Effect of raloxifene hydrochloride on bone mineral density and bone turnover in Kuwaiti postmenopausal women with osteoporosis.

SUMMARY: Osteoporosis is a major cause of mortality and morbidity worldwide. Decreased bone turnover markers and increased lumbar spine and total hip bone mineral density (BMD) in raloxifene-treated women add further support to the idea that raloxifene is an effective well-tolerated option for treating Kuwaiti postmenopausal osteoporosis, suitable for long-term use. INTRODUCTION/PURPOSE: Osteoporosis is currently a major cause of mortality, morbidity, and medical expense worldwide, and it is important to investigate therapies for the prevention and treatment of osteoporosis in postmenopausal women. This study was designed to detect the effect of raloxifene hydrochloride on bone mineral density and bone turnover in Kuwaiti postmenopausal women with osteoporosis. METHODS: Postmenopausal women who were free of severe or chronically disabling conditions, had their last menstrual period at least 2 years before the beginning of the study, had a T score for femoral neck or lumbar spine BMD measurements ≤2.5, and were without fractures were included in this study. One hundred and seventy-six (176) women were included in this study and were divided into two groups; the first group (study) received raloxifene with calcium and vitamin D daily for 12 months, and the second group (control) received only calcium and vitamin D. BMD and bone metabolism markers were measured before and after treatment. RESULTS: One year after treatment, BMD of lumbar spine and total hip was significantly increased in study group (3.21 ± 5.4 and 1.62 ± 7.4, respectively) compared to controls (0.9 ± 3.8 and -0.8 ± 5.6, respectively); also, Ward's triangle and trochanter BMD was significantly increased in study group (4.84 ± 9.3 and 1.78 ± 8.5, respectively) compared to controls (1.53 ± 6.6 and -1. 4 ± 6.4, respectively). C-telopeptide was significantly decreased in study group (121 ± 7.8) compared to control group (1,480 ± 6.3); also, serum osteocalcin was significantly decreased in study group (14.5 ± 8.3) compared to control group (43.8 ± 1.3) 1 year after treatment. Occurrence of fractures during this study was significantly low in raloxifene group compared to controls (0 (0%) versus 3 (3.6%), respectively). CONCLUSIONS: Raloxifene appears to be an effective, well-tolerated option for treating osteoporosis in Kuwaiti postmenopausal women, suitable for long-term use.

Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section.

OBJECTIVE: To detect the maternal and obstetrical factors associated with successful trial of vaginal birth among women with a previous cesarean delivery. MATERIAL AND METHODS: A total of 122 women who were eligible for a trial of labor after cesarean section (TOLAC) according to departmental protocol were included in this comparative prospective study. After informed consent, the women included in this study were subjected to a thorough history to detect maternal and obstetric characteristics and a standard examination to estimate fetal weight, engagement of the fetal head, intra-partum features of fetal membranes, and cervical dilatation. After delivery, data on duration of labor, labor augmentation, mode of delivery, birth outcome, and neonatal intensive care (NICU) admission were recorded and analyzed. RESULTS: Trial of labor after cesarean section was successful in 72.13% and was unsuccessful in 27.87%. Body mass index (BMI) was significantly lower in the successful TOLAC group compared to the unsuccessful group (23.8±0.03 versus 26.2±0.02 kg/m(2)), and the number of women with BMI >25 kg/m(2) was significantly high in the unsuccessful group; also, mean gestational age was significantly lower in the successful TOLAC group compared to the unsuccessful group (37.5±0.04 versus 38.5±0.03 weeks), and the number of women admitted in labor with gestation ≥40 weeks was significantly high in the unsuccessful group. The number of women admitted with >2/5 of fetal head palpable abdominally and fetal head station ≥-2 was significantly high in the unsuccessful TOLAC group. CONCLUSION: In carefully selected cases, TOLAC is safe and often successful. Presence of BMI >25 kg/m(2), gestation ≥40 weeks, and vertex station ≥-2 were risk factors for unsuccessful TOLAC.