This study assessed persistence and compliance with anti-osteoporosis therapies, and associations between compliance and clinical outcomes (fracture, fracture-related hospitalization and death), in Hungarian women with postmenopausal osteoporosis. The study used the Hungarian National Health Insurance Fund Administration database and included women with PMO aged at least 50 years, for whom a prescription for anti-osteoporosis medication had been filled between 1 January 2004 and 31 December 2013 (index event). Persistence (prescription refilled within 8 weeks of the end of the previous supply) was evaluated over 2 years; good compliance (medication possession ratio ≥ 80 %) was evaluated at 1 year. Associations between compliance and clinical outcomes (data collected for up to 6 years) were assessed with adjustment for baseline covariates. A total of 296,300 women met the inclusion criteria (524,798 index events). Persistence and compliance were higher for less frequent and parenteral therapies (1- and 2-year persistence: half-yearly [parenteral] vs. daily/weekly/monthly [oral and parenteral], 81 and 38 % vs. 21-34 and 10-18 %, respectively; parenteral vs. oral, 75 and 36 % vs. 32 and 16 %; good compliance: half-yearly vs. daily/weekly/monthly, 70 vs. 24-39 %; parenteral vs. oral 78 vs. 36 %). Good compliance significantly reduced the risks of fracture, fracture-related hospitalization and death (relative risk vs. non-compliance [95 % confidence interval]: 0.77 [0.70-0.84], 0.72 [0.62-0.85] and 0.57 [0.51-0.64], respectively; P < 0.01). Improving compliance through long-interval parenteral therapies may result in clinical benefits for patients.

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Estrogen therapy, using either oral or transdermal routes, decreases bone turnover and prevents postmenopausal bone loss. It has been suggested that oral and transdermal 17␤-estradiol (E 2 ) may have different effects on serum insulin-like growth factor I (IGF-I), a potent bone-forming growth factor. In this study we investigated the effects of a new route of administration, the intranasal E 2 spray (S21400), on bone turnover and circulating IGF-I and IGF-binding protein-3 (IGFBP-3). Four hundred and twenty early postmenopausal women (Ͻ5 yr since menopause; mean age, 52 yr) were enrolled in a 3-month, double blind, placebo-controlled study of four doses of intranasal E 2 (100, 200, 300, and 400 g/day), two doses of oral E 2 valerate (1 or 2 mg/day), and placebo. One hundred and twelve women were further treated for 12 months with intranasal E 2 (300 g/day, i.e. the dose that has been shown to be adequate for the majority of postmenopausal women). Markers of bone resorption (urinary type I collagen C telopeptides) and formation [serum osteocalcin, serum type I collagen N-terminal extension propeptide (PINP), and serum bone alkaline phosphatase (BAP)] were measured at baseline, 1 month, 3 months, and 15 months. Serum IGF-I and IGFBP-3 were measured at baseline, 1 month, and 3 months. Urinary type I collagen C telopeptides decreased significantly in all active treatment groups as soon as 1 month (P Ͻ 0.001 vs. placebo) and continued to decrease at 3 months with a dose effect for intranasal E 2 . Serum osteocalcin and PINP did not change at 1 month for oral E 2 (1 and 2 mg), but decreased significantly at 3 months. In contrast, formation markers increased significantly at 1 month for the two highest doses of intranasal E 2 (P Ͻ 0.01 vs. placebo for osteocalcin and BAP) and did not decrease at 3 months. Oral E 2 induced a marked decrease in circulating IGF-I as early as 1 month, which was amplified at 3 months (Ϫ29% and Ϫ32% for 1 and 2 mg, respectively), whereas no significant change from placebo was observed for intranasal E 2 during the 3-month period. Changes in circulating IGF-I correlated significantly (P Ͻ 0.01) with changes in osteocalcin, PINP, and BAP at 3 months. Oral and intranasal E 2 did not induce any significant change from placebo in serum IGFBP-3 at both 1 and 3 months. After 1 yr of treatment with intranasal E 2 (300 g/day), both resorption and formation markers decreased, reaching the levels in premenopausal women, regardless of the type of treatment during the first 3 months.We conclude that E 2 administered by this new nasal route normalizes bone turnover to premenopausal levels. The delayed decrease in bone formation observed with intranasal E 2 compared to oral E 2 may be related to different effects on serum IGF-I levels. (J Clin Endocrinol Metab 84: 2390 -2397, 1999) E STROGEN supplementation, given mainly as conjugated equine extracts or 17␤-estradiol (E 2 ), has been shown to decrease bone turnover, prevent postmenopausal bone loss, and significantly reduce fracture risk in both ea...

Our findings infer that the standardized and uniform health care of osteoporotic patients in a country may reduce general fracture incidence and hospitalization in a cost-effective way.

Summary A new simple method of treating urinary stress incontinence is to fix a fibrin implant vaginally to the bladder neck and upper urethra. The support provided by the implant is maintained after its resorption by the fibrous tissue which replaces it. The two‐year cure rate in 85 patients was 93 per cent.