Established in 1927 by the American College of Physicians


6 July 2010 Annals of Internal Medicine Tip Sheet

Below is information about two early online releases and two articles being published in the July 6 issue of Annals of Internal Medicine. The information is not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of a study, contact Angela Collom at or 215-351-2653.

In This Issue:

1. Men Taking Erectile Dysfunction Drugs Have Higher Rate of STDs, Especially HIV

Nearly 40 percent of middle aged men experience some degree of erectile dysfunction (ED). Pharmacologic treatments for ED have gained widespread popularity. Although middle-aged and older adults generally take fewer risks with their health, their decreased need for contraception may lead to less than optimal safe sexual practices compared with younger populations. Researchers sought to determine the rates of STDs among men who use and do not use ED drugs. The researchers reviewed database claims from 1997 to 2006 for 1,410,806 men older than age 40. Of those men, 33,968 had filled a prescription for an ED drug and 1,376,838 had no prescription. Men who use ED drugs had higher rates of STDs, particularly HIV infection, in the year before prescription and also more new STDs in the year after prescription. The observed association between ED drug use and STDs may be related to the types of patients using ED drugs rather than a direct effect of ED drug availability. Health care providers should identify risks for STDs and counsel men about safe sexual practices when prescribing ED drugs.

Early Online Releases:

2. USPSTF to Update Osteoporosis Guidelines with Recos for Screening Men and Women at Low Risk for Fracture*

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended bone density screening for women 65 years or older and women aged 60 to 64 at increased risk for osteoporotic fractures. At the time, the Task Force made no recommendations for or against screening men or women in other patient populations. Researchers reviewed research published between 2001 and 2009 to determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures. The researchers found that although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals for this patient population.

* A draft recommendation statement will be posted for public comment on the USPSTF Web page for a period of four weeks. The USPSTF will consider posted comments when finalizing the recommendations.

3. Physicians Still Unsure As to When is the Best Time to Initiate Surgery for Rotator Cuff Injuries

More than half of adults over the age of 60 have a partial or complete rotator cuff tear. Both surgical and nonsurgical treatments are used to relieve pain and restore movement and function of the shoulder. Before surgery, physicians often prescribe six weeks to three months of nonoperative treatment such as oral medications and injections, rest from activity, passive and active exercise, and modalities like heat, cold, or ultrasound. If these approaches do not offer relief, the cuff is often surgically repaired. However, some experts believe that initiating surgery sooner may result in better patient outcomes, earlier return to normal activities, and decreased costs. Researchers conducted a comparative effectiveness review of 137 studies assessing nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears. Evidence on the comparative effectiveness and the harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive.

Clinical Observation:

4. Most Cardiologists Ignore Nutraceutical and OTC Drug Use Among Heart Patients

Half of all patients worldwide, and especially those with chronic illnesses such as cardiovascular disease, use nutraceuticals and over-the-counter (OTC) drugs. However, these patients often do not discuss the use of these agents with their clinicians. Researchers evaluated cardiologits’ attitudes towards and accuracy in identifying their patients’ nutraceutical and OTC drug use. A clinical pharmacist observed patient interactions and recorded how the provider inquired about nutraceutical and OTC drug use. When the clinician left the room, the observer asked the patient about nutriceutical and OTC drug use. While the pharmacists identified 54 patients who together were using 86 nutraceuticals and 45 OTC drugs, the providers only identified nutraceutical and OTC use during seven encounters. According to the researchers, “providers neglect evaluation of these agents because they consider them innocuous; lump them with dietary measures and lifestyle interventions; or consider them to be ‘natural’ and, therefore, safe and effective.” The researchers conclude that clinicians should use a structured approach for identifying patient use of nutraceuticals and OTC drugs.