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This Week in JAMA
December 27, 2006

This Week in JAMA

JAMA. 2006;296(24):2889. doi:10.1001/jama.296.24.2889
Continuing vs Stopping Alendronate After 5 Years

Bisphosphonate therapy reduces the risk of fractures in women with postmenopausal osteoporosis, but the optimal duration of therapy is not known. In the randomized Fracture Intervention Trial Long-term Extension (FLEX) trial, investigators compared the effects on bone mineral density (BMD) of 5 years vs 10 years of alendronate therapy in a cohort of postmenopausal women. Black and colleaguesArticle report that women who discontinued alendronate at 5 years experienced moderate declines in BMD, although not to their pretreatment level, and a gradual increase in biochemical markers of bone turnover compared with women who continued therapy for 10 years. In exploratory analyses, the authors found that nonvertebral fracture risks were similar in both groups and clinically detected vertebral fractures were higher in women who discontinued therapy. In an editorial, Colón-EmericArticle discusses the implications of the FLEX trial results for women with osteoporosis.

Fifty-Year Trends in Stroke

Carandang and colleagues analyzed data from participants in the Framingham Study, original and offspring cohorts, who were free of prevalent stroke to assess temporal trends in stroke incidence, lifetime risk, severity, and 30-day mortality from 1950 through 2004. The authors found that stroke incidence decreased over time, but lifetime risk did not decline significantly. Stroke severity remained relatively stable, and 30-day mortality decreased significantly in men but not in women.

Proton Pump Inhibitors and Risk of Hip Fracture

Proton pump inhibitor (PPI) therapy may affect bone through 2 opposing actions—reducing calcium absorption as a result of PPI-induced hypochlorhydria and reducing bone resorption through inhibition of osteoclastic vacuolar proton pumps. To investigate the net effect of PPI therapy on the risk of hip fracture, Yang and colleagues conducted a nested case-control study of patients who were 50 years and older and were users of PPI therapy or nonusers of acid suppressive therapy. The authors found a significantly increased risk of hip fracture among persons taking PPIs for more than 1 year. The risk of fracture increased with higher-dose therapy and longer duration of use.

PFO and High-Altitude Pulmonary Edema

Individuals who are prone to high-altitude pulmonary edema (HAPE) have exaggerated pulmonary hypertension and arterial hypoxemia at high altitude for reasons that are not clear. Limited evidence has suggested that a patent foramen ovale (PFO) might be a contributing factor. Allemann and colleagues investigated this possibility in a case-control study of HAPE-prone and HAPE-resistant mountaineers who underwent transesophageal echocardiography, Doppler echocardiography, and pulse oximetry at low and high altitude. The investigators found that the frequency of PFO was significantly higher in HAPE-prone than in HAPE-resistant persons. At high altitude, HAPE-prone individuals with a large PFO had more severe hypoxemia compared with persons having a small PFO or closed foramen ovale.

A Piece of My Mind

“When you name something, it's as it you give it life. My thyroid cancer was born on Monday, June 12.” From “A Bump in the Neck.”

Medical News & Perspectives

Experts are trying to understand and reverse persistently increasing rates of preterm birth in the United States by promoting more research and by testing novel interventions.


End-of-life care for homeless patients is discussed in the case of Mr K, a 66-year-old man with metastatic renal cell carcinoma, who has been homeless for much of the past 50 years.

Poverty and Human Development

Authors may submit manuscripts for a JAMA theme issue on poverty and human development.

Author in the Room Teleconference

Join Dennis Black, PhD, January 17, 2007, from 2 to 3 PM eastern time to discuss the effects of continuing or stopping alendronate after 5 years. To register, go to

JAMA Patient Page

For your patients: Information about patent foramen ovale.