The Pharmaceutical Journal
Vol 269 No 7226 p772
30 November 2002

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Drug and Therapeutics Bulletin reviews focus on bone health

A range of lifestyle measures aimed at preventing osteoporotic fractures are outlined in the latest issue of the Drug and Therapeutics Bulletin (2002;40:83). A second DTB review concludes that glucosamine can bring benefits to those with osteoarthritis of the knee (ibid, p81).

DTB reviewers assessed the research evidence supporting a variety of lifestyle interventions. They conclude that measures to reduce the risk of osteoporosis should include encouraging people at risk to eat a varied diet with at least five portions of fruit and vegetables a day and an adequate intake of calcium — 700mg a day for most adults. In addition, smoking should be discouraged and alcohol intake should be moderate.

The reviewers say there is evidence to show that calcium and vitamin D supplementation can reduce fracture risk in elderly people living in institutions and therefore should be offered to these individuals. They also say falls prevention programmes may be of benefit and that regular weight bearing exercises, such as brisk walking for 30 minutes five days a week, are essential for maintaining bone health.

Chris Martin, who runs an osteoporosis programme at his pharmacy in St David's, Pembrokeshire, told The Journal: "It is absolutely spot-on. This is good solid advice that we should be giving to all our patients who are at risk of osteoporosis."

In the second review, the authors looked at research comparing glucosamine with a non-steroidal anti-inflammatory drug or placebo. They note that although oral glucosamine is well absorbed from the gut, there are no clinical data to confirm that it reaches the joints, or that concentrations in cartilage are high enough to influence formation of new cartilage. In addition, they say pharmacokinetic studies suggest that glucosamine breaks down extensively after absorption.

However, patients with osteoarthritis of the knee taking a typical daily dose of glucosamine (1,500mg glucosamine sulphate) experienced pain relief comparable to that produced by NSAIDs. They reviewers say there is little evidence to support its use as a treatment for osteoarthritis in other parts of the body.

Dr Ike Iheanacho, deputy editor of DTB, said: "While further trials are needed to determine the best use of glucosamine sulphate in the management of osteoarthritis, there is evidence to suggest it is as effective as NSAIDs in providing relief in patients with knee osteoarthritis."