Coherence Therapy Does Not Prevent Axial Bone Loss in Osteoporotic Women: A Preliminary Comparative Study

Abstract

Coherence therapy, also known as ADFR (activate, depress, free, repeat) therapy, has been proposed as a new form of treatment for osteoporosis. We compared the effects of this therapy with those of gonadal steroid and calcium and of calcium alone in 93 osteoporotic women. Thirty women were treated for 1 yr with ADFR, in the form of K-phosphate (1.5 g/day), for 3 days followed by etidronate, (400 mg/day) for 14 days, followed by 8 weeks of neither drug, plus continuous calcium carbonate therapy (1 g/day). Thirty-six women received conjugated estrogens (0.625 mg/day) for 25 days/month plus medroxyprogesterone acetate (10 mg/day) for 10 days/month and calcium, while 27 women received calcium carbonate (500 mg, twice daily). Sixteen women in the ADFR group, 15 in the calcium group, and 19 in the hormone-calcium group completed 2 yrs of treatment. Spinal bone mineral density was measured by single energy quantitative computerized tomography (QCT) and in the proximal and distal radius by single energy photon absorptiometry. The 3 groups were similar in age, initial bone mass, years since menopause, and dietary calcium intake. After 2 yrs, the mean women in the ADFR therapy group had a mean reduction of 8.0% in spinal QCT (P less than 0.05), and no change in proximal radius mineral content/bone width (BMC), and distal radius BMC. The group treated with calcium only had a decrease of 3.8% in QCT (P less than 0.05), of 5.6% in proximal BMC (P less than 0.05), and of 4.9% in distal BMC (P less than 0.05). The group treated with hormonal replacement and calcium had no change in any of their measurements. The relative bone loss in the spine at the end of the study was greater in the ADFR group than in the hormone-calcium group (P less than 0.05). Bone loss in the calcium group was slightly but not significantly greater than that in the hormone group and lower than that in the ADFR group. In conclusion, these preliminary results indicate that the ADFR regimen using phosphate and etidronate in doses of 1.5 g/day for 3 days and 400 mg/day for 14 days, respectively, is not as effective as hormonal replacement in preventing trabecular bone loss in osteoporosis, nor it is any more effective than calcium supplementation alone.

Treatment of established osteoporosis: a systematic review and cost-utility analysis

“…77, [93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110] In these studies, patients in both the intervention and control groups received calcium and/or vitamin D in comparable doses. Studies in which a bisphosphonate was compared with another active intervention are discussed later (page 36).…”

“…100,106 Three trials were open-label in design. 103,104,110 For further details of methodological quality, see appendix 5.…”

“…99 In a further eight studies, vertebral fracture was only included as secondary outcome measure, 94,96,97,101,103,104,107,110 while in a study that included vertebral fracture as an outcome measure, no differentiation between primary and secondary outcome measures was apparent. 95 In two trials, non-vertebral fracture was a primary outcome measure.…”

“…102 The results in terms of vertebral fracture may not have been directly comparable in all cases: in four studies, it was specified that only fractures in previously unfractured vertebrae were included 106,[108][109][110] and, in another, criteria were used that allowed the inclusion of both these fractures and worsening fractures in previously fractured vertebrae -but only fractures in previously normal vertebrae were reported; 100 in two studies, it was stated explicitly that further fractures in previously fractured vertebrae were included, 98,99,107 and this was implicit in a further study. 101 In six studies, it was not clear whether the criteria used would allow the inclusion of further fractures in already affected vertebrae [94][95][96][97]103,104 and, in two studies, only symptomatic vertebral fractures were reported. 93,102 The definition of vertebral fracture also varied between studies.…”

“…In two, a minimum reduction of 15% in vertebral height was required for a vertebral deformity to be termed a fracture 100,106 and, in a third study, a minimum reduction was required of either 15% in posterior height or 20% in anterior or middle height. 104 In eight studies, a minimum reduction of 20% was required 94,98,99,101,103,[107][108][109][110] and, in another, the results from two trials were combined, one of which had used a definition of at least 15% and the other 25%. 97 In two studies, the definition being used was not specified.…”