Pelvic irradiation is linked to hip fracture in elderly women

Radiotherapy for pelvic cancers is associated with hip fractures in elderly women, according to an observational study from the United States. The authors linked data from a national cancer database with data on Medicare claims for pelvic fractures among 6428 women aged > 65. Women who had radiotherapy for cervical, rectal, or anal cancers were more likely to have a pelvic fracture subsequently than women with the same cancers who did not have radiotherapy (risk over 5 years, 14% v 8% for anal cancer, 8% v 6% for cervical cancer, and 11% v 9% for rectal cancer). Nine out of ten of these fractures were of the hip. The association was most obvious among women with anal cancers: radiotherapy increased their risk of hip fracture threefold (hazard ratio 3.16, 95% CI 1.48 to 6.73).

Although the researchers adjusted their analysis for other risk factors—including age, ethnic background, and stage of cancer—it's impossible to say for certain whether radiation alone was responsible for these differences in fracture rates. We don't know which of these women had other treatments such as chemotherapy, which might also affect bone metabolism, or oophorectomy, which certainly does.

Even so, it's likely that radiation is at least partly to blame for the extra fractures, and the researchers argue that women having radiotherapy for pelvic cancers should be told.

JAMA 2005;294: 2587-93

Don't rely on history alone in patients with chest pain

Some kinds of pain are probably more serious than others in patients with chest pain. But a good description of the pain, though useful, is not powerful enough to identify patients who can be sent home safely, according to a systematic review. All it can do is raise or lower the index of suspicion.

For years doctors have been searching for a quick and easy way to distinguish between patients with and without cardiac …