The American journal of medicine
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Approximately 40 in 100 women will experience one or more fractures after the age of 50 years. At 50 years for women the lifetime risk is 17.5% for hip fracture, 16% for vertebral fracture, and 16% for Colles' fracture; for men, the respective lifetime risks are 6%, 5%, and 2.5%. The incidence of hip fractures has increased in recent years in most but not all European countries, partly as a result of the aging of the population. ⋯ Determining the causes of the large geographic differences in hip fracture incidence and the large differences in sex ratios for hip fractures in European countries could lead to identification of hitherto unknown risk factors and provide clues for prevention of fractures. Many risk factors cannot be prevented or modified; however, these risk factors (for example, family history, past fracture, and visual loss) can identify risk groups amenable to drug treatment or to preventive measures such as protective hip pads or environmental changes. Assessment of risk factors and definition of risk profiles are important steps toward the prevention of fractures in the elderly.
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Hip fractures are a burden to both the individual and the community. Only 50% of patients regain the mobility and independence they enjoyed 12 months before the hip fracture occurred. Direct costs are high: about US$7,000 for the immediate hospital care and $21,000 in total costs for the first year. ⋯ Health economic models allow for changes in assumptions, such as extent of compliance, effectiveness of therapy, and risk of side effects. Cost-effectiveness varies according to treatment and is highly sensitive to the estimated efficacy of treatment, patient compliance, age of the patient at the start of treatment, and fracture risk assigned to the patient. Greater cost-effectiveness occurs when treatments are more efficacious and when they are directed at patients with the highest risk of fracture.
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Around 40% of white women and 13% of white men in the United States have at least one fragility fracture after the age of 50 years. The risk of fracture increases with advancing age and progressive loss of bone mass, and varies with the population being considered. The age-adjusted incidence of fragility fractures in both sexes is 25% lower in Britain and many areas of Europe than in the United States. ⋯ After a clinically diagnosed vertebral fracture, survival rate decreases gradually from that expected without fracture. Women with severe vertebral deformities have a consistently higher risk of back pain and height loss. An accurate assessment of the risk of fractures associated with osteoporosis and of their impact on quality of life is essential if appropriate and cost-effective interventions are to be designed for different populations.
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Recent advances in the diagnosis and treatment of medullary thyroid carcinoma (MTC) have been significant, but some issues remain controversial. MTC may occur either as a hereditary or a nonhereditary entity. Hereditary MTC can occur either alone--familial MTC (FMTC)--or as the thyroid manifestation of multiple endocrine neoplasia type 2 (MEN 2) syndromes (MEN 2A and MEN 2B). ⋯ Radiation therapy is reserved for skeletal metastasis or nonresectable metastatic MTC. Efficacy of current chemotherapy programs is not well established. Overall, the 10-year survival rates are approximately 65%.
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Although many treatments are available for genital warts caused by human papillomavirus (HPV), none are uniformly successful in the treatment of this disease. Most current treatment options work by destroying affected tissue, either by a cytotoxic or a physically ablative mode of action. Interferons have antiviral, antiproliferative, and immunomodulatory activities, but these have not translated into a high level of cure rates against warts. ⋯ A cream formulation containing 5% imiquimod resulted in good total clearance rates and generally tolerable side effects in controlled clinical trials of patients with external genital warts. Perhaps the most effective means for managing HPV disease would be a vaccine that prevents the occurrence of genital warts. Although it is unlikely that such a vaccine will be introduced in the near future, preliminary studies indicate that it may be possible to develop suitable prophylactic and therapeutic vaccines.