The European Musculoskeletal Arena – In Brief Trends, Statistics and Clinical Research

Breast Cancer Drug Linked to Bone Loss
In a study conducted at Northern General Hospital in Sheffield, the breast cancer drug anastrozole has been shown to cause progressive bone loss over five years of treatment. The research, led by Dr Richard Eastell, was based on measurements made at baseline and afterone, two and five years via dual-energy X-ray absorptiometry. Measurements suggested that anastrozole-treated women presented a decrease in overall median bone mineral density (BMD) in the spine (-6.08%) and total hip (-7.24%). The authors note that anastrozole remains more effective and better tolerated in treatment for breast cancer than rival treatment tamoxifen. However, when reducing circulating oestrogen the subsequent low oestradiol levels may increase fracture risk. “Women who start aromatase inhibitors for breast cancer should have their bone density checked,” said Dr Eastell. “If it is between normal and osteoporosis(osteopoenia), then it would be important to have another measurement of bone density after two years of treatment.” The team is preparing a second study to measure BMD in patients two years after ceasing anastrozole treatment to discover whether the effect is reversible.

Gluten-free Diet Improves Cardiovascular Health of High-risk
Rheumatoid Arthritis Sufferers A gluten-free vegan diet benefits the cardiovascular health of rheumatoid arthritis (RA) sufferers, a high-risk group for atherosclerosis due to their often disturbed balance of blood fats. Findings by researchers at the Karolinska Institute that were published in the March edition ofArthritis Research and Therapy were based on evidence from a one-year study of two groups of patients: one following a strict gluten-free vegan diet and a control group following ordinary dietary advice. Blood levels of oxidised low-density lipoprotein (LDL) cholesterol were significantly lower in the vegan group, who also presented higher levels of anti-PC, a cardio-protective antibody. “Our findings suggest a new mechanism by which the level of natural protective antibodies can be increased. They also show that diet can have effects on the immune system, with implications for the incidence of the disease,” says Professor Johan Frostegard, lead investigator in the study initiated by Professor Ingiald Hafstrom and carried out by CVDImmune, a consortium investigating the significance of anti-PC in atherosclerosis vaccinations.

Computer Simulation Successfully Tracks Impact of Medication on Bone Strength
In a study carried out at the Vienna University of Technology, biomechanical engineers have developed a pioneering simulation model to compute changes in bone strength and track the evolution of vertebral bone density in progressive osteoporosis. Led by Professor Philippe Kurt Zysset from the Institute of Lightweight Design and Structural Biomechanics in Vienna, the team observed the effect of the medication teriparatide, which their computer simulation showed to increase bone strength by up to 30%. In monitoring the effects of this growth over a two-year period the group applied the finite element method, using “3D images from computed tomography to gain information about the geometry and material properties of the bone,” according to Professor Zysset. There are hopes that the research will advance to be able to measure the effect of antiresorptive as well as anabolic medications, in order to improve mechanical understanding of glucocorticoid-induced osteoporosis.

Publicly Accessible Online Tool for Individuals to Assess Their Risk of Bone Fracture
A simple Internet-based tool developed by scientists at the Garvan Institute of Medical Research in Sydney will allow people over 60 years of age to predict their individual risk of bone fracture. Accessible online from the beginning of April 2008 at www.fractureriskcalculator.com, the tool forms a specific risk profile based on factors including gender, age, weight, history of prior fracture and bone mineral density. Calculated against two decades of data accumulated in the Dubbo Osteoporosis Epidemiology Study (DOES), its computation assesses risk factors according to a statistical model and with carefully devised weighting. Lead investigator Professor Tuan Nguyen and his team worked to ensure usability, claiming that “we have kept our model simple and easy to use”. A similar online fracture risk assessment tool has been devised by the World Health Organization (WHO). The tool is called FRAX™, and predicts the likelihood of fracture by drawing on a similar combination of risk factors with increased weighting for genetic history. Nick Rijke, Public and External Affairs Director at the National Osteoporosis Society, has welcomed such online developments, claiming: “We want to see these practical tools in widespread use within months”.