Examining the relationship between bone mineral density and fracture risk reduction during pharmacologic treatment of osteoporosis.

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes the patient to an increased risk for fracture. Elements of bone strength include bone mineralization, architecture, turnover, size, and bone mineral density (BMD). Measurement of BMD is the most readily available, noninvasive method for assessing osteoporotic fracture risk and is used by the World Health Organization for diagnostic purposes. Because low BMD is predictive of increased fracture risk, it was believed that changes in BMD during pharmacologic therapy for osteoporosis would strongly predict observed fracture risk reductions. We examined the relationship between changes in BMD and reduction in fracture risk during pharmacologic therapy in postmenopausal women with osteoporosis. The correlation between BMD increases and fracture risk reduction during treatment is not consistent; larger increases in BMD do not necessarily correlate with greater reductions in fracture risk. Multiple factors, in addition to BMD, appear to contribute to the increased bone strength and decreased fracture risk achieved with approved drug therapies for osteoporosis. Until the exact relationship of these factors is fully understood, clinicians should continue to evaluate drug efficacy for osteoporosis based on the fracture risk reductions from well-designed clinical trials.

Evaluation of the ability of seven herbal resources to answer questions about herbal products asked in drug information centers.

STUDY OBJECTIVE: To evaluate the ability of seven widely known herbal references and electronic databases to answer questions about herbal products asked at drug information centers. DESIGN: Cross-sectional study. SETTING: Five academic and institutional drug information centers. METHODS: Fifty-seven herbal-related questions were obtained from academic and institutional drug information centers. Seven herbal references and electronic databases were evaluated for their ability to answer these 57 questions: The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, 1st edition; Physicians' Desk Reference (PDR) for Herbal Medicines, 2001 edition; Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 4th edition; The Lawrence Review of Natural Products, 2001; Natural Medicines Comprehensive Database (electronically updated, 2001); The Natural Pharmacist (electronically updated, 2001); and AltMedDex (electronically updated, 2001). RESULTS: Natural Medicines Comprehensive Database outperformed all other products evaluated, providing direct answers to 61% of questions. AltMedDex and The Natural Pharmacist performed similarly to one another, answering 49% and 44% of questions, respectively. The Lawrence Review of Natural Products, PDR for Herbal Medicines, The Complete German Commission E Monographs, and Tyler's Honest Herbal were the least helpful in providing direct answers to the questions (24%, 21%, 11%, and 9%, respectively). CONCLUSION: Natural Medicines Comprehensive Database, AltMedDex, and The Natural Pharmacist outperformed all other evaluated herbal references and electronic databases in their ability to answer questions about herbal products posed in clinical practice.