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pharmacological

Obesity, Weight Loss, and Low Back Pain: An Overview for Primary Care Providers—Part 2

Obesity, Weight Loss, and Low Back Pain: An Overview for Primary Care Providers—Part 2

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

1,2Darren M. Roffey PhD; 1Simon Dagenais DC, PhD, MSc; 3Ted Findlay DO, CCFP; 4,5Travis E. Marion MD, MSc; 6Greg McIntosh MSc; 7,8Mohammed F. Shamji MD, PhD, FRCSC; 1,2,4,5Eugene K. Wai MD, MSc, FRCSC

1University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON,

3
Department of Family Medicine, University of Calgary, Calgary, AB, 4Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 5Department of Surgery, Faculty of Medicine, University of Ottawa, ON, 6CBI Health Group, Toronto, ON, 7Division of Neurosurgery, Toronto Western Hospital, Toronto, ON,

8Department of Surgery, University of Toronto, Toronto, ON.

Abstract

Obesity and low back pain are equally complex medical conditions with multi-factorial etiologies. Their clinical practice guidelines both include recommendations for screening and examination that can be easily implemented. There is sufficient information to compile a framework for the primary care provider, partnering with the patient and appropriate specialists, to manage obesity and low back pain in a structured fashion. Weight loss and exercise are paramount and should be recommended as the first options. Cognitive behavioural therapy, pharmacological treatment and bariatric surgery may then be implemented sequentially depending upon the effectiveness of the initial interventions.

Key Words: Obesity, low back pain, exercise, nutrition, cognitive behavioural therapy, bariatric surgery, weight loss, pharmacological, evidence-based guideline.

Pharmacological Prevention of Fractures

Pharmacological Prevention of Fractures

Teaser: 

Anna Liachenko, BSc, MSc

While non-pharmacological approaches are clearly beneficial for prevention of osteoporosis (OP), for many women these measures are not enough and a pharmacological treatment is required. Until early this decade, this meant one choice, hormone replacement therapy. Now, non-hormonal bisphosphonate treatments are also available. Both approaches are comparably efficient in preventing bone loss, at least on repeat bone mineral density testing. Some experts are also advocating slow-release fluoride, and combination therapy is also increasing. However, treatment choice is a complex decision which should only be made after careful consideration of the risks and benefits of each treatment, by the patient and her physician.

Before reviewing particular classes of drugs, physicians need to remember that all patients at risk for OP or with proven OP should be taking calcium and vitamin D in appropriate doses (see Fracture Prevention Part 1).