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

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

Does anovulation exist in eumenorrheic women?

OBJECTIVE: To determine whether anovulation exists in normally menstruating women. METHODS: In a database of 550 consecutive couples seeking pregnancy, results of the midluteal serum progesterone level analysis planned for 7 days before the onset of the next menses were examined in women with predictable cycles shorter than 35 days. RESULTS: Of the 550 couples seeking pregnancy, 410 of the female partners (74.5%) were eumenorrheic. Fifteen of these women (3.7%) had apparently anovulatory cycles with a progesterone lower than the normal ovulatory value of 15 nmol/L. Further examination showed that four of the 15 women (26.7%) had an isolated prolonged cycle, whereas an additional four (26.7%) failed to have their sample taken at an appropriate time. One (6.7%) had a low progesterone level that was normal in the subsequent cycle. Two patients (13.3%) were older than 40, both having elevated early follicular follicle-stimulating hormone levels. One patient (6.7%) conceived in the following menstrual cycle without further evaluation. The three remaining women (20%) showed consistently apparently anovulatory cycles. However, the levels were exclusively above the follicular range. CONCLUSION: Our findings cast doubt on the concept of anovulatory cycles in eumenorrheic women and suggest that further examination of the lower level of ovulatory progesterone may indeed be necessary.

Follow-up of infertile couples who dropped out of a specialist fertility clinic.

Lack of commitment to infertility investigations and treatment was not the reason for patient dropout.

Should we try to understand the high rate of dropout from fertility treatment?

Failure to adhere to therapy is common in couples with fertility problems. Explaining why is difficult and worthy of further investigation without stigmatizing assumptions.

Post-maternity outcomes following health care reform in Alberta: 1992-1996.

OBJECTIVE: The effect of Alberta's health reform on length of stay for maternity cases and on subsequent mothers' rehospitalization was examined in the present study. METHODS: The data set included all Alberta acute care hospital separation records from 1991/92 to 1996/97 inclusive. A logistic regression was applied to the data in order to examine the effects of prepartum condition, type of delivery, length of stay, maternal age, and year on the likelihood of readmission. RESULTS: Health reform proved to be associated with a dramatic decrease in length of stay for maternity cases; from 3.8 to 2.4 days on average. This was accompanied by very little variation in the 90-day readmission rate for mothers over the same time period (notably, a slight decrease). Higher readmission rates were associated with the existence of difficulties during the pregnancy and other prenatal conditions, maternal age, and with the type of delivery. There were no dramatic changes in the rates for prepartum diagnoses, nor for the type of delivery. DISCUSSION: The data suggest that the reduction in the length of maternity stay has had no discernible negative health effects on new mothers, perhaps because of the home visiting programs that were put in place. Furthermore, there may still be room to improve outcomes by focussing on those with prepartum conditions and cases involving complicated births.

Use of health services associated with increased menstrual loss in the United States.

OBJECTIVE: The study was conducted to estimate the effect of abnormal uterine bleeding on health care use. STUDY DESIGN: Data were taken from the National Health Interview Survey 1999, a nationwide representative sample of the civilian noninstitutionalized population of the United States. The participants who were eligible for the study were 3133 women aged between 18 and 64 years who reported having a natural menstrual period in the last 12 months and in the last 3 months, never having taken medication containing estrogen (except past use of oral contraceptives), and never been told they had reproductive cancer. From these, 328 women were excluded-5 women because they were more than 64 years old and 323 because of the imprecision of their answers related to their menstrual flow. Analysis was performed with the data from 2805 women: 373 having self-described heavy flow and 2432 having normal flow. RESULTS: Age, family size, insurance coverage, perception of health, and flow of menstrual periods are associated with the majority of questions used to measure health care use (P < or =.05). The odds ratios related to the flow of menstrual periods were all equal to or higher than 1.45 (P < or =.05), which indicates that women who have a heavier flow are at least 1.45 times as likely to use health care as are women who have a lighter or normal flow. CONCLUSION: Women having heavy flow of menstrual bleeding are more likely to use health care than women having a normal flow.