Painkillers may prevent broken bones healing

Some painkilling drugs may delay or even prevent the healing of fractures, researchers have warned.

"It's time to tell the public," says Thomas Einhorn, an orthopaedic surgeon at Boston University Medical Center and also a paid consultant to Merck, which makes one of the drugs under scrutiny. "It would seem that a prudent approach is to temporarily avoid the use of these drugs during bone healing."

The main concern is the new generation of non-steroidal anti-inflammatory drugs (NSAIDs). When Patrick O'Connor's team at the University of New Jersey gave these newer painkillers to rats their broken bones did not fully heal. Both drugs, Rofecoxib (sold as Vioxx) and Celecoxib (Celebrex), are often used to ease the pain of broken bones.

Merck, the maker of Rofecoxib, rejects the claim that healing could be impaired in people too. It pointed out a study on spinal fusion operations that found no bone healing problems in people given Rofecoxib. Celecoxib's maker Pharmacia did not respond to queries before New Scientist went to press.

Delay or block
But for over 20 years there have been occasional reports of impaired bone healing in patients taking NSAIDs. The issue may have escaped attention because the older generation of NSAIDS, such as ibuprofen and indomethacin, only appear to delay healing by a few weeks instead of blocking it. Aspirin is one of the few NSAIDs that appears to kill pain without this side effect.

"Ibuprofen and indomethacin delay bone healing by about one to two weeks in rats, which is the equivalent to slowing it down by 25 to 50 per cent in humans," says O'Connor. None of the rats treated with Rofecoxib managed to heal their bones. In those treated with Celecoxib, none managed to completely heal their bones but about half had some form of bone regrowth.

Traditional NSAIDs inhibit the enzymes cox-1 and cox-2. Cox-2 catalyses the production of hormone-like chemicals known as prostaglandins involved in inflammation, while cox-1 has a variety of roles not specific to the inflammatory response. Since the new generation of NSAIDs such as rofecoxib block cox-2 almost exclusively, it was hoped they would have fewer side effects.

But it now seems that cox-2 may be crucial in helping bone-forming stem cells and growth factors do their work. This area now needs to be investigated urgently, says Jeremy Saklatvala of the Kennedy Institute of Rheumatology in London. "In the meantime, people with healing fractures should steer clear of these drugs."

Journal reference: Journal of Bone and Mineral Research (vol 17, p 963)

Source: http://www.newscientist.com/article/dn2364-painkillers-may-prevent-broken-bones-healing.html

Last 10 Keyword Searches: man leg cast, evil knievel broken bones, bone healing process time, broken thumb healing time, natural bone healing process, how to break a bone painlessly, how to tell if i fractured or broke a leg?, healing old fractures, osteoporosis broken leg amputations, how to tell is my forearm is broken

Childhood Arthritis Raises Risk Of Broken Bones

Childhood arthritis increases the risk of fractures, particularly during adolescence, according to a large study of British patient records. The researchers say that more targeted treatments promoting bone health would benefit patients with childhood-onset arthritis throughout their lifespan.

In addition to raising the risk of fracture during childhood, the researchers also found that childhood-onset arthritis potentially heightens fracture risk after age 45.

A research team led by pediatric rheumatologist Jon M. Burnham, M.D., of The Children's Hospital of Philadelphia and the University of Pennsylvania, analyzed the medical records of 1,959 patients in the United Kingdom who first experienced arthritis between ages one and 19. The researchers compared those patients to a larger control group of 207,000 patients in a primary care database.

The study appeared online in the Annals of the Rheumatic Diseases on April 21. It was the first research to examine, in a population-based study, the risk of fractures in childhood arthritis patients.

Juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis, is the most common pediatric rheumatic disease, affecting approximately one in 1,000 U.S. children. It was already known that low bone mass occurs in patients with JIA, because of risk factors such as chronic inflammation, delayed puberty, malnutrition, weakness, inactivity and treatment with steroid medications.

"The goal of this study was to determine if the bone abnormalities seen in JIA are clinically significant, resulting in higher fracture rates, and that is exactly what we found," said Dr. Burnham. "The low bone mass in JIA is associated with skeletal fragility, and causes both short-term and long-term health problems. Someone who fails to attain peak bone mass during adolescence and young adulthood is more vulnerable to fractures in later life, when bone mass inexorably declines."

Fractures are not unusual in healthy, active children, and the researchers compared the records of patients who had juvenile-onset arthritis with those of control subjects. Their data source was the United Kingdom General Practice Research Database, representing primary care records from 1987 to 2002.

The researchers found that 6.7 percent of patients with JIA sustained first fractures, compared to 3.3 percent of control subjects with first fractures, during an average follow-up period of four years. The comparative risk for patients with arthritis was highest at ages 10 to 15 and peaked again after age 45. Patients with arthritis were significantly more likely than controls to suffer fractures in their arm and leg bones.

Dr. Burnham added that the study findings should encourage physicians caring for children with arthritis to more closely monitor their patients for signs of osteoporosis, and to focus on nutritional steps that promote bone health, such as increasing regular intake of calcium and vitamin D.

Because bone health is affected by a combination of factors, including inflammation, inactivity, delayed puberty, impaired nutrition and the use of steroid medications, he added, further studies should concentrate on determining how JIA interacts with these risk factors, and how specific therapies might benefit JIA patients. Dr. Burnham is currently leading multidisciplinary research on bone and muscle strength in JIA and other inflammatory diseases.

Source: http://www.medicalnewstoday.com/articles/43062.php

CT scan's merits weighed against its risks

BLUFFTON -- Recent reports say that CT scans are overused nationwide and could cause cancer in as many as 3 million people over the next three decades.

Computed Tomography (CT) scans superimpose hundreds of X-ray images to make 3-D pictures of the body. In a matter of minutes, they can show doctors what is occurring inside the body without having to cut someone open. They are especially useful in high-trauma situations that require quick decision-making or to find out what is happening to a stroke patient.

The scans, however, expose patients to radiation, which has the potential to cause cancer.

Dr. Robert Hewes of Hilton Head Regional Medical Center said a CT scan is equivalent to one year's exposure of sunlight. The information doctors can obtain from the scans sometimes far outweighs the risks, he said.

The New England Journal of Medicine study, released last month, reports that one-third of CT scans are medically unnecessary.

Hewes said that number is much higher than what he sees locally. Doctors determine what tests are appropriate based on the type of injury or ailment, a person's medical history and physical exam.

"We want to make sure the patients are getting appropriate exams with the least amount of radiation possible," he said. "I have to say, though, that we also need to be careful of the population, especially those people who are young and females."

Women are more vulnerable to radiation, which can lead to an increased risk of still births.

Dr. Joseph Borelli, president of Bluffton's MRI at Belfair and chairman of the national committee on MRI Accreditation, said excessive levels of radiation lead to breaks in a person's DNA, allowing cancer to spread.

He stands by the MRI, which stands for magnetic resonance imaging.

While an MRI takes about 20 minutes, compared to a five-minute CT, it can provide a better picture of the body.

"It picks up more tumors than a CT would," Borelli said. "And, it's better at looking at bone marrow."

Borelli doesn't expect MRI technology to catch up to CT speed. He also says CT scans are more portable and often used for military men and women in times of war.

Other alternatives include:

• X-rays provide one-dimensional views of fractures or broken bones.

• Ultrasound technology uses sound waves to show the structure and movement of the body's internal organs, along with its blood flow. It does not have any negative side effects and is the method of choice for tracking fetal growth and movement.

• A PET scan, or positron emission tomography scan, is a nuclear medicine exam. It carries higher amounts of radiation because a radioactive substance is injected into the body, which causes the person to be radioactive for a few days following the exam.

Source: http://www.beaufortgazette.com/local/story/121710.html

Crew injury Pretty Fly II, Cougar ll out of Hobart

A second crewman has been injured and a third yacht has this afternoon retired from the 63rd Rolex Sydney Hobart Yacht Race.

The NSW yacht Pretty Fly II, skippered by Colin Woods, is heading for Eden this afternoon after crew member Derek Brown suffered a broken nose and cheek bone when he was hit in the face by the spinnaker pole when the boat was about 27 nautical miles from the port town.

Pretty Fly II is making for a rendezvous with a Water Police boat in Eden Harbour so Brown can be transferred to Pambula Hospital.

Full article: http://www.sail-world.com/index.cfm?SEID=2&Nid=40267&SRCID=0&ntid=0&tickeruid=0&tickerCID=0