Detection and management of atypical femur fractures

PURPOSE OF REVIEW: This article summarizes the risk factors for atypical femur fractures (AFF), discusses current and emerging imaging modalities for early identification of AFF, and offers recommendations for prevention and management of AFFs based on the current concepts. RECENT FINDINGS: Antiresorptive therapies are widely recommended for prevention and treatment of osteoporosis. Despite their well established effectiveness to reduce fracture risk, emerging concerns related to potential adverse effects have led to a substantial decline in the use of bisphosphonates. Although, the pathogenesis of AFF has not yet been elucidated, the bulk of evidence supports that the well known therapeutic benefits of bisphosphonate far outweigh the relatively low risk of AFFs. Recommendations for early identification of patients at risk for AFF using radiographic imaging have been established. Consensus on the management of AFF and osteoporosis in patients with AFF needs to be formulated. SUMMARY: AFF is a rare event associated with long-term bisphosphonate therapy, which represents an apparent paradox in the management of osteoporosis. Improved understanding of pathogenetic mechanisms will be helpful in further refining of screening guidelines and standardization of management and treatment strategies

A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss.

OBJECTIVE: Dietary supplements and alternative therapies are commercialized as a panacea for obesity/weight gain as a result of the minimal regulatory requirements in demonstrating efficacy. These products may indirectly undermine the value of guideline-driven obesity treatments. We systematically reviewed the literature of purported dietary supplements and alternative therapies for weight loss. METHODS: A systematic review evaluated the efficacy of dietary supplements and alternative therapies for weight loss aged ≥18 years. We searched Medline (Pubmed), Cochrane, Web of Science, CINAHL, EMBASE (Ovid), and PsychINFO (EBSCO). Risk of bias and results were summarized qualitatively. RESULTS: Of 20,504 citations, we reviewed 1,743 full-text articles, of which 315 were randomized controlled trials evaluating the efficacy of 14 purported dietary supplements, therapies or a combination thereof. Risk of bias and sufficiency of data varied widely. Few studies (n=52 [16.5%]) were classified low risk and sufficient to support efficacy. Of these, only 16 (31%) noted significant pre/post inter-group differences in weight (range: 0.3,4.93 kg). CONCLUSIONS: Dietary supplements and alternative therapies for weight loss have a limited, high-quality evidence-base of efficacy. Practitioners and patients should be aware of the scientific evidence of claims before recommending use