Once-weekly oral alendronate is well tolerated, suppresses bone resorption and may improve volumetric bone density at the lumbar spine and mechanical strength of the femoral shaft in children with chronic illness taking glucocorticoids. It does not affect bone growth. Larger controlled studies are needed to determine if these changes translate into reduced fracture incidence or greater peak bone mass. This study highlights the importance of differentiating between changes in bone size and changes in volumetric bone density in assessing bone in children, and also having control subjects in intervention studies.

The combination of itraconazole and inhaled corticosteroids is increasingly being used to treat conditions such as allergic bronchopulmonary aspergillosis. Clinicians need to be aware of the potential for an interaction between such a combination.

We report further evidence for our previous suggestion [Garner et al., 2001: Am J Hum Genet 68:1061-1064] of a locus on 5q predisposing to bipolar I disorder (BP-I) in an extended Costa Rican pedigree. We genotyped additional microsatellite markers in this region and applied a multi-point non-parametric linkage analysis (SimWalk2). Significant identity-by-descent allele sharing among affected relatives was observed for all of the 20 markers tested in a segment of approximately 15 cM. Most affected individuals shared a single haplotype over this region; breaks within this haplotype may suggest a more restricted candidate location for a BP-I gene. These results support the suggestion that a locus at 5q31-33, together with a previously reported locus at 18q22-23, may provide the major genetic risk for BP-I in this family.

Background: The prescription of opioids for acute pain may be a driving factor in chronic opioid abuse. We examined patients' characteristics associated with the expectation of the receipt of opioid prescriptions for acute pain control. Methods: A 1-time survey was administered to adult patients at family medicine clinics in the Pacific Northwest between November 2018 and January 2019. Logistic regression modeled adjusted odds of expecting an opioid prescription in ≥ 3 of the 4 dispositional acute pain scenarios by patient demographics, opioid use, past-week pain intensity and duration, past-week anxiety, and pain catastrophizing. Results: The survey was completed by 108 patients (62% female, 48% between 30 and 49 years of age, 75% non-Hispanic Whites). Most patients (71%) expected an opioid prescription in ≥ 1 of the 4 scenarios; 26% expected a prescription in ≥ 3 scenarios. Patients with higher levels of pain catastrophizing had more than 3 times greater odds of expecting opioids than those with lower pain catastrophizing (OR, 3.73; P = .032; 95% CI, 1.12-12.46); no other characteristics were statistically significant. Conclusion: Higher pain catastrophizing was associated with increased odds of expecting opioids in dispositional acute pain scenarios in outpatient settings. Future studies can determine whether addressing pain catastrophizing reduces expectations of opioid prescribing for acute pain control. The finding that most patients expected opioid prescriptions in acute pain scenarios needs further exploration into other potential factors associated with these expectations. Evidence-based guidelines for condition-specific acute pain management are warranted for appropriate opioid prescribing and to guide treatment expectations.

The attainment of optimal peak bone mass during adolescence is important in the primary prevention of osteoporosis. Exercise may contribute to skeletal development and bone density during growth, although competitive exercise is suggested to have an adverse effect. This study assesses the effect of moderate exercise on the bone density of adolescent females. Additionally, other factors which significantly influence attainment of peak bone mass were identified. This was a cross-sectional study of 42 adolescent females, classified as runners (n=15) or non-runners (n=27). Nutrient intake, energy expenditure, menstrual history and pubertal stage were recorded. Bone age, skinfold thickness, body composition and bone mineral density (BMD) of total body, lumbar spine and proximal femur were measured. Statistical analyses used Student's t-test, Pearson correlation and multiple regression analyses. Runners had lower fat mass and higher lean mass, with a trend to higher BMD in all sites measured. There were no significant differences in menstrual cycle regularity, age at menarche or number who had attained menarche. Pubic hair development was similar in both groups. Breast development was delayed in runners, although this may have been a function of lower fat mass in this group. When subjects were categorized according to menarchal status, postmenarchal girls were significantly taller and heavier, with higher fat mass and significantly higher total body and lumbar spine BMD. There was no significant relationship between BMD at any site and dietary nutrient intake. Multiple regression analyses, using BMD as the dependent variable, identified running status, pubertal stage, fat mass and lean mass as significant determinants. When BMD/height was used, significant determinants in total body BMD were fat mass, pubertal stage and running status, while in the lumbar spine, only the latter two variables remained significant. In conclusion, body composition, physical activity and sexual maturity were identified as significant determinants of bone density during adolescence. Runners had significantly lower body fat than non-runners, but this did not interfere with hormonal cyclicity, and caused no detriment to their bone density. The results of this study are reassuring, since they indicate that sub-elite competitive athletics has no detrimental effect on bone mass accrual in adolescent females.