Testosterone Therapy May Reduce Bone Loss in Older Men

(HealthDay News) -- Injections of testosterone appear to improve bone density and reduce bone loss in older men who have low testosterone levels and may help to prevent osteoporosis, a new study suggests.

Testosterone therapy has been used to improve bone strength and muscle mass in some men. However, the hormone treatment is controversial, because it has been associated with increasing the risk of prostate cancer and high levels of red blood cells. And other potential effects of long-term use of testosterone therapy aren't known.

"These preliminary data show beneficial effects of testosterone therapy on bone turnover markers in older men with low-to-normal testosterone concentrations using both continuous and monthly cycled testosterone replacement," lead researcher E. Lichar Dillon, of the Department of Internal Medicine at the University of Texas Medical Branch in Galveston, said in a prepared statement. "The effects of sex hormones on markers of bone formation are complex, but this is an important step in understanding how the process works."

Preliminary study results were expected to be presented April 7 at the American Physiological Society's annual meeting, during the Experimental Biology 2008 conference, in San Diego.

For the study, Dillon's team studied 13 men, ranging in age from 60 to 85. During the five-month trial, the men were either given weekly injections of testosterone, weekly injections of testosterone every other month, or a placebo.

The researchers found that men receiving testosterone had reduced bone turnover, compared with men on a placebo. While the effects of testosterone therapy over the long term aren't clear, the researchers said they believed the treatment would be beneficial by preserving bone mass and preventing osteoporosis.

One expert said the study was too small to prove or disprove the value of testosterone therapy in preventing bone loss and, perhaps, preventing osteoporosis.

"This small, short-term study indicates that men with low levels of testosterone respond to appropriate replacement as far as turnover markers indicate," said John Eisman, director of the Bone and Mineral Research Program at the Garvan Institute of Medical Research, in Sydney, Australia.

While calling the study "too small and too short to provide any insight into fracture-risk reduction or safety outcomes," Eisman said it does complement research he has done. "Our study showed that men with testosterone in the lowest quartile of the population had much higher risk of osteoporotic fractures," he said.

A large, long-term trial testing whether testosterone can prevent osteoporosis in men is needed to settle the question, Eisman said.

More information
To learn more about men and osteoporosis, visit the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Gulf War Illness Strongly Linked to Chemical Exposure

(HealthDay News) -- A new scientific review finds a strong association between exposure to certain chemicals and the Gulf War illness suffered by many veterans.

The class of chemicals, known as acetylcholinesterase inhibitors (AChEIs), are found in pesticides, nerve agents and in pills given to soldiers to protect against nerve agents. The review, which was conducted by researchers at the University of California, San Diego, looked at 115 papers on the topic.

"Some of this has been stated for a while," said Joy Ray Miller, an assistant professor of pharmacy practice at the Irma Lerma Rangel College of Pharmacy at Texas A&M Health Science Center. "This article pulls it all together. It's definitely something to be aware of for our future veterans and for the military that's out there now. There are so many variants in the article that we can't really say as a matter of fact that [AChEIs cause the symptoms], but I think there are enough coincidences going on that we can have a pretty good understanding that maybe we should do something differently."

Veterans of the 1990-1991 Persian Gulf War have a higher rate of "chronic multi-symptom health problems" than either non-deployed military personnel or those deployed in other regions. In fact, 26 percent to 32 percent of personnel deployed to the Persian Gulf during this period have chronic health problems, a range that may actually understate the magnitude of the problem, according to the study, published in this week's issue of the Proceedings of the National Academy of Sciences.

Symptoms of the syndrome include fatigue, mood-cognition problems and musculoskeletal symptoms.

Although the exact causes remain unknown, evidence is mounting to suggest that exposure to organophosphate and carbamate acetylcholinesterase inhibitors (AChEIs), including pyridostigmine bromide (PB), pesticides and nerve agents, may be responsible.

The authors of this paper looked at epidemiological studies assessing the link between these chemicals and symptoms observed in Gulf War vets.

Many of the studies reported a link between exposure to AChEI and chronic symptoms.
An estimated 250,000 personnel received the carbamate pyridostigmine bromide (PB) as a pretreatment for potential exposure to nerve agents. Those who took more pills had a higher incidence of symptoms.

Also, an estimated 41,000 service members may have been overexposed to pesticides, which were used to control vector-borne disease, and 100,000 personnel may have been exposed to low levels of sarin nerve agent after the demolition of the Khamisiyah munitions depot in Iraq.

The symptoms are akin to those suffered by agricultural workers exposed to AChEIs, said the study authors, as well as symptoms suffered by victims of the sarin terrorist attacks in Japan.

Exposure to AChEIs could also be linked to the higher rate of amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, in Gulf War veterans. Sporadic ALS has been associated with exposure to agricultural chemicals.

And men and women with the Gulf War symptoms were more likely to have lower concentrations and activity levels of enzymes which work to clear AChEIs from the system. Genetics may impact the way the body processes these chemicals, specifically the actions of these related enzymes.

"They're giving certain people so many of these nerve agent pills or pesticides, and [the authors] say that some people metabolize them and some not," Miller said. "Are we really giving a toxic dose apart from the genetics? What are they giving and have they really tested the amounts that they're giving? Are we overdosing?"

More information
There's more on Gulf War syndrome at the University of Chicago Medical Center.

Psoriasis Often Goes Untreated: Survey

(HealthDay News) -- Many Americans with chronic moderate or severe psoriasis receive no treatment or inadequate treatment, a new survey from the National Psoriasis Foundation (NPF) shows.

The poll also revealed a link between severe psoriasis and low income.

Psoriasis is a non-contagious disease in which the immune system causes skin to grow at an accelerated rate.

The surveys, conducted from 2003 to 2005, found that nearly 40 percent of people with chronic moderate or severe psoriasis were receiving no treatment, and that 57 percent of people with severe psoriasis, and 73 percent of those with moderate psoriasis, were receiving topical treatment only. Over half of patients with moderate to severe psoriasis were not receiving treatment that meets American Academy of Dermatology guidelines.

Those guidelines say that people with chronic moderate to severe psoriasis are candidates for phototherapy or systemic therapy, including biologic agents. However, many of those patients were receiving topical treatment alone, according to the survey data.

"Psoriasis is not a cosmetic disease but rather a chronic inflammation condition that can have a profound negative impact on a person's ability to function," Dr. Mark Lebwohl, chairman of the NPF's medical board, said in a prepared statement. "It's important for patients to openly discuss with their dermatologist how the condition may be impacting them, so that together they can determine the most appropriate treatments."

The survey data also revealed a possible association between psoriasis and low income -- 21 percent of people with severe psoriasis had a low household income (less than $30,000 per year), compared to 13 percent for people with mild psoriasis.

"These are the first data to show a relationship between psoriasis severity and household income," Liz Horn, NPF director of research, said in a prepared statement. "Psoriasis is a serious disease that can significantly affect a person's life by interfering with everyday activities, including work."

The survey findings were to be presented Friday at a meeting of the American Academy of Dermatology in Washington, D.C.

As many as 7.5 million people in the United States have psoriasis, according to the National Institutes of Health.

More information
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about psoriasis.

Narcotics Offer Only Short-Term Relief of Back Pain

(HealthDay News) -- Potent opioid drugs, such as Oxycontin and Vicodin, may help treat chronic back pain in the short term, but it's not clear the drugs help in the long run and abuse may be common, a new review has found.

"Opioids may be effective for short-term relief," said study author Dr. Bridget A. Martell. "But all studies [reviewed] were less than four months."

Martell and her colleagues did what is known as a meta-analysis, pooling the results of 38 previously published studies. "The meta-analysis does not show statistical significance that opioids work any better than placebo," she said, although "they possibly work for short-term relief."

The new report is published in the Jan. 16 issue of the Annals of Internal Medicine.

"This is the first meta-analysis to look at opioids for chronic back pain," Martell said. She conducted the study while an associate research scientist at Yale University and wrote the report while she was associate director of the Pfizer New Haven Clinical Research Unit, part of the pharmaceutical company's Global Research and Development Division.

Martell's team found that the prescription of these drugs varied by treatment settings, with the percentage of patients prescribed the drugs for chronic back pain ranging from 3 percent to 66 percent.

Prescribing them was most likely if patients went to a specialty treatment center and least common in primary-care centers.

Included in the reviewed studies were five reports that looked at "suspicious" medication-taking behaviors that would make health-care providers suspect abuse, such as ordering refills before they are needed. These behaviors occurred in up to 24 percent of cases.

Back pain is the second leading symptom seen by physicians in the United States, according to Martell. Chronic back pain is defined as discomfort lasting more than three months. It afflicts up to 19 percent of working adults, Martell wrote.

Besides narcotic medication, physicians can treat chronic back pain in other ways, using exercise, nonsteroidal anti-inflammatory medicines (NSAIDs), tricyclic antidepressants, acupuncture and electrical stimulation.

Based on the analysis, Martell offers this advice to patients with chronic back pain: "Consider all your options carefully, weigh the risks vs. the benefits of those options, and be sure to seek specialty care from a pain specialist."

Dr. Andrew Sherman, head of spine and musculoskeletal rehabilitation at the Spine Institute at the University of Miami Miller School of Medicine, agreed. "This meta-analysis suggests that significant risks do exist with the use of opioid medicines," he said. "Patients need to consult with a board-certified expert physician in pain management."

The lack of high-quality scientific studies is another important issue, Sherman said. The researchers found 2,378 studies but discarded most because they didn't meet the standards of their meta-analysis.

More information
To learn more about chronic back pain, visit the U.S. National Institute of Neurological Disorders and Stroke.