Osteoporosis.

Osteoporosis is the most common bone disease in adults and confers significant morbidity and mortality in women. Universal screening is recommended for women above the age of 65 years; however, screening rates remain low. Bisphosphonates are the treatment of choice despite a decline in their use due to concerns about rare side effects. Treatment of osteoporosis dramatically decreases the likelihood of fragility fractures.

An Evaluation of Contraceptive Methods After Implementation of a Novel LARC Program in a Residency Primary Care Clinic.

BACKGROUND AND OBJECTIVE: Internal medicine (IM) residency programs have inadequate education and training around contraception, creating and perpetuating a potential barrier for patients. Contraceptive access is a critical part of primary care, yet few IM residency programs offer long-acting reversible contraception (LARC) in their clinic. To address the LARC needs of our patients and education needs of our residents, one attending (MS) created a procedure clinic and provided LARC in our residency clinic in 2015. In this initial study, we sought to determine the use of contraceptive methods among reproductive age women at our residency clinic two years after offering LARC. This data will shape future care provision and resident education. STUDY DESIGN AND METHODS: Data were extracted from 1,182 female patients ages 20-39 years attributed to the Rhode Island Hospital Center for Primary Care (CPC) between February 2017 to August 2018. Of the total, 260 patients were excluded because they had not been seen in the clinic within the preceding 12 months or had left the practice. Descriptive and bivariate methods were used to calculate the proportion of women using any contraception and long-acting reversible contraception (LARC) and to test for associations with demographic characteristics. PRIMARY RESULTS: Fifty-five percent used any contraception and 19% used LARC. LARC use was higher among women ages 20-29 when compared to women 30-39. Demographic characteristics other than age were not associated with contraceptive use. PRINCIPAL CONCLUSIONS: In this clinic, LARC usage exceeds the national average (19.0% v 10.3%). Residency training is ideal for learning skills around this aspect of medical care, providing the ability to ensure appropriate oversight and supervision. This initial study suggests almost one fifth (18%) of patients who utilize LARC find access at an IM residency primary care clinic acceptable. Internal medicine primary care clinics can address the nonsurgical contraceptive needs of their patients by providing access to LARC. To achieve this goal, internal medicine residents should receive training in and exposure to LARC provision.

Beyond Estrogen: Treatment Options for Hot Flashes.

Nonhormonal medications and complementary and alternative therapies are used by many women seeking relief from bothersome hot flashes. However, health care professionals may be less familiar with these treatment modalities. Although estrogen remains the most effective medication to reduce hot flashes, its potential harmful effects have led investigators to examine other treatments for hot flashes, and many women seek alternative forms of relief. Most of these trials are limited by a significant placebo effect, which frequently equals the effectiveness of the medication being evaluated. Despite this limitation, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and gabapentin have robust evidence for hot flash reduction. Each of these may be chosen for additional treatmenteffects that may benefit some women. Complementary and alternative medication trials are fraught with additional limitations, namely, a large placebo effect, greater homogeneity of participants, lack of validated tools, and lack of robust reporting of adverse effects. The data appear most robust for isoflavone supplementation, with overall hot flash reduction similar to the SSRIs, SNRIs, and gabapentin. Mindfulness-based stress reduction therapy also has evidence of effectiveness and may be an ideal choice for some. Primrose oil, Chinese herbal medicine, acupuncture, and yoga have mixed results. The concerns related to hepatotoxicity preclude the use of black cohosh. Exercise, relaxation, and paced respiration have no proven benefit thus far in reducing hot flashes. Our goal with this commentary is to arm clinicians with information about the medications and complementary therapies available to provide symptom relief to women. Providing information about the possible benefits and harms of these therapies despite the limitations of the current evidence is helpful to patients and can help guide them to seek the treatment option most beneficial and appealing to them.