Grade A, meta-analysis of randomised, controlled trials or from at least one randomised, controlled trial, or from at least one well designed, controlled study without randomisation; grade B, from at least one other type of well designed, quasi-experimental study, or from well designed, nonexperimental studies (e.g. comparative studies, correlation studies, case-control studies); grade C, from expert committee reports/opinions and/or clinical experience of authorities. ND, not demonstrated. Data from the Royal College of Physicians and the Bone and Tooth Society.

Fig. 38.1 The prevention of osteoporosis.With permission from J Manson, Harvard Medical School and the New England Journal of Medicine

rate of bone loss occurs during the first 6-12 months of corticosteroid use. Patients taking the equivalent of prednisolone 7.5 mg or more each day for 3 months or longer should be considered for prophylactic treatment, and this is mandatory in those over 65 years. Treatment for osteoporosis should be given when a patient taking a corticosteroid sustains a low-trauma fracture. Long-term use of inhaled corticosteroids may reduce bone mineral density and place patients at risk. The treatment options for both the prophylaxis and treatment are: hormone replacement (HRT in women, testosterone in men), a bisphosphonate and calcitriol.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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