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General practitioner's section
 
Do not Diagnose Osteoporosis in Male Patients Unless The Following Three Conditions are Excluded
O P Kapoor
 

Osteoporosis is a disease mainly of menopausal females. It is especially common among those who have a family history of fracture with minimal trauma. Therefore, do not diagnose osteoporosis in males (except above the age of 80) unless the following three conditions are excluded:

  1. Patients using drugs, which are known to cause osteoporosis. These include very commonly used drugs like steroids, dilantin, etc.
  2. Serum Protein Electrophoresis should always be asked for to exclude multiple myeloma, which can mimic osteoporosis and is a fairly common condition.
  3. Hyperparathyroidism must be excluded by asking for Serum Calcium and PTH levels.

Although in literature, secondary carcinomatous deposits have also been mentioned and are known to mimic osteoporosis, I have yet to come across such cases in my practice.
 

GASTRIC ACID SUPPRESSION IS ASSOCIATED WITH INCREASED RISK OF PNEUMONIA

Current use of drugs that suppress gastric acid, including H2 receptor antagonists and proton pump inhibitors, is associated with a slightly increased risk of community acquired pneumonia. Higher doses of PPIs are associated with increasing risk. The risk is very low, and patients currently taking these drugs can be equally well controlled with a reduced dose or by stopping treatment altogether.

JAMA 2004; 292 : 1955-60..

PRESCRIBE NSAIDs FOR OSTEOARTHRITIS OF THE KNEE CAUTIOUSLY

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce short term pain in osteoarthritis of the knee slightly better than placebo, but there is no evidence of long term benefit. In a meta-analysis of randomised, placebo controlled trials, Bjordal and colleagues analysed data on change in the overall intensity of pain for 7807 patients taking NSAIDs and 3038 receiving placebo. Given the serious adverse effects of NSAIDs, they recommend only limited use of these drugs in osteoarthritis of the knee.

BMJ, 2004; 329 : 1317.