Hi:
Here are 2 articles for you to read reagrding the Ipriflavone studies.
Ipriflavone in the Treatment of Postmenopausal Osteoporosis
A Randomized Controlled Trial
Peter Alexandersen, MD; Anne Toussaint, MD; Claus Christiansen, MD,
PhD; Jean-Pierre Devogelaer, MD, PhD; Christian Roux, MD, PhD;
Jacques Fechtenbaum, MD, PhD; Carlo Gennari, MD, PhD; Jean Yves
Reginster, MD, PhD; for the Ipriflavone Multicenter European Fracture
Study
Context- Data on the efficacy and safety of ipriflavone for
prevention of postmenopausal bone loss are conflicting.
Objectives- To investigate the effect of oral ipriflavone on
prevention of postmenopausal bone loss and to assess the safety
profile of long-term treatment with ipriflavone in postmenopausal
osteoporotic women.
Design and Setting Prospective, randomized, double-blind, placebo-
controlled, 4-year study conducted in 4 centers in Belgium, Denmark,
and Italy from August 1994 to July 1998.
Participants Four hundred seventy-four postmenopausal white women,
aged 45 to 75 years, with bone mineral densities (BMDs) of less than
0.86 g/cm2.
Interventions Patients were randomly assigned to receive
ipriflavone, 200 mg 3 times per day (n = 234), or placebo (n = 240);
all received 500 mg/d of calcium.
Main Outcome Measures Efficacy measures included spine, hip, and
forearm BMD and biochemical markers of bone resorption (urinary
hydroxyproline corrected for creatinine and urinary CrossLaps
[Osteometer Biotech, Herlev, Denmark] corrected for creatinine),
assessed every 6 months. Laboratory safety measures and adverse
events were recorded every 3 months.
Results Based on intent-to-treat analysis, after 36 months of
treatment, the annual percentage change from baseline in BMD of the
lumbar spine for ipriflavone vs placebo (0.1% [95% confidence
interval {CI}, -7.9% to 8.1%] vs 0.8% [95% CI, -9.1% to 10.7%]; P
= .14), or in any of the other sites measured, did not differ
significantly between groups. The response in biochemical markers was
also similar between groups (eg, for hydroxyproline corrected for
creatinine, 20.13 mg/g [95% CI, 18.85-21.41 mg/g] vs 20.67 mg/g [95%
CI, 19.41-21.92 mg/g]; P = .96); urinary CrossLaps corrected for
creatinine, 268 mg/mol (95% CI, 249-288 mg/mol) vs 268 mg/mol (95%
CI, 254-282 mg/mol); P = .81. The number of women with new vertebral
fracture was identical or nearly so in the 2 groups at all time
points. Lymphocyte concentrations decreased significantly (500/µL
(0.5 109/L]) in women treated with ipriflavone. Thirty-one women
(13.2%) in the ipriflavone group developed subclinical
lymphocytopenia, of whom 29 developed it during ipriflavone
treatment. Of these, 15 (52%) of 29 had recovered spontaneously by 1
year and 22 (81%) of 29 by 2 years.
Conclusions - Our data indicate that ipriflavone does not prevent
bone loss or affect biochemical markers of bone metabolism.
Additionally, ipriflavone induces lymphocytopenia in a significant
number of women.
JAMA. 2001;285:1482-1488
Current News Index
News Archives
Ipriflavone Fails to Prevent Bone Loss in Postmenopausal Women
By Donald J. Brown, ND
Healthnotes Newswire (March 22, 2001)According to a clinical trial
published in this week's Journal of the American Medical Association
(JAMA), ipriflavone supplementation failed to prevent bone loss in
postmenopausal women with osteoporosis who took the product for three
years.1 Ipriflavone is a synthetic isoflavone, derived from the soy
compound daidzien.
The trial enrolled 474 women from Belgium, Denmark, and Italy, who
were diagnosed with osteoporosis. Their ages ranged from 45 to 75
years. Once enrolled, each participant was randomly given either 200
mg of ipriflavone or a placebo three times per day. All participants
also took 500 mg of calcium per day during the trial.
At the end of the three-year trial, the researchers determined that
bone loss, measured in the lumbar spine, was the same in both groups.
Not only did ipriflavone fail to slow bone loss, but it also did not
produce a decrease in chemical markers used to measure bone loss.
To compound matters, the researchers report that 29 of the 132 women
(22%) in the ipriflavone group completing the three-year clinical
trial developed a clinically significant drop in lymphocytes. These
cells, which make up approximately nearly one-third of the white
blood cells in the normal adult, are critical components of the
immune system and its ability to respond to viral infections. In some
of these women, a return to normal levels took almost two years after
they had stopped supplementing the ipriflavone.
The researchers conclude that, " the relative benefit-risk ratio of
ipriflavone appears low when compared with the alternative
antiosteoporotic drugs available. Its use in treatment is not
supported by these data."
Ipriflavone was first synthesized in the 1930s and has been primarily
researched in Japan and Europe. The product is sold in the United
States as a dietary supplement, with a typical recommendation of 200
mg three times per day.
The results of this new clinical trial veer dramatically from the
promising results seen in several earlier clinical trials with either
osteoporotic women 2 3 4 5 or those at risk for osteoporosis.6 These
trials have found that 200 mg of ipriflavone three times per day
paired with 8001,000 mg of calcium per day prevented bone loss and,
in some cases, actually increased bone density and reduced vertebral
fractures.
However, none of these trials was greater than two years in length.
As noted by the researchers of the new trial, the women enrolled in
their study were somewhat older than women in earlier trials,
suggesting that ipriflavone may be more likely to work in younger
postmenopausal women with early signs of bone loss.
The red flag in the current trial is the significant drop in
lymphocyte levels measured in almost 22% of the women taking
ipriflavone. Although this finding has been reported in one other
smaller clinical trial,7 it suggests that women choosing to take
ipriflavone should have their lymphocytes measured regularly by their
doctor.
While the results of the current trial do not bode well for the
future of ipriflavone in the treatment of osteoporosis, there
continues to be a need for safe and effective approaches to the
prevention and treatment of osteoporosis. Despite the endorsement of
the authors of this study for drugs to treat and prevent
osteoporosis, the fact remains that most of these have very
unpleasant side effects that negatively affect the quality of life of
the many women taking them.8 9 10 11
References
1. Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in
the treatment of postmenopausal osteoporosis. JAMA 2001;285:14828.
2. Agnusdei D, Bufalino L. Efficacy of ipriflavone in established
osteoporosis and long-term safety. Calcif Tissue Int 1997;61:237.
3. Passeri M, Biondi M, Costi D, et al. Effects of 2-year therapy
with ipriflavone in elderly women with established osteoporosis. Ital
J Mineral Electrolyte Metabol 1995;9:13744.
4. Kovacs AB. Efficacy of ipriflavone in the prevention and treatment
of postmenopausal osteoporosis. Agents Actions 1994;41:867.
5. Adami S, Bufalino L, Cervetti R, et al. Ipriflavone prevents
radial bone loss in postmenopausal women with low bone mass over 2
years. Osteoporos Int 1997;7:11925.
6. Gennari C, Agnusdei D, Crepaldi G, et al. Effect of ipriflavonea
synthetic derivative of natural isoflavoneson bone mass loss in the
early years after menopause. Menopause 1998;5:915.
7. Agnusdei D, Bufalino L. Efficacy of ipriflavone in established
osteoporosis and long-term safety. Calcif Tissue Int 1997;61:237.
8. Coakley G, Isenberg DA. Toxic epidermal necrolysis, pancytopenia
and adult respiratory syndrome. Br J Rheumatol 1995;34:798 [letter].
9. Rolla G, Bucca C, Brussino L. Bisphosphonate-induced
bronchoconstriction in aspirin-sensitive asthma. Lancet 1994;343:426
7.
10. Bauer DC, Black D, Ensrud K , et al. Upper gastrointestinal tract
safety profile of alendronate: The Fracture Intervention Trial. Arch
Intern Med 2000;160:51725.
11. Lanza FL, Hunt RH, Thomson AB, et al. Endoscopic comparison of
esophageal and gastroduodenal effects of risedronate and alendronate
in postmenopausal women. Gastroenterology 2000;119:6318.
Catherine