June 27, 2008

Osteoporosis, Weight and CFS

By Hunter, Suzanne

JOURNALS WATCH Too busy to catch up on the latest research? Let Dr Suzanne Hunter update you on recent papers

Genetic screening for osteoporosis

Lancet 2008; 371:1,505-12

Osteoporosis causes significant morbidity and mortality. It has long been recognised that there is a strong hereditary basis for osteoporosis.

The aim of this study was to identify genetic loci that are associated with bone mineral density. The international team identified two genes that were associated with increased osteoporotic fracture.

The genes were present in more than one in five white people (the cohort examined). The presence of these genes indicated a risk similar to other known risks, such as low body weight, family history or steroid use.

The authors conclude that with further research this couldbeusedasabasisfor population screening.

Childhood chronic fatigue syndrome

Arch Dis Child 2008; 93: 419-22

The purpose of this study was to describe the characteristics of children under the age of 12 with chronic fatigue syndrome (CFS) presenting to an out-patient clinic, and comparing those patients to older children and adults also diagnosed with CFS.

Of all the children referred, 16 per cent were 11 years or under; the youngest being two years old. The levels of symptomology and functional disability were similar in the under-11s and the over- 11s. Indeed, almost all of the under-lls would have fulfilled the much stricter adult criteria for diagnosing CFS.

Just because the patient is a young child, we should not dismiss the diagnosis of CFS.

Reducing frequent attending

Br J Gen Pract 2008; 58: 324-30

This randomised, controlled trial set in Spain, which has a free- at-the-point-of-use service similar to the NHS, investigated an intervention designed to reduce the number of times unnecessary frequent attenders see their GP.

The intervention is called 'Seven Hypotheses and Team'. The GP of a frequent attender classifies the patient into one of seven hypotheses that explains their attendance rate - biological, psychological, social, family, cultural, administrative- organisational or related to the doctor-patient relationship - then discusses this and the plan to address it with the team.

After one year follow-up, they found that the intervention group had significantly reduced attendance compared with two control groups.

Stopping atherosclerosis

JAMA 2008; 299:1,678-89

In the Stop Atherosclerosis in Native Diabetics study, aggressive treatment targets of LDL cholesterol and systolic BP were compared with usual treatment targets. Systolic BP was treated to 115mmHg as opposed to 130mmHg and LDL cholesterol to 70mg/dl as opposed to 100mg/dl in Native Americans with type-2 diabetes.

The primary endpoint they used was the progression of atherosclerosis measured by intimalmedial thickness (IMT) of the common carotid artery.

They found that in the aggressively treated cohort there was IMT regression while in the standard group there was IMT progression. There was also greater decrease in left ventricular mass index in the aggressive group, but unfortunately at three years follow-up there was no difference in adverse cardiovascular events.

From the primary endpoints it would suggest that aggressive treatment should be beneficial, but this is not proven here.

Age and seeking medical help

Br J Gen Pract 2008; 58:318-23

There is a belief that older people are less able to access healthcare than their younger counterparts, despite obviously having more healthcare needs. Likewise, it is thought that older women are even less able to access healthcare.

In this cross-sectional survey nearly 1,000 people of varying ages were given a vignette to read (where a 51-year-old had chest pain carrying a grandchild upstairs) and were asked whether they would seek help.

Contrary to what might be expected there was a rise in helpseeking behaviour with age.

In men, the most likely were the 60- to 69-year-olds and in women the most likely were the over-70s.

Whatever it is that prevents the elderly seeking help, it is not their attitudes, and perhaps more could be done to educate the younger patients.

Regional weight differences

Arch Dis Child 2008; 93:407-13

Like the rest of the population, the prevalence of overweight and obesity has increased in pre-school children.

This prospective study examined whether there were regional variations in levels of overweight children.

They found that, independently of confounding factors such as socio-demographic characteristics, certain regions had higher levels of overweight children.

Children from Wales and Northern Ireland had a third greater chance of being overweight than children in England. Those from the East and South East had a third less chance of being overweight than children from London.

Clearly there must be some underlying reason, maybe in attitudes or infrastructure that leads to this difference, and understanding this would help reduce the inequity.

Of note, 23 percent of 3-year-olds were overweight or obese.

Reduced bone density (yellow area) can lead to osteoporotic fracture

"The presence of indicated a risk similar to other known risks, such as low body weight or steroid use


Osteoporotlc fracture can be linked to the presence of two genes, and this may provide a basis for population screening.

Chronic fatigue syndrome in children can be as severe in terms of functional disability as in adult cases.

Frequent attendance by a patient who does not need to see their GP may be reduced by classifying and addressing their behaviour.

Atherosclerosis progression was reduced after lowering systolic BP and LDL more aggressively than in standard therapy.

Elderly patients are willing to seek healthcare help even though they may find it difficult to access it.

Overweight and obesity in children varies in prevalence according to region.

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals

Copyright Haymarket Business Publications Ltd. May 16, 2008

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