Prescrire international
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(1) Osteodensitometry is the standard method for measuring bone mineral density. Since the 1990s, diagnosis of osteoporosis has been defined, by convention, by a bone density T score cut-off of less than -2.5. This threshold, based on population statistics, is appropriate for the diagnosis of osteoporosis in Caucasian postmenopausal women in Europe and North America but may not be suitable for other populations. (2) To determine whether measurement of bone mineral density is useful in the prevention of fractures in postmenopausal women, we reviewed the relevant literature using our established in-house methodology. (3) Two meta-analyses of cohort follow-up studies involving tens of thousands of women showed a statistically increased risk of fracture in women with low bone density, especially in those with osteoporosis diagnosed by means of osteodensitometry. ⋯ The screening for osteoporosis in postmenopausal women, or exposing large numbers of women to the adverse effects of these drugs. (6) Severe osteoporosis in postmenopausal women is defined by the presence of both low bone mineral density and a history of fragility fractures following low-energy trauma. Alendronic acid is the best-assessed drug in these women, preventing about 3 symptomatic vertebral fractures and 1 hip fracture when 100 patients are treated for 3 years. After a first fracture, women should be asked questions designed to assess the severity of the trauma, and should undergo osteodensitometry to document osteoporosis before exposure to the potential adverse effects of bisphosphonates.
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Prescrire international · Apr 2008
0.4% glyceryl trinitrate ointment: new drug. Not useful for anal fissures.
(1) Anal fissures are very painful but often heal spontaneously. After eliminating other diagnoses, various treatments can be tried while waiting for fissures to heal: warm seat baths, local anaesthetics, and adequate fibre and fluid intake. (2) Clinical evaluation of glyceryl trinitrate 0.4% ointment, a nitrate derivative, is mainly based on a double-blind trial versus excipient in 193 adults with "chronic" fissures. ⋯ Abrupt-onset hypotension is a risk during concomitant use of other vasodilatory drugs. (5) There are no data on pregnant women exposed to glyceryl trinitrate. (6) In summary, glyceryl trinitrate 0.4% ointment does not reduce the pain linked to chronic anal fissures, but it does carry a risk of sometimes severe headache. It is best to continue using simple, non-aggressive treatments.