Items in AFP with MESH term: Fractures, Bone
Hyperthyroidism - Clinical Evidence Handbook
Osteoporosis in Men - Article
ABSTRACT: Osteoporosis is an important and often overlooked problem in men. Although the lifetime risk of hip fracture is lower in men than in women, men are twice as likely to die after a hip fracture. Bone mineral density measurement with a T-score of -2.5 or less indicates osteoporosis. The American College of Physicians recommends beginning periodic osteoporosis risk assessment in men before 65 years of age and performing dual-energy x-ray absorptiometry for men at increased risk of osteoporosis who are candidates for drug therapy. All men diagnosed with osteoporosis should be evaluated for secondary causes of bone loss. The decision regarding treatment of osteoporosis should be based on clinical evaluation, diagnostic workup, fracture risk assessments, and bone mineral density measurements. Pharmacotherapy is recommended for men with osteoporosis and for high-risk men with low bone mass (osteopenia) with a T-score of -1 to -2.5. Bisphosphonates are the first-line agents for treating osteoporosis in men. Teriparatide (i.e., recombinant human parathyroid hormone) is an option for men with severe osteoporosis. Testosterone therapy is beneficial for men with osteoporosis and hypogonadism. Adequate intake of calcium and vitamin D should be encouraged in all men to maintain bone mass. Men should be educated regarding lifestyle measures, which include weight-bearing exercise, limiting alcohol consumption, and smoking cessation. Fall prevention strategies should be implemented in older men at risk of falls.
Update on Subclinical Hyperthyroidism - Article
ABSTRACT: Subclinical hyperthyroidism is defined by low or undetectable serum thyroid-stimulating hormone levels, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (as in Graves disease or toxic nodular goiter), administration of thyroid hormone for treatment of malignant thyroid disease, or unintentional excessive thyroid hormone therapy. The rate of progression to overt hyperthyroidism is higher in persons who have suppressed thyroid-stimulating hormone levels compared with those who have low but detectable levels. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation in older adults, and with decreased bone mineral density in postmenopausal women; however, the effectiveness of treatment in preventing these conditions is unknown. There is lesser-quality evidence suggesting an association between subclinical hyperthyroidism and other cardiovascular effects, including increased heart rate and left ventricular mass, and increased bone turnover markers. Possible associations between subclinical hyperthyroidism and quality of life parameters, cognition, and increased mortality rates are controversial. Prospective randomized con- trolled trials are needed to address the effects of early treatment on potential morbidities to help determine whether screening should be recommended in the asymptomatic general population.
ABSTRACT: Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology.
Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions - Putting Prevention into Practice