JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, December 18, 2007)
JAMA NEWS RELEASES
WOMEN WITH OSTEOPOROSIS, PREVIOUS VERTEBRAL FRACTURE HAVE INCREASED LONG-TERM RISK FOR NEW FRACTURE
STUDY EXAMINES IMAGING PROCEDURES FOR DIAGNOSING BLOOD CLOTS IN THE LUNG
‘FALSE-POSITIVE’ ACTIVATION OF CARDIAC CATHETERIZATION LABORATORY MAY OCCUR IN SOME PATIENTS WITH SUSPECTED HEART ATTACK
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
RESEARCHERS IDENTIFY PREDICTORS FOR SPINE FRACTURES — MOST COMMON KIND OF OSTEOPOROTIC FRACTURES
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 18, 2007
Media Advisory: To contact Jane A. Cauley, Dr.P.H., call Clare Collins at 412-624-2607.
WOMEN WITH OSTEOPOROSIS, PREVIOUS VERTEBRAL FRACTURE HAVE INCREASED LONG-TERM RISK FOR NEW FRACTURE
CHICAGO—Over a 15 year period, women with low bone mineral density and a previous vertebral fracture had an increased risk of a new vertebral fracture compared to women with normal bone mineral density and no previous fracture, according to a study in the December 19 issue of JAMA.
Vertebral fractures are the most common osteoporotic fracture, with prevalence estimates of 35 percent to 50 percent among women older than 50 years. About 700,000 vertebral fractures occur each year in the United States, according to background information in the article. Women with low bone mineral density (BMD) and previous vertebral fractures have a greater risk of new vertebral fractures over the short-term, but their risk of vertebral fracture over the long-term is uncertain.
Jane A. Cauley, Dr.P.H., of the University of Pittsburgh, and colleagues examined the absolute risk of new vertebral fractures by spine and hip BMD and previous vertebral fracture status over 15 years of follow-up in a group of 9,704 white women, who were recruited at four U.S. clinical centers and enrolled in the Study of Osteoporotic Fractures. Of these, 2,680 attended a clinic visit an average of 14.9 years after entering the study. The average age of the women was 68.8 years at entry and 83.8 years at follow-up.
The researchers found that of these 2,680 women, 487 (18.2 percent) experienced a new vertebral fracture, including 163 (41.4 percent) of the 394 with a previous vertebral fracture at baseline and 324 (14.2 percent) of the 2,286 without a previous vertebral fracture at baseline. Women who experienced a new fracture also weighed less, were more likely to have a positive fracture history and a previous vertebral fracture at study entry, and less likely to report estrogen use at baseline.
Women with a previous vertebral fracture at baseline had more than four times the odds of experiencing a new vertebral fracture over follow-up compared with women without a previous vertebral fracture at baseline. The risk was greatest among women with two or more previous fractures at baseline.
Low BMD was a strong predictor of new vertebral fracture. About one-third of women with a low hip BMD measurement had a new vertebral fracture, compared with about 10 percent of women with normal BMD. The absolute risk of vertebral fractures was 56 percent among women with both a previous vertebral fracture and BMD in the osteoporotic range. In contrast, women with normal BMD and no previous fracture had an absolute risk of about 9 percent.
“Our results support the recommendation that older women with a prevalent vertebral fracture should be treated for osteoporosis irrespective of BMD. Treatment of women with prevalent asymptomatic vertebral fractures with bisphosphonates and selective estrogen receptors modulators has been shown to decrease fracture incidence,” the authors write.
(JAMA. 2007;298(23):2761-2767. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 18, 2007
Media Advisory: To contact David R. Anderson, M.D., call Alison Gerard at 902-494-1789. To contact editorial author Jeffrey Glassroth, M.D., call Marla Paul at 312-503-8928.
STUDY EXAMINES IMAGING PROCEDURES FOR DIAGNOSING BLOOD CLOTS IN THE LUNG
CHICAGO—New research indicates that a diagnostic strategy using computed tomographic pulmonary angiography (CTPA) may be a safe alternative to conventional lungs scans (known as ventilation-perfusion scans) for excluding the diagnosis of pulmonary embolism (blood clots in the lung vessels), although CTPA may detect more clots, according to a study in the December 19 issue of JAMA.
Pulmonary embolism is a common and serious medical condition leading to the hospitalization or death of more than 250,000 people in the U.S. each year, and is estimated to result in 5 percent to 10 percent of all deaths in U.S. hospitals. Pulmonary embolism remains one of the most difficult conditions for clinicians to diagnose accurately, with timely, accurate tests essential to start appropriate therapy, while avoiding the risks of therapy to patients diagnosed as not having a pulmonary embolism, according to background information in the article.
For 30 years, ventilation-perfusion (V/Q) lung scanning had been the non-invasive imaging procedure of choice in patients with suspected pulmonary embolism. In the last decade, CTPA was introduced as an alternative non-invasive test and has been adopted rapidly, despite some concerns about the sensitivity (the proportion of affected individuals who have a positive test result for a condition the test is intended to reveal) of this method.
David R. Anderson, M.D., of Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues conducted a comparison of CTPA with V/Q scanning to determine if CTPA is a safe, reliable alternative to V/Q scanning, and does not miss the detection of clinically important pulmonary blockages. The trial was conducted at four Canadian and one U.S. tertiary care centers between May 2001 and April 2005 and included 1,417 patients considered likely to have acute pulmonary embolism. Patients were randomized to undergo either V/Q scanning (n = 716) or CTPA (n = 701). Patients in whom this testing did not indicate pulmonary embolism did not receive anti-thrombotic therapy and were followed-up for three months.
Of the patients randomized to CTPA, 133 (19.2 percent) were diagnosed with pulmonary embolism or deep vein thrombosis in the initial evaluation period; 101 (14.2 percent) of patients in the V/Q scanning group had a similar diagnosis. Both groups of patients were treated with anti-coagulant therapy. The overall rate of venous thromboembolism (the composite of deep vein thrombosis and pulmonary embolism) found in the initial diagnostic period was significantly greater in patients randomized to the CTPA strategy (difference, 5 percent).
Of those in whom pulmonary embolism was considered excluded, 2 of 561 patients (0.4 percent) randomized to CTPA vs. 6 of 611 patients (1.0 percent) undergoing V/Q scanning developed venous thromboembolism in follow-up (difference, -0.6 percent).
“The results of our study are reassuring given previous reports of relatively low sensitivity of CTPA for the diagnosis of pulmonary embolism,” the authors write.
“...an unanticipated finding in our study was that CTPA resulted in a significantly greater number of venous thromboembolism diagnoses than did V/Q scanning,” they add. “Further research is required to confirm whether some pulmonary emboli detected by CTPA may be clinically unimportant, the equivalent of deep vein thrombosis isolated to the calf veins, and not require anti-coagulant therapy.”
(JAMA. 2007;298(23):2743-2753. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: IMAGING A PULMONARY EMBOLISM — TOO MUCH OF A GOOD THING?
In an accompanying editorial, Jeffrey Glassroth, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, writes that the findings by Anderson and colleagues have clinical implications.
“First, clinicians should consider the likelihood of pulmonary embolism in a structured manner based on patients’ presenting histories and physical examinations much the way Anderson and colleagues did, and based on those assessments, proceed, as necessary, to D-dimer testing [a blood test to diagnose thrombosis]. These 2 steps may substantially reduce the probability that pulmonary embolism, at least large clots, are present and obviate the need for additional study. Where significant concern remains, including some patients whose pulmonary embolism probability may not be very high but whose comorbidities put them at great risk were an embolism to occur, additional testing should be pursued. If readily available, lower extremity ultrasound studies to search for deep vein thrombosis to treat those patients found to have such clots is a reasonable next step.”
(JAMA. 2007;298(23):2788-2789. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 18, 2007
Media Advisory: To contact corresponding author Timothy D. Henry, M.D., call Steve Linders at 612-863-4801. To contact editorial author Frederick A. Masoudi, M.D., M.S.P.H., call Dee Martinez at 303-436-6615.
‘FALSE-POSITIVE’ ACTIVATION OF CARDIAC CATHETERIZATION LABORATORY MAY OCCUR IN SOME PATIENTS WITH SUSPECTED HEART ATTACK
CHICAGO—Physicians caring for patients suspected of having a heart attack may trigger “false-positive” activation of the cardiac catheterization laboratory based on test results suggestive of a heart attack, according to a study in the December 19 issue of JAMA.
Allowing the emergency department physician to activate the cardiac catheterization laboratory is a key strategy to reduce the time to receiving treatment for patients with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack), according to background information in the article. “Time to reperfusion [restoration of blood flow to the heart] is a major determinant of outcome in patients presenting with an STEMI,” the authors write.
Guidelines recommend that the emergency department physician make the decision regarding reperfusion therapy, such as coronary angiography, within 10 minutes of interpreting the initial diagnostic electrocardiogram (ECG), which may be challenging because clinical decisions are often made without a previous ECG result for comparison or time to observe ST-segment changes or cardiac biomarker results. A variety of other serious conditions aside from a heart attack may also cause ST-segment elevation. The researchers add that although rapid reperfusion is important, the potential clinical and financial consequences associated with “false alarms” need to be considered.
David M. Larson, M.D., of the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, and colleagues conducted a study to determine the prevalence and outcomes of “false-positive” catheterization laboratory activation for patients with a suspected STEMI. The study included a total of 1,345 patients who were enrolled from March 2003 to November 2006. The patients were part of a registry from a regional system that included transfer of patients with STEMI from 30 community and rural hospitals with pre-transfer catheterization laboratory activation for percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) at a tertiary cardiovascular center in Minnesota.
Of the 1,335 patients with suspected STEMI who underwent angiography, 187 (14 percent) did not have a clear culprit coronary artery (the coronary artery identified as responsible for the STEMI), and 127 (9.5 percent) did not have significant coronary artery disease. Of the 14 percent of patients with no clear culprit artery, 64 (4.8 percent) had positive and 123 (9.2 percent) had negative cardiac biomarker results. Of the 1,335 patients who had angiography, cardiac biomarker results were negative in 149 (11.2 percent) patients. The rate of death at 30 days was 2.7 percent without vs. 4.6 percent with a culprit coronary artery.
“...the issue of false-positive catheterization laboratory activation remains a significant concern because unnecessary emergency coronary angiography is not without risk to the patient and may impose a burden on limited human and physical catheterization laboratory resources,” the authors write. “This critical decision process must balance the risk of a false alarm with the consequences of delaying myocardial reperfusion.”
“In the setting of increased emphasis on rapid door-to-balloon times, the consequences of false-positive catheterization laboratory activation need to be considered. False-positive catheterization laboratory activation may be another quality metric to monitor for a STEMI program.”
(JAMA. 2007;298(23):2754-2760. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MEASURING THE QUALITY OF PRIMARY PCI FOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION — TIME FOR BALANCE
In an accompanying editorial, Frederick A. Masoudi, M.D., M.S.P.H., of the Denver Health Medical Center, Denver, comments on the findings regarding treatment for STEMI.
“The study by Larson et al should stimulate further development of quality measurement and reporting efforts. In the case of primary PCI, the view of quality should extend beyond the time to treatment to include patient selection, and ultimately to outcomes. While efforts to improve the quality of care will—and should—continue, the science of improvement must advance so that clinicians can be increasingly confident that efforts to deliver the right care to the right patient at the right time are improving and extending patients’ lives.”
(JAMA. 2007;298(23):2790-2791. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
RESEARCHERS IDENTIFY PREDICTORS FOR SPINE FRACTURES — MOST COMMON KIND OF OSTEOPOROTIC FRACTURES
INTRO:
Spine fractures are the most common kind of bone fractures caused by osteoporosis. About seven-hundred thousand spine fractures occur each year in the U.S., but about two-thirds of those go undiagnosed. A new study aims to help identify women at greatest risk for those fractures, in hopes of preventing them. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Elderly woman walking using walker
Different elderly women getting off of bus
AUDIO:
ABOUT SEVENTY-FIVE PERCENT OF VERTEBRAL (ver-TEH-bral), OR SPINE FRACTURES, ARE SILENT, MEANING THE BONE COLLAPSES WITH NO SIGNS OR SYMPTOMS.
VIDEO:
SOT/FULL
@ :11
Super: Jane Cauley, Dr.P.H.
University of Pittsburgh
Runs :14
AUDIO:
“So women may be walking around without even knowing that they have a spine fracture, yet these silent spine fractures are associated with an increased risk of disability, loss of function, as well as an increased risk of mortality.”
VIDEO:
B-ROLL
Dr. Cauley and colleague at computer
Bone scan image
Ruth lying on table, then having bone scan
GFX/JAMA COVER
AUDIO:
SO DR. JANE CAULEY AND COLLEAGUES AT UNIVERSITY OF PITTSBURGH WERE AMONG THE RESEARCHERS WHO STUDIED SPINE FRACTURES. THEY REVIEWED DATA ON ALMOST TEN-THOUSAND WOMEN AGE SIXTY-FIVE AND OLDER WHO GOT BONE DENSITY TESTS – LIKE A MILD X-RAY – UPON ENTERING THE STUDY, AND WERE THEN TRACKED FOR FIFTEEN YEARS. THE FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Jane Cauley, Dr.P.H.
University of Pittsburgh
Runs :09
AUDIO:
"We found that women who entered the study and had an existing spine fracture, they were four times as likely to have a new spine fracture over the 15 years.”
VIDEO:
B-ROLL
Elderly women crossing the street
Different older woman walking on sidewalk
AUDIO:
EVEN IF THEY HAD GOOD RESULTS ON THAT FIRST BONE DENSITY TEST. BUT WOMEN WITH LOW RESULTS ON THAT FIRST DENSITY TEST WERE ALSO AT INCREASED RISK.
VIDEO:
SOT/FULL
Jane Cauley, Dr.P.H.
University of Pittsburgh
Runs :11
AUDIO:
“A quarter of the women who had low bone density when they entered the study developed a new spine fracture over the course of the study, compared to only nine percent of women who had normal bone density when they entered the study.”
VIDEO:
B-ROLL
Dr. Cauley testing Ruth’s bone strength/Ruth standing and sitting
AUDIO:
WHY IS THIS INFORMATION SO IMPORTANT TO OLDER WOMEN AND THEIR DOCTORS? BECAUSE OSTEOPOROSIS CAUSES THESE FRACTURES, AND…
VIDEO:
SOT/FULL
Jane Cauley, Dr.P.H.
University of Pittsburgh
Runs :10
AUDIO:
“Osteoporosis is preventable, is treatable, so I think we have to dispel this myth that if you get older, no matter what, you’ll get osteoporosis.”
VIDEO:
B-ROLL
Different sequence of Ruth having bone scan
Nurse measuring Ruth‘s height
AUDIO:
SHE SAYS A BONE DENSITY TEST, WHICH MEDICARE COVERS, CAN HELP WOMEN AND THEIR DOCTORS DECIDE IF OSTEOPOROSIS TREATMENT IS NEEDED. RUTH CHESTER WAS PART OF DR. CAULEY’S STUDY.
VIDEO:
SOT/FULL
@ 1:42
Super: Ruth Chester
Study participant
Runs :07
AUDIO:
“I think it’s important for a doctor to know who is at risk for those things.”
VIDEO:
B-ROLL
Ruth and Dr. Cauley – talking about Ruth’s arm strength
AUDIO:
AND FOR A WOMAN TO KNOW HER RISK AS WELL. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Cauley recommends that women age 50 and older talk with their physicians about their bone density, and that women age 65 and older should definitely have a bone density test. For more information, visit www.jama.com.
