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