Doctor HealthHealth Tips

According to a recent study by the National Institutes of Health, pre-menopausal women with even mild depression have less bone mass than do their nondepressed peers, The level of bone loss is at least as high as that associated with recognized risk factors for osteoporosis, including smoking, low calcium intake, and lack of physical activity.

Hip bones, the site of frequent fractures among older people, were among those showing the most thinning in depressed premenopausal women. The reduced bone mass puts them at higher risk of these costly, sometimes fatal fractures and others as they age, the researchers note in the November 26 issue of the Archives of Internal Medicine. The report was submitted by Giovanni Cizza, MD, PhD, MHSc, of NIMH and the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Farideh Eskandari, MD, MHSc, of NIMH; and colleagues.

“Osteoporosis is a silent disease. Too often, the first symptom a clinician sees is when a patient shows up with a broken bone. Now we know that depression can serve as a red flag — that depressed women are more likely than other women to approach menopause already at higher risk of fractures,” said NIMH Deputy Director Richard Nakamura, PhD.

After bone mass reaches its peak in youth, bone-thinning continues throughout life, accelerating after menopause. Preliminary studies had suggested that depression may be a risk factor for lower-than-average bone mass even in young, premenopausal women. Results of the current study lend considerable weight to those earlier findings. The study?s design reduced the possibility that the lower bone mass was linked to factors other than depression.

Study participants included 89 depressed women and 44 nondepressed women, for comparison. All were between 21 and 45 years old and were premenopausal. Except for depression, the two groups were similar in risk factors, including calcium, caffeine, and alcohol intake; smoking; level of physical fitness; use of oral contraceptives; and age of first menstrual period. Both groups were of relatively high socioeconomic status and were well nourished.

One difference was that the depressed women were taking antidepressant medications. A previous study suggested that older adults taking antidepressants called selective serotonin reuptake inhibitors had more bone fractures than others. However, the current study showed that these medications were not linked to low bone mass in premenopausal women.

The researchers found that 17 percent of the depressed women had thinner bone in a vulnerable part of the hip called the femoral neck, compared with 2 percent of those who were not depressed. Low bone mass in the lumbar spine, in the lower back, was found in 20 percent of depressed women, but in only 9 percent of nondepressed women. Bone mass was measured via an X-ray technique called DXA scanning.

There was no significant link between the degree of bone loss and the severity of depression or the cumulative number of depressive episodes, the researchers found. The depressed women had been diagnosed with mild depression and were having, or had recently had, a depressive episode.

“Depression generally isn?t on clinicians? radar screens as a major risk factor for osteoporosis, particularly for premenopausal women. It should be,” said Cizza.

Blood and urine samples also showed that depressed women have imbalances in immune-system substances, including those that produce inflammation, compared to their healthy peers. This additional finding strengthens the case for a suspected link between depression-induced imbalances in the immune system and accelerated bone loss. The blood and urine samples were taken every hour for a full day, providing a truer picture than does less frequent testing, as had been done in previous studies.

The immune-system imbalances may be tied to excess adrenalin, since the part of the nervous system that produces adrenalin is over-active in depressed people. Increased adrenalin can over-stimulate the immune system. Compared to the others, the depressed women in this study had higher levels of immune-system proteins that promote inflammation, and lower levels of those that prevent it.

One of these inflammation-promoting proteins, IL-6, is known to promote bone loss. At the molecular level, bones routinely break down, and their minerals, notably calcium, are reabsorbed into the blood, where they travel throughout the body to perform crucial functions in cells. At the same time, the body builds the bone back up. Imbalances in this normal loop of bone re-absorption and build-up, such as high levels of IL-6, could promote bone loss, the researchers suggest.

The study was funded in part by the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH). Other NIH contributors to the study, in addition to NIMH and NIDDK, included the NIH Clinical Center and the National Center for Complementary and Alternative Medicine.

Source: National Insitutes of Health

The FDA has approved Bayer HealthCare AG’s drug, Nexavar (sorafenib) in patients with hepatocellular carcinoma when the cancer can not be removed surgically. Hepatocellular carcinoma is a type of liver cancer.

Hepatocellular carcinoma accounts for 80-90% of all liver cancers. If it can’t be removed surgically, hepatocellular carcinoma is usually fatal within 3-6 months. The American Cancer Society estimates that there will be more than 19,000 new cases and nearly 17,000 deaths in 2007 from liver cancer and intrahepatic bile duct cancer in the U.S.

Nexavar is a type of anticancer drug called a kinase inhibitor. It interferes with molecules that are thought to be involved in chemical messages sent within cancer cells, in the formation of blood vessels that supply tumors, and in cell death.

FDA’s approval of Nexavar was based on the results of an international randomized placebo-controlled trial in patients with inoperable hepatocellular carcinoma. The study was designed to compare the survival of a group of patients who received the drug against a group of similar patients who did not.

“In a randomized clinical trial, the group of patients with inoperable hepatocellular carcinoma who received Nexavar survived 2.8 months longer than the group of patients who didn’t receive the drug,” said Robert Justice, M.D., director of FDA’s division of drug oncology products. “This is an important new treatment option for patients who are fighting this very difficult form of cancer.”

A total of 602 patients were studied. Each patient received Nexavar or a placebo. Both groups were comparable with regard to age, gender, race, the stage and other characteristics of their cancer, and the types of cancer treatment they had received before entering the clinical trial.

The trial was stopped after a planned interim analysis showed a statistically significant advantage in overall survival for the patients who had received Nexavar. Patients who received Nexavar survived a median of 10.7 months while patients who received placebo survived a median of 7.9 months. A separate analysis showed that tumors progressed more slowly in patients who received Nexavar compared to patients who had received placebo.

The most common adverse reactions that have been observed in patients taking Nexavar (for hepatocellular carcinoma or renal cell carcinoma) are fatigue, weight loss, rash or superficial skin shedding, hand or foot skin reaction, hair loss, diarrhea, anorexia, nausea and abdominal pain. Twenty percent or more of patients had experienced at least one of these reactions. In patients with hepatocellular carcinoma, diarrhea was reported in 55 percent of patients who received Nexavar. Inadequate blood supply to the heart or heart attack were reported in 2.7 percent of patients who received Nexavar, compared to 1.3 percent for patients who received placebo. New high blood pressure was reported in 9 percent of patients who received Nexavar, compared to 4 percent of patients who received placebo.

Elevated serum lipase, an enzyme that measures liver function, occurred in 40 percent of patients who received Nexavar, compared to 37 percent of patients who received placebo, and hypophosphatemia, or low blood levels of phosphate, occurred in 35 percent of patients who received Nexavar, compared to 11 percent of patients who received placebo.

Nexavar comes in 200 milligram tablets and the usual dose is two tablets (400 milligrams) taken twice a day on an empty stomach. Nexavar was originally approved in 2005 for the treatment of patients with advanced renal cell carcinoma, a form of kidney cancer.

Nexavar is manufactured by Bayer HealthCare AG, Leverkusen, Germany for Bayer Pharmaceuticals Corporation, West Haven, Conn. and by Onyx Pharmaceuticals, Inc., Emeryville, Calif.