All you need to read in the other general journals

doi:10.1136/bmj.39576.709444.80

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ research articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Older, thinner men are at risk of osteoporosis

Ann Intern Med2008;148:685-701

OpenUrl FREE Full Text

Men get osteoporosis too—particularly those who are over 70, thin (body mass index <20-25), or losing weight, according to a meta-analysis and systematic review of 177 studies in over 28 000 participants. Physical inactivity and a history of fractures were also powerful risk factors for low bone mineral density and further osteoporotic fractures. The authors found a weaker but still potentially important link between osteoporosis in men and alcohol, smoking, and treatment with corticosteroids or androgen deprivation therapy.

A national guideline (p 680) based on these findings says doctors should periodically assess their older male patients for these factors and consider screening those at risk using dual energy x ray absorptiometry (DXA). A close look at 20 studies showed that DXA is the only test supported by decent evidence in men. Compared with this gold standard, calcaneal ultrasound had a sensitivity of only 75%, and a self assessment screening tool based on questions about age and weight had a sensitivity of 81%. A more complex risk score developed by the World Health Organization has been validated only in women.

Supplements to lower homocysteine fail to prevent cardiovascular disease, again

JAMA2008;299:2027-36

OpenUrl FREE Full Text

Another large trial, this time in women, has shown that lowering serum concentrations of homocysteine with B vitamins and folic acid does not prevent cardiovascular events. The trial included 5442 professional women with cardiovascular disease or at least three coronary risk factors, compared a combination of vitamin B₁₂, vitamin B₆, and folic acid with placebo, and lasted more than seven years—the longest trial to date. Rates of heart attack, stroke, coronary revascularisation, or death from cardiovascular disease were statistically indistinguishable between the two groups (226.9/10 000 person years v 219.2 for the active v placebo groups; relative risk 1.03, 95% CI 0.90 to 1.19).

These results are entirely consistent with other large trials and confirm for women what we …