Hormone Drugs Affect Bone Density

THE QUESTION: In women, low levels of the hormone estrogen contribute to loss of bone density, increasing the chances of a fracture. Might something similar occur in men who take drugs to suppress hormones such as testosterone to control and shrink the tumors of prostate cancer?

THIS STUDY examined the medical records of 50,613 men, aged 66 and older, diagnosed with prostate cancer, comparing those who received hormone therapy within a year with men who did not. About five years after their diagnoses, 19 percent of those in the hormone- therapy group had broken a bone, compared with 13 percent of those who did not take the drugs. The risk of fracture increased as the number of doses increased: Men who took one to four doses were 7 percent more likely to break a bone than those who took none of the drugs; five to eight doses, 22 percent; and nine or more doses in a year meant a 45 percent increased chance of fracture. Men who had surgery to remove one or both testicles, which produce testosterone, were 54 percent more likely to break a bone.

WHO MAY BE AFFECTED BY THESE FINDINGS? Men with prostate cancer. An estimated 220,000 men in the United States are diagnosed with this cancer each year; about 40 percent of them are treated with hormone-suppressing drugs.

CAVEATS: The study determined risk only for drugs given during the first year after diagnosis; whether longer-term use of hormone- suppressing drugs would yield different results remains unknown. The study was not randomized.

BOTTOM LINE: Men with prostate cancer may want to talk with an oncologist about the risks associated with hormone therapy before deciding on a particular treatment.

FIND THIS STUDY: Jan. 13 issue of the New England Journal of Medicine; abstract available online at nejm.org.

LEARN MORE ABOUT hormone therapy for prostate cancer at urol ogyhealth.org and cancer.gov.

*

Folate lowers hypertension risk

THE QUESTION: Too much weight, too little activity, too much salt in the diet or too little potassium: All can make high blood pressure more likely. Does consumption of the vitamin folate also have an effect?

THIS STUDY compared daily intake of folate, in the diet and via supplements, in 93,803 women who averaged 36 years old and 62,260 women who averaged 55. Younger women who consumed at least 1,000 micrograms (mcg) were 46 percent less likely to develop hypertension than those who consumed less than 200 mcg. In the older group, the difference was 18 percent. The recommended daily intake of folate is 400 mcg for adults.

WHO MAY BE AFFECTED BY THESE FINDINGS? Women, especially those at risk for hypertension.

CAVEATS: The study did not determine why folate decreased the risk more in younger than older women. Data for the study came from participants’ responses to questionnaires. The study was not randomized.

BOTTOM LINE: Women may want to talk with a doctor about whether increasing folate intake might be beneficial.

FIND THIS STUDY: Jan. 19 issue of the Journal of the American Medical Association; abstract available online at jama.com.

LEARN MORE ABOUT high blood pressure at american heart.org and nhlbi.nih. gov.

*

Good cholesterol benefits arteries

THE QUESTION: Drugs that lower total cholesterol and low-density lipoprotein (LDL), the so-called bad cholesterol, can help keep arteries from narrowing. Might drugs that instead raise levels of high-density lipoprotein (HDL), the “good” cholesterol, achieve a similar outcome?

THIS STUDY randomly assigned 143 retirees with low HDL levels and narrowed arteries to take a combination of gemfibrozil, niacin and cholestyramine or a placebo daily. All participants were counseled to eat a low-fat diet, exercise and stop smoking. After about 2 1/2 years, angiograms showed that arteries had become more restricted in people who took the placebo, whereas arteries were more open than at the start of the study in people who took the drugs to raise their HDL levels. Those given the drugs also had fewer heart problems than the others (nine people vs. 19). Their HDL levels increased 36 percent, total cholesterol dropped 20 percent, LDL decreased 26 percent and triglycerides went down 50 percent compared with those who took the placebo. All participants lost weight.

WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with low HDL. An HDL reading of less than 40 milligrams per deciliter increases the risk of coronary heart disease.

CAVEATS: Side effects were more common in the drug group, especially flushing (92 percent vs. 25 percent) and rashes (41 percent vs. 7 percent). The number of participants was relatively small. The study did not determine whether improvements in artery narrowing were the result of higher HDL or lower LDL levels, or both. Pfizer Pharmaceuticals, which makes cholesterol drugs, funded the study; two authors received consulting fees from the company.

BOTTOM LINE: People seeking a better cholesterol level may want to ask a doctor about drugs that raise HDL.

FIND THIS STUDY: Jan. 18 issue of Annals of Internal Medicine; abstract available online at annals.org.

LEARN MORE ABOUT cholesterol and coronary artery disease at americanheart.org and family doctor.org.