January 2nd, 2007 by Dr. Val Jones in News
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Many people use glucosamine and chondroitin sulfate as a natural therapy to treat their arthritis pain. This seems like a reasonable thing to do since glucosamine is a critical building block for cartilage, and chondroitin can help keep joints properly hydrated. And as we know, osteoarthritis is caused by joint wear and tear and decreased cartilage health.
Unfortunately, the research results have been fairly underwhelming.
Here is how one author* summarized the latest research:
“It seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain. If patients choose to take dietary supplements to control their symptoms, they should be advised to take glucosamine sulfate rather than glucosamine hydrochloride and, for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs.”
So I guess the bottom line is that these supplements are no magic cure for knee pain – they aren’t known to be harmful (except to the wallet) but they aren’t sure to be helpful either.
*Hochberg, Marc C.
Nutritional Supplements for Knee Osteoarthritis — Still No Resolution
N Engl J Med 2006 354: 858-860
Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 31st, 2006 by Dr. Val Jones in News
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As I was reviewing some research articles for a blog I was planning about the benefits of pet therapy in pain management, I came across a recent Finnish study suggesting that pet owners are more likely to be overweight and unhealthy than those who had no pets. It just didn’t seem right to me – so I decided to go to the source and read the original article.
The researchers surveyed about 8 thousand people. They found that a total of 80% of those with pets and 82% of those without pets reported good health.
They also said,
“In the multivariate ordinal logistic regression analysis, perceived health was no longer associated with pet ownership. When investigating which explanatory variables included in the model caused the disappearance of the statistical significance, basic education, form of housing, or BMI did so.”
Translation: being at risk for poorer health is not really about your pet, it’s about your socio-economic status and the degree to which you are overweight.
But this still begs the question: why are Finnish people in poorer health more likely to have a pet?
The authors offer this explanation:
“Pets seem to be part of the lives of older people who have settled down and experience an increase in the number of illnesses, whereas young healthy single people have no time, need, or possibility for a pet.”
Hmmm. Would an American survey find similar results I wonder? Is there any cultural bias in these data? What do you think? Are American pet owners more likely to be overweight and socio-economically challenged than non-pet owners?
Source: Koivusilta, L. and Ojanlatva, A. PloS ONE, December 2006; vol 1: pp e109. News release, Public Library of Science.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 29th, 2006 by Dr. Val Jones in News
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Well, I fell for it again – that panic that follows breaking news that a drug once thought to be safe was now causing some horrible, unexpected side effect. I nervously wrung my hands as I thought of all the proton pump inhibitors I had prescribed for heartburn in the past. Did I hurt my patients? Are they all lying in a hospital somewhere with pins in their broken hips?
I took a deep breath and decided to go back to the source of the news. There it was – the offending research study in the Journal of the American Medical Association. I read it carefully – looking for the devil in the details. And lo and behold, the caveats started slinking off the pages.
First of all, the “44% increased risk of hip fractures” sounds really bad, doesn’t it? Well, what if I said that a person’s risk of getting a hip fracture (IF they were over 55 years old AND took a proton pump inhibitor for over a year straight) was 1.44 in 1000 whereas if they never took the medicine, their risk would be 1 in 1000. Does that sound as bad? Well, I’m actually saying the same thing.
There were some other interesting details – men were significantly more likely to get fractures than women 1.78:1000 compared to 1.36:1000. There was no explanation as to why that might be. Also, I noticed that there was no discussion of a potential confounder – which of these patients were in nursing homes? In my experience, patients in nursing homes often automatically get proton pump inhibitors – and stay on them indefinitely as “GI prophylaxis.” Now if you’re sick enough or demented enough to be in a nursing home, then you’re probably at higher risk for falls… which would be a good reason why people on proton pump inhibitors break their hips more frequently, right? If you fall more frequently, then – bingo – there goes your increased risk for fractures.
Well, the research does seem to suggest that there’s a trend – people who take proton pump inhibitors for long times in higher doses may have a higher risk of fractures. But the jury’s still out on why that may be. For most folks in the US who are under the care of a watchful physician, their dose and duration of taking the medicine doesn’t put them at increased risk at all.
So to me the take home message is that people shouldn’t stay on proton pump inhibitors indefinitely, which isn’t really news to me. I hope that this blog entry has reduced your anxiety level… stay tuned for more critical analysis of research findings.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
