Statin lipid-lowering drugs appear to increase bone formation and reduce
bone resorption in animal studies, but whether they reduce the risk of bone
fractures in older adults is not known. Based on a case-control analysis of
data from a population of 91,611 individuals aged at least 50 years in the
UK General Practice Research Database, Meier and colleaguesArticle found that the
total fracture risk among individuals using statins was 45% lower than among
individuals not using lipid-lowering drugs. In a second case-control study
among 6110 individuals aged 65 years or older, Wang and colleaguesArticle found that
use of statins was associated with a 43% to 50% reduction in hip fracture
risk. Use of lipid-lowering drugs other than statins was not associated with
reduction in fracture risk in either study. In an editorial, Cummings and
BauerArticle point out that the association between reduction of bone fracture risk
and statin use suggested by these observational studies must be confirmed
in randomized clinical trials before statins are prescribed to prevent fractures.
Recommendations for the detection and treatment of prostate cancer may
differ depending on the specialty of the physician who is consulted. In this
1998 mail survey of US urologists and radiation oncologists, Fowler and colleaguesArticle
found that urologists and radiation oncologists agreed on several beliefs
and practices regarding prostate cancer detection and management. For most
tumor grades and prostate-specific antigen levels, however, urologists were
more likely to recommend radical prostatectomy than external beam radiation,
and radiation oncologists were more likely to recommend external beam radiation
than radical prostatectomy. In an editorial, WiltArticle discusses the important
role of primary care physicians in helping patients with prostate cancer understand
To determine whether treatment and mortality differ among patients with
acute myocardial infarction (MI) who present without chest pain compared with
patients with chest pain, Canto and colleagues analyzed data from 434,877
patients with confirmed MI enrolled in the National Registry of Myocardial
Infarction 2 from June 1994 to March 1998. Thirty-three percent of patients
in the registry did not have chest pain on presentation to the hospital. Compared
with patients with MI who presented with chest pain, those without chest pain
had longer delays before hospital presentation, were less likely to be diagnosed
as having acute MI on initial evaluation or to receive thrombolysis or primary
angioplasty, and had greater in-hospital mortality.
Management of common medical conditions in older individuals is complicated
when dementia is also present. Brauner and coauthors present a case study
of a patient with probable Alzheimer disease and osteoporosis and 2 composite
vignettes to illustrate how dementia-related decreased cognition, communication
difficulties, and reduced life expectancy alter the risk-benefit ratio and
goals of routine care for coexisting medical illnesses.
Ms C, a woman with severe obesity that began in adolescence, continued
to gain weight despite many attempts at weight loss with a variety of interventions.
She is being treated in a comprehensive weight loss program with a combination
of diet, exercise, and phentermine, and lost 14.5 lb after 3 months in the
program. Atkinson discusses etiology and complications of obesity and medical
and surgical treatments.
"Oh, no! I thought to myself. What if he asks me a question that, in
order to be answered, requires that I understand fully the connection between
valvular heart disease and shopping?" From "The Patient's Heart."
A review of recent studies on the treatment of hypertension in patients
with diabetes mellitus.
Health care professionals who believe that investigators have tended
to ignore the growing problem of heart disease and stroke in women met at
the first international conference on the subject to plan research efforts.
A summary of key recommendations in the updated clinical practice guideline
for treatment of tobacco use and dependence recently published as a US Public
Health Service Report.
For your patients: Information on treatment of tobacco dependence.
This Week in JAMA. JAMA. 2000;283(24):3165. doi:10.1001/jama.283.24.3165