is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.
Abstract:Osteoporosis (OP) is the leading cause of hip fractures in patients. Primary prevention focusses on engaging in strategies that prevent the development of osteoporosis. Physicians often provide health information to patients on how to optimize their overall wellness, and therefore, ought to educate patients on bone health as well. Offering advice on specific interventions that decrease the risk of developing OP is an effective way to engage patients in maintaining peak bone mass. Physicians should counsel patients on key points such as dietary modifications, physical activity, and decreasing the use of alcohol and smoking. Setting mutual goals with patients and ensuring that they understand the positive impact this will have on their health is critical.
Key Words: Osteoporosis, bone health, health promotion, primary prevention, education.
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1) Educating patients about methods to decrease the risk of osteoporosis is a critical role of the physician, as peak bone mass develops in early adulthood
2) CALCIUM (see figure 4) is a mnemonic that can help physicians recall what strategies they can address with patients: calcium/vitamin D intake, aerobic activities, limit alcohol, cut down on smoking, increase balance, use supplements if indicated, and maintain a healthy weight
3) Physicians should provide patients with resources and referrals if appropriate to ensure patients receive adequate information/support in promoting their bone health
Patients should be advised that a vitamin D supplement is required to obtain the 1000-2000 IU daily requirement
A calcium supplement is not always indicated if dietary intake is adequate
Both aerobic and weight-bearing activities are essential for OP prevention
Smoking cessation and limiting alcohol are also factors that impact bone health
Patients should be encouraged to mutually set goals around bone health with their physicians, as this increases the likelihood that their behaviour changes will be successful
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Critical Appraisal of Articles on Preventive Health Care
Teaser:
Christopher Patterson, MD, FRCPC, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON. John W. Feightner, MD, MSc, FCFP, Chair, Canadian Task Force on Preventive Health Care; Department of Family Medicine, Faculty of Medicine, University of Western Ontario, London, ON.
The ultimate aim of critical appraisal is to decide whether the conclusions of an article are helpful in the prevention or management of illness in your patients. This requires the article to be relevant to your practice and to contain sufficient information to determine if the conclusions are supported by the evidence within it. We offer approaches to the appraisal of different types of publications addressing primary and secondary prevention. Key words: prevention (primary, secondary), clinical research, critical appraisal, clinical practice guidelines.
Diagnosis and Management of Impaired Glucose Tolerance and Impaired Fasting Glucose
Teaser:
Shobha Rao, MD, Assistant Professor, Department of Family Practice and Community Medicine, UT Southwestern, Dallas, TX, USA.
Impaired glucose tolerance and impaired fasting glucose (prediabetes) form an intermediate stage in the natural history of diabetes. People with prediabetes are at high risk for developing diabetes and thus are a key target group for primary prevention of the disease. A structured program of lifestyle interventions that includes weight loss and regular exercise has demonstrated benefit in delaying or preventing diabetes among people with prediabetes. Lifestyle interventions are most effective. Pharmacotherapy with metformin, acarbose, orlistat, and thiazolidinediones has also shown success in preventing diabetes, although cost effectiveness of these agents in managing prediabetes has not been assessed.
Prevention of Diabetes in High-risk Patient Populations, With Application to the Older Population
Teaser:
Ellie Chuang, MD and Mark E. Molitch, MD, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
The worldwide prevalence of diabetes is expected to double to 300 million people by 2025, and nearly 40% of those currently diabetic are older than 65 years. In those who are at high risk for diabetes, including older adults, intervention with diet and exercise has been shown to markedly reduce the development of diabetes. Medications such as metformin, acarbose, troglitazone, pravastatin, ramipril, losartan and estrogen/progestin also have been shown to be effective, although benefits in older patients have not always been demonstrated. Implementation of lifestyle changes in people of all ages could dramatically reduce the size of the developing diabetes epidemic. Key words: diabetes, primary prevention, impaired glucose tolerance, impaired fasting glucose, older adults.
