Bisphosphonates for post-menopausal osteoporosis: are they all the same?

The primary goal of treatment for post-menopausal osteoporosis (PMO) is reduction in fracture risk. Therefore, clinicians must recommend therapies that are safe and have proven anti-fracture efficacy. Bisphosphonates have long been established as first-line therapy for osteoporosis and several of these drugs significantly reduce osteoporotic fracture risk. However, choosing among different bisphosphonates can represent a difficult clinical decision. This review outlines the pharmacology of various bisphosphonates, discusses how their pharmacological characteristics affect their efficacy, and summarizes clinical safety and efficacy data. Clinical trial data and the opinions of expert bodies suggest that alendronate, risedronate, ibandronate and zoledronic acid all provide fracture protection for patients with PMO. However, there are differences among these agents. For example, all four agents have demonstrated efficacy in preventing vertebral fractures, but only zoledronic acid and risedronate significantly reduce non-vertebral fracture risk in pivotal trials. Moreover, reduction in hip fracture risk has only been established for alendronate, risedronate and zoledronic acid. Current data suggest that ibandronate and zoledronic acid have the most persistent antifracture effect. Bisphosphonates have been associated with a number of side effects, the evidence for which is summarized in this review. The most pertinent of these when choosing a bisphosphonate for a particular patient are the well-documented associations between gastrointestinal adverse events and oral administration, and between acute phase reactions and intravenous administration. Ultimately, selection of a specific bisphosphonate for treatment of PMO should be based on efficacy, risk profile, cost-effectiveness and patient preferenc

Generic stabilizers for simple algebraic groups acting on orthogonal and symplectic Grassmannians

We consider faithful actions of simple algebraic groups on self-dual irreducible modules, and on the associated varieties of totally singular subspaces, under the assumption that the dimension of the group is at least as large as the dimension of the variety. We prove that in all but a finite list of cases, there is a dense open subset where the stabilizer of any point is conjugate to a fixed subgroup, called the generic stabilizer. We use these results to determine whether there exists a dense orbit. This in turn lets us complete the answer to the problem of determining all pairs of maximal connected subgroups of a classical group with a dense double coset.Comment: 48 pages, 5 table

Climate and Health Action Award to the One Health Commission, Speech at the Award Ceremony

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10 Things Clinicians Need to Know About Healthcare Cyberattacks

The threat of cyberattacks on healthcare systems is increasing. Individual providers should be aware of potential weaknesses in their systems and should begin immediately to look for ways they can help to minimize the risks of a potentially devastating attack upon their healthcare system. Examples of potential threats are reviewed along with suggested solutions. Going forward we will all need to become more educated in order to help prevent such attacks