In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory.

These findings confirm the important role of serum albumin in assessing in-hospital health status and defining its role as a strong predictor of early and late mortality after hospital discharge. They also emphasize the effects of comorbidity and functional impairment on long-term mortality after hip fracture. Identifying these predictive factors may be helpful in improving case management during hospital stay and more accurate discharge planning.

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Hip fracture (HF) is a major health care problem in the Western world, associated with significant morbidity, mortality and loss of function. Its incidence is expected to increase as the population ages. The authors discuss the role of a coordinated multidisciplinary team in the management of patients during hospital stay, at discharge and during rehabilitation. Orthogeriatric care should not just be viewed as a multidisciplinary activity, but as a radical alternative to the traditional model of care, an alternative based on all those strategies in which evidence shows an improvement in outcomes in the fractured elderly. Therefore, key points of the care are early surgery, immediate mobilization, prevention and management of delirium, pain and malnutrition, as well as an integrated and multidisciplinary approach. Comprehensive geriatric assessment is useful in identifying frail elderly and in providing information that is essential in formulating clinical recommendations and making care plans. In each hospital, the orthogeriatric unit should represent a center of excellence for treating elderly patients with major fractures. However, when an orthogeriatric project is implemented, it is essential that detailed data about the case-mix of patients, process of care and outcomes are collected, to compare the results with historical data and to be able to participate in audit processes.

Persistence of secondary HPTH reduces BMD response to ALN in older women with osteoporosis.

Passeri M. Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premenopausal women. Acta Endocrinol 1992:126:238-42. The effects of suppressive doses of L-thyroxine on the appendicular and axial bone mineral content were followed for 12\p=n-\36 months after total or subtotal thyroidectomy in 15 premenopausal women. Compared to age-matched controls, these patients had a more marked bone loss of the spinal bone mineral content (2.6 \m=+-\1.9% vs 0.2 \m=+-\ 1.2% per year). The changes in radial cortical bone density were not significantly different from the control group. We conclude that when a suppressive therapy with L-thyroxine is necessary the rate of bone loss should be monitored at regular intervals.Suppressive doses of L-thyroxine. a common form of therapy after thyroidectomy for different thyroid dis¬ eases, prevent further growth of abnormal tissue. Patients taking suppressive doses of L-thyroxine fre¬ quently have elevated serum thyroxine and free thyrox¬ ine concentrations, but serum triiodothyronine levels are within the normal range ( 1 ). These patients do not usually show biological or clinical signs of hyperthyroidism, but controversy exists as to whether such patients might have adverse tissue effects (2, 3). Thyroid hor¬ mones have important effects on bone metabolism and hyperthyroidism alters the bone remodelling activity and increases mainly cortical bone porosity, even if trabecular volume and cortical width may also be reduced (4). Cross-sectional studies have shown a reduction in bone density after prolonged suppression of the pituitary-thyroid axis with L-thyroxine (5-7) and marked bone mineral changes have been observed also under replacement therapy in hypothyroidism (8,9).The bone effects of thyroid hormone therapy could be particularly important in thyroidectomized patients in whom a decrement of calcitonin secretion, a potentially protective factor for bone (10), occurs.The aim of this longitudinal study was to assess the effects of suppressive doses of L-thyroxine on the appen¬ dicular and axial bone mineral content in premenopau¬ sal thyroidectomized women. Materials and methodsThe subjects for the study were chosen from all the premenopausal women consecutively admitted during the course of one year for thyroidectomy and were candidates for suppressive therapy. Criteria for exclusion were the presence of other medical disorders, the use of drugs known to interfere with bone and mineral metab¬ olism or previous treatment with thyroid hormones.Fourteen premenopausal women (age: 43 ±6.8 years) undergoing thyroidectomy for goiter (N = 6) and carcinoma (N = 8) were recruited. All the patients were euthyroid at the time of the study. Each subject gave written informed consent to the study.Ten patients underwent near-total thyroidectomy and four subtotal thyroidectomy. All were normally men¬ struating before and throughout the study. After surgery the women began a suppressive therapy with L-thyrox¬ ine. The initial dose was 150¿ug/day (3 ¿tg-kg^-day-1...