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Archive for May 4th, 2011

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These are my links for May 4th from 17:49 to 18:33:

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I have written a number of pieces about the problems associated with bisphosphonates and osteonecrosis of the jaw. Now, there is this piece about some additional problems with these drugs.
Nearly six years ago in this column, I discussed what was then a little-known problem associated with long-term use of bisphosphonates, the valuable drugs that protect against fractures caused by bone loss. The drugs, among them Fosamax, Actonel and Boniva, can slow bone loss, increase bone density and cut fracture rates in half in women with established osteoporosis.

Reports had begun to emerge that some women taking bisphosphonates for many years suffered an unusual fracture of the femur, the long bone of the thigh. There was little or no trauma; in most cases the women were simply standing or walking when the femur snapped in half. In some, breaks occurred in both thighs, and many of the fractures were unusually slow to heal.

Experts think the fractures happened because of the way the drugs work: by slowing the rate of bone remodeling, the normal process by which injured bone heals. As a result, microfractures that occur through normal wear and tear are not repaired. Although bone density may be normal, the bone can become brittle and crack under minor stress.

In the years since, hundreds of cases of atypical femur fractures have been reported among women and some men taking bisphosphonates for five or more years. A number of studies have tried to assess the risk, and last fall the Food and Drug Administration issued a “safety announcement” and required that the drugs’ labels warn physicians and patients to be alert for this potential complication.

So, with all of the problems associated with these drugs and the realized benefit, do the risks outweigh the benefits? The latest study was published in JAMA on February 23rd.

“Compared to the number of fractures prevented,” she said, “the actual risk of a subtrochanteric femur fracture is small” — 1 case in 1,000 in the sixth year of therapy and 2.2 cases in 1,000 the seventh year.

And, in another report in the The New England Journal of Medicine.

A report published last year in The New England Journal of Medicine found no increase in atypical femur fractures, but that study did not include enough patients taking bisphosphonates for many years to produce a reliable result. Preliminary data from a much larger study has indicated that the risk of atypical femur fractures increased from 2 cases a year per 100,000 users after two years of bisphosphonate therapy to 78 cases a year per 100,000 after eight years on the drug.

One more study:

In a report from a 27-member task force of the American Society for Bone and Mineral Research (published online in September in The Journal of Bone and Mineral Research), the experts noted that the way bisphosphonates work can reduce the “toughness” of bones. “It is highly likely that case reports and case series of atypical femur fractures will continue to accumulate,” the task force wrote, noting that another 47 cases had been reported since their analysis was prepared. Many cases are not reported, and in an unknown number of cases physicians may not recognize the fractures as atypical.

The task force called for an international registry of cases, including details that could help define who is most at risk.

So, what should a patient and a dentist do?

Certainly, be aware of the inherent risks of the bisphosphonates and be sensitive to the need, particularly if you are not at a high fracture risk.

Initial excitement about bone-protecting drugs led to prescriptions for millions of women who were not necessarily at high fracture risk, and many experts now urge a thorough evaluation before a bisphosphonate is prescribed. In addition to bone density test results, the evaluation should take into account a patient’s smoking and drinking habits, thinness, family history of osteoporosis, previous osteoporotic fractures, drug prescriptions and weight-bearing exercise regimen. An online evaluation tool developed by the World Health Organization is at www.shef.ac.uk/FRAX, though some experts have criticized it as incomplete.

The task force said a decision to treat should be “based on an assessment of benefits and risks,” and added, “patients who are deemed to be at low risk of osteoporotic-related fractures should not be started on bisphosphonates.”

Even those with osteoporosis in the spine but little or no problem in their hips, the experts concluded, should consider alternative remedies.

Osteonecrosis of the jaw is NOT a minor complication and the dentist in consult with the patient and patient’s physician must evaluate the risks, prior to dental surgery.

The femur of Dr. Jennifer Schneider of Tucson, an internist who after seven years on Fosamax suffered a nontraumatic femur fracture that took two years to heal

Dr. Schneider invites patients who have had such a fracture to write her at jennifer@jenniferschneider.com

Previous:

Oral Bisphosphonates Associated with a SLIGHTLY Elevated Risk of Developing Osteonecrosis of the Jaw?

New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?

Dentistry Today: Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate disodium) Associated with Osteonecrosis of Jaw – REDUX

Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

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These are my links for May 4th from 14:49 to 14:55:

  • The Slippery Story of the bin Laden Kill – As for the claim that bin Laden was living in a mansion, as opposed to just a big house, all that's needed to debunk that description is some pictures of the house. A Wall Street Journal reporter went to the scene and gave this eye-witness account, concluding there was nothing mansion-like about it:

    The size and fortress-like nature of the compound stood out in the area, though many of the houses in Abbottabad, built by ex-servicemen and business people, also have high walls. Homes are separated by empty plots where people grow crops like potatoes and wheat.

    The top two floors of bin Laden's three-story house are visible above the high perimeter walls. The house, built in 2005, appears run-down. Grass grows off a ledge below the roof. The outside walls are scarred with damp and mold. A hand-painted advertisement for Jamia Girls College, in Urdu and English, decorates one of the outside walls of the compound.

    One of the awnings on an outdoor window hung down at an angle, perhaps after being damaged during the attack. Otherwise, the house stood intact, with few signs a major firefight only two days earlier.

    There were no visible airconditioning units to keep residents cool through the Pakistan summer. At the back of the house was a small, private triangular garden with a towering fir tree, where bin Laden could have gotten air without being seen by outsiders.

    =====

    Read it all.

    Definitely not a mansion and there has to be a reason why Obama is not releasing bin Laden's death photos.

  • To get bin Laden, Obama relied on policies he decried – Let's cheerfully and ungrudgingly give credit to Barack Obama for approving the military operation that resulted in the death of Osama bin Laden.

    In my Washington Examiner column last Sunday I criticized Obama's foreign policy, which was characterized by one of his advisers in an interview with the New Yorker's Ryan Lizza as "lead from behind." That criticism still stands.

    But in tracking down and nailing bin Laden, Obama led from behind the right way — behind the scenes he made a right but risky decision, without any leaks to the press, to achieve an objective sought by two presidents and thousands in the American government and military since Sept. 11, 2001.

    The decision was risky because the operation could have failed, like Jimmy Carter's Desert One operation to rescue American hostages in Iran failed in April 1980.

    But this time, even though one helicopter was lost, the operation succeeded. There was evidently a lot of redundancy in the plan and a lot of flexibility on the ground. A lot of good people did a lot of good things right.

    ======

    Read it all.

    Yes, he Did

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These are my links for May 4th from 12:26 to 12:38:

  • John Yoo: From Guantanamo to Abbottabad – WSJ.com – John Yoo: From Guantanamo to Abbottabad
  • John Yoo: From Guantanamo to Abbottabad – President George W. Bush, not his successor, constructed the interrogation and warrantless surveillance programs that produced this week's actionable intelligence. For this, congressional Democrats and media pundits pilloried him for allegedly exceeding his presidential powers and violating the Bill of Rights.

    As a candidate in 2008, then-Sen. Obama held Mr. Bush and Sen. John McCain "responsible for the most disastrous set of foreign policy decisions in the recent history of the United States." These decisions, he said, allowed bin Laden and his circle to establish "a safe-haven in northwest Pakistan, where they operate with such freedom of action that they can still put out hate-filled audiotapes to the outside world."

    Upon taking office, Mr. Obama tried to fulfill the dreams of the antiwar left. In January 2009, he signed executive orders to close the prison at Guantanamo Bay and limit the CIA to U.S. military interrogation methods. He made it clear that al Qaeda leaders would be tried in civilian courts. And in August 2009, his attorney general, Eric Holder, launched a criminal investigation into CIA officers who had interrogated al Qaeda leaders.

    Imagine what would have happened if the Obama administration had been running things immediately following 9/11. After their "arrest," we would have read KSM and al-Libi their Miranda rights, provided them legal counsel, sent them to the U.S. for detention, and granted them all the rights provided a U.S. citizen in criminal proceedings.

    =====

    Read it all

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