Young
Men and Women with Anorexia Nervosa
or Inflammatory Bowel Disease at Greater
Risk for Osteoporosis
We
usually think of osteoporosis as a condition that primarily strikes
older women as a result of the aging process. However, certain
disorders and medications can also lead to bone loss in younger
people, both male and female. Two recent studies from the Annals
of Internal Medicine show that bone loss is significantly more
likely to occur in young men and women suffering from anorexia
nervosa or inflammatory bowel disease than in the general population.
Researchers evaluated the loss of bone tissue in women with
the eating disorder anorexia nervosa by measuring bone mineral
density at different regions of the skeleton. More than 90%
of the women had significant bone loss at one or more skeletal
regions. Depending on the region measured, this bone loss put
13–24% of the women at risk for fractures. Physicians
commonly prescribe estrogen to slow bone loss in postmenopausal
women. Estrogen is also given to women who do not menstruate
regularly, which is the case for many women with anorexia.
Interestingly, in this study, women who used estrogen experienced
the same levels of bone loss as women who did not. The researchers
theorized that poor nutrition might decrease the effectiveness
of estrogen in preserving bone. The results also showed that
current weight, independent of other factors, is the best predictor
of bone density in anorectic women.
In a separate study, researchers sought to determine the risk
of bone fractures associated with osteoporosis in patients
with inflammatory bowel disease. Results of the study showed
that patients with the disease had a 40% greater risk of hip,
spine, wrist, or rib fractures than healthy people. Researchers
are still uncertain what factors contribute to bone loss in
these patients. They speculate that corticosteroids, which
are used to treat inflammatory bowel disease, may play a role,
and that cigarette smoking, lower levels of sex hormones, and
low dietary intake of calcium and vitamin D may also contribute
to bone loss.
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Study
Links Smoking to Colorectal Cancer
Lung, mouth, and bladder cancers, among others, are well established
as cancers caused by cigarette smoking. A recent study from
the American Cancer Society, published in the Journal of
the National Cancer Institute shows that cigarette smoking
also raises the risk of dying from colorectal cancer, which
is cancer of the colon or rectum. Indeed, the study notes that
as many as 12% of colorectal cancer deaths in the United States
may be associated with smoking.
Researchers analyzed data from 312,332 men and 469,019 women
enrolled in the Cancer Prevention Study II. They found that
for both men and women, risk of colorectal cancer increased
after 20 or more years of smoking. Among men, current smokers
were 31% more likely to die from colorectal cancer than nonsmokers;
female smokers were 41% more likely than nonsmokers to die
from the disease. The risk of death from colorectal cancer
rose with the number of years cigarettes were smoked, the number
of cigarettes smoked per day, and the number of packs smoked
over the years. In addition, the risk of death was higher the
younger a person was when he or she started smoking. The association
was not confined to cigarette smoke. Those who smoked pipes
or cigars also faced a significantly increased risk of death
from colorectal cancer.
The bright spot of the study was that it showed a benefit from
quitting. Twenty years after quitting, men's risk of colorectal
cancer death returned to normal. And women who had stopped
smoking 10 or more years earlier had the same risk as nonsmokers.
The take-home message: If you smoke, stop. If you don't smoke,
don't start.
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Manufacturer
Voluntarily Withdraws Lotronex
Lotronex (alosetron) is a prescription medication used to treat
diarrhea-predominant irritable bowel syndrome in women. Last month,
the Food and Drug Administration issued important safety warnings
for the use of this drug based upon reports of intestinal damage
due to impaired blood flow to the intestine (ischemic colitis)
and complications of severe constipation (bowel obstruction and
rupture) in patients on Lotronex. (See the Family Health Guide
Online update on Lotronex).
On November 30, the manufacturer (Galaxo Wellcome) informed the
FDA that it will voluntarily remove this drug from the market.
Any patient currently taking Lotronex should contact her physician
to discuss other treatment options. For more information, please
visit the Center for Drug Evaluation and Research web page on Lotronex or
call 888-INFO-FDA (888-463-6332).
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