Update From the Medical Journals: February 2013

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Update From the Medical Journals: February 2013


Harvard Medical School


What's the latest news in the medical journals this month? Find out what your doctor is reading.

Calcium Supplements Do More Harm than Good

Many doctors recommend calcium supplements to women for their bone health. In fact, the Institute of Medicine has recommended calcium supplements for years. But the U.S. Preventative Services Task Force (USPFTF) published a new recommendation February 26 telling women not to take calcium supplements with vitamin D, unless they have osteoporosis or a previous fracture. The recommendation was published in the Annals of Internal Medicine.

The task force says that the evidence is now clear that typical doses of the supplements do more harm than good to women after menopause. The evidence was not as complete for women before menopause and for men. But for now, the task force does not see a strong reason to recommend supplements for these groups either.

Low daily doses — 400 IU of vitamin D and 1,000 milligrams of calcium) — increase the risk of kidney stones. And studies using these doses don't detect a benefit for reducing bone fractures. Higher doses may lower fracture risk, but it is hard to be sure that this benefit outweighs the risks that come from treatment.

Another study about calcium supplements shows that they may increase heart disease risk. JAMA Internal Medicine published the study online February 4. Calcium from pills gets into your bloodstream faster than calcium from food. Too much calcium in the blood at one time can harden your arteries, experts think.

This study followed 388,000 men and women over 12 years. Of this group, 51% of men and 70% of women were taking calcium pills. Men who took 1,000 milligrams of calcium daily had a 20% increased risk of heart-disease death. There was no visible increase in risk for women who were taking calcium pills. Calcium in the diet (for example, the amount of dairy products consumed) did not affect death risk for men or women.

This news about calcium is disappointing. Many of us thought calcium supplements were part of good health. Everyone, especially women and children, should try to get plenty of calcium in foods. That hasn't changed. Research shows that vitamin D helps prevent falls. Vitamin D (without calcium) is recommended for people who are at risk for falls. If you are being treated for osteoporosis (thin bones) or have a previous history of fracture, you should take both calcium and vitamin D supplements in doses recommended by your doctor. For most other women and men, calcium supplements are not recommended.

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Deep Brain Stimulation May Be Useful in Early Years of Parkinson's

A surgical treatment for Parkinson's disease called deep brain stimulation or neurostimulation has helped reduce some symptoms of the disease when it's in the advanced stages. A study published February 14 in the New England Journal of Medicine shows that the treatment may also be useful for people who are in earlier stages of the disease.

Parkinson's disease causes tremors in the hands and head. At the same time, purposeful movements such as walking and reaching can be difficult to initiate. These symptoms can be treated with medicines. Unfortunately, the medicines cause side effects and don't always relieve symptoms completely.

During deep brain stimulation an electrode on a wire is placed into a specific location in the brain. Electric pulses are generated, similar to a pacemaker. These reset the electric current in the brain. This seems to improve overall function for people with Parkinson's.

This study included 251 people in the early stage of Parkinson's. They were randomly divided into two groups. One group received deep brain stimulation surgery and medications, if needed. The other group received only medications. After two years, patients were asked about their symptoms. The group that had surgery could move more easily and could better manage their activities of daily living. However, there were more side effects in the group that had surgery. Most of these problems were short term, such as infections related to the surgery. In some cases the stimulator had to be removed. Other side effects from the stimulator included falls, walking or balance difficulty, and uncoordinated or uncontrolled movements. Depression scores were improved overall in the group that had surgery, but the researchers were concerned to see that there were more suicides in the surgically treated group. This was unexpected.

We need to be cautious about using this aggressive treatment in people who are in the early stages of Parkinson's disease. This study only included people who were under 60 years old, who did not have Parkinson's-related dementia, and who were otherwise healthy. We can expect older people to have more complications. But this study provides hope to Parkinson's patients who wish to consider deep brain stimulation as a possible treatment. The treatment seems to improve quality of life, although complications are fairly frequent. Doctors don't yet know the long-term results for this treatment.

More News in Brief

  • Marijuana Increases the Risk for Stroke. Research presented at the International Stroke Conference 2013 showed that marijuana use was to blame for some strokes in young adults. A news release about the study appeared on the American Stroke Association website. The study included 160 people between ages 18 and 55 who were hospitalized for a stroke. They agreed to have urine drug testing done during their hospital stay. Twice as many people in the stroke group had traces of marijuana in their urine compared with a similar group of people who didn't have a stroke. Most of the positive drug tests were in men. The study strongly suggests that marijuana use can trigger stroke in young adults.

 

  • Tdap Booster Shot Should Be Repeated During Each Pregnancy. Moms take note. New recommendations say women should have a booster shot to prevent whooping cough (pertussis) with each pregnancy. Whooping cough has been epidemic in some areas of the United States this year. The booster shot, called "Tdap" (tetanus, diphtheria, and acellular pertussis vaccine) helps to prevent the infection in new babies by giving them immunity while in the womb. Updated vaccination recommendations were published January 28 in the journal Pediatrics. They are available on the website of the U.S. Centers for Disease Control and Prevention (CDC). The recommendations were approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices and the American Academy of Family Physicians.

 

  • Drug Helps Pain in Legs from Blocked Arteries. Claudication is pain in one or both legs or buttocks after walking a distance. One cause of this is a pinched nerve. But the most common cause is peripheral artery disease (also called peripheral vascular disease). Peripheral artery disease is caused by thick cholesterol deposits in the arteries of the legs. These deposits limit blood flow through the muscles in one or both of your legs. Like any circulation problem, it can worsen over time. We know exercise improves symptoms of claudication. People who walk for exercise at least three times per week can walk farther before symptoms appear. Quitting smoking can also help. But medicines don't improve symptoms very much.

    A study in the February 6 issue of the Journal of the American Medical Association (JAMA) looked at a common drug that did improve symptoms. It was a blood pressure medicine called ramipril (Altace). This drug is an ACE inhibitor. (Lisinopril, captopril and enalapril are other drugs in this class.)

    The study followed 212 people with peripheral artery disease. Researchers divided them into two groups. One group took ramipril for two years. The other group took placebo pills. People in the ramipril group were able to walk without symptoms for 75 seconds longer than patients in the placebo group. Although this change might sound small, it can make a big difference in how often a person has symptoms. The treated group could walk faster and did better with stair climbing. It is likely that all ACE inhibitors are similarly effective for claudication. If you have claudication, a medicine from this drug family may be helpful.

 

  • Steroid Injections for "Tennis Elbow" Fall Out of Favor. Tennis elbow is a common condition. It occurs when extra stress is repeatedly put on the muscles of the forearm. These muscles allow your wrist to bend upwards. This condition can occur from gripping a tool too tightly. The small tears where the tendons attach at the elbow cause pain. For bad cases of tennis elbow, doctors often recommend an injection of steroid medicine. A new study of 165 patients shows that these injections are not a useful treatment in the long run. Patients who got the injections had the best pain relief at 4 weeks. But after a year, pain relief was better for the patients who never had an injection. They were less likely to have a relapse. The study was published February 6 in the Journal of the American Medical Association. If you get tennis elbow symptoms, you can best manage your symptoms by relaxing your wrist and relaxing your grip on tools. Or use a wrist strap (tennis elbow band) and try over-the-counter pain medicines, like ibuprofen.

 

  • New Website Helps People with Cancer to Share Information. The American Cancer Society announced January 31 that is has a new website for people affected by cancer. It's called WhatNext. Cancer patients, cancer survivors and their caregivers can share information and experiences, and provide support "peer to peer." People can post comments about specific treatments, side effects and strategies that they have found useful. People who are already using the site have found it to be a good way to connect with people who have the same cancer. More than 10,000 users were already active at the time of the announcement.

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Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.

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Last updated February 28, 2013


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