DrugDoses (Frank Shann’s Android version)

For more than 25 years, Frank Shann’s little booklet has helped physicians all around the world prescribe drugs to children. DrugDoses now contains more than 2050 entries. It lists every drug commonly prescribed for systemic use in both adults and children.

The Android version of the booklet gives you an enormous amount of information, which will be updated twice a year! You will therefore always have the latest drugs, which will only be available in the paper version in a year or two! We offer you the initial 2-year license, with all the updates. After that period, as you will need to keep the drugs database updated, we offer you the possibility to purchase a lifetime license for only 5$!
The Android version has also lots of other features: more than 150 current laboratory values, a useful cardiology database and a calculator that will help you give the correct resuscitation doses when you are coding a child.
DrugDoses also integrates PedCalc. It contains the most common pediatric scores and formulas:
- ASA score
- Alveolo-arterial gradient
- Anion gap
- Apgar score
- Blunt abdominal trauma score
- Body mass index
- Body surface area
- Corrected Ca*
- Creatinine clearance - measured
- Creatinine clearance - estimated
- Drip rate
- Endotracheal tube sizes
- FeNa
- Genta dosing*
- Glasgow Coma Score
- Glasgow Outcome Scale
- Heparin dosage*
- Maintenance fluids
- Mallampati
- NACA score
- Neonatal central lines
- Oxygen index
- PaO2/FiO2 ratio*
- Parkland formula*
- Pediatric trauma score
- Predicted height
- Predicted spirometry values
- QTc
- Tubular phosphate reabsorption
- Vanco dosing*
* These calculations are available via an In-App bundle
We have also integrated Frank Shann's Pediatric Critical Care Guidelines. The booklet contains all the latest guidelines available for pediatric critical care. Our new feature contains all the 67 chapters of the booklet, ranging from Analgesia & Sedation to Ventilation.
PICU Guidelines is fully searchable, and will save your personal notes, as well as give you the possibility to sen them to colleagues.
PICU Guidelines is available via an InApp purchase. Once you've bought it, you'll be give free access to all future updates of this great reference. However, if you already have the separate app, it will unfortunately not entitle you to get this in-app version.
By the way, did you know that by becoming a fan of DrugDoses on Facebook (http://facebook.drugdoses.net), you can directly request new features and get information on the updates and changes in the database?
PHYSICIANS' FEEDBACK:
"It's great!
Thanks and congrats!"
Kate
"Great work!"
Seppie
"This is a great program! I am delighted to have it on my iPhone. Thanks so much for your initiative and contribution to all of us."
Susan
"Thanks for the new app. It looks great!"
Steve
In-App Purchases:
• When you purchase DrugDoses, you will get a complimentary 2-year license. Thereafter, you will have to purchase a lifetime license.
• There are also some extra PedCalc features that can be bought as a bunddle, also using In-App purchase. There is no subscription to these extra features, so you will only have to buy them once.
• PICU Guidelines can also be bought as an In-App purchase. There is no subscription to this extra feature, so you will only have to buy it once.
• Payment will be charged to your Google Play Account at confirmation of purchase.
• Our Privacy Policy is available on our website: www.drugdoses.net/privacy

Download link
Mediafire

Oxford Handbook of Psychiatry

This Oxford Handbook of Psychiatry, Second Edition is developed by MedHand Mobile Libraries. It provides comprehensive coverage of all major psychiatric conditions and sub-specialities.
• In-depth coverage of general psychiatry and all the sub-specialties
• Information on psychopathology, evidence-based practice, legislation, eponyms and much more
• Contains practical advice on assessment and management in real-life situations
• Includes a full symptom dictionary to aid diagnosis, and full guide to prescribing
• Includes an additional index of ICD-10 and DSM-VI codes, and a quick index for acute presentations
• Features a completely updated legal section with coverage of the new English mental health act, updated coverage of the Scottish mental health act and new coverage of incapacity legislation in England & Wales and Scotland.
• Includes a fully updated section on schizophrenia.
• Contains addition of new drugs and new clinical guidance from internationally recognized institutions such as NICE.
• Features specialist chapters in learning disability, psychotherapy and child psychiatry reviewed and revised by specialist registrars working in the fields currently.
It provides detailed and practical advice on the management of psychiatric disorders, in-depth coverage of psychiatric assessment, psychopathology, evidence-based practice, mental health and capacity legislation in the British Isles, difficult and urgent situations, transcultural psychiatry, and therapeutic issues.
Also features a completely updated legal section with coverage of the new English mental health act, updated coverage of the Scottish mental health act and new coverage of incapacity legislation in England, Wales and Scotland, a completely updated section on schizophrenia, and the addition of new drugs and new clinical guidance from recognized institutions such as NICE.
It also includes specialist chapters on learning disabilities, psychotherapy and child psychiatry reviewed and revised by specialist registrars currently working in the fields.
The book is internally cross-referenced and has both key references to important papers and to further information resources. As well as being indexed alphabetically, it is also indexed by ICD-10 / DSM-IV codes, and there is a quick index for acute presentations.
This handbook is practical and didactic in style, designed to provide portable reassurance to doctors beginning psychiatry. There is helpful advice for the management of difficult and urgent situations, and the text is peppered with clinical observations on the practice of clinical psychiatry and guidance based upon the experience of the authors.
Readership: Senior House Officers starting psychiatric training, clinical medical students, psychiatric trainees approaching professional exams (e.g. MRCPsych in the UK), and psychiatric specialists
Authors: David Semple and Roger Smyth
Publisher: Oxford University Press
________________________________________________________
MedHand Mobile Libraries offers a SUBSCRIPTION FREE application without edition upgrade. The apps enables you to make notes, search, add bookmarks and review what you previously been reading.
MedHand delivers what you need, trusted knowledge at the point of care! Offering most trusted and well recognized medical guidelines provided by excellent publishers like Oxford University Press, McGraw-Hill, PDR Network LLC, Wiley and more.

Download Link
http://adf.ly/ZYJyb
http://adf.ly/ZYJuf

2013 Medical Diagnosis v4.1.036

2013 Medical Diagnosis v4.1.036
Requirements: Android OS 2.2 +
Overview: The #1 bestselling annual guide to internal medicine—now completely updated!

The #1 bestselling annual guide to internal medicine—now completely updated!
Learn from the experts – and accelerate your clinical decision making
Internationally acclaimed for its scholarship, conciseness, full-color presentation, and encyclopedic scope, CMDT puts the latest research where it belongs . . . into your practice. The new edition of this streamlined clinical companion delivers at-a-glance summaries of the signs, symptoms, epidemiology, etiology, and treatment options for more than 1,000 diseases and disorders. Practitioners in both the hospital and ambulatory settings rely on CMDT to keep up with new medical advances, prevention strategies, and cost-effective therapies.
Here’s why CMDT is essential to clinical practice:
* Covers the fundamentals of clinical diagnosis and patient management in all fields of internal medicine
* A-to-Z survey of all primary care topics, including gynecology and obstetrics, dermatology, neurology, ophthalmology, otolaryngology, psychiatry, neurology, toxicology, urology, geriatrics, orthopedics, and palliative care
* The only text with an annual update on the treatment of HIV infection and AIDS
* Easy-to-navigate design with numerous figures and tables
* Drug treatment tables, with indexed trade names and updated costs in each section
* Current references—with PubMed and PMID numbers
* “Essentials of Diagnosis” callouts for most diseases/disorders
* ICD-9 codes listed on inside covers
NEW to this edition:
* New chapter on Women’s Health Issues
* Extensively revised chapters: “Viral & Rickettsial Infections,” “Disorders Related to Environmental Factors,” and “Blood Disorders”
* Coverage of critical developments in anticoagulation and antiplatelet therapy, antihypertensive therapy, hematology, neurology, infectious disease, and cardiovascular medicine
* Important updates in oncology, including breast cancer treatment options, new lung cancer screening protocols, and cervical screening recommendations
* New risk assessment model for deep vein thrombosis (DVT) and DVT preventive therapies following hip or knee replacement
* Recent CDC guidelines on adult and adolescent immunizations and the treatment of sexually transmitted infections
* Overview of new medications, including ivacaftor, eltrombopag, romiplostim, and eculizumab
* Extensive revision of the section on rhabdomyolysis
* New section on peripheral artery aneurysms
The MSDict Dictionary Format
The 2013 CURRENT Medical Diagnosis & Treatment is here presented in MSDict electronic format. MSDict offers best experience in mobile reference and is available for any handheld platform.
* Quick dynamic search of words while you type
* Ability to add bookmarks to favorite words
* Hyperlinks between different related words
* History to see the last 50 words you have looked up
* Filters to help you locate the word you are searching for:
* * Fuzzy filter- used when you are not sure of the correct spelling of a word
* * Keyword-used to locate the instances of a key word within other compound words
* * Wild card - "?" and "*" replace a letter and group of letters in words
* Convenient two pane design for tablets
* Fast article scrolling
* Online and offline modes supported; the offline mode allows you to download the whole dictionary and work independently from data connections
* Ability to have dictionary Word of the day as a widget on the phone home screen
* Ability to search words in the installed dictionaries through the standard phone search feature
* Support for memory cards

This app has no advertisements


Download Link
http://adf.ly/Ywfxg
http://adf.ly/Ywg1p

Poisoning, Drug Overdose

An instant-answer guide you can turn to for on-the-spot treatment of poisoning and drug overdose
Poisoning & Drug Overdose, Sixth Edition delivers critical information on effective diagnosis and treatment of drug-related emergencies and chemical exposures.
Divided into four sections:
* Section I covers initial emergency management, including treatment of complications; physical and laboratory diagnosis; and decontamination and enhanced elimination procedures
* Section II provides detailed information on 150 common drugs and poisons
* Section III describes the use of antidotes and therapeutic drugs to treat poisoning
* Section IV describes the medical management of chemical and occupational exposures, with a table of more than 500 industrial chemicals
Poisoning & Drug Overdose, Sixth Edition is enhanced by numerous tables, charts, and a comprehensive index featuring generic, chemical, and brand names, making it an essential resource for anyone responding to drug-related emergencies and chemical exposures.
“Poisoning & Drug Overdose belongs in every emergency physician’s workroom.” --Academic Emergency Medicine reviewing earlier edition
“…a great addition to any emergency department library when rapid reference is needed to treat and diagnose the poisoned patient.” -- Annals of Emergency Medicine reviewing earlier edition

A search tool
Featuring various search options to help you find the words you need more easily, including:
* A quick search of words while you type
* A 'fuzzy filter' for when you are not sure of the correct spelling of a word
* A 'keyword' search for finding key words within phrasal verbs
* A wild card search facility which can replace a letter or a group of letters
A learning tool
The dictionary app includes a number of features which help you to expand your vocabulary further:
* A 'Favourites' feature allows you to create your own categories and lists of words
* Your last visited words are all saved in your 'History', so that you can quickly look back at recently checked words
* Discover a new word every day with the 'Daily' feature
* Ability to have dictionary Word of the Day as a widget on the device home screen
* See words in context with example sentences
* Online and offline modes supported, the offline mode allows you to download the whole dictionary and work independently from data connections

Download link
http://adf.ly/YlIBM

http://adf.ly/YlIFq

Lab Values + Medical Reference

**The lab reference app with by far the most features on the app store!**
Now available for Android!
** 3 in 1: Lab Values, Abbv, Prefix/Suffix is the premium resource for all healthcare professionals and students. Inside this one app you’ll find Lab Reference Values, Medical Abbreviations and Medical Prefix/Suffix, all at hand and ready to use, anytime, anywhere.
You’re a busy healthcare worker on the go, seeing patients, helping people. You need answers and references fast, so you can keep the flow going and get to as many patients as you can. That’s why you need 3 in 1 Lab Reference on your iPhone, iPod touch or iPad.
This is really three medical apps in one. Lab Reference Values, Medical Abbreviations, and Medical Prefix and Suffix, are all inside this amazingly helpful application.
Everything you need for fast reference is in here – 265 lab values organized into 16 classic categories as well as 12 common panels categories with links to Google, Clinilab Navigator, Lab Tests Online, Medline Plus, and WebMD for more information. Thousands of commonly used abbreviations. More than 400 prefixes/suffixes with the meaning, origin language, etymology, and examples. Vast resources and examples are right at your fingertips, ready for whenever or wherever you might need them, as reminders or as an educational tool.
What separates us from the rest of the Lab Values apps? Our app is fully customizable. All of the data contained in 3 in 1 Lab Reference if fully editable, so go ahead and customize it to suit your needs or add notes to an entry.

Look at the indispensable features you get in 3 in 1 Lab Reference:
* Simple and easy to use interface
* 3 apps in 1
* 265 Lab Reference Values in 16 different categories
* "Common Panels" section to look up lab values organized by commonly ordered lab panels
* Labs values are presented in SI or US units
* Thousands of medical abbreviations
* Over 400 prefixes/suffixes with origin language, etymology, and examples
* Only medical reference app with fully editable data!
* Links to important resources including Google, Wikipedia, Medline Plus, Clinlab Navigator, Lab Tests Online, and WebMD
* Recently viewed section, Favorites section, and powerful search for fast retrieval of data
* The perfect reference tool for healthcare professionals and students
Lab Value categories include:
* Cardiac Labs (12)
* Renal Labs (6)
* Urinalysis (14)
* Electrolytes (19)
* Acid/Base Balance (8)
* Iron Studies (9)
* Pancreatic Disease (5)
* Liver Disease (13)
* Tumor Markers (9)
* Hematology (38)
* CSF Analysis (11)
* Lipid Panel (8)
* Drug Levels (27)
* Toxicology (7)
* Endocrine Labs (38)
* Immunology Labs (23)
Common Lab Panels include:
* Acute Viral Hepatitis Panel
* Arterial Blood Gas
* Basic Metabolic Panel
* Coagulation Panel
* Complete Blood Count
* Complete Metabolic Panel
* CSF Analysis
* Iron Studies
* Lipid Panel
* Liver Function Tests
* Thyroid Function Panel
* Urinalysis
Information included for Lab Values includes:
* Reference Values (SI and US)
* Critical Values
* Lab Description
* Differential diagnosis for elevated values
* Differential diagnosis for low values
* Container information
* Personal comments
* Additional information section with links to Google, Clinilab Navigator, Lab Tests Online, Web MD, Medline Plus, and Wikipedia
* Related Labs section
If you are in the healthcare industry, this app is the one to help you heal others and get through your day productively.

Download Link
http://adf.ly/YkzzV

http://adf.ly/Yl056

Oxford Handbook of Clin Med

This Oxford Handbook of Clinical Medicine, Eighth Edition is developed by MedHand Mobile Libraries.
As ubiquitous in hospitals as stethoscopes, the Oxford Handbook of Clinical Medicine is a guiding star for all medical students, junior doctors and trainees. The culmination of more than 20 years' clinical experience, and containing the knowledge and insight gained by more than 15 authors, the eighth edition continues to be the definitive guide to today's clinical medicine.

Packed with clear, clinical management advice which is practical to implement at the bed-side, it is written in a clear and didactic style. With witty, esoteric asides linking medicine to everything from the classics to popular culture, all the material is presented in a way that is instantly memorable and even easier to put into practice.
With extensive improvements based on reader feedback, the eighth edition boasts even more black and white and full-colour images. Mindful of how doctors' training is constantly evolving, a new chapter on 'history and examination' explores this relevant critical skill in depth, enabling you to elicit as much information from the patient as possible. An expanded radiology chapter features improved images, and new topics are devoted to new cancers such as nosocomial infections, and further common surgical procedures. The references have been thoroughly overhauled with 'key references' identifying the best places to start when researching a subject, and all references are fully accessible via the supporting website.
Loved and trusted by generations of doctors, the Oxford Handbook of Clinical Medicine is a reassuring beacon of wisdom, knowledge and skills that is forever in your sights.
Readership: Clinical medical students, junior doctors, general practitioners, and nurses. A wide range of other medical and allied health personnel.
Authors: Murray Longmore, Ian Wilkinson, Edward Davidson, Alexander Foulkes, and Ahmad Mafi
Publisher: Oxford University Press
______________________________________
MedHand Mobile Libraries offers a SUBSCRIPTION FREE application without edition upgrade. The apps enables you to make notes, search, add bookmarks and review what you previously been reading.
MedHand delivers what you need, trusted knowledge at the point of care! Offering most trusted and well recognized medical guidelines provided by excellent publishers like Oxford University Press, McGraw-Hill, PDR Network LLC, Wiley and more.


Download link:
http://adf.ly/YkzDu

http://adf.ly/YkzIt

Oxford Handbook of Critical Care

Requirements: 2.1+
Overview: This Oxford Handbook of Critical Care, Third Edition is developed by MedHand Mobile Libraries.

 The fully revised, third edition of this bestselling Handbook describes best practice of critical care in a succinct, concise and clinically-orientated way. Covering the principles of general management, it includes therapeutic and monitoring devices, specific disorders of organ systems, as well as detailed information on drugs and fluids.

This app has NO advertisements

Download Link

http://adf.ly/Yjlzm

http://adf.ly/Yjn2p

MedCalc 3000 Complete

Requirements: Android OS v2.2+
Overview: MedCalc 3000 Complete: Your answer for medical calculation

MedCalc 3000 is the most popular and comprehensive Medical Calculator system on the web. MedCalc 3000 has been highly acclaimed, reviewed and tested over the last 11 years. As a trusted resource it has been integrated into many prestigious websites for Medical Education, Medical Literature, Pharmacology, Nursing and more. Now you can put this invaluable resource in the palm of your hand!

MedCalc 3000 encompasses over 520 pertinent medical equations, clinical criteria sets, decision tree tools and dose/unit converters used every day by clinicians, educators, nurses, pharmacologists and students of all types. With the growing emphasis on Evidence-Based Medicine, there has never been a greater need for a system such as MedCalc 3000.

MedCalc 3000 Complete mirrors the web based resource MedCalc3000.com There you can see the complete list of components you’ll have in the Android Edition.


Download Link
http://adf.ly/YjnVl
http://adf.ly/Yjjzs

Dorland's Illustrated Medical

Requirements: 2.0 and up
Overview: Dorland's medical - 120 000 entries, 1500 images, 35000 audio pronunciations

Dorland's medical - 120 000 entries, 1500 images, 35000 audio pronunciations

The first and last word in medicine for over 110 years! Thoroughly updated, this user-friendly reference, trusted for more than a century by healthcare personnel at every professional level, allows you to grasp the meanings of all medical terms in current usage. Understand and correctly use all the latest terminology in today’s ever-evolving medical field with the 32nd Edition of the comprehensive, highly respected Dorland’s Illustrated Medical Dictionary!

Key Features:

* Enhance your understanding of all the current medical terminology in your field by relying on the most comprehensive and highly respected medical dictionary, bringing you more than 120,000 well-defined entries and 1500 clear illustrations.
* Listen to 35,000 audio pronunciations.

* New to This Edition:
* Make sure you're familiar with the very latest medical terms used today with more than 5,500 new entries drawn from current sources.
* Complement your understanding of new words and ideas in medicine with 500 new illustrations .
* Get more information in a smaller amount of space as the revised entry format includes related parts of speech.


The MSDict Dictionary Format

The Dorland's Illustrated Medical Dictionary is here presented in MSDict electronic format. MSDict offers best experience in mobile reference and is available for any handheld platform.

* Quick dynamic search of words while you type
* Transcriptions facilitating pronunciation
* Hyperlinks between different related words
* History to see the last 50 words you have looked up
* Support for memory cards
* Filters to help you locate the word you are searching for:
* Fuzzy filter- used when you are not sure of the correct spelling of a word
* Keyword-used to locate the instances of a key word within other compound words
* Wild card - "?" and "*" replace a letter and group of letters in words
* Fast article scrolling
* Ability to have dictionary Word of the day as a widget on the phone home screen
* Ability to search words in the installed dictionaries through the standard phone search feature

Download link:
http://adf.ly/YjS14
http://adf.ly/YjSA3

Pedi Safe Medications v3.3

Requirements: Android 1.6+
Overview: Pediatric Emergency Guide for medications, airway equipment, and Broselow Colors

Pediatric Emergency Guide for medications, airway equipment, and Broselow Colors

Features
• Pediatric & Adult Weight-Based Doses
• Broselow Colors Help Identify Weight
• Airway Equipment Selection & Size
• Normal Vitals Signs for Pediatrics
• ACLS & PALS Emergency Medications
• Simplify the Medication Delivery System

Download link:
http://adf.ly/YjIiH
http://adf.ly/YjJOs

Sanford Guide v2.02

Requirements: Android 1.6+
Overview: The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care.

The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care.

Always a pocket guide, still a pocket guide. Portability has been a hallmark of The Sanford Guide for over 40 years. The Sanford Guide to Antimicrobial Therapy application extends that portability to Android devices. The most trusted infectious diseases treatment resource in print now presents the same comprehensive, treatment- focused coverage of infectious diseases and clinical conditions, anti-infective drug information, therapeutic adjuncts and comparative spectra of activity in a clean, uncluttered, device-optimized interface. Based on the Sanford Guide Web Edition, the application features expanded coverage of topics compared to the print edition.

Other than for the initial download and to receive updates, the application may be used fully without the need for connectivity. Maximum screen space is devoted to the display of content by limiting buttons to those considered to be most essential: Home, Back and Search. All buttons are located on the application menu bar. The Index is activated by the search button on the application menu bar. The same button also hides the keyboard for full screen display of Index topics. For more about the application and the Sanford Guide, use the Info button on the launch screen.

Content queries are begun on the launch screen using a searchable Index or four Rapid Reference categories. Diseases and Clinical Conditions are organized by type (bacterial, fungal, mycobacterial, parasitic and viral). Bacterial diseases are further organized by site of infection and organism. Drug Information is similarly organized by type. Therapeutic Adjuncts include post-exposure antimicrobial prophylaxis (e.g., hepatitis, HIV, rabies), as well as preventative prophylaxis for surgical procedures and post-transplants. Comparison Tables include activity spectra tables for bacteria, fungi and viruses. These tables are color-coded for ease of use.

Extensive internal links provide efficient navigation to related content. For instance, drug regimens on disease pages are linked to corresponding pages for each drug containing comprehensive information on usage, dosing, adverse effects, activity, pharmacology, pharmacodynamics and drug-drug interactions. Broad topics such as meningitis and pneumonia include Overview pages with an outline and links to all sub-topics for that disease.

This app has NO advertisements

Download Link
mediafire

30% of oropharyngeal cancers worldwide are related to HPV infection, linked to sexual practices such as oral sex

In WHO press release on 18 July 2013, A new study by the International Agency for Research on Cancer (IARC), in partnership with Costa Rican investigators and the United States National Cancer Institute (NCI), shows for the first time that the vaccine against human papillomavirus (HPV) types 16 and 18, which is used to prevent cervical cancer, also provides strong protection against oral HPV infections, known to be associated with cancer of the oropharynx and tonsils.

The study, conducted in Costa Rica and published in the journal PLOS ONE, was initially designed to evaluate the vaccine’s efficacy against cervical cancer. It later included evaluation of the vaccine’s efficacy at other anatomical sites, including the oral cavity, where researchers established that the vaccine reduces oral infections with HPV 16 and 18 by more than 90%.

HPV is better known for causing cervical cancer, which is the third most common cancer in women worldwide, with an estimated 530 000 new cases and 275 000 deaths in 2008. HPV types 16 and 18 are also associated with cancers in a variety of other locations, including the vulva, vagina, penis, anus, and oropharynx. The estimated number of new cases of cancer of the oropharynx (including the tonsils and the base of the tongue) is approximately 85 000 per year in both sexes worldwide, and men are 4 times more likely than women to be affected.4 However, the incidence of oropharyngeal cancer has increased significantly in recent years in the USA and Europe, particularly among men and in young people.

According to a recent study in the USA, over the past 20 years, the rate of HPV detection in oropharyngeal tumour specimens increased from 16% to 70%.

play safe or risk your life :p

Osteoporosis Management Guidelines Updated by The National Osteoporosis Guideline Group (NOGG)

The National Osteoporosis Guideline Group (NOGG) has updated its 2009 guidelines on the diagnosis and management of osteoporosis in postmenopausal women and men at least 50 years of age in the United Kingdom. The new recommendations were published online June 17 in Maturitas.

"Since [2009] there has been a number of advances in the field, particularly with respect to glucocorticoid-induced osteoporosis, the role of calcium and vitamin D therapy, and the benefits and risks of long-term bisphosphonate therapy," write J. Compston, MD, from the University of Cambridge School of Clinical Medicine, United Kingdom, and colleagues from the NOGG. "In addition new pharmacological interventions have been approved for the prevention of glucocorticoid-induced osteoporosis and the management of osteoporosis in postmenopausal women and men at increased risk."


Selected Highlights of the 2013 Guidelines

• Pharmacotherapies shown to lower the risk for vertebral fracture (and for hip fracture in some cases) include bisphosphonates, denosumab, parathyroid hormone peptides, raloxifene, and strontium ranelate.
• Generic alendronate is usually first-line treatment because of its broad spectrum of antifracture efficacy and low cost.
• Ibandronate, risedronate, zoledronic acid, denosumab, raloxifene, or strontium ranelate may be appropriate therapy when alendronate is contraindicated or poorly tolerated.
• Because of the high cost, parathyroid hormone peptides should be used only for patients at very high risk, especially for vertebral fractures.
• Postmenopausal women may benefit from calcitriol, etidronate, and hormone replacement therapy.
• Approved treatments for men at increased fracture risk are alendronate, risedronate, zoledronic acid, and teriparatide.
• Patients at increased risk for fracture should start alendronate or other bone-protective treatment at the onset of glucocorticoid therapy.
• For postmenopausal women, approved pharmacotherapy for prevention and treatment of glucocorticoid-induced osteoporosis includes alendronate, etidronate, and risedronate; approved treatment options in both sexes are teriparatide and zoledronic acid.
• Calcium and vitamin D supplementation is widely recommended for older persons who are housebound or live in residential or nursing homes and is often recommended as an adjunct to other treatments for osteoporosis.
• Potential adverse cardiovascular effects of calcium supplementation are controversial, but it may be prudent to increase dietary calcium intake and use vitamin D alone rather than using both calcium and vitamin D supplementation.
• Withdrawal of bisphosphonate treatment is associated with decreases in bone mineral density (BMD) and bone turnover after 2 to 3 years for alendronate and 1 to 2 years for ibandronate and risedronate.
• Continuation of bisphosphonates without the need for further evaluation is recommended for high-risk individuals. When bisphosphonates are continued, treatment review, including renal function evaluation, is needed every 5 years.
• If bisphosphonates are discontinued, fracture risk should be re-evaluated after every new fracture, or after 2 years if no new fracture occurs.
• After 3 years of zoledronic acid treatment, the benefits on BMD density persist for at least another 3 years after discontinuation. Most patients should stop treatment after 3 years, and their physician should review the need for continuation of therapy 3 years later.
• Persons with a previous vertebral fracture or a pretreatment hip BMD T-score of −2.5 SD or less may be at increased risk for vertebral fracture if zoledronic acid is discontinued.

"At present there is no universally accepted policy for population screening in the UK to identify individuals with osteoporosis or those at high risk of fracture," the guideline authors write. "Patients are identified opportunistically using a case finding strategy on the finding of a previous fragility fracture or the presence of significant [clinical risk factors]. Some of these risk factors act independently of BMD to increase fracture risk whereas others increase fracture risk through their association with low BMD (e.g. some of the secondary causes of osteoporosis)."

An independent expert related the new UK guidelines to those used in Canada, released and published in 2010. "As with the current Canadian guidelines, the UK guidelines generally recommend fracture risk assessment in advance of making treatment recommendations," said Joanna Sale, PhD, associate scientist, Mobility Program Clinical Research Unit, St. Michael's Hospital, Toronto, Ontario, Canada, in an interview with Medscape Medical News.

"The recommendations in the guideline are intended to aid management decisions but do not replace the need for clinical judgment in the care of individuals in clinical practice," the group contributors conclude.

Malaysia's Clinical Guidance on Management of Osteoporosis 2012 can be found here.

Article reposted from Medscape.




Maturitas. Published online June 17, 2013. Full text

Latest study finds out elderly patients taking some cholesterol-lowering drugs have increased risk of developing type 2 diabetes

Latest study which was published online May 23 in the journal BMJ has showed that elderly patients who take certain high-potency cholesterol-lowering drugs especially atorvastatin, rosuvastatin and simvastatin have an increased risk of developing diabetes relative to a lower-potency statin, pravastatin.

 

“Our findings are significant because statins are among the most commonly used drugs in the world and our findings suggest that certain statins may confer a slightly increased risk of diabetes relative to other statins among those without a history of diabetes,” said Dr. Muhammad Mamdani, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and senior author of the study.

Statins are prescribed not just for lowering cholesterol to prevent cardiovascular events but also for people who have already had cardiovascular incidents such as a heart attack, stroke or peripheral artery disease. They are considered to be highly effective, but recent research has linked them to an increased risk of developing Type 2 diabetes, commonly known as adult onset diabetes.

In January, Health Canada required new labelling for statins to point out these risks, which it said were found mainly in patients with pre-existing risk factors for diabetes such as high levels of glucose in the blood, being obese or having high blood pressure.

 

 

Dr. Mamdani, an adjunct scientist with the Institute for Clinical Evaluative Sciences, used the health records of 1.5 million residents in Ontario to examine the association between statin use and new-onset diabetes.The patients were aged 66 and over and started statin therapy between 1997 and 2010. Atorvastatin accounted for more than half of all new statin prescriptions followed by rosuvastatin, simvastatin, pravastatin, lovastatin and fluvastatin. The study used pravastatin-treated patients as the comparison group as pravastatin has been shown to have favourable effects on diabetes in animals and in clinical trials.

 

 

This was the largest study to date to directly compare individual statins with respect to a risk for diabetes. The study demonstrated significant increased risk of diabetes with some statins relative to others irrespective of whether the patient had a prior history of cardiovascular events.

 

 

Of the 471,250 patients they identified with no history of diabetes and who were newly treated with a statin, patients treated with atorvastatin were found to have a 22% increased relative risk of new-onset diabetes compared to patients treated with pravastatin.

 

 

Rosuvastatin was linked to an 18% relative increased risk and simvastatin a 10% relative increased risk, relative to pravastatin. In contrast, patients treated with fluvastatin and lovastatin did not demonstrate an increased risk.

 

 

The researchers say several factors may explain the increased risk of developing diabetes, including the possibility that certain statins could block the release of insulin, the hormone that manages blood sugar levels.

 

 

“Overall, the risk of developing diabetes among patients taking statins appears to be low and may not outweigh the benefits of statin therapy in moderate to high risk patients,” said Dr. Mamdani. “For example, for every 1,000 persons treated with atorvastatin, only about six to eight additional people will be diagnosed with diabetes relative to those taking pravastatin. Both pravastatin and atorvastatin can be used for most patients to prevent future cardiovascular events, however our findings suggest pravastatin may confer a slightly lower risk of incident diabetes. ”

 

 

 

FDA mandates label change in 2012

In 2012, the US Food and Drug Administration mandated a labeling change to the entire drug class, issuing a warning that statins can raise blood sugar and HbA1c levels (pravastatin was exempted from the label change). The risk of diabetes began to gain traction first with the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study, where investigators reported a 27% increase in the risk of diabetes in patients taking rosuvastatin compared with placebo. Other analyses and meta-analyses confirmed the increased risk with statins in JUPITER, with an analysis from the Women's Health Initiative (WHI) showing a 48% increased risk of diabetes among women, while an analysis of PROVE-IT, A to Z, TNT, IDEAL, and SEARCH showed that high-dose statin therapy increased the risk of diabetes by 12%. In addition, a similar meta-analysis found that statin therapy increased the risk of diabetes by 9%.