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Biomedical subjects

R Wasnich

Publications and source records attributed to R Wasnich.

14 recordsLinked to original sources
PubMed1998

Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group.

BACKGROUND: Estrogen-replacement therapy prevents osteoporosis in postmenopausal women by inhibiting bone resorption, but the balance between its long-term risks and benefits remains unclear. Whether other antiresorptive therapies can prevent osteoporosis in these women is also not clear. METHODS: We studied the effect of 2.5 mg or 5 mg of alendronate per day or placebo on bone mineral density in 1174 postmenopausal women under 60 years of age. An additional 435 women who were prepared to receive a combination of estrogen and progestin were randomly assigned to one of the above treatments or open-label estrogen-progestin. The main outcome measure was the change in bone mineral density of the lumbar spine, hip, distal forearm, and total body measured annually for two years by dual-energy x-ray absorptiometry. RESULTS: The women who received placebo lost bone mineral density at all measured sites, whereas the women treated with 5 mg of alendronate daily had a mean (+/-SE) increase in bone mineral density of 3.5+/-0.2 percent at the lumbar spine, 1.9+/-0.1 percent at the hip, and 0.7+/-0.1 percent for the total body (all P<0.001). Women treated with 2.5 mg of alendronate daily had smaller increases in bone mineral density. Alendronate did not increase bone mineral density of the forearm, but it slowed the loss. The responses to estrogen-progestin were 1 to 2 percentage points greater than those to the 5-mg dose of alendronate. Alendronate was well tolerated, with a safety profile similar to that of placebo or estrogen-progestin. CONCLUSIONS: Alendronate prevents bone loss in postmenopausal women under 60 years of age to nearly the same extent as estrogen-progestin.

Alendronate↗
PubMed1998

Adiposity and blood pressure in a multiethnic population of women in Hawaii.

OBJECTIVE: To compare the amount and distribution of fat among White, Japanese, Filipino and Hawaiian women and to investigate associations between measures of adiposity and serum cholesterol and blood pressure. DESIGN: Cross-sectional survey of adiposity, serum cholesterol and blood pressure of 421 volunteer women of White (N = 137), Japanese (N = 144), Filipino (N = 74) and Hawaiian (N = 66) ethnicities, age 25-35 years. Anthropometric measures (weight; height; subscapular, bicep, tricep, suprailiac and calf skinfold thickness; waist, hip and mid-upper arm circumferences), grip strength, serum cholesterol and blood pressure. RESULTS: Hawaiian women had the highest levels of adiposity by all measures. Asian women (especially Filipinos) had higher subscapular skinfold thicknesses than did Whites and, for the same value of body mass index (BMI), had a greater percentage of body fat. BMI was the strongest correlate of systolic blood pressure, while subscapular skinfold thickness was the strongest correlate of diastolic blood pressure. Blood pressure varied by adiposity but not ethnicity. No measures of body fat were associated with serum cholesterol. CONCLUSION: Higher body fat measures, especially BMI, were associated with higher systolic blood pressure. However, higher subscapular skinfold (upper body) thickness was also associated with higher diastolic blood pressure. Subscapular fatness appears to be especially important among women of Asian ethnicity, Filipino women in particular.

Adult↗
PubMed1996

New method for breast cancer detection using TC-99m sestamibi scintimammography.

The combination of breast examination and radiographic mammography (XRMM) are the established methods for breast cancer detection. However, XRMM lacks sensitivity and specificity in women with dense breasts, leading to false positive findings in 80% and false negative findings in 10% to 15% of the cases. Tc-99m Sestamibi (MIBI) scintimammography (SMM) is a new breast-imaging technique. This study shows that SMM has a positive predictive value of 83% and negative predictive value of 93%, which is similar to that reported by others. This supports other published reports that SMM is a potential excellent complimentary imaging technique to XRMM in improving the accuracy of breast cancer detection.

Adult↗
PubMed1995

Evaluation of therapeutic efficacy in osteoporosis.

Evaluation of the efficacy of osteoporosis treatments poses a major challenge for clinical investigators. This paper addresses the question of whether increases in bone mass induced by therapy for osteoporosis are sufficient to determine the efficacy of that therapy, or whether long-term fracture endpoint studies are required. Osteoporosis has been defined as a systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. This association between bone mass and fracture risk has been found to be stronger than other well-recognized risk factor associations, such as blood pressure and risk of stroke. Although fracture endpoint studies would provide confirmation of the benefit of osteoporosis therapy, such trials require that several thousand patients be studied for many years, making such studies impractical as a means for providing data for the approval of new therapies. Determination of increased bone mass may provide data that are just as useful in evaluating therapeutic efficacy. The use of bone mass as the primary efficacy endpoint for those therapies that are associated with normal bone quality is justified by the well-documented relationship between bone mass and fracture risk observed in several epidemiological studies.

Bone Density↗
PubMed1995

Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound.

We investigated the usefulness of bone density measurements from multiple skeletal sites and calcaneus ultrasound for evaluating the probability of vertebral deformation. Bone mineral density (BMD) was measured at the second metacarpal and middle phalanges using radiographic absorptiometry of hand radiographs, and at the lumbar spine using dual-energy x-ray absorptiometry. Distal radius and proximal radius were measured using single-energy x-ray absorptiometry (SXA), expressed as bone mineral content (BMC, grams per centimeter), and as BMD (grams per square centimeter). The calcaneus was measured using both SXA (BMD) and broadband ultrasound attenuation (BUA). Among the women in this study (mean age 74, SD = 5), 84 women developed new vertebral deformations (57 cases with one and 27 cases with two or more deformations), which were identified on serial radiographs during an average of 9 years prior to the measurements of bone density. Logistic regression analysis was used to calculate odds ratios for risk of deformation corresponding to a 1-SD difference in density or ultrasound, adjusted for age. All bone measurements were significantly associated with vertebral deformation, with odds ratios (95% confidence intervals) ranging from 1.40 (1.10, 1.78) for proximal radius BMD to 1.88 (1.45, 2.44) for calcaneus BMD measurements. Measurements of calcaneal BUA, calcaneal BMD, and hand BMD generally remained significant when included simultaneously with another measurement in the same model, suggesting that spine or radius BMD may not provide much additional information about risk of deformation. It appears that all of the measurements of bone density and ultrasound provide useful information regarding the probability of deformation. These findings await confirmation in a prospective study.

Absorptiometry, Photon↗
PubMed1993

Bone mass measurement: prediction of risk.

Accurate assessment of individual fracture risk requires measurement of bone mass (density). Another strong risk factor for identifying women or men who will develop fractures in the near future is the presence of previous (spine and nonspine) fractures. However, the occurrence of a low-trauma fracture almost anywhere in the skeleton is indicative of a more advanced stage of disease and is associated with a substantial, further increase in fracture risk, independent of bone mass. Thus, prevention of the first fracture should receive priority. In a clinical setting, initial assessment of bone mass can be combined with other, known risk factors and projected over the patient's remaining life expectancy, to estimate future, cumulative fracture probability. Estimates such as "remaining lifetime fracture probability" can also approximate the impact and cost-effectiveness of treatment, allowing for more objective and rational therapeutic planning for individual patients.

Accidental Falls↗
PubMed1990

Effect of thiazide on rates of bone mineral loss: a longitudinal study.

OBJECTIVE: To determine the effect of thiazide diuretic drugs on rates of bone mineral loss. DESIGN: Longitudinal, observational study with a mean follow up of five years. SETTING: Hawaii Osteoporosis Center, Honolulu. SUBJECTS: 1017 Japanese-American men born between 1900 and 1920, of whom 378 were treated for hypertension (study group) and 639 did not have hypertension (control group). INTERVENTION: Thiazide diuretics were taken by 325 men for a mean of 11.9 years; 53 men took antihypertensive drugs other than thiazides. MAIN OUTCOME MEASURE: Rate of bone loss estimated from serial photon absorptiometric scanning at three skeletal sites (calcaneus, distal radius, and proximal radius). RESULTS: Rates of bone loss at all three sites were significantly reduced among thiazide users when compared with controls. The reductions in loss rate ranged from 28.8% (p = 0.02) (distal radius) to 49.2% (p = 0.0005) (calcaneus) relative to the controls. At all three sites the men taking other antihypertensive drugs had faster loss rates (22.6-43.1%) than those of the controls but the difference was significant only for the distal radius. CONCLUSION: Thiazide diuretics slow the rate of bone loss in elderly men.

Absorptiometry, Photon↗
PubMed1984

The effect of long-distance running upon appendicular bone mineral content.

The bone mineral content (BMC) of the os calcis was measured for a group of 20 male runners at the beginning and the end of a 9-month marathon training program. The participants had no previous running experience. The percent change in bone mineral in the runners was compared with that of a control group of male subjects of the same age range (38-68 yr). The consistent runners showed a significant increase in bone mineral over that of the controls; the increase was not significant for inconsistent runners. The data suggest that those runners with longer, more consistent distances gained more bone mineral than those with shorter, more inconsistent distances.

Adult↗
PubMed1983

Postmenopausal bone loss at multiple skeletal sites: relationship to estrogen use.

Bone mineral content (BMC) was measured in the distal radius, proximal radius, and os calcis in 608 postmenopausal women, and the values were compared to vertebral osteoporosis and compression fractures determined radiographically, as well as to history of estrogen use. Current estrogen users had significantly higher BMC at all appendicular sites as compared to non-users. Prior estrogen users had lower appendicular BMC's than current users, but they were still significantly higher than non-users. However, radiographic assessment of the lumbar spine showed no difference in osteoporosis or compression fracture prevalence between prior users and non-users of estrogen, whereas current estrogen users had a significantly lower prevalence of osteoporosis in the spine. These findings suggest that estrogen effect on trabecular bone in the os calcis may be more transient than on cortical, appendicular bone. They also suggest that long term or permanent estrogen replacement is required to prevent spinal compression fractures.

Adult↗
PubMed1979

Simple computer quantitation of spleen-to-liver ratios in the diagnosis of hepatocellular disease.

Increased splenic uptake of radiocolloids is a helpful sign in the scintigraphic diagnosis of various hepatocellular diseases, but little attempt has been made to quantify this physiologic phenomenon. We have devised a simple computer method that compares average splenic activity to average right-lobe liver activity. The method is reproducible (r = 0.97) and exhibits little interobserver variation (r = 0.99). One hundred clinically normal subjects were found to have a nearly symmetrical distribution of S/L ratios around a mean of 0.77, with a s.d. of 0.20. Fifteen subjects normal by biopsy were found to have a similar mean spleen-to-liver (S/L) ratio of 0.74. Based upon a normal range of 0.37 to 1.17 (0.77 +/- 2 s.d.), elevated S/L ratios were found in fatty metamorphosis (85%), cirrhosis (67%), and chronic hepatitis (43%). Abnormal S/L ratios in the range from 1.17 to approximately 1.4 were not visually obvious. Overall sensitivity of the S/L ratio in these three diseases is 69%. When combined with the other scintigraphic indications of hepatocellular disease (nonhomogenous colloid uptake, hepatomegaly, splenomegaly, and bone-marrow colloidal uptake), the liver scan was found to have a sensitivity of 93%.

Colloids↗
PubMed1975

Evaluation of portable radionuclide method for measurement of left ventricular ejection fraction and cardiac output.

Seventeen patients with coronary artery, valvular, or myopathic heart disease were studied to determine correlations of the cardiac output and ejection fraction when comparing the results obtained with a portable probe technique using 113mIn with those obtained with standard methods (cineangiographic, Fick, and dye dilution). With ejection fractions ranging from o.10 to 0.85, the coefficient of correlation was 0.90 when comparing cineangiographic and radionuclide techniques. Cardiac output determinations by the radionuclide technique also correlated well with standard methods (r equals 0.88). The radionuclide method shows promise as an accurate, safe, and simple method in the evaluation of cardiac function at the bedside.

Angiocardiography↗