[Osteoporosis in the geriatric population]. / Diagnostik und Therapie der Osteoporose bei geriatrischen Patienten.

The global prevalence of osteoporotic fractures and the socioeconomic burden is increasing with aging of the population. Frailty, sarcopenia, malnutrition and a propensity to falls are contributing to osteoporotic fractures in old age with an estimated 750 000 fragility fractures per year in Germany. Despite this increasing number of fractures, osteoporosis remains underdiagnosed and undertreated in the geriatric population. In order to estimate fracture risk in elderly patients, it is important to combine bone mineral density measurement by dual-energy X-ray absorptiometry (DXA) with a problem-oriented geriatric assessment. This includes evaluation of muscle strength, walking speed, nutritional status, risk of falls, as well as cognitive function. Since age per se is the dominant fracture risk factor in women over 70 and men over 80, it is possible to omit DXA measurement in this age group, especially after an incident fragility fracture. The cornerstones of an effective fall and fracture prevention include a targeted training of strength, endurance, coordination and balance in addition to a healthy and active lifestyle. Because of the high prevalence of calcium and/or vitamin D deficiency in old age, close monitoring and appropriate substitution are essential in the management of osteoporosis in the elderly. Anti-osteoporotic drugs are effective and well tolerated in the geriatric population and should be initiated to prevent fractures in high risk cohorts and for secondary prevention. Recently, coordinator-based fracture liaison services have been shown to effectively reduce fracture risk in the high risk geriatric population.

Cardiovascular risk and hippocampal thickness in Alzheimer's disease.

Cardiovascular risk factors influence onset and progression of Alzheimer's disease. Among cognitively healthy people, changes in brain structure and function associated with high blood pressure, diabetes, or other vascular risks suggest differential regional susceptibility to neuronal damage. In patients with Alzheimer's disease, hippocampal and medial temporal lobe atrophy indicate early neuronal loss preferentially in key areas for learning and memory. We wanted to investigate whether this regional cortical thinning would be modulated by cardiovascular risk factors. We utilized high-resolution magnetic resonance imaging and a cortical unfolding technique to determine the cortical thickness of medial temporal subregions in 30 patients with Alzheimer's disease. Cardiovascular risk was assessed using a sex-specific multivariable risk score. Greater cardiovascular risk was associated with cortical thinning in the hippocampus CA2/3/dentate gyrus area but not other hippocampal and medial temporal subregions. APOE genotype, a family history of Alzheimer's disease, and age did not influence cortical thickness. Alzheimer's disease-related atrophy could mask the influence of genetic risk factors or age on regional cortical thickness in medial temporal lobe regions, whereas the impact of vascular risk factors remains detectable. This highlights the importance of cardiovascular disease prevention and treatment in patients with Alzheimer's disease.

Withdrawal phenomena and dependence syndrome after the consumption of "spice gold".

BACKGROUND: "Spice" and other herbal blends were marketed in Germany until January 2009 as substances purportedly exerting similar effects to cannabis, yet containing no cannabinoids. These products were recently forbidden in Germany under the provisions of the German Narcotics Law after they were found to contain undeclared, synthetic cannabinomimetic substances. The authors describe physical withdrawal phenomena and a dependence syndrome that developed after the consumption of "Spice." CASE PRESENTATION AND COURSE: A 20-year old patient reported that he had smoked "Spice Gold" daily for 8 months. He developed tolerance and rapidly increased the dose to 3 g per day. He felt a continuous desire for the drug and kept on using it despite the development of persistent cognitive impairment. His substance use led him to neglect his duties in his professional training position. Urinary drug screens were negative on admission to the hospital, as they were again on discharge. On hospital days 4-7, he developed inner unrest, drug craving, nocturnal nightmares, profuse sweating, nausea, tremor, and headache. His blood pressure was elevated for two days, with a maximal value of 180/90 mm Hg accompanied by a heart rate of 125/min. The patient stated that he had experienced a similar syndrome a few weeks earlier during a phase of abstinence owing to a short supply, and that it had quickly subsided after he had started consuming "Spice" once again. CONCLUSIONS: The authors interpret the symptoms and signs described above as a dependence syndrome corresponding to the ICD-10 and DSM-IV criteria for this entity. The physical withdrawal syndrome closely resembles that seen in cannabis dependence. The authors postulate that the syndrome in the patient described was due to an admixture of synthetic cannabinomimetics such as JWH-018 and CP 47497 in "Spice Gold," in combination with the patient's daily consumption in very large amounts.