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Suicide Assessment

Heidi James, MD and Rob Orman, MD
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05:52
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No me gusta!

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Heidi and Rob discuss the assessment of suicide.

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Eric S. -

Hi,

Regarding osteoporosis, I heard that we should not screen anyone > 75 y.o. if they never have been treated and have no risk factors - is it accurate?

Thank you!

Heidi J., MD -

Hi Eric!

We passed along your question to Dr. Ouellette - here is her response:
"Age, sex and previous history of fracture are the single most important risks for fracture.
CAROC (the Canadian Osteoporosis Guidelines) has no “end date” for screening, since age becomes an increasingly important driver to fracture risk.
I do not believe that FRAX has an “end date” either."

Hope this helps - thanks for listening!
Heidi

Eric S. -

Thank you, I finally found where I took this notion. It is more specifically regarding whether we should do a second DEXA scan for patient(e)s after 75yo, if one was done < 4 years... https://www.ncbi.nlm.nih.gov/pubmed/24065012 "In untreated men and women of mean age 75 years, a second BMD measure after 4 years did not meaningfully improve the prediction of hip or major osteoporotic fracture. Repeating a BMD measure within 4 years to improve fracture risk stratification may not be necessary in adults this age untreated for osteoporosis."

Thanks for keeping me up to date!

Danielle K. -

had a patient come in today after a 72 hours hold and kept this in mind! documented about safety plan and resources she had available to her! Thankful I listened to this over the weekend for a quick refresher!!!

Heidi J., MD -

Glad to hear the segment was helpful, Danielle :)

John K., MD -

99% of my 65 plus year old patients refer to both pcv23 and prevnar 13 at the pneumonia vaccine. Out state does not have an online adult vaccine database. Many of my patients are relatively new to the practice as well.
1. any hints on figuring out what patients have actually received?
2. is there a risk if a patient receives prevnar 13 twice?
thanks, JK

Heidi J., MD -

Hi John -

I feel your pain! Vaccination records are notoriously difficult to track. In the absence of a database, perhaps your patient's previous providers would have that information?

Regarding receiving Prevnar twice, I wasn't able to find any specific info, but in general getting an additional, unintended dose of any vaccine should only expose you to the baseline risks associated with receiving the vaccine. I'll check with Dr. Smyth, our ID doc, and update you if he has any comments to the contrary.

Thanks and good luck!
Heidi

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Bones Lose Their Autonomy Full episode audio for MD edition 193:25 min - 91 MB - M4AHippo Primary Care RAP January 2017 Summary 329 KB - PDF