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3 April 2001 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. Full content of the issue is available on the Internet at

ACP-ASIM Issues New Guidelines on Chronic Obstructive Pulmonary Disease

Older Women with Too Much Thyroid Hormone at Risk for Fractures

Women older than 65 with excessive levels of thyroid hormone were three times more likely to have a hip fracture and four times more likely to have a spine fracture than women with normal thyroid hormone level, according to a new study (Article, p. 561). Researchers indirectly determined the thyroid hormone levels by measuring the level of thyroid-stimulating hormone. By itself, use of thyroid hormone replacement, the usual treatment to adjust thyroid function, was not associated with increased risk for hip fracture.

Bone Marrow Lesions, Common in Knee Osteoarthritis, Linked to Knee Pain

Noone knows why knee arthritis is painful, since the joint cartilage it affects does not contain pain-carrying nerves. A new study found that abnormalities (lesions) in the bone marrow cavity near the arthritic knee were common in all people with knee osteoarthritis and that large bone marrow lesions were linked to pain (Article, p. 541). The next step is to determine if this knowledge helps identify better treatment for knee pain, an editorial says (Editorial, p. 591).

Medical Profession Must Do More to Self-Regulate and Self-Police

The medical profession has not done a good job recently of self-regulating, self-monitoring and self-disciplining members, says the author of a Perspective piece (p. 587). It has set up "pseudoaccountable" regulatory procedures that look real but don't do an effective job. If the medical profession does not set and enforce high standards, government and others outside the profession will step in.

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