Effectiveness of Teriparatide in Women Over 75 Years of Age with Severe Osteoporosis: 36-Month Results from the European Forsteo Observational Study (EFOS)

This predefined analysis of the European Forsteo Observational Study (EFOS) aimed to describe clinical fracture incidence, back pain, and health-related quality of life (HRQoL) during 18 months of teriparatide treatment and 18 months post-teriparatide in the subgroup of 589 postmenopausal women with osteoporosis aged ≥75 years. Data on clinical fractures, back pain (visual analogue scale, VAS), and HRQoL (EQ-5D) were collected over 36 months. Fracture data were summarized in 6-month intervals and analyzed using logistic regression with repeated measures. A repeated-measures model analyzed changes from baseline in back pain VAS and EQ-VAS. During the 36-month observation period, 87 (14.8 %) women aged ≥75 years sustained a total of 111 new fractures: 37 (33.3 %) vertebral fractures and 74 (66.7 %) nonvertebral fractures. Adjusted odds of fracture was decreased by 80 % in the 30 to <36–month interval compared with the first 6-month interval (P < 0.009). Although the older subgroup had higher back pain scores and poorer HRQoL at baseline than the younger subgroup, both age groups showed significant reductions in back pain and improvements in HRQoL postbaseline. In conclusion, women aged ≥75 years with severe postmenopausal osteoporosis treated with teriparatide in normal clinical practice showed a reduced clinical fracture incidence by 30 months compared with baseline. An improvement in HRQoL and, possibly, an early and significant reduction in back pain were also observed, which lasted for at least 18 months after teriparatide discontinuation when patients were taking other osteoporosis medication. The results should be interpreted in the context of an uncontrolled observational study

Relationship therapy with lesbian, gay, bisexual and trans clients.

The history of the psychotherapeutic professions and lesbian, gay, bisexual and trans (LGBT) clients is a deeply troubled one (Davies and Neal, 1996). Thankfully most of the negative attitudes of the past seem to be changing with all of the major UK therapy associations (BACP, UKCP, BPS) providing guidance on working ethically with clients from sexual and gender minorities and making statements critical of conversion/reparative therapy (which is designed to change someone's sexual orientation). In spite of such changes, pathologizing stances concerning LGBT clients still exist amongst some therapists, particularly those from a psychoanalytic perspective and some religiously informed therapists. The earliest school of existential therapy – Daseinsanalysis – does not escape charges of homonegativity and heteronormativity either. Medard Boss, the founder of Daseinsanalysis wrote in his book The Meaning and Content of Sexual Perversions (1947/1949) about homosexuality as a sexual perversion and, even as recently as 1987, thought that the healthiest state for a woman was to have children in a loving relationship with a man (Boss & Kenny, 1987)