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M Ettinger

Publications and source records attributed to M Ettinger.

14 recordsLinked to original sources
PubMed2004

Insufficiently dosed intravenous ibandronate injections are associated with suboptimal antifracture efficacy in postmenopausal osteoporosis.

Less frequent bisphosphonate dosing in women with postmenopausal osteoporosis has the potential to promote therapy adherence through improved convenience. Ibandronate is a highly potent nitrogen-containing bisphosphonate, proven to significantly increase vertebral and nonvertebral bone mineral density (BMD) when administered as a convenient intravenous injection. A recent double-blind, placebo-controlled, randomized phase III study explored the antifracture efficacy and safety of 1 and 0.5 mg iv ibandronate injections, given once every 3 months, in 2862 women (55-76 years) with postmenopausal osteoporosis [one to four prevalent vertebral fractures and lumbar spine (L1-L4) BMD T score of less than -2.0 and greater than -5.0 in >or=1 vertebra]. All participants received daily vitamin D (400 IU) and calcium (500 mg) supplementation. The primary endpoint was the incidence of new morphometric vertebral fractures after 3 years. However, although a consistent trend toward a reduction in the incidence of new morphometric vertebral fracture was observed in the active treatment arms compared with placebo (9.2% vs. 8.7% vs. 10.7% in the 1 mg, 0.5 mg and placebo groups, respectively), as well as in the incidence of nonvertebral and hip fractures, the magnitude of fracture reduction was suboptimal and was insufficient to achieve statistical significance. At the studied doses, intravenous ibandronate injections also produced dose-dependent, but comparatively small, increases in lumbar spine BMD (4.0% and 2.9%, respectively) and decreases in biochemical markers of bone resorption and formation, relative to placebo. Optimal fracture efficacy likely requires more substantial increases in BMD and more pronounced suppression of bone turnover. In light of the clear dose-response relationship observed in this and other studies, this is likely to be achieved with higher intravenous doses of ibandronate. The results of a recent phase II/III study (Intermittent Regimen Intravenous Ibandronate Study: the IRIS study) provide support for this hypothesis.

Aged↗
PubMed2000

Alendronate for the treatment of osteoporosis in men.

BACKGROUND: Despite its association with disability, death, and increased medical costs, osteoporosis in men has been relatively neglected as a subject of study. There have been no large, controlled trials of treatment in men. METHODS: In a two-year double-blind trial, we studied the effect of 10 mg of alendronate or placebo, given daily, on bone mineral density in 241 men (age, 31 to 87 years; mean, 63) with osteoporosis. Approximately one third had low serum free testosterone concentrations at base line; the rest had normal concentrations. Men with other secondary causes of osteoporosis were excluded. All the men received calcium and vitamin D supplements. The main outcome measures were the percent changes in lumbar-spine, hip, and total-body bone mineral density. RESULTS: The men who received alendronate had a mean (+/-SE) increase in bone mineral density of 7.1+/-0.3 percent at the lumbar spine, 2.5+/-0.4 percent at the femoral neck, and 2.0+/-0.2 percent for the total body (P<0.001 for all comparisons with base line). In contrast, men who received placebo had an increase in lumbar-spine bone mineral density of 1.8+/-0.5 percent (P<0.001 for the comparison with base line) and no significant changes in femoral-neck or total-body bone mineral density. The increase in bone mineral density in the alendronate group was greater than that in the placebo group at all measurement sites (P<0.001). The incidence of vertebral fractures was lower in the alendronate group than in the placebo group (0.8 percent vs. 7.1 percent, P=0.02). Men in the placebo group had a 2.4-mm decrease in height, as compared with a decrease of 0.6 mm in the alendronate group (P=0.02). Alendronate was generally well tolerated. CONCLUSIONS: In men with osteoporosis, alendronate significantly increases spine, hip, and total-body bone mineral density and helps prevent vertebral fractures and decreases in height.

Adult↗
PubMed2000

Biological variability of serum and urinary N-telopeptides of type I collagen in postmenopausal women.

Measurement of N-telopeptides of type I bone collagen (NTX) provides a specific indicator of the current level of bone resorption. The biological intrasubject variability of NTX in urine and serum was studied in 277 postmenopausal women, mean age, 63.6 years +/- 10.2 (+/-SD) years. Second-morning void urine and serum specimens were collected at baseline and for two consecutive days to determine short-term variability (% CV). Long-term variability was determined by comparing NTX results at baseline and two consecutive months. Subjects were instructed to maintain current diet, lifestyle, and medications during the study. The median short-term %CV was 13.1% for urine NTX. This compared with 6.3% for serum NTX. Calculation of long-term %CV showed similar trends, with the %CV for NTX measured in serum (7.5%) lower than when measured in urine (15.6%). Using the least significant change (LSC) calculation, our data show that to be 90% confident that a decrease in NTX after initiation of antiresorptive therapy in an individual patient is not caused by variability alone, a 31 % decrease in urine NTX and a 14% decrease in serum NTX is required. As reported changes in NTX caused by antiresorptive therapy are greater than these calculations; our results support the use of either specimen to measure NTX to monitor the effect of therapy.

Aged↗
PubMed1991

Hypnotic efficacy of estazolam compared with flurazepam in outpatients with insomnia.

Estazolam is a new benzodiazepine hypnotic agent with an intermediate half-life of 12 to 15 hours. The authors designed an investigation to compare its hypnotic efficacy to that of flurazepam, generally considered the reference standard. The hypnotic efficacy of estazolam at two doses (1 mg and 2 mg) was compared with that of flurazepam (30 mg) in a double-blind, placebo-controlled, multicenter, 7-night study that involved 223 outpatients with insomnia. On subjective assessments of the patients, no differences were noted between estazolam 2 mg and flurazepam 30 mg on any of six sleep parameters. Patients who were receiving estazolam 1 mg rated their sleep significantly better than did patients who were receiving placebo on all parameters except sleep latency. Global evaluation of the physicians indicated significant improvement in quality of sleep, sleep depth, sleep duration, and nocturnal awakenings in all three active treatment groups; estazolam 2 mg and flurazepam also decreased sleep latency significantly. The percentage of patients who reported any adverse experience was 68% for flurazepam, 58% for estazolam 2 mg, and 54% for estazolam 1 mg; the incidence of adverse events in the placebo group was 43%. In conclusion, estazolam 2 mg was found to be as effective a hypnotic as flurazepam 30 mg. Estazolam 1 mg is also effective in the treatment of outpatients with insomnia, but to a lesser degree.

Adolescent↗
PubMed1989

Advances in noninvasive bone measurement.

Several noninvasive measurement methods are used for evaluation of metabolic disease. Single-photon (125I) scans of the peripheral skeleton are useful in some diseases but are ineffective in osteoporosis (even on the distal radius or os calcis) because they cannot predict spinal or femoral density. Also, peripheral measurements show high percentages of false negatives, that is many patients with fractures have normal peripheral density. Dual-photon (153Gd) scans of the spine, femur, and total skeleton are precise and accurate (2% error) and provide direct measurements of bone strength at fracture sites. This gives the best discrimination of abnormality and the most sensitive monitoring. Quantitative computed computed tomography (QCT) allows measurement of the spine but not the critical proximal femur area. QCT has a large accuracy error because (a) the limited area measured (under 5 cm3) fails to represent the total vertebral body, (b) technical errors, and (c) variable fat and osteoid influence the results.

Bone and Bones↗
PubMed1988

Radial and spinal bone mineral density in a patient population.

Density of the radius (by single-photon absorptiometry) and the spine (by dual-photon absorptiometry) was measured in 281 normal young women and in a large heterogeneous group of 1,622 consecutive female patients. Both spinal and radial density were useful measurements when performed on patients with medical indications; spine and radius densities in these patients averaged 10-20% below those of age-matched controls. However, patients younger than 60 years of age had deficits of spine density that were twice as large as those in the radius, and twice as many of these patients had spinal osteopenia, compared with those with radial osteopenia. After age 70, loss of density in the radius approximated that in the spine and the prevalence of osteopenia was similar at both sites. The poorer sensitivity of the radius measurement reflected the fact that it did not predict spine density. The standard error of the estimate was 0.12 gm/cm2 in normal subjects and 0.15 gm/cm2 in patients. At any given radial density, the spinal density of patients averaged 0.18 gm/cm2 (15-20%) below that in normal subjects. Predictions of spinal density from body weight were as accurate as predictions from radial density. Preferential spinal osteopenia occurring without radial osteopenia precluded radial densitometry as a screening method for individuals with osteoporosis before age 60. However, measurement of the radius was more effective than body weight for defining groups at risk, even though the radius did not reliably predict individual spine density. A radius shaft density less than 0.55 gm/cm2 occurring with a body weight less than 55 kg was associated with a high prevalence of spinal osteopenia.

Adult↗
PubMed1988

Bone density of the radius, spine, and proximal femur in osteoporosis.

Bone mineral density (BMD) was measured in 140 normal young women (aged 20 to 39 years) and in 423 consecutive women over age 40 referred for evaluation of osteoporosis. Lumbar spine and proximal femur BMD was measured using dual-photon absorptiometry (153Gd), whereas the radius shaft measurement used single-photon absorptiometry (125I). There were 324 older women with no fractures, of which 278 aged 60 to 80 years served as age-matched controls. There were 99 women with fractures including 32 with vertebral and 22 with hip fractures. Subsequently, another 25 women with hip fractures had BMD measured in another laboratory; their mean BMD was within 2% of that of the original series. The mean age in both the nonfracture and fracture groups was 70 +/- 5 years. The BMD in the age-matched controls was 20% to 25% below that of normal young women for the radius, spine, and femur, but the Ward's triangle region of the femur showed even greater loss (35%). The mean BMD at all sites in the crush fracture cases was about 10% to 15% below that of age-matched controls. Spinal abnormality was best discriminated by spine and femoral measurements (Z score about 0.9). In women with hip fractures, the BMD was 10% below that of age-matched controls for the radius and the spine, and the BMD for the femoral sites was about 25% to 30% below that of age-matched control (Z score about 1.6). Femoral densities gave the best discrimination of hip fracture cases and even reflected spinal osteopenia. In contrast, neither the spine nor the radius reflected the full extent of femoral osteopenia in hip fracture.

Adult↗
PubMed1987

Spine and femur density using dual-photon absorptiometry in US white women.

Bone mineral density (BMD) of the spine (n = 892) and femur (n = 634) was measured using dual-photon absorptiometry in normal white women from seven diverse locations. The same model commercial scanner with a 153Gd source was used in all locations (SD = 1.3% among locations). There was not an age-associated decrease of spinal BMD during young adulthood (20-40 years); the correlation of age and femoral BMD in this period was low but significant (r = -0.21). There was a narrow range of intra-population variation at all ages (10-12%). The cross-sectional data showed an average diminution of about 20% in the spine and 25% in the femur between 40 and 70 years of age, followed by a continued but slower, decrease of density in older women. Adjustment of values for height and weight was called for mainly at extremes of body size.

Aging↗
PubMed1986

Sleep parameters after surgery for obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a disorder that is frequently treated surgically. Few reports in the literature give objective reports of the effect of such treatment on polysomnographic parameters before and after treatment, although symptomatic improvement is common. This article reviews total sleep time (TST) spent in apnea, number of apneic episodes per hour or sleep apnea index (SAI), and oxygen desaturations in such patients treated with tracheostomy, uvulopalatopharyngoplasty (UPP), and combinations of these. Although improvement is noted in these parameters after UPP, this is not as impressive as some reports in the literature indicate. Our suggested indications for this type of surgery are discussed.

Humans↗
PubMedDate not supplied

Experience with Endopap endometrial sampling in the cytodiagnosis of endometrial carcinoma and its precursor lesions. I. A correlative cytologic-histologic-hysteroscopic diagnostic pilot study.

From June 1 through December 3, 1991, 146 women were referred to the Gynecology Outpatient Clinic of Nahariyya Medical Center for uterine bleeding and pathologic conditions. Their ages ranged from < 40 (26 patients) to > or = 60 (18 patients), with 60 (41%) in the 40-49 age group. An Endopap endometrial sampling pilot study was undertaken to find a correlative index between cytologic, histologic and hysteroscopic sampling methods as well as to investigate the possibility that Endopap sampling could avoid excessive use of nontherapeutic dilation and curettage. In 118 patients for whom concomitant cytologic and histologic specimens were available there was no statistically significant difference between the number of correct cytologic and histologic diagnoses of intrauterine pathology. Cytodiagnostic accuracy of the Endopap samples was expressed in terms of sensitivity (68.2%), specificity (80.7%), predictive value of a malignant test result (100%) and predictive value (PV) of an abnormal (hyperplasia) test result (73.2%). The lower values for sensitivity, specificity and PV in this study as compared with those in the literature were probably due to three attenuating factors: the relatively small number of patients (146), the fact that the cytodiagnostic accuracy for hyperplasia and precursor lesions of endometrial carcinoma is significantly lower than for histologic diagnosis, and the presence of 15 (10.3%) inadequate cytologic specimens. The results did tend to concur with the range of reported results. It is recommended that Endopap sampling be employed in cases of medically and anatomically contraindicated dilation and curettage--e.g., cervical canal stenosis and intrauterine adhesions (Asherman's syndrome)--in monitoring perimenopausal and postmenopausal patients on estrogen replacement therapy and in obese women, diabetics and hypertensives at risk of developing endometrial hyperplasia. The study also showed that the combined hysteroscopic and Endopap techniques could result in increased rates of sensitivity and specificity.

Adult↗