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In This Issue of Archives of Internal Medicine
April 14, 2003

In This Issue of Archives of Internal Medicine

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Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Intern Med. 2003;163(7):755. doi:10.1001/archinte.163.7.755
Alendronate Prevents Loss of Bone Density Associated With Discontinuation of Hormone Replacement Therapy

Many women using hormone replacement therapy will discontinue it and therefore lose any bone-protective effect of estrogen. This study by Ascott-Evans et al evaluated the effect of therapy with alendronate on bone density in postmenopausal women who had recently discontinued estrogen therapy. In the group of women who received alendronate sodium, bone density at the lumbar spine increased by 2.3% at 1 year. However, in the group who received placebo, bone density at the lumbar spine fell by 3.2% and 41.5% of patients had a decrease in spine bone density of 5% or more, whereas 49.4% of the women treated with alendronate had an increase in spine bone density of more than 2%. Better preservation of bone density was also seen at the hip and total body in the group treated with alendronate. This study demonstrates that a rapid decline in bone density occurred in women discontinuing estrogen therapy and that alendronate was effective in preserving bone density in these women.

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Bone mineral density of the lumbar spine.

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Reported Pain Following Mammography Screening

Two hundred women were interviewed immediately following mammography screening and questioned about the pain they experienced, how much it differed from what they expected, and the most stressful part of the procedure. On a pain scale of 1 to 10, 72% reported the pain to rank 4 or less, with the highest level of pain resulting from the compression of the breasts; 96% reported that the pain was "less than" or "about as expected"; and 94% said that they were "very likely or somewhat likely" to get a mammogram next year. The most stressful aspect of the procedure was waiting for the results (41%).

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Management of Venous Thromboembolism: Past, Present, and Future

The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. The review article by Hyers highlights the history of current anticoagulants and describes new antithrombotic agents, focusing primarily on those now being evaluated for use in the prevention and treatment of venous thromboembolism. Many new anticoagulants exhibit potentially superior properties to the heparins, including improved pharmacodynamic profiles and targeted activity at single points in the coagulation cascade. Other favorable properties include total chemical synthesis, once-daily dosing without any monitoring or dose adjustment, and oral administration. Each of the new agents offers advantages that require consideration as progress continues toward the development of better anticoagulants.

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Electrolyte Disorders Following Oral Sodium Phosphate Administration for Bowel Cleansing in Elderly Patients

Oral sodium phosphate, currently used for colon preparation prior to colonoscopy or barium enema, induces hyperphosphatemia, hypocalcemia, and hypokalemia. Elderly patients are at an increased risk for phosphate intoxication due to decreased glomerular filtration rate, medication use, and systemic and gastrointestinal diseases. To investigate these electrolyte disorders and their correlation with creatinine clearance, coexistent diseases, medications, and functional status, Beloosesky et al studied 36 hospitalized patients 65 years or older, who underwent bowel cleansing with the standard sodium phosphate preparation for colonoscopy or barium enema. Venous blood samples for electrolyte determination were obtained at days 1, 2 (the procedure day), and 3, and urine samples were obtained from 10 patients. An increase in serum phosphorus level was correlated with a decreased creatinine clearance (R = −0.52; P = .001). Hypocalcemia and hypokalemia were present in 21 (58%) and 20 (56%) of the patients, respectively. Beloosesky et al conclude that sodium phosphate induces serious electrolyte abnormalities in elderly patients and advise that serum electrolytes, phosphorus, and calcium are assessed prior to sodium phosphate preparation and that in selected patients, postprocedural assessment and correction may be required.

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