Journals watch: Caesarean, osteoporosis and sleep

No time to read the journals? Let Dr Louise Newson guide you through the latest research.

Teriparatide for glucocorticoid-induced osteoporosis
N Engl J Med 2007; 357; 2,028-39

International guidelines still recommend bisphosphonates for both the prevention and treatment of glucocorticoid-induced osteoporosis.

Teriparatide is a parathyroid hormone derivative and is given subcutaneously. It reduces both vertebral and non-vertebral fractures in postmenopausal women with osteoporosis.

This was a randomised controlled trial comparing teriparatide with alendronate in 428 women and men with osteoporosis who had received glucocorticoids for at least three months (prednisone equivalent, 5mg daily or more).

The results showed that among patients with osteoporosis who were at high risk for fracture, both spine and hip bone mineral density increased more in patients receiving teriparatide than in those receiving alendronate. Teriparatide therapy was also associated with a reduction in non-vertebral fractures, compared with alendronate.

Is being 'too posh to push' justified?
BMJ 2007; 335: 1,025-9

This study is very timely in view of the rapidly rising rates of caesarean sections performed in the UK. It involved 410 health facilities in eight Latin-American countries, involving over 106,000 deliveries in the three-month study period.

The results showed that caesarean section reduces overall risk in breech presentation and as such should be the recommended form of delivery for breech presentations.

This was not the case for cephalic presentations. Although caesarean was shown to reduce the risk of intrapartum fetal death in cephalic presentations, it also increased the risk of severe maternal and neonatal morbidity and mortality.

Patients need to be aware that it is not necessarily a safe option to decide on an elective caesarean section.

Endorphins may prevent heart disease
Am J Physiol Heart Circ Physiol 2007; doi:10.1152/ajpheart.00280.2007

This study has shown that opioids such as endorphins, which are responsible for the so-called 'runner's high' also seem to mediate the cardioprotective effects of exercise.

Although this study used a rat model of exercise-induced cardioprotection to study a potential role for opioids, the results are likely to be similar in humans.

Their findings demonstrate that the acute cardioprotective effects of exercise are mediated, at least in part, through opioid receptor-dependent mechanisms that may include changes in gene expression. This is yet another reason why taking regular exercise is beneficial to health.

Children that sleep well reduce maternal depression
Arch Dis Child 2007; 92: 952-8

As a mother of young children, the results of this study were interesting but not entirely surprising to me.

This Australian study was designed to investigate whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being in 328 mothers who reported infant-sleeping problems.

It showed that the prevalence of infant sleep problems was lower in the group who received advice about sleep problems at 10 months (56 per cent versus 68 per cent) and 12 months (39 per cent versus 55 per cent) than those given usual care).

In addition, there was less depression in the mothers of children who slept better. It was interesting to note that the sleep intervention programme was also shown to be cost-effective.

The quick study

Bone mineral density of osteoporosis patients at high risk of fracture improved more with the parathyroid hormone derivative teriparatide than with alendronate.

Caesarean section reduces overall risk in breech presentations but not cephalic presentations.

Endorphins released during activity may mediate the cardioprotective effects of exercise.

Maternal depression is lower when infants sleep well. Advice to mothers can reduce infant sleep problems.

Research of the week

Is chocolate good for you?
Circulation 2007; 116: 2,376-82

This study investigated the antioxidant properties of dark chocolate with respect to cardiovascular disease.

Heart-transplant patients were given flavonoid-rich dark (70 per cent cocoa) chocolate in a double-blinded, randomised trial and the effects were compared with those in patients given cocoa-free control chocolate.

Dark chocolate was shown to induce coronary vasodilation, improve coronary vascular function and also decrease platelet adhesion two hours after consumption.

These effects were not seen in the control group. However, whether dark chocolate can justifiably be promoted as a 'healthy' food as a result of this study is still questionable.

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