In a randomized, placebo- and active-controlled trial involving 2463 postmenopausal women with osteoporosis, Miller and colleagues compared treatment with subcutaneous abaloparatide—a novel selective activator of the parathyroid hormone type 1 receptor—with placebo or open-label teriparatide for the prevention of new vertebral fractures. The authors report that compared with placebo, use of abaloparatide reduced the risk of new vertebral and nonvertebral fractures over 18 months. In an Editorial, Cappola and Shoback discuss treatment to reduce fracture risk among postmenopausal women.
Genetic testing of prospective parents to detect carriers of inherited recessive diseases has been based in part on self-reported racial and ethnic background. Haque and colleagues assessed the performance of expanded carrier screening in a retrospective cohort of 346 790 adults of diverse racial and ethnic backgrounds and without known indication for genetic testing. The authors found that compared with current recommendations, expanded (pan-ethnic) carrier screening may increase the detection of carrier status for potentially serious genetic conditions. In an Editorial, Grody discusses a cautious approach to advances in prenatal genetic testing.
Using a simulation model of cardiovascular disease in US adults, Kazi and colleagues estimated the cost-effectiveness of adding proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy to current statin therapy for patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease. The authors found that the addition of PCSK9 inhibitor therapy to statins would prevent major adverse cardiovascular events; however, assuming 2015 prices, PCSK9 inhibitor use in these patient populations did not meet the generally acceptable incremental cost-effectiveness threshold of $100 000 per quality-adjusted life-year.
Author Video Interview and CME
Acute aortic syndromes, including aortic dissection and intramural hematoma, are uncommon but potentially fatal. Mussa and colleagues report results of a systematic review of the evidence from 2 randomized trials and 80 prospective cohort studies (57 311 patients) relating to the diagnosis and treatment of acute aortic syndromes. The diagnosis should be considered in patients presenting with acute chest or back pain and hypertension. Computed tomography, magnetic resonance imaging, and transesophageal echocardiography are reliable tools for diagnosis. Dissection or intramural hematoma of the ascending aorta requires open surgical repair. For acute aortic syndromes in the descending aorta, the data suggest that early mortality is lower with medical or endovascular management compared with open surgery.
This inaugural article in a new JAMA series, JAMA Professionalism, considers the professional responsibility to disclose medical errors to patients. Levinson and Ginsburg present a case in which a dermatologist performed skin biopsy procedures on 2 patients and shortly thereafter discovered the biopsy instruments used had not been sterilized. What should the physician tell the patients? An Editorial by Livingston and colleagues introduces the article series and highlights the multifaceted nature of medical professionalism—a learned competency developed over time and refined with practice.
Editorial and Related Article
Use of insect repellents is recommended to prevent mosquito-borne and tickborne diseases. This Medical Letter on Drugs and Therapeutics article summarizes information about commonly available insect repellents, including their efficacy, associated adverse effects, and safety when used on children or during pregnancy.
Highlights. JAMA. 2016;316(7):685-687. doi:10.1001/jama.2015.14432