geoffrey modest medical blogs

A brief report looked at the frequency of screening and treatment of osteoporosis after a stroke (see stroke bone density stroke2019  in dropbox, or DOI: 10.1161/STROKEAHA.118.024685) Details: -- Data-mining from the Ontario Stroke Registry of patients >65 yo seen at one of 11 regional stroke centers in Ontario, linked to physician claims database to identify those who had bone mineral density testing (BMD) or medication prescriptions for fracture prevention within one year post-stroke, from 2003-2013 -- exclusions: those in long-term care facilities -- 16,581 patients identified: 77% female, 78 yo, 88% ischemic stroke/12%intracerebral hemorrhage, severe stroke 13%/moderate 20%/mild 67%, prior fracture 10%, prior BMD 27%, prior osteoporosis med 18%, dementia 15% -- 1-yr outcomes after stroke:     -- fracture rate 4%     -- falls 10%     -- mortality 20% Results: -- 846 (5.1%) had a BMD done, and 2575 (15...

a recent article, which got some general press, looked at the utility of exercise and/or vitamin D in fall prevention in older women (see  vit d not prevent falls jama int med 2015  in dropbox, or JAMA Intern Med. 2015;175(5):703-711). The backdrop here is that falls are common in the elderly, and 20% lead to injury requiring medical attention. a systematic review and meta-analysis documented the benefit of vitamin D (see  vit d and falls metanalysis 2011  in dropbox, or J Clin Endocrinol Metab, October 2011, 96(10):2997–3006), finding that in 26 studies with 46K people (majority elderly women), vitamin D was associated with 14% decreased risk of falls (47% in those vitamin D deficient, 10% in those not deficient, and both statistically significant), and this was especially true in patients who had calcium co-administered with the vitamin D. The US Preventive Services Task Force (USPSTF) in 2012 " recommends exercis...