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April 28, 2008

Considering Competing Risks . . . Not All Black and White

Arch Intern Med. 2008;168(8):793-795. doi:10.1001/archinte.168.8.793

The world is not black and white. More like black and gray. —Graham Greene

Osteoporosis and type 2 diabetes mellitus (DM), 2 of the most common chronic conditions, represent major public health burdens. The lifetime risk of an osteoporotic fracture ranges from 40% to 50% in women and from 13% to 22% in men.1,2 The goal of osteoporosis treatment is to reduce fractures because fractures cause significant morbidity and mortality. Diabetes mellitus affects 7% of the US population, or 20.8 million people.3 The goal of glucose-lowering treatment is to reduce long-term microvascular and macrovascular complications of the disease. Pharmacologic options for the treatment of osteoporosis and type 2 DM have expanded exponentially during the past decade.4,5 Trials in osteoporosis have demonstrated a reduction in risk of fracture with pharmacologic treatment. Trials in type 2 DM have demonstrated improvement in glycemic control with treatment. However, most trials have not been designed to determine the effect of treatment on risk of macrovascular outcomes (myocardial infarction and stroke). The decision to treat an individual patient with a given medication for a specific condition should be made with consideration of the risks associated with no treatment and of the benefits, risks, and adverse effects of each therapy.

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