Osteoporosis in men causes significant morbidity and mortality. The Endocrine Society released clinical practice guidelines (CPG) for management of this condition in men. ‘Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline.’
Osteoporosis is a silent disorder characterised by reduced bone strength predisposing to increased fracture risk. Approximately 20 percent of Americans with osteoporosis or low bone density are men and studies show this condition increases mortality rates in men between the ages of 50 and 69. Risk factors for osteoporosis in men include low body weight, prior fracture as an adult and smoking.
‘For men age 50, one in 5 will experience an osteoporosis-related fracture in their lifetime,’ said Nelson Watts, MD, of Mercy Health Osteoporosis and Bone Health Services in Cincinnati, OH and chair of the task force that authored the CPG. ‘Mortality after fracture is higher in men than in women. Of the 10 million Americans with osteoporosis, 2 million are men. Of the 2 million fractures due to osteoporosis that occur each year, 600,000 are in men.’
Recommendations from the CPG include:
Men at higher risk for osteoporosis (including men aged 70 years or older and men between the ages of 50 and 69 who have risk factors) should be tested using dual-energy x-ray absorptiometry (DXA);
Men with low vitamin D levels [<30 ng/ml] should receive vitamin D supplementation to achieve levels of at least 30 ng/ml; Pharmacologic treatment should be given to men aged 50 or older who have had spine or hip fractures and men at high risk of fracture based on low bone mineral density and/or clinical risk factors; Clinicians should monitor bone mineral density by DXA at the spine and hip every one to two years to assess the response to treatment; and Men who are at risk for osteoporosis should consume 1000

A Kansas State University professor’s research improving post-surgery pain treatment and osteoarthritis therapy in dogs may help develop better ways to treat humans for various medical conditions.
From the use of hot and cold packs to new forms of narcotics, James Roush, professor of clinical sciences, is studying ways to lessen pain after surgery and improve care for small animals, particularly dogs. He is working with the clinical patients who come to the College of Veterinary Medicine’s Veterinary Health Center.
Because humans and dogs experience some diseases in similar ways, his research may improve how doctors and physicians understand human health, too.
‘Several of our projects have human applications, particularly one involving intra-articular prolotherapy,’ Roush said.
Here’s a closer look at three of Roush’s current projects:
* A recent project with Ralph Millard, former Veterinary Health Center resident, focuses on ways that hot packing and cold packing affect tissue temperature in beagles and beagle-sized dogs after surgery.
After surgery in both humans and dogs it is common to put a cold pack or hot pack on tissue to prevent and reduce swelling. How long the pack is used and what type of cold or hot pack is used depends on the type of injury and surgery. Roush said that no studies have looked at how deep in the tissue the packs affect temperature and how long the packs must be applied so that the tissue reaches a desired temperature.
The researchers studied the temperature and tissue depth that hot and cold packing affected and the time it took to reach that temperature.
‘We found that you don’t really need to cold pack anything longer than 10 minutes because there is not a great change in temperature after that,’ Roush said.
When tissue is cold packed, it will stay cold for a while after the ice pack is removed. But when tissue is hot packed and the pack is removed, the tissue temperature will return to normal much more quickly. Leaving the hot or cold pack on the tissue longer than 10 minutes will extend the time that the tissue stays at the same hot or cold temperature, Roush said. There just will not be a great change in temperature after 10 minutes.
The same technique of hot and cold packing after surgery is also used in humans. Although more research in humans is needed, Roush said there is a strong possibility that a similar 10-minute time frame for hot and cold packing may apply to humans as well.
For another project, Roush and Matt Sherwood, Veterinary Health Center resident, are using a mat system to study lameness and osteoarthritis in dogs. When dogs step on the mat, it measures the pressure in their step.
The mat system is a useful clinical tool for evaluating and developing treatment of lameness, Roush said. Roush and Sherwood are using the mat for measuring lameness and determining in which leg the lameness is worse.
‘We’ve designed the study to help improve osteoarthritis treatment,’ Roush said. ‘We will also use it to measure clinical patients when they come in for regular checkups. We can measure their recovery and a variety of other aspects: how they respond to non-steroidal anti-inflammatories, how they respond to narcotics or how they respond to a surgical procedure that is designed to take that pressure off the joint.’ Kansas State University

Only in certain cases are recurrences detected more reliably than with conventional techniques. Due to the lack of studies, there is currently no proof that patients with ovarian cancer can benefit from positron emission tomography (PET) alone or in combination with computed tomography (CT). As regards diagnostic accuracy, in certain cases, recurrences can be detected earlier and more accurately with PET or PET/CT than with conventional imaging techniques. This is the conclusion of the final report by the German Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne that was published on 23 May 2012.

Ovarian cancer is the fifth most common malignant tumour in women. Every year 15.9 women in every 100,000 are diagnosed with the disease in Germany and it claims the lives of 8 in 100,000 women per year. Since the ovaries lie deep in the abdomen and an ovarian tumour normally causes no symptoms for a long time, it is often only discovered at a late stage.

Many experts hope that an investigation using PET or PET/CT alone or in combination with other methods would be better able to distinguish between benign and malignant tumours when ovarian cancer is suspected. It could also help classify cancerous tumours into the correct stage, make it easier to assess whether they respond to treatment and to show earlier and with greater certainty whether a recurrence or secondary tumour (metastasis) has occurred. This information should then enable patients to be given better treatment recommendations.

IQWiG therefore searched the international literature for studies investigating the effects of diagnosis using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of this research – and an appropriately tailored treatment – could contribute to patients having better chances of survival, spare them unnecessary operations or other diagnostic procedures, or improve their quality of life. However, the search for such studies was unsuccessful, so the question as to the patient-relevant benefit of PET or PET/CT had to remain unanswered.

In addition, IQWiG searched for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT were compared with other diagnostic methods. The basic question is how often a PET investigation gives a correct result. On the one hand, it should overlook true, cancerous tumours as rarely as possible, but on the other, it should not awake any false suspicions.

The results of a total of 40 individual studies on this topic were evaluated. However, these studies permit a robust conclusion only in respect of the detection (or exclusion) of a recurrence, where PET or PET/CT appears to be more reliable than other methods. Nevertheless, it remains unclear whether this only applies to patients in whom symptoms (e.g. pain) have already occurred, or also to those in whom routine screening has shown an abnormal blood test result. This is because only very few studies give precise details on this point.

Since even the above patients have not been investigated to determine whether the higher test accuracy of PET or PET/CT has positive effects on mortality, the burden of disease or the quality of life, IQWiG assumes that a patient-relevant benefit of PET or PET/CT is not proven. For instance, it is particularly questionable whether a recurrence detected by PET or PET/CT can actually be better treated – and the patient thereby has a noticeable advantage.

It is therefore essential that doctors fully inform their patients not only of the possible benefits in the form of an earlier diagnosis, but also of the possible harms. The latter can arise from an earlier start to second-line treatment associated with considerable side effects, but not with a prolongation of survival. Hence studies are urgently needed to investigate the patient-relevant benefit of PET or PET/CT in the diagnosis of ovarian cancers in direct comparison with conventional diagnostic techniques.

The ‘bubble’ at the top of the picture is a tumour growing on Leyna’s mouth
Surgeons have removed a tumour from the mouth of a foetus, in what has been described as a ‘world first’ procedure.
After a scan at 17 weeks, mother Tammy Gonzalez said she ‘could see a bubble’ coming out of her baby’s mouth. Doctors said it was a very rare tumour called an oral teratoma and there was little chance her daughter would survive.
After the pioneering operation, baby Leyna was born five months later.
Doctors at the Jackson Memorial Hospital in Florida, said this type of tumour was so rare it had been seen only once in 20 years at the hospital.
In the procedure, Mrs Gonzalez was put under a local anaesthetic as a needle was pushed through the protective amniotic sac around the foetus.
A laser was then used to cut the tumour from Leyna’s lips. The operation lasted just over an hour.
Tammy told a press conference in Miami: ‘When they finally severed the whole thing off and I could see it floating down, it was like this huge weight had been lifted off me and I could finally see her face.’
She described the surgeons as ‘saviours’.
The doctors said: ‘To our knowledge, this is the first successful treatment of a foetal oral teratoma in utero.’ Leyna Mykaella Gonzalez was born in October 2010 weighing 8lb 1oz. She is now a healthy 20-month-old child.
The only sign of her life-saving surgery is a tiny scar on her mouth. BBC