Timothy F. Kirn

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.

SAN ANTONIO — The older generation osteoporosis drug, strontium ranelate, is receiving renewed attention as a result of a metaanalysis showing that it reduces fracture rates in postmenopausal women as well as bisphosphonates do.

Like bisphosphonates, strontium ranelate inhibits bone resorption but also increases bone formation, a combination that improves bone density and bone mass, Jean-Yves Reginster, M.D., said at the annual meeting of the American College of Rheumatology.

In one of the reports, strontium ranelate for 3 years reduced vertebral fracture risk by 41%, and increased lumbar-spine bone density by 14% and femoral neck density by 8%, relative to placebo. The 1,649 subjects were osteoporotic women who had previously had a vertebral fracture (N. Engl. J. Med. 2004;350:459-68).

Dr. Reginster's metaanalysis of that study and a similar investigation confirmed strontium ranelate's effectiveness in preventing hip and vertebral fractures, even in the frail elderly.

In that analysis, which involved more than 7,000 postmenopausal women, the risk of vertebral fracture during a 3-year period was reduced by 32% in 1,488 women aged 80 years or older, and nonvertebral fracture risk was reduced by 31%. Among the 1,977 women who were older than 77 years and had a baseline bone mineral density T-score of -3 or less, the hip fracture rate was reduced by 36% relative to placebo.

The drug's efficacy in elderly patients shows it was building bone mass, not just density, Dr. Reginster of the University of Liege (Belgium) said at a press briefing.

Bisphosphonates tend not to be so effective in the very elderly, he added.

Among the patients in both studies who had not previously had a vertebral fracture—about 2,500 patients—the vertebral fracture rate was reduced by 48% relative to placebo. Similar risk reductions are seen with bisphosphonate treatment (47% for alendronate and 49% for risedronate).

Diarrhea was the only side effect that was significantly more associated with the study drug, occurring in 6% of those patients.

Like a bisphosphonate, strontium ranelate is taken on a fasting stomach. The dosage used in the studies was 2 g daily. Participants also took calcium and vitamin D supplements.

SAN ANTONIO — The older generation osteoporosis drug, strontium ranelate, is receiving renewed attention as a result of a metaanalysis showing that it reduces fracture rates in postmenopausal women as well as bisphosphonates do.

Like bisphosphonates, strontium ranelate inhibits bone resorption but also increases bone formation, a combination that improves bone density and bone mass, Jean-Yves Reginster, M.D., said at the annual meeting of the American College of Rheumatology.

In one of the reports, strontium ranelate for 3 years reduced vertebral fracture risk by 41%, and increased lumbar-spine bone density by 14% and femoral neck density by 8%, relative to placebo. The 1,649 subjects were osteoporotic women who had previously had a vertebral fracture (N. Engl. J. Med. 2004;350:459-68).

Dr. Reginster's metaanalysis of that study and a similar investigation confirmed strontium ranelate's effectiveness in preventing hip and vertebral fractures, even in the frail elderly.

In that analysis, which involved more than 7,000 postmenopausal women, the risk of vertebral fracture during a 3-year period was reduced by 32% in 1,488 women aged 80 years or older, and nonvertebral fracture risk was reduced by 31%. Among the 1,977 women who were older than 77 years and had a baseline bone mineral density T-score of -3 or less, the hip fracture rate was reduced by 36% relative to placebo.

The drug's efficacy in elderly patients shows it was building bone mass, not just density, Dr. Reginster of the University of Liege (Belgium) said at a press briefing.

Bisphosphonates tend not to be so effective in the very elderly, he added.

Among the patients in both studies who had not previously had a vertebral fracture—about 2,500 patients—the vertebral fracture rate was reduced by 48% relative to placebo. Similar risk reductions are seen with bisphosphonate treatment (47% for alendronate and 49% for risedronate).

Diarrhea was the only side effect that was significantly more associated with the study drug, occurring in 6% of those patients.

Like a bisphosphonate, strontium ranelate is taken on a fasting stomach. The dosage used in the studies was 2 g daily. Participants also took calcium and vitamin D supplements.

SAN ANTONIO — The older generation osteoporosis drug, strontium ranelate, is receiving renewed attention as a result of a metaanalysis showing that it reduces fracture rates in postmenopausal women as well as bisphosphonates do.

Like bisphosphonates, strontium ranelate inhibits bone resorption but also increases bone formation, a combination that improves bone density and bone mass, Jean-Yves Reginster, M.D., said at the annual meeting of the American College of Rheumatology.

In one of the reports, strontium ranelate for 3 years reduced vertebral fracture risk by 41%, and increased lumbar-spine bone density by 14% and femoral neck density by 8%, relative to placebo. The 1,649 subjects were osteoporotic women who had previously had a vertebral fracture (N. Engl. J. Med. 2004;350:459-68).

Dr. Reginster's metaanalysis of that study and a similar investigation confirmed strontium ranelate's effectiveness in preventing hip and vertebral fractures, even in the frail elderly.

In that analysis, which involved more than 7,000 postmenopausal women, the risk of vertebral fracture during a 3-year period was reduced by 32% in 1,488 women aged 80 years or older, and nonvertebral fracture risk was reduced by 31%. Among the 1,977 women who were older than 77 years and had a baseline bone mineral density T-score of -3 or less, the hip fracture rate was reduced by 36% relative to placebo.

The drug's efficacy in elderly patients shows it was building bone mass, not just density, Dr. Reginster of the University of Liege (Belgium) said at a press briefing.

Bisphosphonates tend not to be so effective in the very elderly, he added.

Among the patients in both studies who had not previously had a vertebral fracture—about 2,500 patients—the vertebral fracture rate was reduced by 48% relative to placebo. Similar risk reductions are seen with bisphosphonate treatment (47% for alendronate and 49% for risedronate).

Diarrhea was the only side effect that was significantly more associated with the study drug, occurring in 6% of those patients.

Like a bisphosphonate, strontium ranelate is taken on a fasting stomach. The dosage used in the studies was 2 g daily. Participants also took calcium and vitamin D supplements.

SNOWMASS, COLO. — Antimalarials may not only treat active lupus, but also benefit the heart, W. Joseph McCune, M.D., said at a symposium sponsored by the American College of Rheumatology.

Lupus patients have an elevated risk of heart disease, and antimalarials have been shown to have a number of cardioprotective properties, said Dr. McCune, professor of internal medicine at the University of Michigan, Ann Arbor.

Such benefits may help offset the deleterious effects of prednisone, which has been shown to increase cholesterol levels. Each 10-mg titration in prednisone dosage is estimated to increase serum cholesterol by 7.5 mg/dL.

Several studies have shown that antimalarials are associated with lipid profile improvements in lupus patients. Each of those studies has treated patients somewhat differently and has shown slightly different results. “But the body of the studies clearly show that when a benefit is looked for, it is found mostly in lowering LDL cholesterol,” Dr. McCune said.

In one study involving lupus patients not on corticosteroids, antimalarial therapy was associated with a 4% drop in total cholesterol at 3 months and a 1% drop at 6 months, compared with baseline levels. In patients on a corticosteroid, antimalarial therapy was associated with an 11% drop in total cholesterol at 3 months and a 9% drop at 6 months (J. Rheumatol. 1999;26:325-30).

Among diabetes patients, antimalarials have been shown to lower glucose levels in non-insulin-dependent patients. They also reduce insulin requirements in insulin-dependent patients. The dosages used have tended to be much higher than those typically used to treat lupus. However, even at the lower dosages used for treating lupus, it's believed that there is some positive effect on glucose tolerance, Dr. McCune said.

Other drugs have been shown to have beneficial secondary effects in lupus patients, but the supporting evidence is generally less robust, he said.

Dehydroepiandrosterone, which can be steroid sparing when it is added to lupus treatment, may produce increases in bone density that could offset steroid-induced osteopenia. But this has not been shown in patients with lupus, and the evidence is not definitive.

Statins clearly have immunomodulatory effects and have been shown to help prevent transplant rejection and to improve rheumatoid arthritis symptoms. They obviously primarily lower cholesterol, and they may have positive effects on bone formation. But at present there are no trials of statins used in patients with lupus, Dr. McCune said.

SNOWMASS, COLO. — Antimalarials may not only treat active lupus, but also benefit the heart, W. Joseph McCune, M.D., said at a symposium sponsored by the American College of Rheumatology.

Lupus patients have an elevated risk of heart disease, and antimalarials have been shown to have a number of cardioprotective properties, said Dr. McCune, professor of internal medicine at the University of Michigan, Ann Arbor.

Such benefits may help offset the deleterious effects of prednisone, which has been shown to increase cholesterol levels. Each 10-mg titration in prednisone dosage is estimated to increase serum cholesterol by 7.5 mg/dL.

Several studies have shown that antimalarials are associated with lipid profile improvements in lupus patients. Each of those studies has treated patients somewhat differently and has shown slightly different results. “But the body of the studies clearly show that when a benefit is looked for, it is found mostly in lowering LDL cholesterol,” Dr. McCune said.

In one study involving lupus patients not on corticosteroids, antimalarial therapy was associated with a 4% drop in total cholesterol at 3 months and a 1% drop at 6 months, compared with baseline levels. In patients on a corticosteroid, antimalarial therapy was associated with an 11% drop in total cholesterol at 3 months and a 9% drop at 6 months (J. Rheumatol. 1999;26:325-30).

Among diabetes patients, antimalarials have been shown to lower glucose levels in non-insulin-dependent patients. They also reduce insulin requirements in insulin-dependent patients. The dosages used have tended to be much higher than those typically used to treat lupus. However, even at the lower dosages used for treating lupus, it's believed that there is some positive effect on glucose tolerance, Dr. McCune said.

Other drugs have been shown to have beneficial secondary effects in lupus patients, but the supporting evidence is generally less robust, he said.

Dehydroepiandrosterone, which can be steroid sparing when it is added to lupus treatment, may produce increases in bone density that could offset steroid-induced osteopenia. But this has not been shown in patients with lupus, and the evidence is not definitive.

Statins clearly have immunomodulatory effects and have been shown to help prevent transplant rejection and to improve rheumatoid arthritis symptoms. They obviously primarily lower cholesterol, and they may have positive effects on bone formation. But at present there are no trials of statins used in patients with lupus, Dr. McCune said.

SNOWMASS, COLO. — Antimalarials may not only treat active lupus, but also benefit the heart, W. Joseph McCune, M.D., said at a symposium sponsored by the American College of Rheumatology.

Lupus patients have an elevated risk of heart disease, and antimalarials have been shown to have a number of cardioprotective properties, said Dr. McCune, professor of internal medicine at the University of Michigan, Ann Arbor.

Such benefits may help offset the deleterious effects of prednisone, which has been shown to increase cholesterol levels. Each 10-mg titration in prednisone dosage is estimated to increase serum cholesterol by 7.5 mg/dL.

Several studies have shown that antimalarials are associated with lipid profile improvements in lupus patients. Each of those studies has treated patients somewhat differently and has shown slightly different results. “But the body of the studies clearly show that when a benefit is looked for, it is found mostly in lowering LDL cholesterol,” Dr. McCune said.

In one study involving lupus patients not on corticosteroids, antimalarial therapy was associated with a 4% drop in total cholesterol at 3 months and a 1% drop at 6 months, compared with baseline levels. In patients on a corticosteroid, antimalarial therapy was associated with an 11% drop in total cholesterol at 3 months and a 9% drop at 6 months (J. Rheumatol. 1999;26:325-30).

Among diabetes patients, antimalarials have been shown to lower glucose levels in non-insulin-dependent patients. They also reduce insulin requirements in insulin-dependent patients. The dosages used have tended to be much higher than those typically used to treat lupus. However, even at the lower dosages used for treating lupus, it's believed that there is some positive effect on glucose tolerance, Dr. McCune said.

Other drugs have been shown to have beneficial secondary effects in lupus patients, but the supporting evidence is generally less robust, he said.

Dehydroepiandrosterone, which can be steroid sparing when it is added to lupus treatment, may produce increases in bone density that could offset steroid-induced osteopenia. But this has not been shown in patients with lupus, and the evidence is not definitive.

Statins clearly have immunomodulatory effects and have been shown to help prevent transplant rejection and to improve rheumatoid arthritis symptoms. They obviously primarily lower cholesterol, and they may have positive effects on bone formation. But at present there are no trials of statins used in patients with lupus, Dr. McCune said.

Cardiopulmonary resuscitation is often done improperly by rescuers who give too few chest compressions and the wrong amount of ventilation.

Those are the findings of two new studies that are among the first to precisely measure the performance of CPR in real-life situations, both inside and outside the hospital.

CPR has been around for about 50 years, and CPR guidelines are frequently revised. But until now, there has not been a reliable, objective way to measure how well it is being performed, said Lance B. Becker, M.D., a coauthor of the in-hospital study and a professor of emergency medicine and director of the Emergency Resuscitation Research Center at the University of Chicago.

“Now we find that CPR is not being done very well,” he said.

The two studies' investigators used a new monitor/defibrillator device that can count how often compressions are given and how much pressure is exerted with each compression. The device, developed by a Norwegian company, also records the rate of volume of ventilations.

In the in-hospital study, Dr. Becker and his colleagues examined the use of the device in 67 cardiac arrest cases. All the rescuers had received proper training in CPR. Guidelines call for 100 compressions per minute and 12-16 ventilations per minute, but in 28% of the cases, the average compression rate was less than 90 compressions per minute during the first 5 minutes of resuscitation. In 61% of the 30-second segments studied, the ventilation rate was more than 20 ventilations per minute. Moreover, 37% of the compressions were too shallow (JAMA 2005;293:305-10).

The out-of-hospital study looked at use of the device in 176 patients who went into cardiac arrest in three European cities and were attended by paramedics or by a nurse anesthetist.

The researchers found that 48% of the times that the rescuers were performing resuscitation, they were not actually giving compressions. When they did perform compressions during the CPR episode, they gave compressions at a rate of 121 per minute—close to the study's target values of 100-120 compressions per minute. But the average number of compressions delivered in a minute was only 64. Rescuers gave an average of 11 ventilations per minute (JAMA 2005;293:299-304).

Neither study was able to look precisely at whether poor performance of the CPR affected patient survival, because neither had enough patients to make that determination. However, in the study performed by Dr. Becker and his colleagues, the investigators did note that patients who had longer intervals without chest compression had worse resuscitation results.

Speaking at the 2004 American College of Emergency Physicians Scientific Assembly, Dr. Becker noted that he and his colleagues have performed another study, of 100 patients, in which the compression rate was counted and recorded by a trained nurse at the scene. In that study, he said, those patients who received 80-100 compressions a minute were significantly more likely to survive than those who did not.

The results of the in-hospital and out-of-hospital CPR studies are not surprising, noted an editorial that accompanied the studies (JAMA 2005;293:363-5). Prior studies have shown low chest compression rates and high ventilations rates, and they have also shown that CPR training is poorly retained, said Arthur B. Sanders, M.D., in the editorial.

The studies suggest that CPR and advanced cardiac life support (ACLS) training need to be simplified to stress managing cardiac arrest and to emphasize compression over breathing, said Dr. Sanders of the department of emergency medicine at the University of Arizona, Tucson.

ACLS training has become more and more complicated over time so that it now includes instruction on stroke and shock and even managing electrolyte imbalances and asthma, he said.

Both the American Heart Association and the International Liaison Committee on Resuscitation are due to update their CPR and emergency cardiovascular care guidelines in the coming year, Dr. Sanders noted. He called on the groups to simplify their guidelines, and to “return to the core mission” in ACLS training.

“It is time to simplify the CPR guidelines and educational programs so that all patients who sustain cardiac arrest can receive optimal treatment,” Dr. Sanders said.

Dr. Becker said the device used in his study could also be a major aid in improving resuscitation efforts because it can tell someone administering CPR when they need to speed up their compressions and when they need to slow down their breathing.

Dr. Becker disclosed financial relationships with a series of companies involved in developing the device and is a paid consultant to two of them.

Cardiopulmonary resuscitation is often done improperly by rescuers who give too few chest compressions and the wrong amount of ventilation.

Those are the findings of two new studies that are among the first to precisely measure the performance of CPR in real-life situations, both inside and outside the hospital.

CPR has been around for about 50 years, and CPR guidelines are frequently revised. But until now, there has not been a reliable, objective way to measure how well it is being performed, said Lance B. Becker, M.D., a coauthor of the in-hospital study and a professor of emergency medicine and director of the Emergency Resuscitation Research Center at the University of Chicago.

“Now we find that CPR is not being done very well,” he said.

The two studies' investigators used a new monitor/defibrillator device that can count how often compressions are given and how much pressure is exerted with each compression. The device, developed by a Norwegian company, also records the rate of volume of ventilations.

In the in-hospital study, Dr. Becker and his colleagues examined the use of the device in 67 cardiac arrest cases. All the rescuers had received proper training in CPR. Guidelines call for 100 compressions per minute and 12-16 ventilations per minute, but in 28% of the cases, the average compression rate was less than 90 compressions per minute during the first 5 minutes of resuscitation. In 61% of the 30-second segments studied, the ventilation rate was more than 20 ventilations per minute. Moreover, 37% of the compressions were too shallow (JAMA 2005;293:305-10).

The out-of-hospital study looked at use of the device in 176 patients who went into cardiac arrest in three European cities and were attended by paramedics or by a nurse anesthetist.

The researchers found that 48% of the times that the rescuers were performing resuscitation, they were not actually giving compressions. When they did perform compressions during the CPR episode, they gave compressions at a rate of 121 per minute—close to the study's target values of 100-120 compressions per minute. But the average number of compressions delivered in a minute was only 64. Rescuers gave an average of 11 ventilations per minute (JAMA 2005;293:299-304).

Neither study was able to look precisely at whether poor performance of the CPR affected patient survival, because neither had enough patients to make that determination. However, in the study performed by Dr. Becker and his colleagues, the investigators did note that patients who had longer intervals without chest compression had worse resuscitation results.

Speaking at the 2004 American College of Emergency Physicians Scientific Assembly, Dr. Becker noted that he and his colleagues have performed another study, of 100 patients, in which the compression rate was counted and recorded by a trained nurse at the scene. In that study, he said, those patients who received 80-100 compressions a minute were significantly more likely to survive than those who did not.

The results of the in-hospital and out-of-hospital CPR studies are not surprising, noted an editorial that accompanied the studies (JAMA 2005;293:363-5). Prior studies have shown low chest compression rates and high ventilations rates, and they have also shown that CPR training is poorly retained, said Arthur B. Sanders, M.D., in the editorial.

The studies suggest that CPR and advanced cardiac life support (ACLS) training need to be simplified to stress managing cardiac arrest and to emphasize compression over breathing, said Dr. Sanders of the department of emergency medicine at the University of Arizona, Tucson.

ACLS training has become more and more complicated over time so that it now includes instruction on stroke and shock and even managing electrolyte imbalances and asthma, he said.

Both the American Heart Association and the International Liaison Committee on Resuscitation are due to update their CPR and emergency cardiovascular care guidelines in the coming year, Dr. Sanders noted. He called on the groups to simplify their guidelines, and to “return to the core mission” in ACLS training.

“It is time to simplify the CPR guidelines and educational programs so that all patients who sustain cardiac arrest can receive optimal treatment,” Dr. Sanders said.

Dr. Becker said the device used in his study could also be a major aid in improving resuscitation efforts because it can tell someone administering CPR when they need to speed up their compressions and when they need to slow down their breathing.

Dr. Becker disclosed financial relationships with a series of companies involved in developing the device and is a paid consultant to two of them.

Cardiopulmonary resuscitation is often done improperly by rescuers who give too few chest compressions and the wrong amount of ventilation.

Those are the findings of two new studies that are among the first to precisely measure the performance of CPR in real-life situations, both inside and outside the hospital.

CPR has been around for about 50 years, and CPR guidelines are frequently revised. But until now, there has not been a reliable, objective way to measure how well it is being performed, said Lance B. Becker, M.D., a coauthor of the in-hospital study and a professor of emergency medicine and director of the Emergency Resuscitation Research Center at the University of Chicago.

“Now we find that CPR is not being done very well,” he said.

The two studies' investigators used a new monitor/defibrillator device that can count how often compressions are given and how much pressure is exerted with each compression. The device, developed by a Norwegian company, also records the rate of volume of ventilations.

In the in-hospital study, Dr. Becker and his colleagues examined the use of the device in 67 cardiac arrest cases. All the rescuers had received proper training in CPR. Guidelines call for 100 compressions per minute and 12-16 ventilations per minute, but in 28% of the cases, the average compression rate was less than 90 compressions per minute during the first 5 minutes of resuscitation. In 61% of the 30-second segments studied, the ventilation rate was more than 20 ventilations per minute. Moreover, 37% of the compressions were too shallow (JAMA 2005;293:305-10).

The out-of-hospital study looked at use of the device in 176 patients who went into cardiac arrest in three European cities and were attended by paramedics or by a nurse anesthetist.

The researchers found that 48% of the times that the rescuers were performing resuscitation, they were not actually giving compressions. When they did perform compressions during the CPR episode, they gave compressions at a rate of 121 per minute—close to the study's target values of 100-120 compressions per minute. But the average number of compressions delivered in a minute was only 64. Rescuers gave an average of 11 ventilations per minute (JAMA 2005;293:299-304).

Neither study was able to look precisely at whether poor performance of the CPR affected patient survival, because neither had enough patients to make that determination. However, in the study performed by Dr. Becker and his colleagues, the investigators did note that patients who had longer intervals without chest compression had worse resuscitation results.

Speaking at the 2004 American College of Emergency Physicians Scientific Assembly, Dr. Becker noted that he and his colleagues have performed another study, of 100 patients, in which the compression rate was counted and recorded by a trained nurse at the scene. In that study, he said, those patients who received 80-100 compressions a minute were significantly more likely to survive than those who did not.

The results of the in-hospital and out-of-hospital CPR studies are not surprising, noted an editorial that accompanied the studies (JAMA 2005;293:363-5). Prior studies have shown low chest compression rates and high ventilations rates, and they have also shown that CPR training is poorly retained, said Arthur B. Sanders, M.D., in the editorial.

The studies suggest that CPR and advanced cardiac life support (ACLS) training need to be simplified to stress managing cardiac arrest and to emphasize compression over breathing, said Dr. Sanders of the department of emergency medicine at the University of Arizona, Tucson.

ACLS training has become more and more complicated over time so that it now includes instruction on stroke and shock and even managing electrolyte imbalances and asthma, he said.

Both the American Heart Association and the International Liaison Committee on Resuscitation are due to update their CPR and emergency cardiovascular care guidelines in the coming year, Dr. Sanders noted. He called on the groups to simplify their guidelines, and to “return to the core mission” in ACLS training.

“It is time to simplify the CPR guidelines and educational programs so that all patients who sustain cardiac arrest can receive optimal treatment,” Dr. Sanders said.

Dr. Becker said the device used in his study could also be a major aid in improving resuscitation efforts because it can tell someone administering CPR when they need to speed up their compressions and when they need to slow down their breathing.

Dr. Becker disclosed financial relationships with a series of companies involved in developing the device and is a paid consultant to two of them.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

SNOWMASS, COLO. — Pediatric rheumatologists who hope to help adolescents make a smooth transition to adult care would be wise to talk up the importance of work.

That includes asking patients about chores and any volunteer experience, Patience H. White, M.D., said at a symposium sponsored by the American College of Rheumatology.

Children with chronic medical conditions often stay with their pediatric providers for too long, and many have a tough time making the transition to adult care. The provider should start preparing children before they are 12 years old to help ease the transition, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.

Economics can complicate the transition. Adolescents tend to lose their health care coverage as they become adults. In fact, young adults make up the group most likely to lack health insurance. Two-fifths of high school and college graduates have no health insurance during their first year out of school.

The employment situation can be worse for youth with disabilities or special health care needs because they are often the last hired and first to be let go.

What this all indicates, said Dr. White, is that children with chronic conditions, such as juvenile idiopathic arthritis, need to be prepared to get a job, especially one with insurance. In general, the jobs that offer insurance are those that pay at least $15 an hour, and most of those positions require at least 2 years of college and some experience.

Although this might seem like a hard-line requirement, the truth is that most youth already work. It's estimated that 40% of middle school and 80% of high school students do chores and/or have paying jobs, suggesting that working is a developmental milestone of adolescence.

Persons with disabilities who make a successful transition to adult life say that the most important factor in preparing them to be resilient adults—even more important than having friends or receiving support from parents and family—was being required to do household chores.

Patients' transitions toward taking responsibility for their own medical care must begin early, she asserted. Most of organized medicine—including the American Academy of Pediatrics—now recommends that children with special health care needs have a written transition plan by the time they are 14 years old. Dr. White has her patients make a one-page plan, and then works with them on revising it. She begins talking with them about transition when they are about 12 years old, and starts asking parents to leave the room during an examination when patients are 13 years old.

Questioning younger patients helps draw them out and gets them accustomed to the idea of bearing responsibility and making decisions, said Dr. White, who in her ongoing discussions with patients covers the following:

▸ Expectations. Ask patients what they plan to do when they grow up. Also, talk with them about the short-term future.

In addition to the written transition plan, Dr. White also has pediatric patients write out a list of what their responsibilities will be when they take over their own medical care.

▸ Transition. Patients need to be taught to make the transition from pediatrics, which is often prescriptive and nurturing, to adult medicine, which tends to be collaborative and cognitive. That means making sure patients thoroughly understand their condition and prognosis.

▸ Opinions. Solicit patients' takes on their condition and care, as a way of affirming their competence and introducing them to the idea that, even as minors, their decisions are their own.

▸ Participation. Ask patients about their social and leisure activities, and ways they can participate in them more fully.

▸ Reality. Acknowledge that adolescence may be a time of experimentation with sex and drugs. Let patients know about consequences, such as drug-drug interactions, and any other effects such choices can have on their specific conditions.

▸ Chores and work. Find out if patients are doing chores and developing independence skills.

▸ Attendance. Support patients' consistent attendance at school, which will reinforce responsible behavior patterns and improve the likelihood of their completing secondary education.

▸ Planning. Spell out the roles of all individuals who are involved in patients' transition to adult care. Emphasize the need for patients to secure health insurance.

SNOWMASS, COLO. — Pediatric rheumatologists who hope to help adolescents make a smooth transition to adult care would be wise to talk up the importance of work.

That includes asking patients about chores and any volunteer experience, Patience H. White, M.D., said at a symposium sponsored by the American College of Rheumatology.

Children with chronic medical conditions often stay with their pediatric providers for too long, and many have a tough time making the transition to adult care. The provider should start preparing children before they are 12 years old to help ease the transition, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.

Economics can complicate the transition. Adolescents tend to lose their health care coverage as they become adults. In fact, young adults make up the group most likely to lack health insurance. Two-fifths of high school and college graduates have no health insurance during their first year out of school.

The employment situation can be worse for youth with disabilities or special health care needs because they are often the last hired and first to be let go.

What this all indicates, said Dr. White, is that children with chronic conditions, such as juvenile idiopathic arthritis, need to be prepared to get a job, especially one with insurance. In general, the jobs that offer insurance are those that pay at least $15 an hour, and most of those positions require at least 2 years of college and some experience.

Although this might seem like a hard-line requirement, the truth is that most youth already work. It's estimated that 40% of middle school and 80% of high school students do chores and/or have paying jobs, suggesting that working is a developmental milestone of adolescence.

Persons with disabilities who make a successful transition to adult life say that the most important factor in preparing them to be resilient adults—even more important than having friends or receiving support from parents and family—was being required to do household chores.

Patients' transitions toward taking responsibility for their own medical care must begin early, she asserted. Most of organized medicine—including the American Academy of Pediatrics—now recommends that children with special health care needs have a written transition plan by the time they are 14 years old. Dr. White has her patients make a one-page plan, and then works with them on revising it. She begins talking with them about transition when they are about 12 years old, and starts asking parents to leave the room during an examination when patients are 13 years old.

Questioning younger patients helps draw them out and gets them accustomed to the idea of bearing responsibility and making decisions, said Dr. White, who in her ongoing discussions with patients covers the following:

▸ Expectations. Ask patients what they plan to do when they grow up. Also, talk with them about the short-term future.

In addition to the written transition plan, Dr. White also has pediatric patients write out a list of what their responsibilities will be when they take over their own medical care.

▸ Transition. Patients need to be taught to make the transition from pediatrics, which is often prescriptive and nurturing, to adult medicine, which tends to be collaborative and cognitive. That means making sure patients thoroughly understand their condition and prognosis.

▸ Opinions. Solicit patients' takes on their condition and care, as a way of affirming their competence and introducing them to the idea that, even as minors, their decisions are their own.

▸ Participation. Ask patients about their social and leisure activities, and ways they can participate in them more fully.

▸ Reality. Acknowledge that adolescence may be a time of experimentation with sex and drugs. Let patients know about consequences, such as drug-drug interactions, and any other effects such choices can have on their specific conditions.

▸ Chores and work. Find out if patients are doing chores and developing independence skills.

▸ Attendance. Support patients' consistent attendance at school, which will reinforce responsible behavior patterns and improve the likelihood of their completing secondary education.

▸ Planning. Spell out the roles of all individuals who are involved in patients' transition to adult care. Emphasize the need for patients to secure health insurance.

SNOWMASS, COLO. — Pediatric rheumatologists who hope to help adolescents make a smooth transition to adult care would be wise to talk up the importance of work.

That includes asking patients about chores and any volunteer experience, Patience H. White, M.D., said at a symposium sponsored by the American College of Rheumatology.

Children with chronic medical conditions often stay with their pediatric providers for too long, and many have a tough time making the transition to adult care. The provider should start preparing children before they are 12 years old to help ease the transition, said Dr. White, chief of pediatric rheumatology at Children's National Medical Center, Washington.

Economics can complicate the transition. Adolescents tend to lose their health care coverage as they become adults. In fact, young adults make up the group most likely to lack health insurance. Two-fifths of high school and college graduates have no health insurance during their first year out of school.

The employment situation can be worse for youth with disabilities or special health care needs because they are often the last hired and first to be let go.

What this all indicates, said Dr. White, is that children with chronic conditions, such as juvenile idiopathic arthritis, need to be prepared to get a job, especially one with insurance. In general, the jobs that offer insurance are those that pay at least $15 an hour, and most of those positions require at least 2 years of college and some experience.

Although this might seem like a hard-line requirement, the truth is that most youth already work. It's estimated that 40% of middle school and 80% of high school students do chores and/or have paying jobs, suggesting that working is a developmental milestone of adolescence.

Persons with disabilities who make a successful transition to adult life say that the most important factor in preparing them to be resilient adults—even more important than having friends or receiving support from parents and family—was being required to do household chores.

Patients' transitions toward taking responsibility for their own medical care must begin early, she asserted. Most of organized medicine—including the American Academy of Pediatrics—now recommends that children with special health care needs have a written transition plan by the time they are 14 years old. Dr. White has her patients make a one-page plan, and then works with them on revising it. She begins talking with them about transition when they are about 12 years old, and starts asking parents to leave the room during an examination when patients are 13 years old.

Questioning younger patients helps draw them out and gets them accustomed to the idea of bearing responsibility and making decisions, said Dr. White, who in her ongoing discussions with patients covers the following:

▸ Expectations. Ask patients what they plan to do when they grow up. Also, talk with them about the short-term future.

In addition to the written transition plan, Dr. White also has pediatric patients write out a list of what their responsibilities will be when they take over their own medical care.

▸ Transition. Patients need to be taught to make the transition from pediatrics, which is often prescriptive and nurturing, to adult medicine, which tends to be collaborative and cognitive. That means making sure patients thoroughly understand their condition and prognosis.

▸ Opinions. Solicit patients' takes on their condition and care, as a way of affirming their competence and introducing them to the idea that, even as minors, their decisions are their own.

▸ Participation. Ask patients about their social and leisure activities, and ways they can participate in them more fully.

▸ Reality. Acknowledge that adolescence may be a time of experimentation with sex and drugs. Let patients know about consequences, such as drug-drug interactions, and any other effects such choices can have on their specific conditions.

▸ Chores and work. Find out if patients are doing chores and developing independence skills.

▸ Attendance. Support patients' consistent attendance at school, which will reinforce responsible behavior patterns and improve the likelihood of their completing secondary education.

▸ Planning. Spell out the roles of all individuals who are involved in patients' transition to adult care. Emphasize the need for patients to secure health insurance.

SEATTLE — Bone mineral density measurements are equally good predictors of fracture risk in men and in women, even though men have a lower fracture risk, according to a 3-year study of almost 6,000 older men.

Previous studies have shown that bone mineral density (BMD) measurement predicts risk of fracture in women, but until now it has not been confirmed that the same is true for men, said Peggy M. Cawthon at the annual meeting of the American Society for Bone and Mineral Research.

The Osteoporotic Fractures in Men study found that men with osteoporosis had a 10-fold greater risk of non-spine fracture and a 100-fold greater risk of hip fracture, compared with men with normal BMD, said Ms. Cawthon, of the Research Institute, California Pacific Medical Center, San Francisco.

In the study, spine and hip BMD were measured in the men, whose average age was 74 years. Over the course of the study, there were 211 total non-spine fractures, 21 in the 104 men with osteoporosis, and 39 hip fractures, 10 in those with osteoporosis.

When the subjects were divided into quartiles based on their bone mineral density T scores, fracture rates increased as quartile decreased such that men in the lowest quartile of T score for the total hip had four times the risk of hip fracture of those in the highest quartile. The average T score for the cohort was -0.58.

Total hip density was a stronger predictor of hip fracture than was spine density, and femoral neck density, spine density, and total hip density were all similarly predictive of total non-spine fractures.

The correlations showed that the relative risk of hip fracture increased by 3.6 times with each lower, total hip T score standard deviation, Ms. Cawthon said. The relative risk of any fracture increased 1.8 times for each standard deviation of total hip T score.

In women, the relative risk of hip fracture and any non-spine fracture increases 2.6 times and 1.5 times, respectively, for each lower standard deviation. A comparison of the rate of fracture for any T score in this study with the rate of fracture in a similar study of women indicates a much higher rate of fracture in women, she added.

SEATTLE — Bone mineral density measurements are equally good predictors of fracture risk in men and in women, even though men have a lower fracture risk, according to a 3-year study of almost 6,000 older men.

Previous studies have shown that bone mineral density (BMD) measurement predicts risk of fracture in women, but until now it has not been confirmed that the same is true for men, said Peggy M. Cawthon at the annual meeting of the American Society for Bone and Mineral Research.

The Osteoporotic Fractures in Men study found that men with osteoporosis had a 10-fold greater risk of non-spine fracture and a 100-fold greater risk of hip fracture, compared with men with normal BMD, said Ms. Cawthon, of the Research Institute, California Pacific Medical Center, San Francisco.

In the study, spine and hip BMD were measured in the men, whose average age was 74 years. Over the course of the study, there were 211 total non-spine fractures, 21 in the 104 men with osteoporosis, and 39 hip fractures, 10 in those with osteoporosis.

When the subjects were divided into quartiles based on their bone mineral density T scores, fracture rates increased as quartile decreased such that men in the lowest quartile of T score for the total hip had four times the risk of hip fracture of those in the highest quartile. The average T score for the cohort was -0.58.

Total hip density was a stronger predictor of hip fracture than was spine density, and femoral neck density, spine density, and total hip density were all similarly predictive of total non-spine fractures.

The correlations showed that the relative risk of hip fracture increased by 3.6 times with each lower, total hip T score standard deviation, Ms. Cawthon said. The relative risk of any fracture increased 1.8 times for each standard deviation of total hip T score.

In women, the relative risk of hip fracture and any non-spine fracture increases 2.6 times and 1.5 times, respectively, for each lower standard deviation. A comparison of the rate of fracture for any T score in this study with the rate of fracture in a similar study of women indicates a much higher rate of fracture in women, she added.

SEATTLE — Bone mineral density measurements are equally good predictors of fracture risk in men and in women, even though men have a lower fracture risk, according to a 3-year study of almost 6,000 older men.

Previous studies have shown that bone mineral density (BMD) measurement predicts risk of fracture in women, but until now it has not been confirmed that the same is true for men, said Peggy M. Cawthon at the annual meeting of the American Society for Bone and Mineral Research.

The Osteoporotic Fractures in Men study found that men with osteoporosis had a 10-fold greater risk of non-spine fracture and a 100-fold greater risk of hip fracture, compared with men with normal BMD, said Ms. Cawthon, of the Research Institute, California Pacific Medical Center, San Francisco.

In the study, spine and hip BMD were measured in the men, whose average age was 74 years. Over the course of the study, there were 211 total non-spine fractures, 21 in the 104 men with osteoporosis, and 39 hip fractures, 10 in those with osteoporosis.

When the subjects were divided into quartiles based on their bone mineral density T scores, fracture rates increased as quartile decreased such that men in the lowest quartile of T score for the total hip had four times the risk of hip fracture of those in the highest quartile. The average T score for the cohort was -0.58.

Total hip density was a stronger predictor of hip fracture than was spine density, and femoral neck density, spine density, and total hip density were all similarly predictive of total non-spine fractures.

The correlations showed that the relative risk of hip fracture increased by 3.6 times with each lower, total hip T score standard deviation, Ms. Cawthon said. The relative risk of any fracture increased 1.8 times for each standard deviation of total hip T score.

In women, the relative risk of hip fracture and any non-spine fracture increases 2.6 times and 1.5 times, respectively, for each lower standard deviation. A comparison of the rate of fracture for any T score in this study with the rate of fracture in a similar study of women indicates a much higher rate of fracture in women, she added.

SEATTLE — Vitamin D supplementation at twice the dose usually recommended for elderly individuals decreased falls in nursing home residents by 71%, Douglas P. Kiel, M.D., said at the annual meeting of the American Society for Bone and Mineral Research.

The usual dose of vitamin D recommended for bone health in elderly individuals is 400 IU a day. Vitamin D supplementation has been shown to decrease falls, but it is not certain if the usual dose is adequate for providing this benefit, said Dr. Kiel, director of medical research at the Hebrew Rehabilitation Center for Aged, Boston.

Dr. Kiel and his colleagues randomly assigned 125 elderly residents at a long-term care facility to one of four daily dosages of vitamin D, ranging up to 800 IU.

After 5 months, falls were reduced only among those who took the highest dose, Dr. Kiel noted in a poster presentation.

There were 9 falls among the 23 individuals who took 800 IU of vitamin D daily, compared with 31 falls among the 25 patients assigned placebo, 37 falls among 26 individuals who took 200 IU, 33 falls among 25 individuals who took 400 IU, and 41 falls among 25 individuals who took 600 IU.

The number of individuals who fell was also significantly reduced. Only 5 individuals taking 800-IU fell, compared with a range from 11 to 15 in the lower-dose and placebo groups.

Those figures translate into a three- to fourfold decrease in risk of falling for those who took the 800-IU dose of vitamin D, Dr. Kiel said.

Almost three-quarters of the individuals were already taking a multivitamin containing 400 IU of vitamin D, which could mean that the threshold dosage for preventing falls could be as high as 1,200 IU, Dr. Kiel noted.

The study subjects had a mean age of 89 years, and 72% were female.

SEATTLE — Vitamin D supplementation at twice the dose usually recommended for elderly individuals decreased falls in nursing home residents by 71%, Douglas P. Kiel, M.D., said at the annual meeting of the American Society for Bone and Mineral Research.

The usual dose of vitamin D recommended for bone health in elderly individuals is 400 IU a day. Vitamin D supplementation has been shown to decrease falls, but it is not certain if the usual dose is adequate for providing this benefit, said Dr. Kiel, director of medical research at the Hebrew Rehabilitation Center for Aged, Boston.

Dr. Kiel and his colleagues randomly assigned 125 elderly residents at a long-term care facility to one of four daily dosages of vitamin D, ranging up to 800 IU.

After 5 months, falls were reduced only among those who took the highest dose, Dr. Kiel noted in a poster presentation.

There were 9 falls among the 23 individuals who took 800 IU of vitamin D daily, compared with 31 falls among the 25 patients assigned placebo, 37 falls among 26 individuals who took 200 IU, 33 falls among 25 individuals who took 400 IU, and 41 falls among 25 individuals who took 600 IU.

The number of individuals who fell was also significantly reduced. Only 5 individuals taking 800-IU fell, compared with a range from 11 to 15 in the lower-dose and placebo groups.

Those figures translate into a three- to fourfold decrease in risk of falling for those who took the 800-IU dose of vitamin D, Dr. Kiel said.

Almost three-quarters of the individuals were already taking a multivitamin containing 400 IU of vitamin D, which could mean that the threshold dosage for preventing falls could be as high as 1,200 IU, Dr. Kiel noted.

The study subjects had a mean age of 89 years, and 72% were female.

SEATTLE — Vitamin D supplementation at twice the dose usually recommended for elderly individuals decreased falls in nursing home residents by 71%, Douglas P. Kiel, M.D., said at the annual meeting of the American Society for Bone and Mineral Research.

The usual dose of vitamin D recommended for bone health in elderly individuals is 400 IU a day. Vitamin D supplementation has been shown to decrease falls, but it is not certain if the usual dose is adequate for providing this benefit, said Dr. Kiel, director of medical research at the Hebrew Rehabilitation Center for Aged, Boston.

Dr. Kiel and his colleagues randomly assigned 125 elderly residents at a long-term care facility to one of four daily dosages of vitamin D, ranging up to 800 IU.

After 5 months, falls were reduced only among those who took the highest dose, Dr. Kiel noted in a poster presentation.

There were 9 falls among the 23 individuals who took 800 IU of vitamin D daily, compared with 31 falls among the 25 patients assigned placebo, 37 falls among 26 individuals who took 200 IU, 33 falls among 25 individuals who took 400 IU, and 41 falls among 25 individuals who took 600 IU.

The number of individuals who fell was also significantly reduced. Only 5 individuals taking 800-IU fell, compared with a range from 11 to 15 in the lower-dose and placebo groups.

Those figures translate into a three- to fourfold decrease in risk of falling for those who took the 800-IU dose of vitamin D, Dr. Kiel said.

Almost three-quarters of the individuals were already taking a multivitamin containing 400 IU of vitamin D, which could mean that the threshold dosage for preventing falls could be as high as 1,200 IU, Dr. Kiel noted.

The study subjects had a mean age of 89 years, and 72% were female.