EU_Musc_News_roundup.qxp 1/10/07 12:11 Page 10
News Round-up
The European Musculoskeletal Arena – In Brief
A Round-up of Trends, Statistics and Clinical Research
Common Antidepressant Linked to and also inflicting considerable pain. To date, loosened artificial hip implants by measuring
Bone Density Risk knowledge regarding the progression of OA vibrations in the leg bone. The device is capable
A class of commonly prescribed antidepressants has been somewhat lacking, despite it being of detecting even minor loosening in the joint
may be responsible for lowering the bone the most prevalent form of arthritis. However, and may replace the traditional X-ray
density of older patients. Serotonin re-uptake this latest study, led by Dr Stella Botha- procedure, which can pick up only large
inhibitors (SSRIs) work by inhibiting the protein Scheepers of Leiden University, The amounts of loosening.
that transports serotonin – a neurotransmitter Netherlands, has provided new insight.
involved in depression. Recently, however, It is estimated that around one-quarter of hip
seratonin has also been found in bone, leading The study followed 170 patients with hand OA replacement patients will experience pain in
to concerns that SSRIs may have an adverse for two years, applied a four-point scale to the 10 years following surgery due to
effect on bone formation. assess pain and analysed hand pain and loosening of the joint. The hip implants are
movement limitations, as well as joint space secured to the bone with special cement,
Two studies published in the 25 June issue of narrowing through radiographs. which can loosen over time. However, pain
Archives of Internal Medicine examine the link following hip replacement can also be caused
between SSRIs and bone density. Researchers After a follow-up of two years, the study noted by infection around the joint, so it is vital that
from the University of Minnesota compared the statistically significant rises in radiological diagnostic tools are able accurately and
hip bone density of around 2,700 women – progression in almost 20% of patients, and also efficiently to detect even minor loosening.
average age 78.5 years – between 1997 and in osteophytes, which occurred in mostly The new method, developed by Dr
1999. Among the 7% of women taking SSRIs, female middle-aged patients, particularly in the James Cunningham and colleagues in the
bone mineral density was found to decrease by early post-menopausal stage. Department of Mechanical Engineering, works
0.82% compared with 0.47% for those taking by causing vibrations in the hip joint and the
another class of antidepressant and those Dr Scheepers noted that the speed of OA femur by placing a vibrating piece against the
taking no antidepressant. progression highlighted in this study knee. An ultrasound device then picks up the
underlines the need for early treatment. sound frequency emitted from the hip. ‘Pure’
The second study, from Oregon Health & Science “Effective early intervention in hand OA is frequencies, characterised by a regular pattern
University, found similar results in around 6,000 required in order to prevent irreversible of increasing and decreasing waves, show that
men aged on average 73.7 years. Bone density progression, given the dramatic deterioration the hip joint is firmly in place. Irregular
measured between 2000 and 2002 showed that of clinical and radiological disease status seen frequencies, however, indicate loosening.
the total hip bone density of the 2.7% of men in just two years.” ■
who were using SSRIs was 3.9% lower than that Dr Cunningham claims the ultrasound method is
of those not using any antidepressant. Loose Hip Joints Accurately better than any other method currently available.
Detected with New Device The device may in the future significantly
Just over 60% of antidepressants prescribed in A new device developed by engineers from the increase both the accuracy and efficiency of
the US are SSRIs. While these findings do not University of Bath, UK, can accurately detect monitoring hip replacement patients. ■
prove a direct link between SSRIs and lower
bone density, they do have a potentially
Osteoporosis Drug Pipeline by Selected Class, 2007
important public health impact, say the authors
Number of drugs
of the Oregon study. “If confirmed, people
using SSRIs might be targeted for osteoporosis
12
screening and preventive intervention.” ■
10
Study Highlights Speed of Hand
SERM
8
Osteoarthritis Progression
PTH
Patients with hand osteoarthritis (OA) can 6
Bisphophonates
experience considerable functional limitations
and increased pain over a period of just two
4 Cathepsin K
inhibitors
years, recent data reveal.
2
Calcitonin
If untreated, hand OA causes the bones in the
0
joint to lose their shape, reducing ability to
Not approved Pre-registration Phase I Phase II Phase III
perform activities requiring fine motor control, Source: Touch Briefings.
10 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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