Gender differences in osteoporosis screening: retrospective analysis.

INTRODUCTION: Osteoporosis is a common disease affecting 20 % of all men. It accounts for more than 1.5 million fractures yearly in the USA. Up to 20 % of patients who sustain hip fractures die within the first 12 months from related complications. The Endocrine Society recommends screening all men 70 years or older regardless of risk factors. There are little data comparing gender-specific osteoporosis screening rates. The aim of the study is to identify any gender difference in osteoporosis screening. METHODS: We conducted a retrospective study to determine the screening rates for osteoporosis in males and females in our Division of Internal Medicine, university-based outpatient clinic (UBC). Males aged 70­75 years and females aged 65­70 years with a primary care physician (PCP) at our UBC, who have had at least one routine health maintenance exam (HME) since 2002, were included. RESULTS: A total of 8,262 patients who met the age criteria were identified: 3,255 (39.4 %) males and 5,007 (60.6 %) females. Of the 3,255 male patients, 342 patients had their PCP at our UBC and had at least one HME; of those, 63 patients had DXA performed for an osteoporosis screening rate of 18.4 %. Of the 5,007 female patients, 668 patients had their PCP at our UBC and had at least one HME; of those, 402 patients had DXA performed for an osteoporosis screening rate of 60 %. CONCLUSION: Males are screened less frequently although they have a comparable prevalence of osteoporosis.

Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion.

OBJECTIVE: Tolvaptan, an oral antagonist of the vasopressin V(2) receptor, has been found to improve hyponatremia in patients with mixed etiologies. This study analyzed a subgroup of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to evaluate the efficacy and safety of tolvaptan in this group. DESIGN AND PATIENTS: Hyponatremic patients in the SALT-1 and SALT-2 studies with a diagnosis of SIADH were identified based on clinical diagnosis by individual study investigators. Subjects were randomized to receive oral placebo (n=52) or tolvaptan 15 mg daily, with further titration to 30 and 60 mg daily, if necessary, based on the response of serum [Na(+)] (n=58). RESULTS: In patients with SIADH, improvement in serum [Na(+)] was significantly greater (P<0.0001) with tolvaptan than placebo over the first 4 days of therapy as well as the entire 30-day study, with minimal side effects of increased thirst, dry mouth, and urination. Only 5.9% of tolvaptan-treated patients had overly rapid correction of hyponatremia as defined by current guidelines. After discontinuation of tolvaptan, serum [Na(+)] declined to values similar to placebo. A significant positive treatment effect favoring tolvaptan on the physical component, and a near-significant trend on the mental component, was found using the SF-12 Health Survey. Tolvaptan was associated with a significantly reduced incidence of fluid restriction. CONCLUSIONS: Results for the SIADH subgroup were analogous to those of the combined SALT population regarding efficacy and safety but demonstrated a greater improvement in the physical component of the SF-12 Health Survey than in the full mixed etiology SALT patient group.

The nonthyroidal illness syndrome.

This article briefly summarizes thyroid function alterations generally seen in the euthyroid sick syndrome, provides an overview of specific thyroidal adaptations during several clinical conditions and secondary to specific pharmacologic agents, and discusses the current controversy in thyroid hormone treatment of nonthyroidal illness.

Disorders of body water homeostasis in critical illness.

Disorders of sodium and water homeostasis are among the most commonly encountered disturbances in the critical care setting, because many disease states cause defects in the complex mechanisms that control the intake and output of water and solute. Because body water is the primary determinant of extracellular fluid osmolality, disorders of body water balance can be categorized into hypoosmolar and hyperosmolar disorders depending on the presence of an excess or a deficiency of body water relative to body solute. Because the main constituent of plasma osmolality is sodium, hypoosmolar and hyperosmolar disease states are generally characterized hy hyponatremia and hypernatremia, respectively. After a brief review of normal water metabolism, this article focuses on the diagnosis and treatment of hyponatremia and hypernatremia in the critical care setting.