1/13. Case studies in osteoporosis: a problem based learning intervention for family physicians.OBJECTIVE: To develop and evaluate a practice based small group (PBSG) learning intervention on osteoporosis for primary care physicians. methods: A needs assessment on osteoporosis was performed and objectives for a continuing medical education (CME) program developed by an interdisciplinary advisory committee. Nine clinical cases were developed for evaluation by CME participants with a trained facilitator and content expert using the PBSG format. The effect of the CME intervention was evaluated using a pre and post-test consisting of objective structured clinical examination stations and standardized patients. RESULTS: Fifty-four family physicians participated in 4 pilot PBSG learning sessions. The program format, content, and participant satisfaction was highly rated (> 3.35:4.0). Participants expected the program to have a significant effect on the practices (3:40:4.0). Ninety-eight percent of participants improved their pretest scores, with a mean increase of 13% (range 1-36%). CONCLUSION: Based on our experience, we advocate the use of PBSG learning interventions as an effective and acceptable method of providing CME by rheumatologists for their family physician colleagues. This format appears to be associated with a significant effect on knowledge, skills, and behavior as assessed by our study.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Transient osteoporosis of the hip misdiagnosed as osteonecrosis on magnetic resonance imaging.A 34-year-old man developed idiopathic, bilateral, asynchronous transient osteoporosis of the hip. The symptoms included hip pain with activity, and roentgenography revealed osteoporosis of the femoral head and neck. Radionuclide bone scans showed increased uptake of the involved femoral head. magnetic resonance imaging (MRI) early after the onset of right-side symptoms was characterized by decreased signal intensity on T1-weighted images and patchy areas of increased and decreased signal intensity on T2-weighted images; this was initially interpreted as being consistent with osteonecrosis. Despite evaluation by multiple physicians and imaging methods, including MRI, the correct diagnosis of transient osteoporosis of the hip was delayed until after resolution of the syndrome. Transient osteoporosis of the hip should be included in the differential diagnosis of hip pain.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
3/13. Osteoporotic fracture of the dens revealed by cervical manipulation.Osteoporotic vertebral fractures selectively affect the thoracolumbar junction, usually sparing the cervical spine. A 65-year-old woman with documented osteoporotic fractures and chronic alcohol abuse presented with neck pain and occipital neuralgia that started after she suddenly flexed then extended her neck. Following several sessions of cervical manipulation, her pain became more severe, and she was admitted. Imaging studies showed multiple fractures in the dens, C6 and C7. These apparently spontaneous fractures suggested a bone tumor, for which investigations were negative. osteoporosis was the only identifiable cause. The spinal manipulations probably worsened the lesions which were performed by a chiropractor who is not a physician and did not obtain cervical spine radiographs before treating the patient. osteoporosis contraindicates spinal manipulation at any level, including the cervical spine.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
4/13. Maternal osteoporosis after prolonged magnesium sulfate tocolysis therapy: a case report.tocolysis therapy with magnesium sulfate is known to affect calcium homeostasis. Prolonged infusion of magnesium sulfate (MgSO(4)) has been used for the treatment of refractory preterm labor, and has been reported to change maternal calcium homeostasis and possible mineralization. In this case report, we present a woman in her mid thirties who had undergone intravenous MgSO(4) tocolysis therapy, and developed osteoporosis leading to significant morbidity after delivery. The laboratory investigation, including the bone scan, magnetic resonance image, indices of bone turnover, and the results of 2 years of follow-up of bone mineral density, are also reported. This case report supports the existence of a possible association between prolonged intravenous magnesium tocolysis and maternal osteoporosis. To prevent osteoporosis, it is important to avoid a prolonged period of MgSO(4) tocolysis. In cases of prolonged MgSO(4) treatment and bedrest, physicians should be aware of the risk of osteoporosis. The recommended management is also discussed in this report.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
5/13. Percutaneous vertebroplasty: a review for the primary care physician.The purpose of this article is to help primary care physicians who are often challenged with the management of vertebral compression fracture (VCF) by presenting clinical background and identifying candidates for percutaneous vertebroplasty, a minimally invasive procedure for treatment of VCF.- - - - - - - - - - ranking = 0.71428571428571keywords = physician (Clic here for more details about this article) |
6/13. Unilateral anterior uveitis complicating zoledronic acid therapy in breast cancer.BACKGROUND: Zoledronic acid is very widely used in patients with metastatic bone disease and osteoporosis. Only one case of bilateral uveitis was recently reported related to its use. CASE PRESENTATION: We report the first case of severe unilateral anterior uveitis in a patient with breast cancer and an intraocular lens. Following zoledronic acid infusion, the patient developed severe and dramatic right eye pain with decreased visual acuity within 24 hours and was found to have a fibrinous anterior uveitis of moderate severity The patient was treated with topical prednisone and atropine eyedrops and recovered slowly over several months. CONCLUSION: Internists, oncologists, endocrinologists, and ophtalmologists should be aware of uveitis as a possible complication of zoledronic acid therapy. patients should be instructed to report immediately to their physicians and treatment with topical prednisone and atropine eyedrops should be instituted immediately at the onset of symptoms. This report documents anterior uveitis as a complication of zoledronic acid therapy. This reaction could be an idiosyncratic one but further research may shed more light on the etiology.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
7/13. Diagnosing primary osteoporosis: it's more than a T score.Although densitometry has contributed immensely to detecting primary osteoporosis, it is only a tool that generates some useful numbers to guide diagnosis. The T score, a leading diagnostic marker for primary osteoporosis, must be put in its proper context. It is but one measurement that is quite useful in one cohort of patients, namely, postmenopausal women older than 60, but it can be misleading in others. The z score is a more descriptive measurement of bone loss in younger patients. However, both the T score and z score are limited in their diagnostic potential and must be incorporated with other diagnostic aspects, such as family history, laboratory results, and genetic influences. In the end, physicians diagnose osteoporosis, not densitometry.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
8/13. osteoporosis and asthma.OBJECTIVE: To summarize the etiology, evaluation, prevention, and management of osteoporosis in a patient with asthma and worsening osteoporosis, a problem that is frequently encountered in an allergy-immunology practice, and the incidence, risk factors, screening guidelines, and recommended prevention and treatment options for this disease. DATA SOURCES: medline was searched for relevant English-language review articles published between January 1993 and March 2006 using the keyword osteoporosis in combination with asthma or COPD (chronic obstructive pulmonary disease). Additional sources and studies cited include relevant references from the official guidelines of the national medical associations, including the National osteoporosis Foundation, the American College of rheumatology, the world health organization, and the National Institutes of Health consensus Development Panel on osteoporosis Prevention, diagnosis, and Therapy. STUDY SELECTION: The authors selected the most relevant and recent sources for inclusion in this review. RESULTS: As the population ages, osteoporosis continues to increase in prevalence and severity. Screening rates of patients at risk of osteoporosis are suboptimal. A variety of effective treatment options are available for osteoporosis prevention and therapy. CONCLUSION: patients with asthma and chronic obstructive pulmonary disease are at risk of osteoporosis, especially those patients who are treated with high doses of corticosteroids. Specialist physicians should be knowledgeable about the screening guidelines, counseling, and therapeutic options for the prevention and management of osteoporosis.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
9/13. Untreated anorexia nervosa. A case study of the medical consequences.This case demonstrates the devastating physical sequelae of 30 years of untreated anorexia nervosa. A full array of these consequences occur in this one patient and include the following: malnutrition and hypoproteinemia, electrolyte disturbances, cortical atrophy with hydrocephalus ex vacuo, tricuspid and mitral valvular dysfunction, anemia, impaired lower gastrointestinal motility, delayed gastric emptying, disturbances in the hypothalamic pituitary target organ axes, severe osteoporosis, marked edema, and extreme muscle wasting. Other possible physical sequelae of her anorexia nervosa are discussed. Psychiatrists, as well as other physicians, should be vigilant in diagnosing this illness and treating it as early as possible. This particular patient was in the medical system for numerous admissions and workups over three decades before the correct diagnosis of anorexia nervosa was made.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
10/13. Regional migratory osteoporosis. A case report and review of the literature.Regional migratory osteoporosis (RMO) is an idiopathic disorder characterized by bouts of severe periarticular lower limb pain associated with rapidly developing localized osteoporosis. Symptoms often reverse spontaneously after six to nine months. recurrence of symptoms in an adjacent joint is a distinguishing feature. Routine laboratory tests are uninformative. diagnosis is made after exclusion of more common entities. knowledge of RMO can prevent unnecessary invasive procedures. Vertebral osteoporosis has recently been associated with RMO. A 50-year-old physician developed the symptoms and signs of RMO superimposed upon well-documented idiopathic vertebral osteoporosis. This association should be recognized when evaluating lower limb pain.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
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