Geriatrics
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Several recent medical articles have described multiple cases of unusual low-impact subtrochanteric stress fractures or completed fractures of the femur in patients who have been on the bisphosphonate alendronate for several years for osteoporosis or osteopenia. Some patients have experienced such fractures in both femurs. ⋯ In patients with atypical or low-impact fractures of the femoral shaft, consider the possible connection with alendronate use. Some bone specialists now recommend stopping alendronate in most patients after 5 years.
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This century will bring an explosion in the geriatric population aged 65 and older, with those over 80 the fastest growing group. Falls, vehicle collisions, burns, and abuse are traumatic events that our geriatric patients may be susceptible to and from which they may not recover. Primary care providers should enhance their understanding of the complex issues of geriatric trauma to facilitate prevention and to assist the patient's recovery to normal function, addressing barriers such as immobility, pain, malnutrition, and acute confusion. Improved outcomes require combined efforts of disciplines and specialties intervening for optimal management for older trauma patients from pre-hospital care through rehabilitation or end-of-life issues.
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Varicella zoster virus (VZV) is the etiologic agent of varicella and herpes zoster (HZ) in humans. Herpes zoster is the result of reactivation of VZV within certain sensory ganglia. The burden of illness from HZ and post-herpetic neuralgia (PHN) is high. ⋯ Reported side effects are mild and generally limited to localized injection site findings. Herpes-zoster vaccine reportedly decreases the occurrence of herpes zoster by approximately 50 percent and prevents the development of PHN by two thirds. The vaccine appears to be minimally effective in those individuals over the age of 80 and is not recommended in this age group.