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Re: Hey janet/55 in april

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Ahhh we are a couple of Spring Babies. Yea Love JanetRita aka Spring wrote: I'll be 55 in April too. Rita Re: [Hepatitis_C_ Central] Decreased bone mineral density after therapy with alpha interferon in combinatio well Im 53 and went through menopause 8 years ago!!!! Janet <doc_jadeyahoo (DOT) . com> wrote: Well I figured I am 55, I better start preparing for ummmm those issues that come with aging. Not that I am admitting to ageing. You should see my bathroom sink, oil of olay this,

and oil of olay that. LOL But I do like my yogurt and it taste so good. And I get some good vitamins from it. Yummy Love JanetJackie on <redjaxjmyahoo (DOT) com> wrote: it really screwed my bone density up,, big

time,, Janet <doc_jadeyahoo (DOT) com> wrote: Dang like we needed this.. LOL Well I have been adding some calicum in my diet and with the walking I do.. That should help with the bone density. Love Janet <elizabethnv1@ earthlink.

net> wrote: Decreased bone mineral density after therapy with alpha interferon in combination with ribavirin for chronic hepatitis C - full report with tables/graphs attachedJournal of Hepatology Nov 2000José A Solís-Herruzo1, Gregorio Castellano1, Inmaculada Fernández1, Raquel Muñoz1, Federico Hawkins2Received 13 August 1999; received in revised form 24 February 2000; accepted 10 May 2000.“We conclude that treatment of chronic hepatitis C with combined therapy for 12 months may cause a reduced BMD in almost all patients Although this study does not definitely prove that this treatment was the cause of the reduced bone mass found in this group of patients, we believe that

physicians should be aware of the risk of this potential secondary effect of the antiviral therapy….. A survey among male patients, aged between 31 and 48 years, who had been treated with either IFN alone or IFN plus ribavirin for 12 months, showed that only patients on combination therapy displayed low bone densitometry T-and Z-scores….. The T-score values were in the normal range in group 1 (0.19±0.6) None of them had T-scores under -1.0. Four of the 19 patients treated with this combination had T-score values below -2.5, that is, in the range of osteoporosis. None of them presented symptoms of bone fractures. The remaining 15 patients showed T-score values between -1.0 and -2.5, that is, in the range of osteopenia.�Ribavirin (l_-D-ribofuranosyl -1H-1,2,4 triazole-3-carboxam ide) is a water-soluble, synthetic guanosine analogue

that exerts a broad spectrum of activity against several DNA and RNA viruses, including viruses of the flaviviridae family 1, 2. Randomized, placebo-controlled studies have shown that therapy of chronic hepatitis C with ribavirin for 24 to 48 weeks resulted in a reduction in serum alanine aminotransferase (ALT) levels 3, 4, 5, 6. However, patients remained viremic and ALT levels returned to pretreatment levels when therapy was stopped (4). Combination therapy of ribavirin with alpha interferon (IFN) has been demonstrated to be more effective than IFN alone in inducing virologic and histologic improvement 7, 8, 9. Ribavirin is generally well tolerated. Its major adverse effects are hemolysis and nonspecific symptoms of fatigue, depression, insomnia, vertigo, anorexia, nausea, nasal congestion and pruritus 10, 11. Although, there is little information about the effect of the combination of ribavirin plus IFN on bone

mineral density (BMD) and bone turnover in patients with chronic hepatitis C, back pain and bone fracture have been reported in some patients (11).In this paper we report the case of a male patient treated with ribavirin plus IFN for 12 months, who developed severe osteoporosis in the absence of any other cause of osteoporosis. A survey among male patients treated for 12 months with IFN alone or in combination with ribavirin showed that osteopenia or osteoporosis was a common finding among patients treated with the combination of both antiviral agents, but not in patients treated with IFN alone. (from Jules: as I have said NRTIs might cause mitochondrial toxicity in bone cells).Discussion Although a few patients have so far been reported to develop bone fractures or back pain during therapy with ribavirin plus IFN (11), little attention has been paid to such events and no study has been published

concerning the effect of this therapy on bone mineral metabolism. In this paper, we report the case of a male patient treated with IFN plus ribavirin who presented several episodes of back pain. A bone densitometry of the lumbar spine demonstrated T-scores and Z-scores in the range of osteoporosis according to the World Health Organization definitions (15). In addition, a magnetic nuclear resonance examination of the spine showed a decreased BMD, expansion of the intervertebral spaces with herniation of the intervertebral disk into the T4 vertebral body (Fig 1). Studies to determine the cause of this reduced bone mass had negative results. There was no suggestion on history or physical examination of hypogonadism, hyperthyroidism, gastrointestinal disease, Cushing's syndrome, malignancy or other pathologic processes. He had never abused alcohol, had never smoked or taken medications involved in the etiology of some

cases of osteoporosis (corticosteroids, anticonvulsants, heparin immunosuppressive agents, thyroid hormone, chemotherapeutic agents, methotrexate, lithium). He maintained normal physical activity and weight. Serum levels of testosterone, cortisol, gonadotropins thyroxine, TSH, iPTH, 25-hydroxycalcifero l, serum protein electrophoresis and immunoelectrophores is, as well as 24-h urinary-free cortisol excretion and fecal fat were normal.Although we cannot definitely rule out osteoporosis being present prior to the antiviral therapy, the fact that no signs of osteopenia could be identified on an X-ray examination of the chest performed 2 years earlier leads us to suggest that bone loss was induced during the ribavirin-IFN treatment. A survey among male patients, aged between 31 and 48 years, who had been treated with either IFN alone or IFN plus ribavirin for 12 months, showed that only patients on combination

therapy displayed low bone densitometry T-and Z-scores. T-score values, that measure the departure of the patient's BMD value from the mean BMD for a young adult population in units of the population standard deviation, were significantly lower in the group of patients on combination therapy (-1.94±0.6) than in the IFN group (0.19±0.6, p<0.001). Likewise, Z-score, that uses as reference the mean BMD and standard deviation for a healthy age-matched population, was also lower in the IFN-ribavirin group (-1.76±0.5) than in the IFN group (0.26±0.6, p<0.001). These observations support the suspicion of an etiologic relationship between the combination therapy and osteoporosis. However, since these observations do not definitely prove this relationship, a prospective study comparing BMD, biochemical markers of bone turnover and secondary osteoporosis prior to and after 12 months of treatment with either IFN

alone or IFN combined with ribavirin is currently in progress.Possible mechanisms of bone loss during ribavirin-IFN treatment are not known. Biochemical markers of bone formation (serum osteocalcin and bone alkaline phosphatase) and resorption (urine pyridinoline) were in the normal range and, therefore, no evidence of an increased bone turnover was found. However, 24-h urinary calcium excretion and urinary calcium/creatinine ratio were markedly decreased and correlated significantly with Z-and T-score values. These results suggest that either an intestinal malabsorption of calcium or vitamin D deficiency might account for an impaired intestinal calcium intake and a loss of the bone mass, although serum levels of 25-hydroxicalciferol and fecal excretion of fat were normal. Examination of small intestine biopsy specimens demonstrated a normal structure. Antigliadin and antiendomysial antibodies were negative. We

speculate that ribavirin treatment might have interfered with the intestinal transport of calcium. However, new studies are mandatory to elucidate the mechanisms of this possible secondary deleterious bone effect of combined treatment of IFN with ribavirin.We conclude that treatment of chronic hepatitis C with combined therapy for 12 months may cause a reduced BMD in almost all patients Although this study does not definitely prove that this treatment was the cause of the reduced bone mass found in this group of patients, we believe that physicians should be aware of the risk of this potential secondary effect of the antiviral therapy.Abstract Background/Aims: Several thousand patients with chronic hepatitis C have been treated with interferon plus ribavirin. After observing a male patient who developed severe bone loss during this treatment, we studied skeletal status and bone mineral metabolism in

patients on therapy with interferon plus ribavirin.Methods: Bone mineral density and biochemical bone markers were studied in 32 male patients (31-58 years old) treated for 12 months with either interferon alone (group 1; n=13) or interferon plus ribavirin (group 2; n=19).Results: Bone mineral density was significantly lower in group 2 (0.877±0.07 g/cm2) than in group 1 (1.108±0.08 g/cm2, p<0.001). Likewise, T- and Z-score values were also decreased in group 2 (T: -1.95±0.6. Z: -1.76±0.51) compared with group 1 (T: 0.19±0.6; p<0.001. Z: 0.26±0.6; p<0.001). Serum and urine biochemical bone markers were normal in both groups. However, urinary calcium excretion was decreased in patients on combined therapy.Conclusion: Treatment of chronic hepatitis C with interferon plus ribavirin may induce bone loss. This secondary effect should be investigated during the followup of

these patients, since they may require therapies aimed at prevention or amelioration of these defects. "There are souls in this world that have the gift of finding joy everywhere and of leaving it behind them when they go" Frederick Faber Jackie "There are souls in this world that have the gift of finding joy everywhere and of leaving it behind them when they go" Frederick Faber Jackie Never miss a thing. Make Yahoo your homepage. Never miss a thing. Make Yahoo your homepage. "There are souls in this world that have the gift of finding joy everywhere and of leaving it behind them when they go" Frederick Faber Looking for last minute shopping deals? Find them fast with Yahoo! Search. "There are souls in this world that have the gift of finding joy everywhere and of leaving it behind them when they go" Frederick Faber

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