Annals of Internal Medicine tip sheet for Sept. 16, 2008, issue

Osteoporosis is a serious disease that affects an estimated 44 million Americans. In addition, nearly 34 million Americans have low bone mass and are at an increased risk of developing the disease. The American College of Physicians released a new clinical practice guideline recommending that physicians offer drug treatment to men and women who have been diagnosed with osteoporosis or a previous fracture not caused by substantial trauma. The guideline also recommends that doctors and their patients consider drug treatment to prevent fracture for men and women who are at risk of developing osteoporosis. The authors did not find evidence to prove that one drug is definitively better than another medication. They recommend that physicians make individual treatment decisions based on the risks, benefits, and side effects profile of available drug options.

A new study from the National Institutes of Health finds that massage therapy may have immediate benefits on pain and mood among patients with advanced cancer. In a randomized trial of 380 advanced cancer patients at 15 U.S. hospices, improvement in pain and mood immediately following treatment was greater with massage than with simple touch. Pain and depressed mood are common problems for patients with advanced cancer. While drug therapies can reduce symptoms, they don't always work and often have troublesome side effects. Researchers think that massage may interrupt the cycle of distress, offering brief physical and psychological benefits. However, researchers caution that while massage may offer some immediate relief for patients with advanced cancer, the effects do not last over time, demonstrating the need for more effective strategies to manage pain at the end of life.

A large-scale, case-control study examined associations between commonly-prescribed respiratory medications and risk for death in veterans with newly diagnosed COPD. Researchers followed a cohort of patients enrolled in the U.S. Veterans Health Administration health care system to assess mortality rates at one year. Inhaled corticosteroids were associated with decreased risk for death, while theophyline and ipratropium were associated with increased risk for respiratory and cardiovascular death, respectively. Ipratropium was associated with an 11 percent increase in the risk for death, raising researchers' concerns about the potential harm associated with the drug rather than simply a lack of effectiveness. Researchers urge more research to weigh the benefits of these medications against the risk for death.

According to a National Health Interview Survey, 28 percent of patients with type 2 diabetes use insulin alone or in combination with oral antidiabetic agents to control their glucose levels. Because of the increasing prevalence of type 2 diabetes, the number of patients who use insulin for glycemic control, and the importance of glycemic control in decreasing mortality and morbidity, researchers wanted to establish the weight of evidence for the safety and effectiveness of premixed insulin compared with other antidiabetic agents. Researchers at the Agency for Healthcare Research and Quality (AHRQ) found that premixed insulin provides tighter glycemic control than long-acting insulin and non-insulin antidiabetic agents. However, researchers cautioned that studies with longer follow-up are needed to determine long-term outcomes. Full text of the article will be available at www.annals.org on September 16. The article will be published in the October 21 issue Annals of Internal Medicine.

Annals of Internal Medicine (www.annals.org) is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 81 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (www.acponline.org), the largest medical specialty organization and the second-largest physician group in the United States.

ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.