AFP Clinical Answers
Osteoporosis, Childhood Bullying, Rheumatoid Arthritis, Diabetes Counseling, Inhaled Steroids
Am Fam Physician. 2019 Mar 15;99(6):356.
What therapies are recommended for osteoporosis?
According to the American College of Physicians, alendronate, risedronate, zoledronic acid, and denosumab reduce risk of hip, nonvertebral, and vertebral fracture in women with osteoporosis. Pharmacologic treatment should continue for five years. Hormone therapy with estrogen or estrogen/progestogen, or raloxifene should not be used to treat women with osteoporosis. Current evidence does not indicate benefit of bone mineral density monitoring during pharmacologic treatment.
How should childhood bullying be evaluated?
Physicians should ask about bullying when children present with multiple somatic problems, school avoidance, or incidents of self-harm. Questions about their online lives should be included in the history for children and adolescents. Patients who are being bullied or are identified as bullies should be screened for psychiatric comorbidities.
How should rheumatoid arthritis be treated?
Patients with rheumatoid arthritis should be treated as early as possible to have the best chance of remission. Methotrexate should be the first-line disease-modifying antirheumatic drug in patients with rheumatoid arthritis unless there are contraindications. Patients who are in remission from rheumatoid arthritis for more than six months and on stable medication regimens are candidates for tapering or discontinuing disease-modifying antirheumatic drugs or biologic treatment.
Does counseling by a diabetes educator improve A1C levels in patients with type 2 diabetes mellitus?
Counseling by a diabetes educator or a team of educators delivered in a variety of formats may reduce A1C levels by 0.2% to 0.8% compared with usual care alone. Diabetes educators should be considered for patients who have higher baseline A1C levels (8% to 9%) because this group had greater improvement in glycemic control after d
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