Simona Abid, MD, FRCP(C), Geriatric Medicine Fellow, McMaster University, Hamilton, ON.
Alexandra Papaioannou, MD, FRCP(C) MSc, Professor, Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON.

Vertebral compression fractures (VCF) are the hallmark of osteoporosis, yet two-thirds of all VCF remain undiagnosed and untreated. Both symptomatic and occult VCF are associated with considerable increases in morbidity and mortality, hospitalization rates, admissions to long-term care, and health care-related costs. These fractures increase the risk of future osteoporotic fractures, both vertebral and nonvertebral, independent of bone mineral density. Older adults have lower rates of diagnosis and treatment compared with younger patients, although clinical studies have shown the efficacy and safety of currently available therapies for osteoporosis in older adults are comparable with those in younger individuals.
Key words: vertebral compression fractures, osteoporosis, bone mineral density, antiresorptive therapy, anabolic agents.

Irwin W. Kuzmarov, MD, FRCSC, Assistant Professor, Department of Surgery (Urology), McGill University; Director of Professional and Hospital Services, Santa Cabrini Hospital, Montreal, QC; Past President, Canadian Society for the Study of the Aging Male.
Jerald Bain, BScPhm, MD, MSc, FRCPC, CertEndo, BA, Professor Emeritus, Department of Medicine, Department of Endocrinology and Metabolism, Mount Sinai Hospital; University of Toronto, Toronto, ON; Past President, Canadian Society for the Study of the Aging Male.

Sexuality and sexual activity do not end when a person reaches a certain age. Sexual desire and activity continue well into later life, and age is not a deterrent to a happy and healthy sex life. However, clinicians should be aware that the normal sexual response of men and women may change with aging. When sexual dysfunction occurs, studies show that men and women tend to view sexual dysfunction differently. Part I of this article addresses sexuality and sexual dysfunction in aging women; Part II ( will address the male side of the picture. It is crucial that family doctors be aware of sexuality in the aging couple, and be able to evaluate and manage problems that may arise.
Key Words: aging, sexual activity, sexual dysfunction, women, testosterone therapy.

Ekaterina Rogaeva, PhD, Associate Professor, Centre for Research in Neurodegenerative Diseases, University of Toronto, Department of Medicine, Toronto, ON.

There are at least four well-confirmed genes responsible for Alzheimer’s disease (AD), the most common form of dementia. In addition, many reports indicate an association between the disease and genetic variations in different gene candidates. The complexity and interpretation of these studies are discussed using, as an example, the recent discovery of the association between AD and the SORL1 gene. The knowledge obtained from AD genetics is applicable to many other forms of dementia, which are also genetically complex disorders and are almost all associated with the deposition of different aberrant proteins in the brain.
Key words: Alzheimer’s disease, gene, APP, APOE, SORL1.

Anita S. Bagri, MD, Geriatric Research, Education, and Clinical Center (GRECC), VA Healthcare System, Miami, FL, USA.
Bernard A. Roos, MD, GRECC, VA Healthcare System, Miami; Stein Gerontological Institute, Miami, FL, USA.
Jorge G. Ruiz, MD, GRECC, VA Healthcare System, Miami; University of Miami Miller School of Medicine, Miami; Stein Gerontological Institute, Miami, FL, USA.

Geriatrics education is severely limited by the paucity of trained educators and models of care for implementing the standardized and competency-building learning experiences that have been recognized during the past decade. Simulation can increase the reach, effectiveness, adoption, implementation, and maintenance of geriatrics education. Through simulation, educators can repeatedly present, with reduced faculty presence, standardized clinical scenarios to multiple learners with no threats to patient autonomy and safety. The knowledge-skill-attitudes elements addressed through simulation can include not only the historically well-tested technical and action skills but also individual cognitive and critical thought processes, team performance, and communication.
Key words: training, competency-based education, older adults, computer simulation, professional competence.

Sophie Robichaud, MD, FRCP(C), Medical Microbiology and Pediatric Infectious Diseases, Royal University Hospital and Saskatoon Health Region, and Departments of Microbiology and Immunology and Pathology, University of Saskatchewan, Saskatoon, SK.
Joseph M. Blondeau, MSc, PhD, RSM(CCM), SM(AAM), SM(ASCP), FCCP, Head of Clinical Microbiology, Royal University Hospital and Saskatoon Health Region, and Adjunct Professor of Microbiology and Immunology, Clinical Assistant Professor of Pathology, Departments of Microbiology and Immunology and Pathology, University of Saskatchewan, Saskatoon, SK.

Urinary tract infections (UTIs) are the most common infectious problem among older adults both in the community and institutional settings. With the expected increase in this population, UTI-related costs--both human and financial--will rise in a parallel fashion. The diagnosis of symptomatic UTI among older adults is complicated by the high prevalence of asymptomatic bacteriuria, which does not require any treatment, and the difficulty in interpreting the signs and symptoms of UTI in a population in which significant comorbidities can undermine the communication between the patient and the medical team. Another important issue is the constant increase in antimicrobial resistance, especially in long-term care facilities, where antimicrobial use is greater than in the community. Newer agents are now available for the treatment of UTI among older adults, targeting both the usual and the multiresistant uropathogens. Rational use of antimicrobials in the treatment of UTI in the older adult is important to both provide appropriate care and control the spread of resistant organisms in this population.
Key words: urinary tract infection, older adults, UTI management, antimicrobials.

M. Bachir Tazkarji, MD, CCFP, CAQ Geriatric Medicine, Lecturer, Family Medicine Department, University of Toronto, Toronto, ON; Toronto Rehabilitation Institute, Toronto; Family Physician, Summerville Family Health Team, Mississauga, ON.

Arterial hypertension is one of the most important and preventable causes of death worldwide; therefore, adequate treatment of high blood pressure should be mandatory for patients with hypertension. Hypertension is defined on the basis of systolic and diastolic blood pressure levels and classified into stages on the basis of the degree of elevation. Normal blood pressure is widely considered as being less than 120/80 mm Hg. The presence of risk factors such as elevated blood cholesterol, smoking, diabetes, and obesity greatly increases the risk for hypertension-related morbid events.
Cardiovascular disease and stroke disproportionately affect older adults. Blood pressure is a potent modifiable target for reducing the risk for stroke and cardiovascular morbidity and mortality in older adults. In clinical trials, the number needed to treat to prevent one cardiovascular death was 79, one fatal or nonfatal stroke was 48, and one fatal or nonfatal coronary event was 64.
Key words: blood pressure, myocardial infarction, CVA, cardiovascular risk, older adults.

Mohammed O. Rahman, BHSc student, McMaster University, Hamilton, ON.
Aliya Khan, MD, FRCPC, FACP, FACE, Professor of Clinical Medicine, McMaster University, Hamilton, ON, Director, Calcium Disorders Clinic, St. Joseph’s Healthcare, Hamilton; Director, Oakville Bone Center, Oakville, ON.

Osteoporosis is a skeletal disease characterized by impaired bone strength and an increased risk of fragility fracture. Effective screening should be aimed at evaluating risk factors for osteoporosis with identification of individuals at risk, allowing for intervention prior to fragility fracture. This article presents an overview of the risk factors for fracture in men and women and the integration of these factors in various models, enabling an assessment of the 10-year fracture risk. Through effective screening, early identification, and early intervention with pharmacological therapy of osteoporosis, significant impact can be made on reducing fragility fracture incidence, thereby alleviating the economic and clinical costs to our health care system.
Key words: osteoporosis, screening, risk factors, diagnosis, FRAX.

Cathy R. Kessenich, DSN, ARNP, Professor of Nursing, University of Tampa, Tampa, FL, USA.
Darlene A. Higgs, RN, BSN, Nurse Practitioner Student, University of Tampa, Tampa, FL, USA.

Osteoporosis is a major cause of health problems in residents of long-term care facilities. It often results in bone fracture, causing poor quality of life and a national financial burden. As the population ages, the incidence of osteoporosis and its consequences increase. It is essential to employ fracture-prevention strategies that have proven most beneficial in long-term care settings and those tailored to promote adherence among older adults. This article reviews osteoporotic treatment appropriate for individuals in long-term care, including treatment through pharmacology, nutritional support, fall prevention, and hip fracture prevention.
Key words: osteoporosis, long-term care, hip protectors, fall prevention, vitamin D.

Angela G. Juby, MD, Associate Professor, Department of Medicine, Division of Geriatrics, University of Alberta, Edmonton, AB.
David A. Hanley, MD, Professor, Department of Medicine, Division of Endocrinology and Metabolism, University of Calgary, Calgary, AB.

Low bone density is major risk for osteoporotic fracture. In older adults special precautions apply in interpreting bone mineral density measurements (either by central dual energy X-ray absorptiometry [DXA] or peripherally with calcaneal ultrasonography). Clinical assessment for vertebral fractures is an important part of the management. Therapeutic regimes for osteoporosis treatment are complicated and require repeated reinforcement to ensure long term compliance. Adequate compliance (80%) is required for optimal therapeutic benefit.
Key words: calcaneal ultrasonography, central dual energy x-ray absorptiometry (DXA), bone mineral density (BMD), older adult, special precautions.