieve Low Back Pain



Careful patient selection and stimulation programming can improve management of axial low back pain with spinal cord stimulation. The researchers note that axial low back pain is a novel indication for spinal cord stimulation. Technological capabilities of the spinal cord stimulation system, particularly fractionalized current across contacts, uniquely provide the type of stimulation needed to relieve axial back pain.



Spinal cord stimulation effectively manages a range of painful etiologies, but little published evidence supports its use for axial low back pain. The researchers studied 226 spinal cord stimulators (Precision™, Advanced Bionics) implanted in patients with axial low back pain to assess the therapeutic value of spinal cord stimulation in treating axial back pain associated with failed back surgery syndrome. Pain scores, quality of life, and disability assessments were gathered at three, six, and 12 months after activation of the spinal cord stimulation system and compared to baseline measures. Additional assessments were made at 3.5 months after a two-week period of no stimulation. The investigators found that spinal cord stimulation significantly reduced axial low back pain, and when present, leg and foot pain, from baseline at all time points. With stimulation off, pain scores returned to near baseline. Quality of life and disability also significantly improved with spinal cord stimulation. Of 226 temporary trials, 172 (76%) were successful, and 159 subjects (70%) received permanent implants. Reported here are outcome data for all subjects through 3.5 months, and for those subjects who have completed six- and 12-month evaluations. A subsequent report will include all 12-month data. This study represents the largest prospective experience reported to date for spinal cord stimulation in axial low back pain.



Investigators: Benchmark Clinical Study Working Group, Advanced Bionics, Valencia, CA; Jim Thacker, MS, Enteromedics, St. Paul, MN; Todd Gross, PhD, Advanced Bionics, Valencia, CA; and Allison Foster, PhD, Advanced Bionics, Valencia, CA.



*
More Patient Education Necessary to Manage Sickle Cell Pain



A significant number of people with sickle cell disease reported significant pain and currently use a combination of pharmacological and non-pharmacological methods to manage pain events.



A number of sickle cell patients manage a great deal of their pain episodes at home. The researchers studied 46 questionnaires completed by sickle cell patients to determine if provision of increased knowledge and skills in the use of pharmacologic and non-pharmacologic methods will provide sickle cell patients with greater self-management of pain, improved quality of life and decreased hospitalizations. The investigators found that the average age of respondents was 30 years and the majority were females (58.4%). 57.9% have a diagnosis of sickle cell anemia (hemoglobin SS), while 38.6% had hemoglobin SC disease, and 5% have other hemoglobinopathies. About 22.2% of the respondents were taking opioids analgesics for pain control. About 44% reported experiencing mild-moderate pain events within the last six months. 60.0% had experienced moderate-severe pain requiring a visit to a medical facility within the past six months. More than 75% reported pain greater than 5 on a 0 - 10 point scale when asked to rate their pain during these events.



Relaxation was reported as being used by 77.8% of respondents to help control pain, heating pad was used by 3.7%, and 14.8% report using other techniques to help manage pain events. The researchers conclude that there are opportunities for education and other interventions to improve such techniques and empower patients to achieve improved pain control. As a corollary, this will decrease health care utilization and improve patients' well being and family life for this group of patients.



Investigators: Arleen Anderson, Wendy Thompson, Stephen Tafor, and Ike Eriator, from the University of Mississippi, Jackson, MS.



*
Novel Radiofrequency Treatment Shows Promise for Lumbar Pain



Intradiscal biacuplasty is an effective procedure to treat chronic discogenic pain. Improvement in pain scores and functional capacity can be observed much earlier with intradiscal biacuplasty than with intradiscal electrothermal therapy suggesting some additional or/and different mechanisms of action. It also appears to be more effective than intradiscal electrothermal therapy producing more than 50% of the pain relief in more than 50% of patients.



Intradiscal electrothermal therapy has produced variable results in the pain reduction and functional improvement in patients with axial discogenic pain. A new procedure called intradiscal biacuplasty utilizes two radiofrequency electrodes placed on the opposite posterolateral sides of the treated annulus. This procedure is minimally invasive and provides an alternative to lumbar fusion or disc replacement surgery. The researchers completed a pilot study of 13 patients who received intradiscal biacuplasty and were followed for six months. Following provocative discography patients underwent intradiscal biacuplasty. There were significant improvements of all of the indices (SF-36, Oswestry, Visual Analog Scale pain scores and opioid use) at the first follow-up at one month. Those improvements were maintained throughout six months of follow-up. At six months after intradiscal biacuplasty, patient's median pain scores measured by Visual Analog Scale decreased from 7 to 3. Functional capacity significantly improved with Oswestry scores median decrease from 25 to 18, and SF-36 PF median increase from 55 to 70. Median SF-36 BP score increased from 35 to 58. Median opioid use expressed in morphine sulphate mg equivalents decreased from 40 to 5 mg. There were no significant differences in any of the indices from first to sixth month after intradiscal biacuplasty. There were eight of 13 patients who had Visual Analog Scale pain scores decreased by three or more points. There were no complications perioperatively or during follow-up.



Investigators: Leonardo Kapural, MD, PhD, Alan Ng, MD, and Nagy Mekhail, MD, PhD., from Cleveland Clinic Foundation, Cleveland, OH.







Founded in 1983, AAPM is a medical specialty society representing physicians practicing in the field of pain medicine. Information is available on the practice of pain medicine at painmed/.



Contact: Amy Jenkins


American Academy of Pain Medicine




View drug information on Oxycodone and Aspirin.

Bayer's Novel Anticoagulant Rivaroxaban Recommended For EU Approval - Venous Blood Clot Prevention After Elective Hip Or Knee Replacement Surgery

The European Committee for Medicinal Products for Human Use (CHMP) has recommended approval of the anticoagulant rivaroxaban (Xarelto®), taken as one tablet, once-daily, for the prevention of venous blood clots (deep vein thrombosis (DVT) and pulmonary embolism (PE)) in patients undergoing elective (planned) hip or knee replacement surgery. It is expected that final approval by the European Commission will follow in the next few months, providing marketing authorisation for rivaroxaban in all EU member states.


The recommendation for approval of rivaroxaban, which comes just nine months after its submission, is based on review of the extensive RECORD clinical trial programme in which rivaroxaban, an oral, direct Factor Xa inhibitor, demonstrated its significant clinical potential when compared to the current standard of care, enoxaparin, an injectable low molecular weight heparin (LMWH).


The limitations of current treatment mean that many patients still do not receive satisfactory anticoagulant therapy to prevent potentially fatal clots. "The prevention and treatment of thrombosis remains a challenge for patients requiring chronic therapy. The availability of agents such as rivaroxaban has the potential for an substantial impact on patient care," said Professor Ajay Kakkar, Professor of Surgical Sciences at Barts and the London School of Medicine and a Principal Investigator in the RECORD programme.


Involving nearly 10,000 patients undergoing elective hip or knee replacement surgery, the Phase III RECORD trials demonstrated superior efficacy of rivaroxaban in both head-to-head comparisons with enoxaparin (RECORD 1&3)1,2 and when comparing extended-duration (x five weeks) rivaroxaban with short duration (x two weeks) enoxaparin (RECORD2).3 In all three trials, rivaroxaban and enoxaparin had comparable safety profiles and similar low rates of bleeding.


Commenting on the CHMP recommendation, Beverley Hunt, Medical Director, Lifeblood: The Thrombosis Charity; "Hospital-acquired DVT is a major patient safety issue. A treatment which improves upon our current standard of care as well as making extended thromboprophylaxis more accessible is an extremely important advance."


The extensive clinical trial programme supporting rivaroxaban makes it the most studied oral direct Factor Xa inhibitor in the world today. Almost 50,000 patients are expected to be enrolled overall into the rivaroxaban clinical development programme which will evaluate the product in the prevention and treatment of a broad range of acute and chronic blood-clotting disorders such as venous thromboembolism (VTE) treatment, stroke prevention in patients with atrial fibrillation, VTE prevention in hospitalised, medically ill patients and secondary prevention of acute coronary syndrome.















About VTE


Venous thromboembolism (VTE) is a term which encompasses two conditions:

Deep vein thrombosis (DVT) - a blood clot in a deep vein (usually the leg) which partly or totally blocks the flow of blood
Pulmonary embolism (PE) - an often fatal condition which occurs when part of the blood clot travels to and blocks the arteries in the lungs
10% of hospital deaths are caused by VTE, making it the leading cause of hospital deaths4


VTE kills up to 60,000 people each year in the UK, a figure that is five times greater than the combined total number of deaths from breast cancer, AIDS, and road traffic incidents4


Patients undergoing major orthopaedic surgery, such as hip or knee replacement are at high risk of VTE due to the combination of immobility and surgical trauma


In November 2007, the All Party Parliamentary Thrombosis Group (APPTG) published a report following an audit of acute hospital trusts which found that only 32% of hospital trusts are taking steps to risk assess patients (for VTE) and bring their practices in line with NICE and government recommendations5 which are as follows:


Current NICE recommendations state that:6
All patients undergoing major surgery should be assessed to identify their individual risk of developing VTE after the procedure
All patients undergoing major orthopaedic surgery of the lower limbs should receive anticoagulant therapy, LMWH (low molecular weight heparin) for up to 28 days after surgery in combination with pressure stockings, to reduce the risk of VTE
About Rivaroxaban


Rivaroxaban is a novel, oral, once-daily direct Factor Xa inhibitor in advanced clinical development for a wide range of indications to prevent and treat blood clots. Rivaroxaban works at a pivotal stage in the coagulation pathway to directly inhibit the enzyme Factor Xa.


To date, rivaroxaban is the most studied oral, direct Factor Xa inhibitor in development. More than 20,000 patients have been evaluated in the completed Phase II programmes and enrolled thus far in the Phase III programmes. Almost 50,000 patients are expected to be evaluated in total.


Bayer HealthCare submitted a regulatory filing to the European Agency for the Evaluation of Medicinal Products (EMEA) at the end of October 2007 for approval to market rivaroxaban in the EU for the prevention of VTE in patients undergoing major orthopaedic surgery of the lower limbs.


The trade name of rivaroxaban is expected to be Xarelto®, pending health authority approval.


About Bayer Schering Pharma UK


Bayer Schering Pharma is a leading, worldwide speciality pharmaceutical company. Its research and business activities are focussed on the fields of haematology & cardiology, oncology, diagnostic imaging, primary care, specialised therapeutics and women's healthcare. With innovative products and using new ideas, Bayer Schering Pharma aims to make a contribution to medical progress and strives to improve the quality of life of patients. bayer


References


1. Eriksson BI, Borris LC, Friedman RJ et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthoplasty. N Engl J Med 2008;358:-2765-75

2. Lassen MR, Ageno W, Borris LC et al. Rivaroxaban versus enoxaparin after total knee arthroplasty. N Engl J Med 2008; 358:2776 - 86

3. Kakkar AK, Brenner B, Dahl OE et al. Extended duration rivaroxaban versus short-term exoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. The Lancet 2008; 372:29-37

4. Fitzmaurice DA. Thromboprophylaxis for adults in hospital. BMJ 2007; 334: 1017-8

5. All-Party Parliamentary Thrombosis Group (APPTG) VTE Research Report, April 19 2007

6. NICE Clinical Guideline 46. Venous Thromboembolism: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in in-patients undergoing surgery. April 2007


Source:

bayer

Osteologix IND For NB S101 For Osteoporosis Accepted By FDA

Osteologix, Inc. (OLGX.OB), a specialty biopharmaceutical company, announced that the U. S. Food and Drug Administration (FDA) has accepted its Investigational New Drug (IND) application for its lead development candidate NB S101 (strontium malonate), for the treatment and prevention of osteoporosis. NB S101, a dual acting bone agent, has a demonstrated ability to decrease resorption of bone while maintaining formation of new bone. The drug has been formulated as a convenient once-daily tablet.


In September 2007, the company presented data from a Phase 1 study at the American Society for Bone and Mineral Research, demonstrating that NB S101 has superior bioavailability as compared to Protelos® (strontium ranelate), a strontium-based compound approved for sale in Europe and other territories outside the United States.


In November 2007, Osteologix announced significant results from its Phase 2 STRONG Study, demonstrating that NB S101 met its primary endpoint. At all doses tested, NB S101 demonstrated statistically significant decreases in CTX-1, a well-validated biomarker that measures bone resorption activity. When directly compared to the EU-approved strontium drug Protelos®, a 2 gram dose of NB S101 achieved significantly greater reductions of CTX-1 (p

EffRx And Nycomed Announces First European Filing For Marketing Approval Of Osteoporosis Drug Targeting Increased Convenience For Patients

The Lausanne, Switzerland, based drug delivery company EffRx Pharmaceuticals SA ("EffRx") and its partner, the global pharmaceutical company Nycomed, headquartered in Zurich, Switzerland, announced that the first European filing for marketing approval of EX101, a once-a-week 70mg buffered effervescent alendronate, for the treatment of osteoporosis, has been submitted. The filing triggers a milestone payment to EffRx.


"This is obviously a key step in getting EX101 to the market and shows Nycomed's commitment to get EX101 into their osteoporosis portfolio of products as soon as possible"


The licensing agreement for EX101 between Nycomed and EffRx was announced early 2009 and Nycomed recently amended its original licensing agreement with EffRx and holds now exclusive rights to develop, manufacture and commercialise the effervescent formulation of alendronate for the treatment of osteoporosis in all territories in the world except USA and Japan.


EX101 will complement Nycomed's osteoporosis portfolio, which consists of Preotact® (full-length parathyroid hormone [PTH 1-84]) for treatment of osteoporosis in post-menopausal women at high risk of fractures, and the company's broad Calcium D3 product range for the prevention and an adjunct of the condition.


"This is obviously a key step in getting EX101 to the market and shows Nycomed's commitment to get EX101 into their osteoporosis portfolio of products as soon as possible," stated Christer RosГ©n, CEO of EffRx.


About EX101


EX101 is a proprietary once weekly administration of a 70mg buffered effervescent formulation of alendronate (bisphosphonate) for treatment of post-menopausal osteoporosis. Product is addressing the complaints of inconvenience when taking bisphosphonates in tablet form. Alendronate reduces the risk of vertebral and hip fractures.


About Nycomed


Nycomed is a privately owned global pharmaceutical company with a differentiated portfolio focused on branded medicines in gastroenterology, respiratory and inflammatory diseases, pain, osteoporosis and tissue management. An extensive range of OTC products completes the portfolio.


Its R&D is structured around partnerships and in-licensing is a cornerstone of the company's growth strategy.


Nycomed employs 12,000 associates worldwide, and its products are available in more than 100 countries. It has strong platforms in Europe and in fast-growing markets such as Russia/CIS and Latin America. While the US and Japan are commercialised through best-in-class partners, Nycomed plans to further strengthen its own position in key Asian markets.


Headquartered in Zurich, Switzerland, the company generated total sales of €3.2 billion in 2009 and an adjusted EBITDA of €1.1 billion.


Source:

EffRx

Stretching Therapy For Plantar Fasciitis

According to a new study from the Journal of Bone and Joint Surgery (JBJS), patients with acute plantar fasciitis who perform manual plantar fasciitis stretching exercises, as opposed to shockwave therapy, had superior results and higher patient satisfaction.



Study details and findings



A total of 102 patients who had acute plantar fasciitis pain, were randomly assigned to two groups. Acute is defined as any patient that experiences pain for less than six weeks. 54 people performed an eight-week stretching program, while 48 people received repetitive low-energy radial shock-wave therapy once a week for three weeks. Each group was asked to refrain from any other forms of physical therapy.



Patients in the stretching group, were told to perform stretching exercises three times a day, for eight weeks. All patients were contacted by phone every two weeks to check on training compliance. After four weeks, the patients were told to slowly return to their previous sport and/or recreational activity. Patients in group two received three sessions of radial shock-wave therapy, three times a week.



Patients were given follow-up evaluations at two, four and fifteen months. At both the two and fourth month evaluation, 65 percent of patients who performed the plantar fascia-specific stretch reported total satisfaction with treatment or satisfaction with treatment with minor reservations. Only 29 percent did so after shockwave therapy.



John Furia, MD, an orthopaedic surgeon in Pennsylvania and one of the study authors added that those who develop plantar fascia pain should begin non-operative treatment promptly. "The earlier you understand how stretching fits in, and the earlier you learn how frequently to perform the simple plantar stretch, the less likely you will require a more invasive treatment method," stated Dr. Furia. "Shockwave therapy has been shown to be a very effective treatment for patients with chronic plantar fasciitis (pain for more than six to eight weeks), however acute cases are probably best treated with more simple measures," he added.



How to do the stretch: According to the American Academy of Orthopaedic Surgeons (AAOS), this stretch should be performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and bring your ankle up and your toes up. Place your thumb along the plantar fascia and rub it to stretch it. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 10-20 times for each foot. Dr. Furia and Dr. Judy Baumhauer, orthopaedic surgeon and president-elect of the American Orthopaedic Foot and Ankle Society (AOFAS) recommend that this exercise be performed initially in the morning, before getting out of bed and after any long periods of sitting. If there is a sharp pain in your heel when getting up, a stretch should have been done before standing or walking. Dr. Baumhauer gives her patients a visual as a reference for this exercise.



Dr. Baumhauer, who was not involved in this study, has been counseling patients on the plantar fascia stretch for 15 years. "I am a firm believer in this type of stretch and nearly 80 percent of my patients have shown improvement in just eight weeks of stretching therapy."



Relevant statistics:
Plantar fasciitis is the most common cause of pain on the bottom of the heel, and approximately two million patients are treated for plantar fasciitis each year.
More than 80 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
Dr. Furia suggests that approximately 20 percent of patients with plantar fasciitis develop a chronic condition.

Disclosure:
Both Dr. Furia and Dr. Baumhauer have nothing related to this study to disclose.



Source:

Lauren Pearson

American Academy of Orthopaedic Surgeons

Ortec Initiates Pre-Clinical Animal Model Study To Evaluate Fibrin Microbead Technology For Stem Cell Regeneration Of Non-Union Bone Defects

Ortec International, Inc.
(OTC Bulletin Board: ORTN), a company focused on advancing regenerative
medicine through the development of cellular technology and advanced
biomaterial products, announced today that it has begun a pre-clinical
study in rabbits to evaluate the capabilities of the Fibrin MB system to
accomplish the full cycle of steps required to use a patient's own stem
cells therapeutically to regenerate large gaps in long bone tissue. The
study involves a collaboration between the laboratories of Dr. Raphael
Gorodetsky (Hadassah Ein-Kerem and Hapto Biotech, Israel) and Dr. Iri
Libergal of the Department of Orthopedics at Hadassah Ein-Kerem Medical
Center in Jerusalem, Israel. Complete results of the study are expected
within six to eight months.


Commenting on the initiation of the study, Ron Lipstein, Ortec's Vice
Chairman and CEO, said, "The launch of this study is another key step
toward accelerating the development and commercialization of the practical
tissue regeneration therapeutic capabilities of our recently acquired
Fibrin Microbead technology. We expect this study will provide us with the
data from which we can design a clinical protocol and initiate a human
clinical trial for this orthopedic indication."


The Fibrin Microbead technology developed at Hapto Biotech, Israel,
Ortec's wholly owned subsidiary, is a proprietary matrix for the isolation,
expansion and differentiation of matrix dependent cells, including
Mesenchymal-type adult stem cells, and their potential reimplantation into
the patient.


About Ortec International, Inc.


Ortec International, Inc. (ORTN) is a company focused on advancing
regenerative medicine and stem cell therapy through the development and
commercialization of innovative products by combining advanced cell
technology and advanced biomaterials. Ortec's lead product is OrCel(R)
(Bilayered Cellular Matrix). Ortec's current focus is the application of
OrCel(R) to heal chronic and acute wounds. OrCel(R) is composed of a
collagen sponge seeded with allogeneic epidermal and dermal cells. These
cells secrete growth factors and cytokines normally found in acute human
wounds and are believed to have a beneficial role in promoting tissue
repair.


A pivotal clinical trial evaluating a cryopreserved version of OrCel(R)
in the treatment of venous leg ulcers has been completed and a Pre Market
Approval (PMA) application has been filed. Ortec has recently completed
patient enrollment in a confirmatory trial and the data from this trial are
expected to be integrated with the results of the pivotal clinical trial
and submitted as a clinical supplement to its PMA filing. Ortec has already
obtained FDA approvals for use of a non-frozen version of OrCel(R) in the
treatment of Epidermolysis Bullosa and donor sites in burn patients. In
addition, the FDA has granted Ortec approval to initiate a pivotal (Phase
III) trial evaluating OrCel(R) for the treatment of diabetic foot ulcers.















Ortec recently acquired two fibrin derived advanced biomaterial
technologies, Fibrin MB and Haptides(TM). Fibrin MB has the potential to
play a significant role in advancing stem cell therapy having demonstrated
the ability to efficiently recover adult stem cells and allow for their
growth, differentiation, and potential reimplantation into the patient.
Haptides(TM) utilize proprietary synthetic peptides that mimic the
mechanism of cell attachment to fibrin. These peptides have demonstrated
the ability to significantly enhance cell attraction and attachment
providing the potential to use Haptides(TM) in the development of product
opportunities applicable to the cosmetic tissue augmentation, wound
healing, orthopedics, and drug delivery markets.


For more information, visit Ortec's website at
ortecinternational.


This news release may contain "forward-looking statements" for the
purposes of the United States Securities and Exchange Commission's "safe
harbor" provisions under the Private Securities Litigation Reform Act of
1995 and Rule 3B-6 under The Exchange Act. Without limitation, statements
regarding expected FDA approvals, clinical trial results, product
performance, expectations with respect to sales, gross margins, research
and development expenditures, earnings per share, capital expenditures,
collaborations, or other expansion opportunities would be "forward-looking
statements." These statements may be identified by words such as "expects,"
"anticipates," "intends," "estimates," "believes" or similar expressions in
connection with any discussion of future financial and operating
performance. The forward- looking statements contained herein involve risks
and uncertainties that may cause results to differ materially from the
Company's expectations including but not limited to, global economic
trends, competitive pricing or product developments, government legislation
and/or regulations, technology, manufacturing, legal and patent issues,
suppliers, capital availability, personnel changes, cancellation or delays
in renewal of contracts, and lack of suitable raw materials or packaging
materials. Investors are cautioned to review risk factors in the Company's
filings with the United States Securities and Exchange Commission.



Ortec International, Inc.

ortecinternational

Some Patients With Cerebral Palsy Have Asymmetric Pelvic Bones

Johns Hopkins Children's Center researchers have discovered that most children with severe cerebral palsy have starkly asymmetric pelvic bones. The newly identified misalignment can affect how surgeries of the pelvis, spine and surrounding structures are performed, the researchers say.


The study will be published online on March 10 in the Journal of Pediatric Orthopaedics.


Previous studies of patients with cerebral palsy have reported asymmetry above the pelvis and misalignment of the hips, but this new report, the researchers say, is the first one to show misalignment between the two sides of the pelvic bone itself.


Most children with severe cerebral palsy have significant spinal curvatures (scoliosis) that often require surgery. Because the pelvis and the spine are connected, any surgical procedures to correct scoliosis should take into account the possibility of a misaligned pelvis, the investigators say. The degree of the asymmetry, they add, should dictate the size, type and placement of the surgical screws and rods used to stabilize the spine and pelvis in such corrective procedures.


"Surgeons preparing to operate on children with cerebral palsy should look out for pelvic asymmetry and tweak their surgical technique accordingly to achieve better outcomes and more lasting benefits," says senior investigator Paul Sponseller, M.D., chief of pediatric orthopedics at Hopkins Children's.


While performing surgeries to correct scoliosis, Sponseller started noticing a recurrent feature among his patients with severe cerebral palsy a pronounced asymmetry between the left and right plates of the pelvic bone.


To quantify the problem, Sponseller performed three-dimensional CT scans on all of his cerebral palsy patients undergoing scoliosis surgery over one year. All 27 patients had asymmetric pelvises with misalignment of the pelvic bones was greater than 10 degrees. Comparing these images with pelvic-bone scans of children without cerebral palsy, the researchers noted that all of them had either no misalignment or only mild asymmetry of less than 10 degrees.


Twenty-three of the 27 children (85 percent) with cerebral palsy also had windswept hips, a hallmark feature in CP patients marked by one hip facing outward and the other one rotated inward. Children with windswept hips had more pronounced pelvic asymmetry than children without windswept hips, the researchers found.


Co-investigators on the research included Phebe Ko, B.S., Paul Jameson II, B.S., and Tai-Li Chang, M.D., all of Hopkins.


Source: Johns Hopkins Medicine

Global Call For Osteoporosis Abstracts - Submission Deadline December 6, 2005

Abstracts are now being accepted for the only global congress dedicated specifically to all aspects of osteoporosis. The deadline for abstracts is December 6, 2005.


Over 5,000 osteoporosis specialists and allied health professionals are expected to attend the IOF World Congress on Osteoporosis, to be held from June 2-6, 2006 in Toronto, Canada. The event will provide a comprehensive overview of new developments, ranging from the latest data on all aspects of basic and clinical osteoporosis research, new developments in bone cell biology, epidemiology, diagnosis and treatment. In addition, numerous presentations will focus on new drugs which can prevent bone loss and reduce fracture occurrence for patients with osteoporosis.


Research must not have been previously presented nor published prior to the IOF World Congress on Osteoporosis in Toronto, June 2-6, 2006.


Accepted abstracts will be published in the IOF World Congress on Osteoporosis program and abstracts book which is to be published as a supplement to the scientific journal Osteoporosis International.


Online abstract submission is now available on the IOF website: osteofound/wco/2006/call_for_abstracts.php


Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men 1, 2, 3. Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.


The International Osteoporosis Foundation (IOF) is the only worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 170 member societies in 84 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.


1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10


2 Kanis JA et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International, 2000; 11:669-674


3 Melton

LJ, et al. Bone density and fracture risk in men. JBMR. 1998; 13:No 12:1915


IOF World Congress on Osteoporosis, held every two years, is the only global congress dedicated specifically to all aspects of osteoporosis. Besides the opportunity to learn about the latest science and developments in diagnosis, treatment and the most recent socio-economic studies, participants have the chance to meet and exchange ideas with other physicians from around the world. All aspects of osteoporosis will be covered during the Congress which will comprise lectures by invited speakers presenting cutting edge research in the field, and a large number of oral presentations and poster sessions selected from submitted abstracts. More than 70 Meet the Expert Sessions covering many practical aspects of diagnosis and management of osteoporosis are also on the program. Visit osteofound


International Osteoporosis Foundation 2005 Osteoporosis Journalism Awards
These awards recognize outstanding print reporting about osteoporosis. With prizes of USD 17,000, the closing date for award entries is January 31,
2006. For more information please go to IOF website journalism award.


For more information on osteoporosis and IOF please visit: osteofound


For further information, please contact:

Paul Spencer Sochaczewski, Head of Communications,

International Osteoporosis Foundation:

Tel. +41 22 994 0100 - Fax. +41 22 994 0101
E-mail: psochaczewskiosteofound