Managing Your Patients With Osteoporosis. Diagnosis of osteoporosis is suboptimal leading to undertreatment of this disease. There is underrecognition of the risk for osteoporosis and deficient assessment of patients who are in need of evaluation. Nearly one-half of adults with osteoporosis remain untreated with pharmacologic therapy after sustaining a fracture. Underutilization of assessment tools such as dual X-ray absorptiometry (DXA) and the FRAX® calculator further contribute to this problem. Although guidelines for the diagnosis and management of patients with osteoporosis have been recently updated, some clinicians are not familiar with them, presenting challenges to the diagnosis and treatment of osteoporosis.

Evaluating the Etiologic Cause and Optimal Treatment of Geriatric Anemia in the Primary Care Setting: A Case-Based Study. Anemia is a very common problem in the elderly, making this clinical finding a growing concern as the proportion of older individuals in the US population continues to increase. According to current US Census Bureau projections, by 2030 there will be approximately 114.1 million Americans aged 65 years and older representing nearly 25% of the total population. By 2050, that number is anticipated to reach 156 million, more than double the estimated current population of 64.7 million persons older than 65 years.

Obstructive Sleep Apnea Syndrome: Recognition, Treatment, and Adherence - Part II. Management of obstructive sleep apnea syndrome (OSAS) consists of not only specific interventions but also appropriate education. The patient needs to be educated about the importance of OSAS, the risk factors, and the importance of treatment, as well as the consequences of untreated OSAS. In addition, education should include discussion about the potential for accidents, particularly motor vehicle accidents, as well as job-related accidents, and accidents around the home.

Recognition of Obstructive Sleep Apnea: Part I. Obstructive sleep apnea syndrome is a disorder that is characterized by repetitive episodes of upper airway obstruction that occur during sleep. These episodes are typically either apneas, which are complete obstructions, or partial obstruction events called hypopneas.

Managing Your Patients With Osteoporosis. Osteoporosis, the most common bone disease, is characterized by reduced bone mass and loss of normal skeletal architecture, which results in an increased risk of fracture. Clinically, osteoporosis may remain silent for many years, until the occurrence of fracture. The most common sites of osteoporosis-related fracture are the lumbar vertebrae, the proximal femur, and the distal forearm.

Current Therapeutic Considerations in Osteoarthritis Management.The prevalence of osteoarthritis in the United States has risen rapidly in recent years, and this trend is expected to continue as the elderly population grows. The Centers for Disease Control and Prevention reported that OA affected approximately 27 million Americans in 2005, which was an increase from the 21 million reported in 1990. The rates were higher in women than in men, especially among those older than 50 years of age.

Osteoarthritis and the Continuum of Care. Review the multifactorial musculoskeletal process and biomechanical factors of the changes in structure and function of synovial joints and other risk factors associated with osteoarthritis.

Prevent the Event: Comprehensive Strategies to Identify Patients at Risk for Atherothrombosis. Atherosclerosis, a hardening of an artery specifically due to an atheromatous plaque, is an ongoing process that typically affects the medium- and larger-sized arteries of the cardiovascular, cerebrovascular, and peripheral vascular beds. Recent US data have confirmed that despite a decrease in age-standardized national death rates, the absolute number of deaths from these conditions continues to increase, and prevalence is sharply increasing in other parts of the world. Thus, atherothrombotic diseases are, and are projected still to be, the leading cause of death worldwide by 2020.

Strategies for Success: Pharmacologic Management of Persistent Pain in the Older Adult. The United States is projected to experience a rapid growth in its older population between 2010 and 2050 as the so-called baby boomers cross into this category. According to current projections, by 2030 there will be approximately 71.5 million Americans aged 65 years and older representing nearly 20% of the total population.

Testosterone Deficiency and Men's Health: A Cruicial Connection. Testosterone levels in men are known to decrease with age; the prevalence of symptomatic testosterone deficiency (TD) increases with age and comorbidities. In recent years, however, epidemiologic evidence has been accumulating to suggest that serum free testosterone and total testosterone levels decrease as men age, even in the absence of advanced illness.

Prevent the Event: A Case Discussion of Atherothrombosis. Rates of death from cardiovascular and cerebrovascular diseases have been steadily declining over the past few decades. In spite of these declines, atherothrombotic disease continues to be a worldwide challenge in terms of morbidity, premature death, and disability with tremendous costs to patients, healthcare systems, and society.

Optimizing Pain Management in the Primary Care Setting. Chronic pain is a serious medical problem in the United States, affecting millions of Americans and costing the healthcare system billions of dollars. According to the National Center for Health Statistics, more than 25% or 1 in 4 Americans reported pain persisting for more than 24 hours with 1 in 3 Americans indicating their pain was “disabling.”

Red Eye Emergencies Not to Miss in Primary Care. In our current healthcare environment, primary care clinicians are often at the frontline of caring for a myriad of acute care issues including diagnosing and managing eye disease. The red eye is the most common ocular disorder and accounts for almost 2% of all primary care patient visits. The term “red eye” describes a large number of diseases that exhibit conjunctival or scleral vascular injection. Although most red eye conditions are benign, some can represent medical emergencies. A recent survey showed considerable variability in how primary care cli-nicians manage the red eye.

Getting Better Is Not Good Enough: Assessing and Addressing Treatment Response in Major Depressive Disorder. Up to 40% of primary care patients will seek treatment for depression at some time in their lives; 14.4% of Americans will have major depressive disorder. The economic impact of depression is significant, with annual direct costs of treatment and indirect costs due to loss of productivity estimated at $83 billion.

Front-line Issues in the Management of Gout. Gout is a form of inflammatory arthritis, with metabolic sequelae, triggered by the deposition of monosodium urate (MSU) crystals within the joints and tissues. This can lead to tophus formation in and around the joints and uric acid urolithiasis, and is associated with hyperuricemia. The deposition of the MSU crystals acts as a catalyst for the inflammatory reaction that is recognized as acute gout.