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The multifactorial disease of osteoporosis is one of the most frequent diseases, affecting about 5 - 6 Mio. postmenopausal women in Germany, today. In spite of the introduction of new technologies of fracture risk assessment and new pharmacological opportunities the incidence of fracture is still increasing. Therefore, early identification of women at high risk as well as early and individualised preventive measures are essential in the prevention of osteoporosis. Changes of dietary habits as well as lifestyle including an increase in physical activity are of up most importance. In addition to Calcium and Vitamin D supplementation, hormone replacement therapy (HRT) is accepted as the first line and cost effective pharmacological treatment for the prevention of osteoporosis. Numerous cross sectional, case-control and prospective studies showing the effect of HRT on bone reabsorption and bone mineral density (BMD) have been published. HRT reduces bone turnover which is followed by an increase of BMD. A number of case-control and cohort studies as well as a few recent prospective studies have been investigating the effect of HRT on osteoporosis related fracture. These studies confirm that HRT leads to a significant decrease of osteoporosis related fracture (Hip fracture by > 25%). However, randomised, prospective studies are needed to underline the effect on osteoporosis related fracture. Although the effect of HRT on BMD is independent of both, the age at which treatment is started and the route of administration, a dose-response relation as well as a greater response in patients with a lower initial BMD has been reported. Since bone is lost rapidly when treatment is stopped, the duration of treatment is clinically important in evaluating the effect of HRT on BMD. Hereby, a duration of 10 years and more seems desirable. Since the ongoing controversial discussion on the duration dependent increase of the incidence of breast cancer and the discussion on secondary prevention of cardiovascular disease, any therapy decision must be individually evaluated. The following article gives a systematical review on the recent literature regarding the influence of HRT on BMD and osteoporosis related fracture.

Objective: Quantitative ultrasonometry is a radiation-free, low-cost, simple, quick and mobile method to evaluate properties of bone. The objective of this study was to evaluate the effectiveness, reliability and age-related findings of this technique in women and to establish a reference database. Methods: In a cross-sectional study we measured speed of sound, broadband ultrasound attenuation and the stiffness index of the calcaneus in 2272 women (mean age, 53.0 ± 10.5 years) with an ultrasound bone densitometer. Women with a history of osteoporosis, osteoporosis-related fractures or those using medications known to affect bone metabolism were excluded. In 791 women both calcanei were studied. Results: The short-term precision in vivo, expressed as coefficient of variance, was 1.2% for broadband attenuation, 0.2% for speed of sound, and 1.3% for stiffness. In women in whom both calcanei were studied the coefficient of correlation was 0.92 for speed of sound (p

Objective: Because estrogens are important in the pathogenesis of both breast cancer and osteoporosis, it has been suggested that the risk of osteoporosis and breast cancer are inversely related. The aim of our study was to evaluate bone mineral density in patients with breast cancer. Methods: Speed of sound, broadband ultrasound attenuation, and the stiffness index of the calcaneus were measured in 1004 subjects (mean age 53.9 years) with an Achilles ultrasound bone densitometer. 148 patients had a history of breast cancer and 856 did not. Breast cancer patients were compared with healthy subjects matched for age, weight, body mass index (BMI), parity, and duration of breast feeding and estrogen exposure. Results: Overall, the patients with breast cancer were 4.4 years older and had higher body weight, BMI and parity, longer duration of breast feeding and estrogen exposure, and a significantly higher speed of sound and stiffness index than healthy controls. In the matched-pairs analysis, women with breast cancer had a higher speed of sound and stiffness index than the controls. Conclusion: Women with breast cancer have a lower risk of osteoporosis than controls. Although the biologic mechanisms linking bone mass and the risk of breast cancer are not fully understood, factors other than cumulative estrogen exposure may play a role. Studies on larger populations are needed to evaluate this relationship.

Purpose: This cross-sectional study collected data on the effectiveness, validity and reliability of QUS. Method and Material: Speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) of the calcaneus were measured in n = 764 postmenopausal patients, mean age 61 years, using the Achilles ultrasound bone densitometer (Lunar Corp., Madison, WI). In addition we measured blood levels of E2 and FSH in 157 patients and correlated these variables with data gathered by a detailed questionnaire. Women using any medication known to effect bone metabolism were excluded from the study. Results: The Achilles shortterm precision in vivo expressed as coefficient of variance was 1.2 % for BUA and 0.17% for SOS and 1.3% for stiffness respectively. A total of 102 women were measured at the right and left calcaneus with a coefficient of correlation of r= 0.92 for SOS, r = 0.84 for BUA and r = 0.93 for SI. Cross-sectional analysis showed a significant yearly postmenopausal decrease of 0.06% for SOS, 0.44% for BUA and 0.74% for SI. Women with a history of osteoporosis (165 patients) as well as 141 women with an osteoporosis-related fracture showed significantly lower results in all ultrasound parameters (SOS, BUA, SI). In conclusion, quantitative ultrasound osteodensitometry of the calcaneus measures properties of bone which continue to decline with age. The low precision error and the high correlation of right vs. left underlines the high technical standard. Conclusion: Our results indicate that QUS is capable of identifying in a precise manner women with previous osteoporotic fractures as well as women with a history of osteoporosis. Hence, QUS may provide a radiation-free, low-cost, easy to handle, fast and mobile method which for the first time could make a screening programme a feasible proposition.

The administration of GnRH analogues is expected to improve treatment by avoiding hysterectomy, since problems connected with the surgical removal of leiomyomata are correlated with their size. In this study the GnRH analogue goserelin in its depot formulation (Zoladex, ICI, Plankstadt) was used for treating isolated leiomyomata of the uterus. All patients were treated for 3 months before myomectomy was performed. The complete regression of a large myoma (206 cm3) was observed in 1 of 11 patients. In 5 cases a reduction in volume of more than 50% was achieved. Ovarian function was suppressed by goserelin, after a short-term stimulation, within 7 +/- 3 days. Serum levels of 17 beta-oestradiol were found to be generally less than 25 pg/ml. All patients reported climacteric complaints, but in no case had therapy to be discontinued. After cessation of goserelin, restoration of ovarian function was observed in all patients.

In the present study we used the well known antiviral properties of interferon alpha 2b in condylomata acuminata. Firstly we investigated 3 different application forms. We found that 1. the local INF application in gel was completely ineffective, 2. the injection of INF into the base of the warts was effective but too painful for routine therapy, 3. the systemic treatment by s.c.-injection had an excellent compliance and a high efficacy. In the second part of the study we treated 16 patients with our own s.c.-regimen of 3 x 5 mill. U and 6 x 2 mill. U INF alpha 2b within 5 weeks. 60% showed a complete response, 30% a partial response; these were treated surgical afterwards. In none of the patients a relapse occurred at a median follow-up of 11 months. The observed side-effects were poor. We consider the systemic treatment with interferon for condylomata acuminata to be highly effective and well tolerated. The relapse rate is very poor.

In a 28-year-old patient with a large uterine leiomyoma, complete tumor regression was achieved by the LHRH agonist Zoladex (ICI 118.630) when administered three times. During the follow-up period of three months, new myoma growth did not occur. On the basis of this case study, it is necessary to discuss a new therapy concept for the differentiated treatment of uterine leiomyomata in young women with a desire for pregnancy.