The effect of prior bisphosphonate therapy on the subsequent therapeutic effects of strontium ranelate over 2 years.

UNLABELLED: Many osteoporotic women prescribed strontium ranelate have previously received bisphosphonates. Prior bisphosphonate use blunted the spinal bone mineral density (BMD) response for 6 months. Hip BMD was blunted to a degree for 2 years, although there was an overall increase in hip BMD in contrast to the heel where BMD did not increase. INTRODUCTION: Many osteoporotic women commenced on strontium ranelate have already received treatment with bisphosphonates. This study investigates whether prior bisphosphonate use impairs the subsequent therapeutic response to strontium ranelate. METHODS: Women were recruited who were either bisphosphonate naïve or currently receiving a bisphosphonate. All women received strontium ranelate and were followed up for 2 years. RESULTS: One hundred and twenty women were recruited. After 2 years, the bisphosphonate-naïve group had significant BMD increases of 8.9%, 6.0% and 6.4% at the spine, hip and heel, respectively. In the prior bisphosphonate group, BMD increased significantly at the spine (4.0%) and hip (2.5%) but not at the heel. At all time points at all sites, the BMD increase was greater in the bisphosphonate-naïve group. BMD at the spine did not increase during the first 6 months in the prior bisphosphonate group but then increased in parallel with the bisphosphonate-naïve group. In contrast, the difference between the two groups in hip BMD continued to increase throughout the 2 years. P1NP was suppressed in the prior bisphosphonate group for the first 6 months. CONCLUSIONS: After bisphosphonate exposure, the BMD response to strontium ranelate is blunted for only 6 months at the spine. At the hip, a degree of blunting was observed over 2 years, although there was an overall increase in hip BMD in contrast to the heel where no increase in BMD was observed.

'Sink or swim': an evaluation of the clinical characteristics of individuals with high bone mass.

SUMMARY: High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. INTRODUCTION: High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. METHODS: Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. RESULTS: Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m(2), p < 0.001). CONCLUSION: Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass.

Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage.

AIMS: To compare obstetric and perinatal outcomes in women with Type 1 and Type 2 diabetes and relate these to maternal risk factors. METHODS: Prospective cohort study of 682 consecutive diabetic pregnancies in East Anglia during 2006-2009. Relationships between congenital malformation, perinatal mortality and perinatal morbidity (large for gestational age, preterm delivery, neonatal care) with maternal age, parity, ethnicity, glycaemic control, obesity and social disadvantage were examined using bivariable and multivariate models. RESULTS: There were 408 (59.8%) Type 1 and 274 (40.2%) Type 2 diabetes pregnancies. Women with Type 2 diabetes were older (P < 0.001), heavier (P < 0.0001), more frequently multiparous (P < 0.001), more ethnically diverse (p < 0.0001) and more socially disadvantaged (P = 0.0004). Although women with Type 2 diabetes had shorter duration of diabetes (P < 0.0001) and better pre-conception glycaemic control [HbA(1c) 52 mmol/mol (6.9%) Type 2 diabetes vs. 63 mmol/l (7.9%) Type 1 diabetes; p < 0.0001), rates of congenital malformation and perinatal mortality were comparable. Women with Type 2 diabetes had fewer large-for-gestational-age infants (37.6 vs. 52.9%, P < 0.0008), fewer preterm deliveries (17.5 vs. 37.1%, P < 0.0001) and their offspring had fewer neonatal care admissions (29.8 vs. 43.2%, P = 0.001). Third trimester HbA(1c) (OR 1.35, 95% CI 1.09-1.67, P = 0.006) and social disadvantage (OR 0.80, 95% CI 0.67-0.98; P = 0.03) were risk factors for large for gestational age. CONCLUSIONS: Despite increased age, parity, obesity and social disadvantage, women with Type 2 diabetes had better glycaemic control, fewer large-for-gestational-age infants, fewer preterm deliveries and fewer neonatal care admissions. Better tools are needed to improve glycaemic control and reduce the rates of large for gestational age, particularly in Type 1 diabetes.

The DXL Calscan heel densitometer: evaluation and diagnostic thresholds.

The DXL Calscan (Demetech AB) is a new dual energy X-ray absorptiometry device for determining heel bone mineral density (BMD). The system is based on the standard technique of dual energy X-ray absorptiometry (DXA), using a fan beam configuration, but introduces an additional laser measurement of heel thickness intended to improve accuracy. We have examined the utility, in vitro and in vivo performance of the DXL Calscan and established triage thresholds based on the UK's National Osteoporosis Society guidelines on peripheral densitometry. The Calscan proved convenient, easy to use and was stable over time and within a range of operating temperatures. Short-term in vitro precision as %CV, with phantom repositioning, was 0.75% and long term precision 0.73%. Precision in vivo, determined from duplicate right heel scans of 67 subjects, was 1.19%. Effective radiation dose to the patient was <0.1 microSv per scan. 140 white females (70 osteoporotic and 70 non-osteoporotic), aged 55-70 years underwent scans of both heels. Subjects were defined as osteoporotic or non-osteoporotic on the basis of axial DXA (spine L2-L4 and total hip). Triage thresholds for reassurance-referral or referral-treatment were 0.391 g cm(-2) and 0.306 g cm(-2) for non-dominant and 0.395 g cm(-2), 0.294 g cm(-2) for dominant heel, respectively. The non-dominant heel proved slightly superior to the dominant for triage purposes. Of the seven non-osteoporotic subjects misclassified as osteoporotic by Calscan of either heel, six had severe axial osteopenia. If operated by trained personnel and used in appropriate populations exhibiting risk factors, the Calscan is well suited for use in the management of post-menopausal osteoporosis.

Effect of intermittent compression therapy on bone mineral density in women with low bone mass.

Intermittent pneumatic compression has been shown to increase blood flow in the leg which, in turn, may improve BMD. We performed a pilot study to assess whether intermittent compression of the leg could improve BMD at the femoral neck. 37 postmenopausal women with low bone density T score < -1 at either hip or spine were recruited into the study of whom 24 completed. Women applied intermittent compression for 2 h a day for 6 months to each leg in turn. The study lasted 1 year. Women were also given daily 1 g of Calcium and 800 IU of vitamin D (Calcichew D 3 forte Shire, UK). Lumbar spine BMD decreased by 0.5% at 12 months compared with baseline (mean difference 0.005 g/cm(2), 95% C.I -0.2287 to 0.03459, P = 0.28). At 12 months the right femoral neck BMD increased by 3% compared with baseline (mean 0.811 +/- 0.08, P = 0.22), while the left increased 2% (0.783 +/- 0.06, P = 0.16). There was no change in BMD at the distal tibia or heels and no site effect of the compression. The fat mass decreased by 4.6% in the right leg and 5% in the left leg (P = 0.005 and 0.003, respectively). Tissue thickness did not change. The analysis of the interaction between the degree of exercise and change in BMD showed a statistically significant increase in right femoral neck BMD following 6 months of right leg intermittent compression, but only in women whose exercise was minimal (P = 0.029). This effect was not seen in the left femur possibly due to the reduced number of patients who completed the study in this group. These preliminary results indicate that intermittent pneumatic leg compression may have a role in osteoporosis prevention. It may provide a mean of inhibiting decline in femoral neck BMD, particularly in sedentary women.

A phantom based study on the effect of subject positioning on morphometric X-ray absorptiometry using the Lunar Expert-XL.

Morphometric X-ray absorptiometry (MXA) relies on accurate measurement of vertical dimensions of vertebrae from a lateral perspective. Deviations resulting from scoliotic curvature or poor patient positioning produce distortions of visible vertebral dimensions and may lead to analysis error. This study utilized a phantom developed at this centre to assess the effect of vertebral malalignment on the accuracy of the MXA technique on the Lunar Expert-XL. Measured vertebral heights were found to be consistently underestimated by an average of 3.7%. Precision ranged from 0.79% for anterior height measurement to 1.03% for middle height measurement. Vertebral malalignment was investigated as the effect of rotation around the anteroposterior, lateral and superoinferior axes. Rotation around the lateral axis produced little discernible effect. However, superoinferior axial rotation showed a change of more than two standard deviations in the mid/posterior ratios of biconcave vertebrae at comparatively small angles of rotation. Anteroposterior axial rotation produced an increase in observed height at small angles of rotation, and a rapid decrease in vertebral height as rotation increased. The results suggest that whilst kyphosis or lordosis of up to at least 5.8 degrees has a minimal effect on MXA, scoliosis of 4.6 degrees or above produces a distinctive effect on the defining crush height ratios.

Doppler ultrasound of the uteroplacental circulation as a screening test for severe pre-eclampsia with intra-uterine growth retardation.

Two hundred primiparae underwent continuous-wave Doppler investigation of the uteroplacental circulation at 18-20 weeks gestation as a possible screening test for hypertension in pregnancy. Seventy-five women with abnormal waveforms suggestive of high uteroplacental resistance were tested again at 24 weeks when 21 demonstrated a persistent abnormality. Only nine (43%) of these went on to have an uncomplicated pregnancy, as compared with 150 (84%) of the remainder. Seventeen (8.5%) of the women in the study developed a hypertensive disorder of pregnancy, five of whom had abnormal waveforms at 18-20 weeks and at 24 weeks. These five women had a more severe degree of hypertension with proteinuria or intra-uterine growth retardation, and two required clinical intervention before term. The remaining 12 women were delivered at term of average, or heavier than average babies. Doppler investigation of the uteroplacental circulation at 24 weeks may prove to be a sensitive screening test for later severe pre-eclampsia with intra-uterine growth retardation.

A phantom for evaluating bone mineral density of the hand by dual-energy x-ray absorptiometry.

Dual-energy x-ray absorptiometry (DXA) is a precise, widely used method for measuring bone mineral density (BMD), usually of the lumbar spine and femoral neck. Recent developments, such as a lower x-ray tube current and pixel by pixel analysis, enable smaller bones and thinner tissues volumes, as in the hand, to be measured. Measurements of hand bone mineral content (BMC) and BMD could be useful in assessing disease severity in early rheumatoid arthritis and in monitoring disease progression and response to therapeutic intervention. A phantom is required for evaluating the software, measuring long-term precision and comparing with other DXA methods. This note describes the design and evaluation of a hand phantom for use on a Lunar DPX-L dual-energy x-ray absorptiometer. The phantom consists of three sections representing the metacarpals, and proximal and distal phalanges, using aluminum and Perspex as the bone and lean tissue equivalents respectively. The BMD of the three sections is approximately 1.0, 0.6 and 0.3 g cm-2. The phantom demonstrates limitations in the potential accuracy of BMD determination at low densities using the Small Animal Software on the Lunar DPX-L. Improved recognition of low-density regions was obtained with the Lunar EXPERT with precision values of 0.9, 1.1 and 2.0% for the three sections of the phantom respectively.

An assessment of the radiation dose to patients and staff from a Lunar Expert-XL fan beam densitometer.

Dual-energy x-ray absorptiometry (DXA) is a widely used technique for measuring bone mineral density for the identification and management of osteoporotic subjects. The original DXA pencil beam systems expose patients to an effective dose of ionizing radiation of around 2 muSv and require no additional protective shielding for staff. The new fan beam densitometers incorporate solid state detectors and have a higher photon flux, enabling faster acquisition times and giving improved resolution. However, this may be at the expense of higher radiation dose. This study was conducted to assess the radiation dose to patients and staff from the standard scan modes using a Lunar Expert-XL fan beam densitometer. This is, we believe, the first dose assessment of the Expert-XL. The results indicate that the scatter dose at 1 m from the scan table, assuming four AP spine and femoral neck examinations per hour, is about 4 muSv h-1. This is well below the limit of 7.5 muSv h-1 set by the UK's Ionising Radiation Regulations for defining a Controlled Area but above the lesser limit of 2.5 muSv h-1 for a Supervised Area. Typical effective doses to patients are 59 muSv for an AP lumbar spine scan, up to 56 muSv for AP femoral neck, 71 muSv for lateral spine morphometry and 75 muSv for whole body. Although exceeding those of pencil beam DXA machines, these doses are less than for standard radiographic procedures, particularly of the lumbar spine. Where reduced scan time, improved image resolution or morphometric analysis of the spine are required, the patient doses from the Lunar Expert-XL are not prohibitive.

Specific therapy in severe fetal intrauterine growth retardation: failure of prostacyclin.

Two case histories of severe, early onset intrauterine growth retardation are presented. Intravenous prostacyclin was administered in an attempt to promote fetal growth and thus prolong the pregnancy, but was unsuccessful and resulted in intrauterine death in each case. The possible reasons for the failure of this treatment and alternative therapeutic options are discussed.

Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures.

UNLABELLED: Fracture risk is underestimated in women with unknown vertebral fractures. Using VFA, we compared two screening methods: targeted (6,388 women) and routine (2,176 women). Routine screening detected fractures in 20%. Targeted screening only required 5% attending for DXA to undergo VFA but only detected 9.6% of women with fractures. INTRODUCTION: BMD alone underestimates fracture risk in women with unknown vertebral fractures. We report the results of routine vertebral fracture assessment (VFA) screening and compare with targeted screening. METHOD: Our centre initially targeted VFA at women with reasons to suspect a vertebral fracture. Later we changed to routine VFA screening for all women over 65. We retrospectively compare each screening method's ability to detect vertebral fractures. RESULTS: Six thousand three hundred and eighty-eight women over 65 underwent DXA during the period of targeted VFA and 2,176 during routine VFA. Routine VFA detected 420 (20.0%) women with fracture. Most vertebral fractures (56.2%) occurred in women with osteopenia. Routine VFA would be expected to alter the management of 1 in 6 osteopenic women. Targeted VFA was performed in 332 (5.2%) women detecting 122 (1.9%) women with fractures. It was estimated that targeted VFA only detected 9.6% of women with a vertebral fracture. Targeted VFA failed to detect fractures in 18.1% of the population attending for DXA and in 29% of those with osteoporosis. CONCLUSION: Routine VFA detects vertebral fractures in 20% of women over 65. Targeted VFA greatly reduces the number of VFAs performed but only detects a minority of the women with vertebral fractures.

The Alara Metriscan phalangeal densitometer: evaluation and triage thresholds.

The Metriscan (Alara Inc, CA) is a compact digital radiographic absorptiometry device capable of determining phalangeal bone mineral density in arbitrary units (BMD(au)) from the second phalanges of the middle three digits. We have examined the utility and the in vitro and in vivo performances of the Metriscan, and established triage thresholds based on the UK's National Osteoporosis Society guidelines on peripheral densitometry. 170 white female participants (70 osteoporotic and 100 non-osteoporotic at the hip or spine) aged between 55 years and 70 years were recruited from patients attending for routine dual X-ray absorptiometry (DXA) examination. All participants underwent two scans of the non-dominant hand (with repositioning) and one of the dominant hand. An additional 10 participants were excluded owing to finger or hand deformities. Radiation exposure to the patient per scan was <0.1 microSv, and a controlled area of 1 m was established around the device. Phantom-based in vitro short-term precision (%CV) was 0.17% without, and 0.22% with, repositioning. Long-term in vitro precision was 0.31% over a 6-month period. In vivo short-term precision was 1.42% for the group as a whole, and 1.30% and 2.23% for the non-osteoporotic and osteoporotic groups, respectively. Triage thresholds for reassurance/referral or referral/treatment were 54.30 BMD(au) and 46.89 BMD(au), respectively, for the non-dominant hand, and 55.02 BMD(au) and 48.73 BMD(au) for the dominant hand. The dominant side proved superior for triage purposes, with a triage referral rate of 44%, compared with 48% for the non-dominant hand. The Metriscan is suitable for use on post-menopausal women in a community-based setting preferably in a triage role as an adjunct to axial BMD.

The effects of short-term hormone replacement therapy on long-term bone mineral density.

INTRODUCTION: Short-term hormone replacement therapy (HRT) relieves menopausal symptoms and increases bone mineral density (BMD), but bone loss reoccurs upon discontinuation. This study assesses whether short-term HRT provides long-term BMD benefits. METHOD: This was a prospective study of women aged 50-54 years followed up for 9 years. Women were categorized into three groups according to the treatment they received: No-HRT (n = 340), Short-term HRT (2-4 years, n = 60), and Long-term HRT (9 years, n = 187). RESULTS: BMD increased significantly at the hip (2.4%, p < 0.001) and spine (8.0%, p < 0.001) over 9 years in the Long-term HRT group. Women without treatment lost BMD at the hip (-4.2%, p < 0.001) and spine (-3.5%, p < 0.001). Women in the Short-term HRT group had no significant loss of BMD at the hip (-1.6%, p = 0.08) or spine (-1.4%, p = 0.18) over 9 years. BMD in the Short-term HRT group was significantly higher at 9 years than in the No-HRT group at both spine (difference 0.023 g/cm(2), p = 0.048) and hip (difference 0.016 g/cm(2), p = 0.042). CONCLUSION: After 9 years, women who had taken short-term HRT had no significant loss of BMD and were better off in terms of BMD than those left untreated. Short-term HRT in the early postmenopausal period provides long-term BMD benefits.

Effect of pure genistein on bone markers and hot flushes.

OBJECTIVE: To evaluate the effect of 90 mg of daily genistein on markers of bone turnover and menopausal symptoms. DESIGN: This was a cross-over, placebo-controlled study involving 100 postmenopausal women. Subjects were randomly assigned to daily genistein or placebo for 6 weeks and crossed over to the alternative preparation for the following 6 weeks. Pure genistein was processed and encapsulated in accordance with British Pharmacopoeia standards. Each capsule contained 90 mg of pure genistein while the placebo contained just the recipients. RESULTS: In women with significant hot flushes (score (intensity x number) > or = 9), genistein reduced symptoms by 30% compared to baseline and the difference compared to placebo was statistically significant. No effect was observed on biochemical markers of bone turnover, possibly due to the short duration of each arm of the study. Genistein reduced osteocalcin, a marker of bone formation, by 3.6% compared to baseline and 0.31% compared to placebo (p = 0.81 and 0.40, respectively). Genistein increased cross-link telopeptide, a marker of bone resorption, by 1.8% compared to baseline and 0.29% compared to placebo; both differences were not statistically significant (p = 0.078 and 0.88, respectively). CONCLUSION: Pure genistein at a dose of 90 mg per day appears to reduce the number of hot flushes in postmenopausal women but the effect is mild.

A list of device-specific thresholds for the clinical interpretation of peripheral x-ray absorptiometry examinations.

The UK National Osteoporosis Society (NOS) has recently issued new guidelines on the use of peripheral x-ray absorptiometry (pDXA) devices in managing osteoporosis. The NOS guidelines recommend a triage approach in which patients' bone mineral density (BMD) measurements are interpreted using upper and lower thresholds specific to each type of pDXA device. The thresholds are defined so that patients with osteoporosis at the hip or spine are identified with 90% sensitivity and 90% specificity. Patients with a pDXA result below the lower threshold are likely to have osteoporosis at the hip or spine, patients with a result above the upper threshold are unlikely to have osteoporosis, while those between the two thresholds require a hip and spine BMD examination for a definitive diagnosis. This report presents data from a multicenter study to establish the triage thresholds for a range of pDXA devices in use in the UK. The subjects were white female patients aged 55-70 years who met the normal referral criteria for a BMD examination. For each device, at least 70 women with osteoporosis at the hip or spine and 70 women without osteoporosis were enrolled. All women had hip and spine BMD measurements using axial DXA systems that were interpreted using the National Health and Nutrition Examination Survey (NHANES) reference range for the hip and the manufacturers' reference ranges for the spine. Data are presented for five different devices: the Osteometer DTX-200 (forearm BMD), the Schick AccuDEXA (hand BMD), the GE Lunar PIXI (heel BMD), the Alara MetriScan (hand BMD), and the Demetech Calscan (heel BMD). The clinical measurements were supplemented by theoretical modeling to estimate the age dependence of the triage thresholds and the effect of the correlation coefficient between pDXA and axial BMD on the percentage of women referred for an axial BMD examination. In summary, this study provides thresholds for implementing the new NOS guidelines for managing osteoporosis using pDXA devices. The figures reported apply to postmenopausal white women aged 55-70 years who meet the conventional criteria for a BMD examination. The results confirm that the thresholds are specific to each type of pDXA device and that the NOS triage algorithm requires 40% of women to have an axial DXA examination.

Delivery of the very low birthweight baby.

The outlook for the baby weighing less than 1500 g at birth has dramatically improved over the last decade largely due to advances in neonatal intensive care. This, however, has created new clinical dilemmas in obstetric management and delivery. This article provides a critical review of published work, highlights the questions that remain unanswered and suggests guidelines for clinical management in the light of current knowledge.

Image resolution of the Lunar Expert-XL.

The Lunar Expert-XL is an example of the latest generation of fan beam densitometers, with the X-ray source and detector array mounted on a C-arm to enable supine lateral imaging. Image resolution for anteroposterior (AP) spine, femur, hand, forearm and lateral morphometry on the Expert-XL were assessed in vitro with the 07-541 Nuclear Associates line pair test pattern. Each scan type was investigated at all available tube currents and scan speeds, and at the maximum, minimum and default bed heights. The effect of soft tissue thickness on resolution was investigated by using varying amounts of Perspex attenuator. The in vitro median lateral (x-axis) resolutions at the default bed height for the default scan types were 0.9 line pairs (lps)/mm for the 5 mA fast AP spine and femur scans, and l.0 lps/mm for 1 mA fast hand, forearm and 5 mA fast morphometry scans. This equates to a resolution of about 1 mm. The best resolution achieved was 1.2 lps/mm (0.83 mm), obtainable on all scan modes with the bed at maximum elevation, but only consistently with the forearm mode. Lower tube current did not affect resolution but did change the range of soft tissue thickness over which an image could be resolved. Turbo scan modes greatly reduced longitudinal (y-axis) resolution but had little effect on lateral resolution. This study demonstrates the importance of including an assessment of resolution when validating new equipment, especially if morphometric investigations are to be conducted.

Employee wellness program: cardiac risk reduction in the school setting.

Corporate wellness programs have been implemented in various work settings. When the Baltimore County (Maryland) School System initiated such a program, benefits were quickly realized and at a low cost.

Attitudes towards and use of dietary supplementation in a sample of postmenopausal women.

OBJECTIVES: To assess the reason why people take food supplements in addition to or in place of medication, as well as the perceived efficacy and risk of these supplements. METHODS: A 20-item, computer-assisted telephone questionnaire was administered to 442 women over 60 years of age in Hull, to assess the prevalence of use and perception of efficacy and safety of food supplements. RESULTS: Data were available for 411 women, of whom 269 (65.4%) were currently taking food supplements, 76 (18.5%) were previous users and 66 (16%) were never-users. There was no difference in terms of age, smoking, consumption of fruit and vegetables, life-style and attitude towards conventional medicine between current or past users of supplements and never-users. The majority of users (n = 229, 66%) thought that food supplements help maintain good health (p < 0.001). Overall long-term (5 years) adherence was achieved in 244 cases of supplement uses (36%). Among users, 150 (43%) thought that supplements were very effective, and 171 (49.5%) women had noticed an improvement of various symptoms. Although the majority of users (n = 176, 51%) believed that supplements might have adverse effects, over 66% would not associate side-effects with the food supplement. Information regarding supplements was obtained primarily from the media, particularly magazine and newspaper articles (27%), with health professionals rarely being consulted (16%). CONCLUSIONS: Users believed supplements to be effective, although possibly with associated side-effects. However, they would not attribute adverse effects experienced to this form of treatment. Medical practitioners and health professionals are rarely informed or consulted, leaving potentially dangerous side-effects of food supplements to go unreported.

Long-term follow-up of detrusor instability following the colposuspension operation.

Pre- and post-operative clinical and urodynamic data have been reviewed in 24 women with detrusor instability following colposuspension. Follow-up ranged from 3 to 5 years. Ten women remained asymptomatic throughout; of the remainder, four (28.6%) were improved by drug therapy. With one exception, patients who were symptomatic at the outset remained so at late follow-up.