Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging.

BACKGROUND: Modic changes (MC) are associated with low back pain (LBP), but effective treatments are lacking. The aim of this randomized, placebo-controlled, double-blinded trial was to evaluate the efficacy of zoledronic acid (ZA) for chronic LBP among patients with MC in magnetic resonance imaging (MRI). METHODS: Inclusion criteria were LBP lasting ≥3 months, with an intensity of ≥6 on a 10-cm VAS or an Oswestry Disability Index (ODI) of ≥30%, and MC in MRI. Patients were randomized into single intravenous infusion of ZA 5 mg (n = 20), or placebo (n = 20) groups. The primary outcome was LBP intensity, secondary outcomes leg pain intensity, ODI, health-related quality of life (RAND-36), lumbar flexibility, sick leaves and use of pain medication. The treatment differences at one month and one year were analysed using ANCOVA with adjustment for the baseline score. RESULTS: The mean difference (MD) between the groups in the primary outcome, intensity of LBP, was 1.4 (95% confidence intervals (CI) 0.01 to 2.9) in favour of ZA at one month. We observed no significant between-group difference in the intensity of LBP at one year (MD 0.7; 95% CI -1.0 to 2.4) or in secondary outcomes at any time point except that 20% of patients in the ZA group used non-steroidal anti-inflammatory drugs at one year compared to 60% in the placebo group (P = 0.022). Acute phase reactions (fever, flu-like symptoms, arthralgia) emerged in 95% of the patients in the ZA group, compared to 35% in the placebo group. CONCLUSIONS: ZA was effective in reducing the intensity of LBP in the short term and in reducing the use of NSAIDs within the time span of one year among patients with chronic LBP and MC confirmed in MRI. Although the results seem encouraging, larger studies are required to analyse the effectiveness and safety of ZA for patients with MC. TRIAL REGISTRATION: ClinicalTrial.gov identifier NCT01330238.

Dietary factors protecting women from urinary tract infection.

BACKGROUND: Because urinary tract infections (UTIs) are caused by bacteria in the stool, dietary factors may affect the risk of contracting a UTI by altering the properties of the fecal bacterial flora. OBJECTIVE: We studied dietary and other risk factors for UTI in fertile women in a case-control setting. DESIGN: One hundred thirty-nine women from a health center for university students or from the staff of a university hospital (mean age: 30.5 y) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the past 5 y. Data on the women's dietary and other lifestyle habits were collected by questionnaire. A risk profile for UTI expressed in the form of adjusted odds ratios (ORs) with 95% CIs was modeled in logistic regression analysis for 107 case-control pairs with all relevant information. RESULTS: Frequent consumption of fresh juices, especially berry juices, and fermented milk products containing probiotic bacteria was associated with a decreased risk of recurrence of UTI: the OR for UTI was 0.66 (95% CI: 0.48, 0.92) per 2 dL juice. A preference for berry juice over other juices gave an OR of 0.28 (95% CI: 0.14, 0.56). Consumption of fermented milk products > or = 3 times/wk gave an OR of 0.21 (95% CI: 0.06, 0.66) relative to consumption < 1 time/wk. Intercourse frequency was associated with an increased risk of UTI (OR for > or = 3 times/wk compared with < 1 time/wk: 2.7; 95% CI: 1.16, 6.2). CONCLUSION: Dietary habits seem to be an important risk factor for UTI recurrence in fertile women, and dietary guidance could be a first step toward prevention.