News in brief - Feb. 28, 2005

Teens can get back bone loss - TIA patients need more diagnostic testing - CDC to research family communication issues around hemochromatosis - Antidepressants associated with infant withdrawal syndrome

Teens can get back bone loss

Bone density appears to recover in adolescent girls when they stop using the injected contraceptive depot medroxyprogesterone acetate, or DMPA, according to a study published in the February issue of the Archives of Pediatrics & Adolescent Medicine.

Earlier studies had shown that women who use DMPA, marketed as Depo-Provera, experience a loss of bone mineral density during the time they are using the contraceptive.

Because teens are developing a large amount of their bone mass from ages 15 to 19, concerns were raised that the drug might place adolescents at higher risk for osteoporosis later in life.

"This study shows that after adolescents stop using DMPA, their bone density can increase to levels comparable to those of other women in their age group," said Duane Alexander, MD, director of the National Institute of Child Health and Human Development, which funded the study.

The researchers believe that DMPA interferes with bone mineral density by lowering levels of estrogen. Bone density losses seen among the young DMPA users occurred at a pace similar to that of women progressing through menopause, said lead researcher Delia Scholes, PhD, of the Group Health Cooperative in Seattle.

TIA patients need more diagnostic testing

Patients who have transient ischemic attacks receive less aggressive diagnostic testing, treatment and education compared with stroke patients, which is a missed opportunity to prevent permanent disability or death, researchers reported at the American Stroke Assn.'s International Conference 2005 held in New Orleans in early February.

About one-third of people who have TIAs will go on to have a major stroke within five years unless they have preventive therapy.

The retrospective study evaluated diagnostic tests, therapy and education of 91 TIA patients, compared with 94 stroke patients. Patient's average age was 73; most were white, and 58% were women.

TIA patients received less diagnostic testing than did stroke patients, but nearly all TIA and stroke patients underwent a brain CT scan. An MRI was performed on 69% of TIA patients and 72% of stroke patients.

Ultrasound tests, which are important in identifying stroke risk and planning therapeutic interventions, were performed in a much lower percentage of TIA patients than stroke patients. Of the TIA patients, 34% had echocardiography, compared with 60% of stroke patients.

"All the diagnostic tests performed on stroke patients should be performed on TIA patients, because TIA represents a ticking time bomb," said Bhuvaneswari Dandapani, MD, medical director of the stroke center at Holmes Regional Medical Center in Melbourne, Fla., and lead author of the study.

CDC to research family communication issues around hemochromatosis

The Centers for Disease Control and Prevention has contracted Research Triangle International, an independent nonprofit organization, to research how physicians, patients and relatives talk to each other about the genetic disease hemochromatosis, according to a statement posted on the agency's Web site last month.

CDC policy currently advocates that those with a diagnosis inform blood relatives to be tested, but some families have an easier time discussing these issues than others. The agency wants to know why.

The study also will look at what factors make it easier or harder for those who need to be tested to actually do so, and the ways that physicians can effectively communicate with patients about the need to tell family members.

Agency policy also calls on doctors to use medical histories to identify patients who should have their iron levels checked. The project will attempt to determine how this can be done more effectively.

Antidepressants associated with infant withdrawal syndrome

The use of selective serotonin reuptake inhibitors by pregnant women is linked to the development of drug-related withdrawal symptoms in newborns, according to a study published in the Feb. 5 issue of The Lancet.

Researchers at the University of La Laguna in Tenerife, Spain, analyzed World Health Organization adverse drug reaction data collected from 72 countries. A total of 93 suspected cases of neonatal withdrawal syndrome were linked to the use of these drugs with 63 associated with paroxetine (Paxil). Thirteen were linked to fluoxetine (Prozac), and one case was associated with using both paroxetine and fluoxetine. Nine were connected to sertraline (Zoloft), and citalopram (Celexa), was linked to seven cases.

The authors suggested that pregnant women using these drugs, particularly paroxetine, should be monitored closely, and an accompanying commentary by researchers at Yale University in New Haven, Conn., warned against abrupt discontinuation.

"A precipitous shift away from widespread prescription of SSRIs is not called for and would do much more damage than good," the authors wrote.