Summary
Whether in-hospital management of patients with newly identified vertebral fractures leads to a higher rate of osteoporosis medication than delayed outpatient management remains unknown. Our ...study showed that early osteoporosis therapy initiation in a fracture liaison service during hospital stay was a more efficacious strategy for secondary fracture prevention.
Introduction
Fracture liaison services are standard care for secondary fracture prevention. A higher rate of osteoporosis treatment initiation may be considered when introduced in the hospital rather than an outpatient recommendation to a primary care physician (PCP). Whether this applies to patients with newly detected vertebral fractures in a general internal medicine ward remains unknown. We prospectively investigated whether in-hospital management of newly identified vertebral fractures led to a higher rate of osteoporosis medication initiation and persistence at 3 and 6 months than delayed outpatient management by a PCP.
Methods
We conducted a prospective study including hospitalized patients > 60 years systematically searched for asymptomatic vertebral fractures on lateral chest and/or abdominal radiographs. Patients were included either in phase 1 (outpatient care recommendations on osteoporosis management to a PCP) or in phase 2 (inpatient care management initiated during hospitalization). The percentage of patients under osteoporosis treatment was evaluated by telephone interview at 3 and 6 months
.
Results
Outpatients’ (84 with fracture/407 assessed (21%); 75.7 ± 7.7 years) and inpatients’ (100/524 (19%); 77.8 ± 9.4 years) characteristics were similar. Osteoporosis medication was more often prescribed in inpatients at 3 (67% vs. 19%, respectively;
p
< 0.001) and 6 months (69 vs. 27%, respectively;
p
< 0.001). The percentage under treatment was also higher in inpatients than in outpatients at 3 (52 vs. 19%,
p
< 0.001) and 6 months (54 vs. 22%,
p
< 0.001). Length of stay and destination post-discharge were not different between groups.
Conclusions
Early patient management after a newly detected vertebral fracture during hospitalization was a more efficacious strategy of secondary fracture prevention than delayed outpatient management following discharge.
As a result of a huge effort of the international community, the burden of malaria dropped impressively during the last decade. One of the reasons is probably the availability of effective and safe ...treatments such as artemisinin derivatives. However, along with the greater use of intravenous artesunate recently in severe malaria, as recommended by the World Health Organization, a new adverse event has been described: post-artesunate delayed haemolysis (PADH). It appears after the end of the treatment in a phase of clinical improvement. Even though several causes may act as co-factors, the mechanism of pitting of the infected erythrocytes is most probably the main explanation. After the description of four PADH cases, we hereby present a short review of the current knowledge on this problem.
Cardiovascular diseases are the first cause of death in women, while cancers come second. Increased tobacco use in women causes a higher incidence of both lung cancer and cardiovascular diseases. The ...end of the hormonal substitution, since it was identified as increasing breast cancer risk, has produced a decreased incidence of the later, while cardiovascular diseases keep increasing after menopausal. These examples highlight the necessity of medical studies taking into consideration women specificities, as well as of an individual weighting of risk factors by physicians.
In an era in which primary and secondary prevention have important implications for public health and health care costs, a series of publications and guidelines give added weight or precision to ...current medical practice in the fields of hospital based internal medicine. This article presents a selective review of new guidelines and therapeutic options for areas of cardiovascular disease, pulmonary disease, gastroenterology and oncology.
This review of articles published in 2011 covers a large spectrum of topics that are of interest for the practice of general internal medicine and of primary care. Authors discuss public health ...issues, such as sleep disorders and their relationship with subsequent weight disorders, and the benefits of commercial weight reduction programs. Clinical topics, such as the management of victims of sexual violence and screening strategies for lung cancer, streptococcal pharyngitis, functional bowel disorders and hypertension in ambulatory settings are also reviewed. Besides, authors cover therapeutic issues, such as the treatment of hand arthritis with chondroitin sulfate and the management of plantar warts with salicylic acids and cryotherapy.
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