Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on "expert opinion" and antimicrobial susceptibi
Family physicians can assess the smoking behavior of their patients in a few minutes, using carefully chosen questions. The CAGE questionnaire for smoking (modified from the familiar CAGE questionnaire for alcoholism), the "four Cs" test and the Fager
How do I feel about giving up smoking?Check one of the boxes below:[] I like to smoke, and I'm not planning to quit.[] I like lots of things about smoking, but I would like to quit.[] I'm ready to quit smoking now. If you said, "I l
Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medication
What is osteoarthritis? Osteoarthritis is a painful knee problem. It is also called degenerative arthritis or wear-and-tear arthritis. Arthritis is what happens when the tissue that protects the bones wears away. This tissue is called cartilag
This feature is part of a year-long series of excerpts and special commentaries celebrating AFP's 50th year of publication. Excerpts from the two 1950 volumes of GP, AFP's predecessor, appear along with highlights of 50 years of family medicine.
Arizona Sept. 10-13: Breast-feeding medicine: the nature and nuture of infant nutrition. Omni Hotel & Golf Resort, Tucson. (16 3/4 hrs: P) Sponsor: Academy of Breastfeeding Medicine. Contact Janene Dawson: 913-541-9077. Sept. 22-25: In
Interest in the effects of creatine use by a number of American athletes has led to numerous studies. Many of these studies have produced conflicting findings. The American College of Sports Medicine (ACSM) has published a consensus statement from the
The Health Technology Advisory Committee (HTAC) has published a report on the use of recombinant human growth hormone (rhGH) in children with idiopathic short stature. HTAC was established in 1992 by the Minnesota state legislature. It is an independe
The Anxiety Disorders Association of America (ADAA) and the National Institute of Mental Health (NIMH) have published a new monograph on the treatment of anxiety disorders in children and adolescents. "Conference on Treating Anxiety Disorders in Youth
Author: Anne D. Walling
Date: Nov 15, 1996
Clodronate is a second-generation bisphosphonate that has shown the ability to induce substantial gains in bone mineral density when administered in a cyclical regimen in patients with osteoporosis. Because progressive gains in calcium balance and bone mass have been achieved with continuous use of related compounds, Giannini and colleagues compared the effectiveness of cyclical and continuous regimens for clodronate therapy.
Sixty postmenopausal women 48 to 70 years of age who had demonstrated significant loss of lumbar bone mass were randomly assigned to three treatment groups. All participants took 1,000 mg of oral calcium as a supplement to their normal diet. For 20 women, this was the only intervention. Another 20 women received 400 mg of clodronate daily throughout the study year. The third group of 20 women took 400 mg of clodronate cyclically for 30 days, followed by 60 days of calcium supplement alone, repeated over the one-year study period.
Biochemical markers of bone metabolism in urine and blood were measured at the beginning of the study and after six and 12 months. Bone mass was also measured at these intervals by dual x-ray absorptiometry. The three groups of women were comparable at the beginning of the study in age, height, weight, bone mineral density and time since menopause. Six women from the calcium-only group and three from each of the other groups did not complete the study.
Both groups of women receiving clodronate showed a significant increase in femoral bone density and lumbar bone mass, compared with women who received calcium alone. The women in the control group showed a decline in both femoral and lumbar bone mass. At six months, both treatment groups remained close to baseline values. At 12 months, those in the intermittently treated group had a higher percentage of change in spinal bone mineral density and spinal bone mass than those treated in the continuous regimen. The biochemical markers of bone metabolism in women taking continuous clodronate indicated a fall in bone resorption. None of the participants had serious side effects or adverse reactions to study medications.
The authors conclude that clodronate treatment for one year prevents progression of osteoporosis by inducing a gain in bone mass. The continuous regimen does not result in significant gains over cyclical regimens in spinal bone mass, but it may have an advantage in femoral bone density. They call for larger studies with longer follow-up to improve understanding of the optimal dosage regimens for these agents.
Giannini S, et al. Continuous and cyclical clodronate therapies and bone density in postmenopausal bone loss. Obstet Gynecol 1996;88:431-6.
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