American family physician最新文献

Vertebral compression fracture is a common complication of osteoporosis. It is often triggered by ordinary behaviors such as turning in bed, coughing, and sneezing, but traumatic or metastatic etiologies are also possible. Although patients with vertebral compression fractures are often asymptomatic, they can present with back pain that worsens with postural movement and the Valsalva maneuver, potentially impairing function. Long term, these fractures can cause kyphosis, decreased vertebral height, muscle atrophy, and further bone mineral density loss. Anteroposterior and lateral projection radiography of the spine should be the initial imaging modality, and magnetic resonance imaging can be used to confirm suspicious but radiography-negative cases. Conservative measures are the mainstay of treatment, with physical rehabilitation and pharmacotherapy for pain relief. In addition to nonsteroidal anti-inflammatory drugs and acetaminophen, several anti-osteoporotic medications can improve pain after fracture. Bracing and nerve root blocks have very limited evidence of short-term benefit. Surgical intervention with vertebroplasty or kyphoplasty can be considered when pain persists for 6 weeks despite conservative intervention. Prevention of low bone mineral density is critical for avoiding vertebral compression fractures.

Antiretroviral therapy has transformed HIV into a chronic condition, enabling many people living with HIV to achieve near-normal life expectancy. However, HIV-associated complications remain common, driven by persistent immune activation, inflammation, sedentary lifestyle, and poor diet with cardiometabolic issues such as dyslipidemia, insulin resistance, body composition changes, and osteoporosis among the most prevalent. Newer antiretroviral therapy regimens, particularly integrase strand transfer inhibitor-based therapies, are better tolerated and typically associated with fewer systemic complications compared with previous therapy options. Neurocognitive impairment persists despite viral suppression and requires ongoing assessment and support. Distal sensory polyneuropathy affects up to 60% of people living with HIV, with evidence supporting treatment using gabapentin and capsaicin and possibly alpha-lipoic acid and medical cannabis in select cases. Chronic kidney disease is commonly driven by hypertension or diabetes. Rising sexually transmitted infection rates highlight the necessity of sexual health counseling and interventions such as doxycycline postexposure prophylaxis. Noninfectious pulmonary conditions such as chronic obstructive pulmonary disease and pulmonary hypertension remain underrecognized. Gastrointestinal complications are common and often worsen as CD4 counts decline. Dermatologic and hematologic complications, including cytopenias and clonal hematopoiesis, are associated with increased cancer risk. Primary care clinicians play a critical role of caring for a patient with HIV through routine screening, lifestyle counseling, and coordinated care.

As a significant portion of the US population ages, family physicians are seeing more adults older than 65. A recommended framework for geriatric assessment is the 4Ms: What Matters, Medication, Mentation, and Mobility. Clinicians should speak with patients and their families about what matters to them most in daily life and in their medical care. Clinicians should review medications to identify inappropriate drugs for discontinuation. They should also check for necessary medications that are missing or used incorrectly. For mentation, tools such as the Mini-Cog should be used for assessment when cognition is a concern. Abnormal results should prompt an evaluation for modifiable causes, mild cognitive impairment, and dementia. Mentation should also be addressed with screening for depression and factors that might predispose the patient to delirium. For mobility, clinicians should screen for fall risk with the Stopping Elderly Accidents, Deaths, and Injuries tool. Patients with positive results should be evaluated further and be instructed to begin exercise interventions, including physical therapy.