Embargoed news from Annals of Internal Medicine

Evidence of significant adverse events led the U.S. Preventive Services Task Force to issue recommendations against using estrogen plus progestin in 2002 and estrogen alone in 2005 to prevent chronic conditions. To update its recommendations, the Task Force conducted a systematic review of articles published since 2002 to determine the effectiveness of HRT in reducing risks for chronic conditions. The Task Force considered adverse events and the differences in outcomes among population subgroups. Fifty-one articles met inclusion criteria for the review. The Task Force found that both estrogen alone and estrogen plus progestin reduce the risk for fractures, but increase risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen alone decreased risk for breast cancer. Estrogen plus progestin increased risk for probable dementia and breast cancer. The risk for breast cancer increased for women with prior oral contraceptive use, prior menopausal estrogen plus progestin therapy, or current smoking. This evidence will inform an upcoming recommendation for menopausal hormone therapy.

2. Doctors Should Recommend Exercise and Vitamin D to Prevent Falls in the Elderly

Falls are the leading cause of injury in adults aged 65 or older. Researchers reviewed more than 50 clinical trials to determine the benefits and harms of various primary care interventions to prevent falls in community-dwelling older adults. They found good evidence that exercise and vitamin D supplementation were effective at reducing falls, and were associated with few harms. Therefore, physicians should prescribe both to their elderly patients. Multifactorial assessment and management interventions, medication assessment and withdrawal, home hazard modification, and behavioral counseling were also assessed. Researchers did not find convincing evidence that providing these interventions to all older adults reduces falls. As such, the Task Force does not recommend that physicians automatically perform an in-depth multifactorial risk assessment for falls in all elderly patients. Physicians should consider the individual patient's history of falls, comorbid conditions, and patient values before making a decision.