An emerging body of evidence is suggesting that osteoporosis may affect different ethnic groups in different ways. "An understanding of these differences might lead to refinements in the strategies to manage osteoporosis within the Asian context, " said Dr. Leonard Koh, consultant physician and endocrinologist, Gleneagles Medical Centre. Koh was speaking at the Singapore Menopause Congress. "Worldwide comparisons of fracture incidence rates suggested that the risk of having a hip fracture is generally less among Asians, but appears to be rising, and approaching those of the West in countries such as Singapore, Hong Kong and Taiwan, " said Koh. He pointed out that between 1991 and 1998, there were 402 hip fractures per year among women in Singapore and 152 among men, per 100, 000 people aged 50 or older. In comparison, the Caucasian population in California, US, in the 1980s had 553 hip fractures per year among women and 198 among men, within the same age group. Interestingly, even within Asian populations, significant ethnic differences exist in hip fracture rates. For example, in Singapore, the Chinese appear to have higher hip fracture rates than Indians, who have higher hip fracture rates than Malays. Osteoporos Int 2001; 12: 311-8 ; Differences in bone mineral density BMD ; do not seem to account for differences in fracture rates among ethnic groups. Most reports suggest that BMD is highest in African-Americans, lowest in Asians, and intermediate in Caucasians, although fracture rates are highest in the latter. J Clin Endocrinol Metab. 2002; 87: 3057-67 ; Ethnic differences also exist in BMD and hip geometry within the Singaporean population. In the 50 to 59 year old age group, BMD is similar between the Chinese and Malays but lower than the Indians. The Chinese have the longest hip axis lengths amongst the three main Singaporean ethnic groups, which may account for their higher fracture rates. a study comparing fractional absorption rates for calcium among osteoporotic and nonosteoporotic Chinese women. The study showed that as calcium intake was reduced, the fractional absorption of calcium increased. For example, osteoporotic women taking a 1, 200 mg calcium supplement absorbed between 45 and 50 percent of it, while absorbing approximately 55 percent of a 600 mg dose. Calcium absorption increased to roughly 70 percent in a reduced calcium diet. J Clin Nutr 1998; 68: 1291-7 ; "That's interesting because it suggests that if we did increase our calcium intake, osteoporotic individuals may be less efficient at absorbing calcium, and may excrete more, " said Koh, noting that genetic polymorphism may contribute to differences in calcium absorption between different ethnic groups. Fortunately, treatment effects appear to be similar between Asians and Caucasians. Studies have observed significant reductions in the incidence of vertebral fractures with alendronate, risedronate, hormone replacement therapy, etidronate and calcitonin, said Koh. There is a move away from treating osteoporosis based on a diagnostic threshold, to one based on absolute 5 to 10 year fracture risk, concluded Koh. The absolute fracture risk differs between countries, and needs to be ascertained for each. The threshold level of risk at which to intervene depends on the standard of living in each country, and the cost the country is willing to pay to prevent a fracture, and these are currently being investigated. PP & PM and anacin and risedronate. Journal of clinical endocrinology and metabolism, july 200 the results of a new study suggest that actonel riedronate ; provides greater fracture protection in the first year of therapy than does fosamax alendronate. Psychopharmacology DOI 10.1007 s00213-006-0459-3 and panadol. Defendants in In Re Brand Name Prescription Drugs Antitrust Litigation, 2000 U.S. Dist. LEXIS 1734, * 5-6 N.D. Ill. February 9, 2000 ; . From Judge Peter J. Messitte, of the U.S. District Court for the District of Maryland: "The experience and ability of the attorneys I have mentioned earlier, in my view in reviewing the documents, which I have no reason to doubt, the plaintiffs' counsel are at the top of the profession in this regard and certainly have used their expertise to craft an extremely favorable settlement for their clients, and to that extent they deserve to be rewarded." Concerning the work of senior member, Merrill G. Davidoff, as stated in a Settlement Approval Hearing, Oct. 28, 1994. Spawd, Inc. and General Generics v. Bolar Pharmaceutical Co., Inc., CA No. PJM-92-3624.
Drug Name Prep class Prescription items dispensed [PXS] thousands ; 0.3 0.7 2.0 Of which class 2 thousands ; Net ingredient cost [NIC] thousands ; 14.5 39.0 52.4 Quantity [QTY] thousands ; Standard quantity unit.

Evidence of efficacy has been identified in this review for few of the interventions studied: 4isedronate and calcidiol for vertebral fracture and none for non-vertebral fracture. However, failure to demonstrate the efficacy of the remaining interventions may reflect the small size and short duration, and also the inappropriate reporting of fracture outcomes of the studies that were suitable for meta-analysis. A further reason for failure to demonstrate efficacy may include the heterogeneity of patient groups in their underlying disease, dose and duration of exposure to glucocorticoids and the timing of intervention for bone disease.

Rifamate .15 rifamaxin .13 rifamaxin Xifaxin ; .13 rifampin .15 rifampin Rimactone ; .15 rifapentine .15 rifapentine Priftin ; .15 Rifater.15 Rimactane see rifampin Rimactone .15 rimantadine .14 rimexolone .12 rimexolone Vexol ; .12 Riomet .8 risedronate .9 risedronate Actonel 75mg ; .9 risedronate Actonel ; .9 risedronate calcium .9 risedronate calcium Actonel w calcium ; .9 Risperdal .16 Risperdal M-Tab.16 risperidone .16 risperidone Risperdal M-Tab ; .16 Ritalin see methylphenidate Ritalin LA .16 rivastigmine .17 rivastigmine Exelon ; .17 rizatriptan .18 rizatriptan Maxalt ; .18 Robaxin see methocarbamol Rocaltrol see calcitriol Roferon .14-15 ropinirole see sulfacetamide sulfur topical Rosac .20 Rosanil .20 rosiglitazone .8 rosiglitazone glimepiride .8 rosiglitazone metformin .8 Rosula cleanser, NS see sulfacetamide sodium Rosula gel see sodium sulfacetamide sulfur rosuvastatin .9 rosuvastatin Crestor ; .9 rosuvastatin 40mg .9 rosuvastatin 40mg Crestor ; .9 Roxicet see oxycodone acetaminophen Roxicodone see oxycodone Rozerem .17 Rx only-Brevoxyl .20 Rx only-Zoderm .20 Rythmol see propafenone Saizen .11 Salagen see pilocarpine salmeterol .23. Increase bone density and reduce vertebral and nonvertebral fractures, but, until recently, no randomized controlled trial of bisphosphonates has had hip fracture as the primary outcome measured. The Hip Intervention Program HIP ; is the first randomized controlled trial of a bisphosphonate with hip fracture incidence as the primary outcome. The HIP trial results1 show that the bisphosphonate risedronate Actonel ; reduced the risk of hip fracture in women age 70 to 79 with osteoporosis; the effect appeared most significant in those women who had a history of vertebral fractures. Although no effect was found in older women in whom bone density was not measured, the HIP study did not evaluate or record risk factors for hip fractures in a systematic manner. At the end of this article, I discuss my recommendations for treatment strategies for different patients.

Independent risk factors for fracture include advanced age, preexisting fractures, and low bone mineral density. Risedronate has been shown in several large trials to be safe and effective for patients with osteoporosis, but its effects in populations at high risk are not well characterized. To determine the effect of risedronate on vertebral fracture in high-risk subjects, we pooled data from two randomized, double-blind studies [Vertebral Efficacy with Risedronate Therapy VERT ; Multinational VERT-MN ; and VERT-North America VERTNA ; ] in 3684 postmenopausal osteoporotic women treated with placebo or risedronate 2.5 or 5 mg d and analyzed fracture risk in subgroups of subjects at high risk for fracture due to greater age or more prevalent fractures vs. median for overall study population ; , or lower bone mineral density Tscore, 2.5 or less ; . Fractures were diagnosed by quantitative and semiquantitative assessment of radiographs at baseline and 1 yr. In the overall population, treatment for 1 yr with risedronate 5 mg d reduced the risk of new vertebral fractures by 62% vs. control relative risk, 0.38; 95% confidence interval, 0.25, 0.56; P 0.001 ; and of multiple new vertebral fractures by 90% vs. control relative risk, 0.10; 95% confidence interval, 0.04, 0.26; P 0.001 ; . Consistent risk reductions were observed at 1 yr the risedronate-treated high-risk subgroups. Significant reduction in fracture risk after 1 yr is important benefit in patients at high risk for fracture because, without treatment, these patients are likely to sustain new fractures in the near term. J Clin Endocrinol Metab 88: 542549, 2003.

A Recent Article in The New York Times from June 2nd, 2006, outlines a new concern regarding the drugs called "bisphosphonates" often used in treating osteoporosis and bone loss due to cancer treatment. Drugs such as Zometa, Aredia, Fosamax, Actonel and Boniva have been linked to a condition called osteonecrosis of the jaw causing parts of the jaw bone to die or to have difficulty in healing after invasive dental procedures. Though these side effects are not common, if you have questions about a bisphosphonate that you are taking and whether it will affect your jaw bone, be certain to talk to your doctor. The FDA is aware of the issue and has required all bisphosphonates to carry a warning on their label disclosing the link between bisphosphonates and osteonecrosis of the jaw. If you have been treated for metastatic cancer or osteoporosis or if you are taking any of the following medications, please ask you physician for more information: Fosamax Alendronate ; Boniva Ibandronate ; Actonel Risedronate ; Pamdronate IV.

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