Study: Hip Fracture Burden to Nearly Double Worldwide by 2050

John Bilezikian, MDNote from AAHPO Board Member John Bilezikian, MD, a renowned metabolic bone disease expert, regarding the article which appears below these remarks:

Osteoporosis, a disorder of weakened bones associated with increased risk of fracture, is a major international health problem. A recent update of the scope of this problem was recently published by Douglas Kiel, Professor at Harvard and a leader in studies related to the global epidemiology of osteoporosis. In the report recently published in the Journal of Bone and Mineral Research, the flagship journal of the American Society of Bone and Mineral Research, Dr. Kiel reports that the expected incidence of hip fracture, the most serious complication of osteoporosis, is likely to increase over the next 30 years, despite a downturn in hip fractures in many countries. The study accessed data from 19 different countries and included over 4 million hip fractures. The reason for the expected doubling in the number of hip fractures, worldwide, relates to the aging population. With aging comes increased risk of osteoporosis and fractures. Another important finding of the study confirms the point that many individuals who sustain an osteoporotic hip fracture do not received therapy to prevent another one. The risk of another fracture in someone who has sustained a hip fracture is markedly higher if treatment is not instituted. This study describes differences among countries but underscores, overall, the need for greater awareness of this disease and for implementation of measures to prevent and treat it.

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An international study that included researchers from Harvard Medical School indicates that while age- and sex-standardized hip fracture incidence rates have decreased in most regions around the globe, the number of hip fractures worldwide is projected to nearly double by 2050, compared to 2018.

A significant treatment gap in patients sustaining a hip fracture and not receiving therapy to prevent future fractures was also observed in all countries and regions, particularly in men.

The study, recently published in the Journal of Bone and Mineral Research, reviewed more than 4 million cases and highlights an urgent need for better strategies in hip fracture prevention and care.

Hip fracture remains a global public health concern contributing to increased dependency, morbidity, and mortality and placing a burden on patients, their families, and health care systems.


What You Need to Know About the Latest COVID Variant

Editor’s Note: Pediatric Infectious Disease Specialist and AAHPO Board Member Tsoline Kojaoghlanian, MD reviewed the article below and approved sharing it with AAHPO newsletter readers.

In early November 2023, the latest COVID variant, called JN.1, caused less than 5% of COVID-19 cases in the U.S. Now it is estimated to cause more than 60% of them. Virologists including Andy Pekosz, a professor in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, are paying attention.

Here, Pekosz explains what virologists are seeing, what this new variant means for case rates and treatments, and why it’s so important for more people to get the updated COVID-19 vaccine rolled out this fall.

What’s most important to understand about this variant?
This latest variant should be a reminder that we have tools to fight off COVID infection and minimize severe disease: Tests detect JN.1, the new vaccines protect against severe disease, and antivirals are still capable of treating infection from JN.1. We just have to use these tools more effectively than we have over the last six months.

So far, only 8% of children and 19% of adults have received the latest vaccine, so a lot of people are missing out on protection from this virus.


Paxlovid™ is a Potential Lifesaver. So Why Aren’t More People Taking It?

Editor’s Note: Pediatric Infectious Disease Specialist and AAHPO Board Member Tsoline Kojaoghlanian, MD agrees with the article below, which asserts that Paxlovid is helpful and should be more widely prescribed and taken.

With COVID-19 cases again on the upswing, the antiviral Paxlovid has been slow to gain traction among patients and doctors even though the medication reduces hospitalizations and deaths.

A recent National Institutes of Health study of about 1 million people found that only 15% at risk for severe disease took a five-day course of the prescription medicine. Of the patients who took Paxlovid, the medication reduced the risk of death by 73% and hospitalizations dropped 26%, showing the medicine is highly effective for people at risk of severe complications.

COVID-19 deaths, hospitalizations and visits to the emergency room increased at double-digit rates in the last week of December, the Centers for Disease Control and Prevention reported. But deaths and hospital stays remain far below earlier peaks.


Should You Take Aspirin for Heart Health?

Aspirin has long been considered a lifesaving option to lower the risk of heart attack or stroke. In fact, aspirin has been used for centuries for medical purposes, beginning more than 2,500 years ago when Egyptian physicians used willow bark as a pain reliever. Aspirin is also one of the most studied therapies in cardiovascular disease over the last half century.

However, taking a daily aspirin isn’t an option for everyone. Is it right for you? It depends on a variety of factors including age, general health, history of heart health, and more. which you should discuss with your health care provider.

Fortunately, we have AAHPO members and cardiologists Shant Manoushagian, MD and George Petrossian, MD to help us sort it out.

“Generally speaking, the widespread use of aspirin for primary prevention of cardiovascular disease has fallen out of favor due to bleeding risk, especially in those over age 60,” noted Dr. Manoushagian. “Guidelines now call for individualized, shared decision-making between health care provider and patient after weighing risk/benefit and cardiovascular (CV) risk vs. bleeding risk.”

“If able to be tolerated, aspirin should be used in patients who have had a prior heart attack, stroke, have documented CV disease, a prior stent of a heart artery or peripheral vascular disease,” said Dr. Petrossian. “In these patients, aspirin reduces the risk of heart attack and stroke.”

Both of these specialists emphasized that the decision to use aspirin should be made in discussion with your health care provider.


Some Reasons to Get Off the Fence about COVID Booster

Editor’s Note: AAHPO Board Member Tsoline Kojaoghlanian, MD, a pediatric infectious disease specialist, agrees with the article below, and also recommends the flu vaccine for those age 6 months and older, and recommends the RSV vaccine for the elderly (scroll down to see additional article).

Though many people remain on the fence about getting the latest COVID vaccine booster, new research suggests a strong argument for getting the shot this winter: It sharply reduces the risk for COVID.

Researchers found that getting vaccinated led to a 69% reduction in long-COVID risk among adults who received three vaccines before being infected. The risk reduction was 37% for those who received two doses. Experts say the research provides a strong argument for getting the vaccine, noting that about 10% of people infected with COVID go on to have long COVID, which can be debilitating for one quarter of those with long-lasting symptoms.

The data come from a systematic literature review and meta-analysis published in October in Antimicrobial Stewardship & Epidemiology. Researchers examined 32 studies published between December 2019 and June 2023, involving 775,931 adults. Twenty-four studies, encompassing 620,221 individuals, were included in the meta-analysis.


Why You Need a Flu Shot and Who Should Receive an RSV Vaccine

There are many reasons to get an influenza (flu) vaccine each year.

Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits.

Flu vaccination can keep you from getting sick with flu.

  • Flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 36 million influenza illnesses, 16 million influenza-associated medical visits, 390,000 influenza-associated hospitalizations, and 25,000 influenza-associated deaths.
  • During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.


Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be dangerous for older adults.

RSV vaccines help protect adults 60 years and older from severe RSV illness. Older adults are at greater risk than young adults for serious complications from RSV because immune systems weaken with age. In addition, certain underlying medical conditions may increase the risk of getting very sick from RSV. Older adults with these conditions may especially benefit from getting RSV vaccine. If you are 60 years and older, talk to your healthcare provider to see if RSV vaccination is right for you.


What You Should Know about Traveler’s Diarrhea

Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30%–70% of travelers during a 2-week period, depending on the destination and season of travel. Traditionally, TD was thought to be prevented by following simple dietary recommendations (e.g., “boil it, cook it, peel it, or forget it”), but studies have found that people who follow these rules can still become ill. Poor hygiene practices in local restaurants and underlying hygiene and sanitation infrastructure deficiencies are likely the largest contributors to the risk for TD.

TD is a clinical syndrome that can result from a variety of intestinal pathogens. Bacteria are the predominant enteropathogens and are thought to account for ≥80%–90% of cases. Intestinal viruses account for at least 5%–15% of illnesses, although the use of multiplex molecular diagnostic assays demonstrates that their contribution to the overall burden of TD disease is probably greater than previously estimated. Infections with protozoal pathogens are slower to manifest symptoms and collectively account for ≈10% of diagnoses in longer-term travelers (see Sec. 11, Ch. 7, Persistent Diarrhea in Returned Travelers).

What is commonly known as “food poisoning” involves the ingestion of infectious agents that release toxins (e.g., Clostridium perfringens) or consumption of preformed toxins (e.g., Staphylococcal food poisoning). In toxin-mediated illness, both vomiting and diarrhea can be present; symptoms usually resolve spontaneously within 12–24 hours.


American Academy of Pediatrics Recommends Infant Protection Against RSV

Lynn Cetin“RSV (Respiratory Syncytial Virus) is a severe viral illness that occurs in our communities each fall and winter. RSV is NOT a new virus, despite what some may think. RSV remains the number one cause of hospitalization in infants under 1 year of age and some of these infants suffer from the consequences of this virus for years. What is NEW is the development and FDA approval of a new ‘vaccine’ that can give our youngest clientele some passive immunity to get through their first RSV season. Beyfortus is a NEW one time “vaccine” for infants birth to 8 months of age that will give them the protection they need! This can be a total game-changer for our littlest of patients. It is heartbreaking to see our infants wheezing and struggling to breathe and then telling the parents they need to go to the hospital. To be able to prevent serious illness by giving a few months of immunity in one shot is incredible! Science and the progress we continue to make in disease prevention justifies all the hard work we do as medical professionals,” noted AAHPO Board Member and pediatrician Lynn Cetin, MD.

Garbis Baydar“Parents are already asking me about this important protection for infants,” noted AAHPO Vice President and pediatrician Garbis Baydar, MD.


The American Academy of Pediatrics (AAP) is recommending all infants under 8 months receive the new monoclonal antibody nirsevimab to protect them from respiratory syncytial virus (RSV), while also providing guidance for continued use of palivizumab (an injection used to prevent RSV) in the 2023-’24 season.

“Pediatricians are sadly familiar with the dangers of RSV and its devastating consequences for some families,” AAP President Sandy L. Chung, M.D., FAAP, said in a press release. “We are eager to offer all infants this protection and urge federal officials to see that it is made available and affordable in all communities.”

RSV causes about 58,000 to 80,000 hospitalizations and 100 to 300 deaths per year in children under 5 years, according to data from the Centers for Disease Control and Prevention (CDC).

Nirsevimab (Beyfortus) is a long-acting monoclonal antibody given as an intramuscular injection that is intended to protect children against lower respiratory tract disease caused by RSV. It was approved by the Food and Drug Administration in mid-July and the CDC in early August. It is expected to be available this fall, although some children may not have immediate access.


What You Should Know About Postpartum Depression

Recently, the U.S. Food and Drug Administration (FDA) approved Zurzuvae (zuranolone), the first oral medication indicated to treat postpartum depression (PPD) in adults. Until now, treatment for PPD was only available as an IV injection given by a health care provider in certain health care facilities.

What is PPD?
PPD is a major depressive episode that typically occurs after childbirth but can also begin during the later stages of pregnancy.

Most new moms experience postpartum “baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Sometimes it’s called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

PPD is not a character flaw or a weakness. Sometimes it’s simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

Learn more from the Mayo Clinic

Indiana Mother Dies from Drinking Too Much Water Too Quickly

An Indiana family had been touring Lake Freeman, located about 80 miles north of Indianapolis, over the Fourth of July weekend. On the final day of their trip, the mother, Ashley Summers (photo at left), started complaining of a headache and other signs of dehydration, like feeling lightheaded. She reportedly drank four 500ml bottles of water in 20 minutes because she couldn’t seem to get enough to quench her thirst.

After that, Ashley went back home with her husband and two young daughters before passing out in the garage. She had severe brain swelling when she was taken to the hospital, but she tragically never recovered consciousness.

Doctors determined that Ashley had water toxicity, also known as hyponatremia, which is brought on by low blood salt levels. It can happen when a large amount of water is consumed quickly, diluting the sodium levels in the body. This exceeds the capacity of the body’s intricate organ systems, particularly the kidneys, to control the fluid balance.

Muscle cramps, soreness, nausea, vomiting, headaches, and general malaise are among the symptoms. In severe cases, the brain may swell, which may cause coma, death, seizures, confusion, and a loss of consciousness. People who frequently work outside or exercise have a higher risk of developing the fatal illness.

Learn more from the Mayo Clinic