Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

BackgroundCanagliflozin is a sodium–glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. MethodsThe CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. ResultsThe mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% c...

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Canagliflozin and cardiovascular and renal events in type 2 diabetes

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Background Once-daily injections of parathyroid hormone or its amino-terminal fragments increase bone formation and bone mass without causing hypercalcemia, but their effects on fractures are unknown. Methods We randomly assigned 1637 postmenopausal women with prior vertebral fractures to receive 20 or 40 μg of parathyroid hormone (1-34) or placebo, administered subcutaneously by the women daily. We obtained vertebral radiographs at base line and at the end of the study (median duration of observation, 21 months) and performed serial measurements of bone mass by dual-energy x-ray absorptiometry. Results New vertebral fractures occurred in 14 percent of the women in the placebo group and in 5 percent and 4 percent, respectively, of the women in the 20-μg and 40-μg parathyroid hormone groups; the respective relative risks of fracture in the 20-μg and 40-μg groups, as compared with the placebo group, were 0.35 and 0.31 (95 percent confidence intervals, 0.22 to 0.55 and 0.19 to 0.50). New nonvertebral fragili...

Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(96)07088-2.pdf

Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures

Meeting report from what is new in bisphosphonates: Sixth workshop on bisphosphonates

/pdf/erratum-to-taxonomy-of-rare-genetic-metabolic-bone-disorders-2rtws918n4.pdf

Erratum to: Taxonomy of rare genetic metabolic bone disorders

Journal Article Corrected proof Letter to the Editor From Watts and Leslie: Comparisons Between Different Antiosteoporosis Medications on Postfracture Mortality: A Population-based Study Get access Nelson B Watts, Nelson B Watts Mercy Health-Osteoporosis and Bone Health Services, Cincinnati, OH 45236, USA Correspondence: Nelson B. Watts, MD, Mercy Health Osteoporosis and Bone Health Services, 4760 E Galbraith Rd, Ste 212, Cincinnati OH 45236, USA. Email: Nelson.watts@hotmail.com. https://orcid.org/0000-0003-0719-9801 Search for other works by this author on: Oxford Academic Google Scholar William D Leslie William D Leslie Department of Medicine, University of Manitoba, Rady College of Medicine, Winnipeg, Canada Search for other works by this author on: Oxford Academic Google Scholar The Journal of Clinical Endocrinology & Metabolism, dgad317, https://doi.org/10.1210/clinem/dgad317 Published: 02 June 2023 Article history Received: 04 April 2023 Editorial decision: 09 May 2023 Published: 02 June 2023 Corrected and typeset: 23 June 2023 

Letter to the Editor from Watts and William: Comparisons between different anti-osteoporosis medications on postfracture mortality: a population-based study.

Objective Interventions to initiate medication and increase adherence for postmenopausal women who have had a fragility fracture were not always successful. The purpose of this study was to derive an empirical framework for patient-identified barriers to osteoporosis medication initiation and adherence from physician experts. Methods A cognitive mapping approach involving nominal group technique (NGT) meetings and a card sorting and rating task were used to obtain formative data. We first conducted four NGT meetings with 18 women patients who were not on osteoporosis treatment to identify barriers to osteoporosis medication, then invited 27 osteoporosis physicians to sort and rate 25 patients identified barriers. Descriptive analysis, multidimensional scaling analysis, and hierarchical cluster analysis were applied for data analysis. Results A two-dimensional five-cluster cognitive map was derived to provide an organizational framework for understanding patients perceived barriers to medication initiation and adherence. The five clusters were concerns about side effects, experience of side effects, lifestyle changes, medication access and complexity, and patient uncertainty about treatment and trust in the provider. The two dimensions were interpreted as internal to patients (X-axis) and external to patients (Y-axis). Conclusions/Implications Views of patients solicited in a structured format provided directions to help in designing interventions to improve osteoporosis medication initiation and adherence.

https://www.dovepress.com/getfile.php?fileID=81943

Understanding Physicians’ Perceptions of Patient-Identified Barriers to Osteoporosis Medication Initiation: A Cognitive Mapping Approach

Iatrogenic bone loss and increased fracture risk caused by therapies for nonskeletal diseases is a growing and important cause of osteoporosis. The skeletal effects of glucocorticoids, progestins, excess thyroid hormone, chemotherapy, and calcineurin inhibitors are described in other sections of the primer.

Nelson B. Watts

Papers

Meeting report from what is new in bisphosphonates: Sixth workshop on bisphosphonates

Erratum to: Taxonomy of rare genetic metabolic bone disorders

Letter to the Editor from Watts and William: Comparisons between different anti-osteoporosis medications on postfracture mortality: a population-based study.

Understanding Physicians’ Perceptions of Patient-Identified Barriers to Osteoporosis Medication Initiation: A Cognitive Mapping Approach

Effects on the skeleton from medications used to treat nonskeletal disorders