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17 September 2002 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.

Screen Women for Osteoporosis Beginning at Age 65, U.S. Group Says

The U.S. Preventive Services Task Force (USPSTF) recommends that physicians routinely screen women over 65 for osteoporosis, a thinning of the bones that can lead to bone fracture. The Task Force did not recommend a specific screening test, but bone densitometry, also known as DEXA (dual-energy x-ray absorptiometry), is currently an accepted and widely available method for measuring bone density.

Women at higher than average risk for osteoporotic fractures should begin screening at age 60, the Task Force says. The USPSTF has no recommendation for or against screening postmenopausal women younger than age 60. It says there are no studies evaluating the optimal intervals for screening, the appropriate age to stop screening, or treating women older than 85. In 1996, the USPSTF found insufficient evidence to recommend for or against routine osteoporosis screening for postmenopausal women. (Recommendations, p. 526; Summary of Evidence, p. 529.)

Early Nephrologist Care Associated With Better Outcomes for Kidney Disease

A study of 828 patients with chronic kidney disease starting dialysis found that 30 percent saw a nephrologist, or kidney specialist, less than four months before beginning dialysis, a period that does not provide enough time for optimal preparation for dialysis (Article, p. 479). Only half saw the specialist at least one year before dialysis. Late evaluation of end-stage renal disease was linked with earlier death. The study found that African-American men, people without medical insurance, and people with other medical conditions, such as diabetes, were the most likely to see a specialist at a late stage. An editorial notes that the correlation of longer survival with early referral to kidney specialists does not prove a causal relationship (Editorial, p. 542). The writer says that data suggest "limited access to good primary care may be a critical factor for which delay in referral to specialist is only a marker." He says carefully coordinated treatment between the primary and specialist physician "not only should reduce the morbidity and mortality of persons who eventually require dialysis but, best of all, may delay or even eliminate the need for it in some fortunate patients."

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