Drug Topics - December 10, 2007 - (Page 34)

34 DRUG TOPICS DECEMBER 10, 2007 www.drugtopics.com CONTINUING EDUCATION to 0.3 mg of conjugated estrogen produced the same effects as taking 600 mg of ipriflavone alone. Both agents led to a decrease in bone turnover as well as an increase in bone density. A more recent randomized control study by Alexandersen et al. reported that when patients receiving 200 mg ipriflavone three times a day and 500 mg/day of calcium were compared with a group receiving only 500 mg of calcium, opposing data were found. Alexandersen et al. did not find ipriflavone to prevent bone loss or affect metabolism. Nevertheless, most data still suggest ipriflavone is likely to be effective against osteoporosis at a dose of 600 mg per day. One major concern found with this natural product is its effect on lymphocytes. The Alexandersen study found 13% of patients experienced asymptomatic lymphocytopenia. Table 1 Risk factors for osteoporosis Alcohol abuse Calcium deficiency Family history of osteoporosis Fair skin (Caucasian or Asian race) Hyperthyroidism Hysterectomy Lack of adequate exercise Medications that increase bone thinning: longterm use of oral steroids, aromatase inhibitors used to treat breast cancer, anticonvulsants such as carbamazepine, thyroid replacement medications, and medroxyprogesterone Menopause before age of 48 Thin body and small bone frame Tobacco use phytoestrogens in the body. Ipriflavone was discovered in the 1930s and is believed to prevent bone loss as well as prevent the loss of bone mineral density in postmenopausal women diagnosed with osteoporosis. Three main mechanisms are thought to be beneficial in the treatment of osteoporosis: decreased resorption, enhanced effects on estrogen, and increased bone formation. Ipriflavone was found to decrease bone resorption through the inhibition of the parathyroid hormone. It lacks a direct effect on estrogen but is thought to enhance estrogen activity. As previously discussed, this is beneficial in osteoporosis because estrogen modulates calcitonin secretion. Ipriflavone is also thought to increase the sensitivity of the thyroid gland, leading to an increased release of calcitonin in the body. Ipriflavone and one of its metabolites stimulate the synthesis of osteoblasts, leading to an increase in bone formation. A normal therapeutic dose of ipriflavone for osteoporosis is 200 mg three times daily. The oral intake of 1,000 mg of calcium daily along with ipriflavone may be necessary to enhance efficacy. For postmenopausal women, the combination of ipriflavone, a low-dose estrogen (0.3 mg), and 500 to 1,000 mg of calcium daily may provide optimal increase in bone mineral levels. Double-blind, placebo-controlled studies have found postmenopausal women taking 200 mg of ipriflavone three times daily maintained bone mass or a slight increase in bone mass when compared with a placebo group in which bone mass was diminished. Other studies have focused on ipriflavone’s use when administered in addition to 1 gm of calcium. A study conducted by Agnusdei observed patients aged 65 to 79 for two years. An increase of 4% to 6% in bone density was documented among the ipriflavone groups, whereas the placebo group experienced a decrease in bone density of as much as 3%. The addition of low-dose estrogen with ipriflavone was also studied. It was determined that 400 mg of ipriflavone daily in addition OSTEOARTHRITIS Osteoarthritis is a degenerative joint disease affecting 21 million Americans with 70% to 90% of patients over age 75. In addition to age, risk factors include joint injury, obesity, and mechanical stress. Anti-inflammatory prescription medications, such as COX-2 inhibitors, have been considered the mainstay of therapy for osteoarthritis patients. Currently, there is only one COX-2 inhibitor available, and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse effects. For this reason, greater attention is now being focused on the role of natural products for these patients. Pathological changes in osteoarthritis Osteoarthritis is associated with biochemical changes in bone and cartilage of weight-bearing and non-weight-bearing joints. Pain associated with osteoarthritis arises from the activation of nociceptive nerve endings within the joint by mechanical and chemical irritants. Pain is the result of the distention of the synovial area by increased joint fluid, micro-fractures, periosteal irritation, or damage to the ligaments, synovium, or meniscus. Natural products for osteoarthritis Capsaicin: Capsaicin is a constituent of the chili pepper plant and belongs to the genus Capsicum. This natural product is a topically applied agent used to treat pain experienced from back problems, postherpetic neuralgia, diabetic neuropathy, rheumatoid arthritis, and osteoarthritis. Capsaicin provides a unique mechanism of action that decreases pain experienced by osteoarthritis patients. First, it binds to nociceptors found within the skin. This leads to a period of enhanced sensitivity and an initial excitation of the neurons, producing a counter-irritant effect. After initial excitation, patients often experience symptoms such as itching, burning, prickling of the skin, and cutaneous vasodilation. The mechanism is also believed to be due to capsaicin’s ability to cause an initial release of substance P as well as selectively stimulate the afferent C fibers. Normally, the release of substance P and stimulation of afferent C fiber lead to symptoms of pain experienced by the body. After the period of initial cutaneous irritation, there is a refractory phase that leads to the http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics - December 10, 2007

Drug Topics - December 10, 2007 Latebreakers Latebreakers in Depth Letters Health-System Edition - Cover Story Clinical Practice Professional Practice Special Report Technology Community Practice Unraveling Medicare 150 Years of American Pharmacy Rx Care In the Pipeline Cover Story: Fair or foul? Self-Care Chains and Business Government and Law Continuing Education: Natural Medicines for Bone Health New Products Advertisers Index Classified Viewpoint

Drug Topics - December 10, 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.