Beijing doctor claims to have cure for bone necrosis caused by corticosteroids

Most people think about the respiratory system when they think about SARS. Chen Weiheng knows it can also affect the pelvis.
The 50-year-old doctor and director of the China Academy of the Chinese Medical Sciences' Wangjing Hospital has spent the past decade treating patients with pelvic bone necrosis caused by the hormone therapies used to treat SARS and the necrosis often causes the affected pelvis to collapse.
Chen had focused on avascular necrosis of the femoral head (ANFH) since 1991. ANFH occurs when bone tissue dies and the bone often collapses due to a lack of blood flow to the top of the femur. This has happened to many SARS survivors who received hormonal treatments.
The doctor has used a myriad of treatments and much research to slow the cellular death of his patients' hips. He has employed surgery, intravenous infusions of traditional Chinese medicine, arterial injections, Western drips, DNA analyses - anything he can to maintain skeletal integrity.
He has saved hundreds of patients from losing their joints to metal replacements.
Source: China Daily

Diclofenac causes 14,000 deaths a year in China and should be banned: researchers

The anti-inflammatory drug diclofenac should be withdrawn from sale in China because of its high risk of cardiovascular adverse effects that may be responsible for 14,000 deaths a year, researchers say.
The call to withdraw the drug comes from UK and Indian researchers who found that diclofenac was still the most popular NSAID drug for pain and arthritis in countries such as China despite having a higher risk of cardiovascular disease.
They called for the drug to be removed the the list of essential medicines because safer alternatives such as ibuprofen and naproxen are available. For China, they estimate that
"The findings  ... have significant implications for public health. In China the age- and sex-standardised death rate from cardiovascular disease is estimated to be 312/100,000 for males and 260/100,000 for females. Diclofenac is the most commonly used NSAID in hospitals in China.  If it were taken by only 1% of China's population of approximately 1.3 billion annually, based on the relative risk calculations from meta-analyses it could cause 14,000 additional unintended deaths. These deaths are preventable - lower risk NSAIDs, including naproxen and low-dose ibuprofen, are widely available and are equally efficacious," they write.
According to the researchers, NSAID recommendations on national essential medicines lists should be based on the optimum balance of benefit and harm and give preference to low risk drugs, in particular to ibuprofen and naproxen.
"Diclofenac has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage. Given the availability of safer alternatives, diclofenac should be de-listed from national EMLs. There are strong arguments to revoke its marketing authorisations globally."
Source: PLOS Medicine

Bisphosphonate treatment worsens bone health in Chinese patients

Bisphosphonates may cause atypical stress fractures due to deterioration of mineral content of the femur

by Michael Woodhead
The anti-osteoporosis bisphosphonate drugs may prevent bone loss but long term use results in weaker bones that are more prone to fracture, Hong Kong researchers have shown.
In a study to assess the link between long-term bisphosphonate treatment for osteoporosis and atypical fractures, researchers from the  Department of Orthopaedics and Traumatology and Bone Quality and Health Centre at the Chinese University of Hong Kong, studied bone health in 28 elderly patients taking bisphosphonates.
They found that when compared to a control group of 37 elderly people, the total hip bone mineral density was no different in the patients who took bisphosphonates for osteoporosis prevention for four years. However, bisphosphonate-treated patients had lower bone mineral content in the femoral shaft, and they also had a weaker bone structure in the subtrochanteric and mid-diaphyseal regions and thus significantly lower bone strength. CT scans confirmed that there was significantly decreased trabecular density, bone volume ratio, trabecular number but increased trabecular spacing in tibia and distal radius. Other tests confirmed significantly lower stiffness and failure load in tibial bone. Biochemical studies also showed lower bone resorption and severely suppressed bone formation activity following bisphosphonate treatment.
The researchers say that the unchanged total hip bone mineral density between the two groups confirmed the beneficial effects of bisphosphonate on trabecular bone, thus preventing osteoporotic fractures in general. However, the inferior structural, densitometric and biomechanical properties at cortical bones, especially femur midshaft, need  special attention to look into the association between long-term bisphosphonate intake and the occurrence of stress fractures, they suggest. They  recommend that when patients taking bisphosphonates complain of proximal thigh pain or discomfort, X-rays should be used for screening. All patients prescribed bisphosphonates should be informed of the possibility of these potential bone weakness complications, they add.
"In conclusion, inferior biomechanical properties due to structural deterioration and poor bone mineral content at cortical bones of osteoporotic patients, together with the uncoupled bone remodelling process with long-term bisphosphonate intake were depicted in this study. These findings may explain high tension stress in the lateral sides of the subtrochanteric and midshaft regions is prone to stress fracture during normal daily activities. Until the risk factors of developing atypical fractures can be identified, patients under bisphosphonate treatment should be monitored closely to detect the potential problems, and early and prompt treatment should be given accordingly. "
And as the half life of the drug in the bone tissue is around ten years, plain film checking for stress fractures in case upper or mid-thigh pain is [advised], even after the drug is stopped, they suggest.
Source: Chinese Medical Journal

More than one in 20 Chinese at risk of gout

About 7% of Chinese people living in urban areas have high blood levels of uric acid that put them at risk of gout, a Shandong study shows. 
A study of 4,218 adults in the Jinan area found that hyperuricemia (serum uric acid ≥416 μmol/L in men and ≥357 μmol/L in women) was present in 6.4 % of men and 2.1 % of women overall. The prevalence of hyperuricemia was greater in urban (6.7 %) than in rural areas (1.7 %) of Jinan city. High uric acid levels were associated with hypertriglyceridemia and high serum creatinine level and also significantly associated with male sex, urban residence, hypertension, obesity, and hypercholesterolemia.
Source: Rheumatology International

Knee arthroplasty rates soar for "crouching" Chinese women

by Michael Woodhead
The number of patients undergoing primary total knee arthroplasty in China has  increased enormously over the last decade, especially among women, Beijing research shows.
Researchers from Peking University Third Hospital analysed data from 3118 Chinese patients who underwent the procedure over the period of 2000–2011.
They found that total knee arthroplasties were performed on 511 males and 2607 females in the hospital during the ten years.  The annual incidence of primary total knee arthroplasty increased from 35 knees in 2000 to 681 knees in 2011. The average annual percentage increase in operation rates was 33%. As expected, the highest incidence knee arthroplasty was in people aged 65–74 years. Surprisingly, however, females accounted for 83% of the patients who underwent primary total knee arthroplasty.
 The researchers say the higher incidence of female patients undergoing primary total knee arthroplasty  may be due to a higher prevalence of advanced knee osteoarthritis in older women.  "There are lifestyle differences between Asian and Western females that may lead to the higher prevalence of primary total knee arthroplasty among [Asians] ... for example, Chinese women tend to use the squatting posture more often than Western women in daily activities, such as for toileting and house chores," they say.
They conclude that their study has demonstrated a rapid increase in the incidence of primary total knee arthroplasty in the Chinese  population.
Read more: Chinese Medical Journal

World Orthopaedic Alliance founded in Beijing

 A world alliance on orthopaedics was established in Beijing on Thursday in a bid to pool global resources and improve developing nations' capacities to fight orthopaedic challenges.
About 70 countries and regions will support and participate in the World Orthopaedic Alliance (WOA), a non-profit organization devoted to the advancement of high-quality care in this branch of medicine within developing countries.
The WOA aims to develop a mechanism to bridge the gap between clinical orthopaedic physicians and companies in the industry, according to Wang Yan, who was elected the WOA's founding chairman.
Wang, who is also president of the Chinese Orthopaedic Association (COA), said the WOA will serve as a platform for surgeons and medical equipment companies to cooperate and improve orthopaedics services.
An important mission of the WOA is to work with government departments, medical equipment companies, doctors and hospitals to create an innovative, comprehensive and cost-effective pattern of thinking that suits local cultures so as to promote medical education, clinical practice, as well as product research and development.
The world is facing more orthopaedics challenges as a result of an aging population and a huge number of motor vehicle accidents, natural disasters, and emerging infectious diseases, experts say.
In China alone, three percent of its more than 1.3 billion people have osteoarthritis and more than 40 million suffer from joint diseases, according to COA statistics.
Challenges in orthopaedics will become greater in China given its rapidly aging population. It is estimated that the country's senior population, or those above 60 years old, will hit 243 million by 2020, accounting for 18 percent of its total population.
The establishment of the WOA runs concurrently with the opening of the Seventh International Congress of the COA.
With a registered membership of more than 30,000 orthopaedic physicians, the COA is the largest specialized professional society in both the medical community of China and among orthopaedic associations around the world.
Read more: CRI