Contraception and birth control Archive

Millions of postmenopausal women are taking a bisphosphonate like oral alendronate (Fosamax) or intravenous (IV) zoledronic acid (Reclast) to increase bone density. But because long-term use of these drugs has been associated with an increased risk of bone death in the jaw and unusual thighbone fractures, experts have debated how long women should stay on the drugs to minimize the risk of hip or vertebral fractures without raising their risk for these rare but serious complications.

After considering major randomized controlled clinical trials, a task force of the American Society for Bone and Mineral Research has released guidelines on the optimal duration of bisphosphonate therapy for osteoporosis. The guidelines, published in the January 2016 issue of the Journal of Bone and Mineral Research, recommend reassessing a woman's fracture risk after five years of oral bisphosphonates or three years of IV therapy. They advise that women whose risk is still high should continue to take oral bisphosphonates for up to 10 years or IV therapy for up to six years. However, fracture risk should be reassessed every two to three years during extended therapy.

The U.S. Preventive Services Task Force has recently updated their guidelines on depression screening to include pregnant and postpartum women, which will be a great help to the many new moms who experience mood changes that go beyond the “baby blues.” The updated guidelines offer other benefits, too, that help improve everyone’s access to mental health care — especially those who can’t currently afford it.

If you’re planning an escape from the dreary winter weather, and you’re pregnant or trying to get pregnant, you may want to plan your destination carefully. There’s still a lot we don’t know about Zika virus — which is now widespread in several favorite tropical destinations, such as the Caribbean — and its potential pregnancy-related complications. Until we know more, it’s better to be safe and follow the precautions we’ve listed here.

They're convenient and affordable, but they don't replace a relationship with a primary care physician.

Walk into a drugstore, supermarket, or "big box" store these days, and you'll find more than prescriptions, food, and household goods. Many now feature health clinics. They're part of the big trend of making health care more convenient. "Twenty years ago you had to go to an emergency department if you got sick and needed immediate care. Now we have an explosion of options, such as retail health clinics," says Dr. Ateev Mehrotra, a researcher on the topic and an associate professor of health care policy at Harvard Medical School.

The clinics

Retail health clinics began showing up about 15 years ago. Today, there are about 2,000 clinics across the United States, mostly in large retail chain settings. A typical clinic is open from 7 a.m. to 7 p.m., seven days a week, and is staffed by a nurse practitioner or a physician assistant. Clinics offer all kinds of health services—everything from treating minor illness like a cold, pinkeye, or a urinary tract infection to providing physicals, health screenings, lab work, smoking cessation help, and vaccinations.

They're cute, cuddly, and loving, but dogs and cats aren't always appropriate for older adults.

There's a reason dogs are dubbed man's best friend. Dogs—and cats, too—make wonderful companions and provide many emotional and physical benefits. "I'm a believer in the beneficial effects of having a pet, and I'm impressed with the ability of dogs in particular to form bonds with human beings. I think the science is starting to support their special ability to do that," says psychiatrist Dr. Greg Fricchione, director of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. However, there are a number of considerations to mull over before adding a pet to your household.

Benefits

The most obvious benefits of pet ownership are love and companionship. "We do best medically and emotionally when we feel securely attached to another, because we're mammals and that's the way we've evolved," says Dr. Fricchione. He points out that we feel especially secure with dogs and cats because of the unconditional love they provide. "No matter what you do or say, your dog or cat accepts you and is attached to you," says Dr. Fricchione. Taking care of a dog or a cat can provide a sense of purpose and a feeling of validation when you wake up or come home and there's someone who's happy to see you.

Ask the doctor

Q: I am 68 years old, and recently my PSA level (which was normal before) increased to 5.2 nanograms per milliliter (ng/ml). My doctor repeated the test one month later, and it was normal again at 3.3 ng/ml. Should I still be concerned?

A: One of the reasons that routine PSA testing is so controversial is the inability of the test to distinguish men with prostate cancer from those without it. A common cutoff is 4 ng/ml, but this is hardly a black-and-white answer. In fact, 30% of men with a PSA result between 4 and 10 have cancer. (The remaining 70% have benign causes, like an enlarged prostate.) In men with a "normal" PSA in the 2-to-4 range, 20% have cancer. So the risk is still present.

Fostering strong social connections does not come easy for many men, but it is one of the best means to a longer and healthier life.

Social connections are as important to your health as proper diet and exercise. Research has linked social bonding to longer lives, lower incidence of depression and anxiety, and reduced risk of disease.

"Our brains and bodies function best when we are part of a community and maintain close, personal connections," says Dr. William S. Pollack, assistant clinical professor in the Department of Psychiatry at Harvard Medical School.

The annual check-up is important for older men. Here is how to make the most out of your visit.

Men have a long reputation for avoiding check-ups, and that resistance tends not to soften when they are older.

"Many older men put off exams because they fear finding out something is wrong," says Dr. Suzanne Salamon, a geriatrician with Harvard-affiliated Beth Israel Deaconess Medical Center. "Also, many of today's baby boomers don't think they will have medical problems associated with age, so it can difficult for the 'younger older men,' like those in their 60s and early 70s, to see their doctor."

Declining muscle mass is part of aging, but that does not mean you are helpless to stop it.

The saying goes there are two certainties in life: death and taxes. But men should also add loss of muscle mass to the list.

Age-related muscle loss, called sarcopenia, is a natural part of aging. After age 30, you begin to lose as much as 3% to 5% per decade. Most men will lose about 30% of their muscle mass during their lifetimes.

Ask the doctors

Q: I'm expecting and want to have a vaginal delivery, but many of my friends have had cesarean sections lately. Is this a preference, or are there medical reasons to have a cesarean?

A: The health of the mother and baby, the family's personal preferences, and the hospital in which a woman delivers her baby play a role in determining whether she has a cesarean. Common medical reasons for cesareans include fetal malpresentation (when the baby is turned so that its feet or buttocks will come out first), pelvic disproportion (a birth canal that is unusually shaped or too small in relation to the size of the baby), and a past cesarean. A study published in the Journal of the American Medical Association in December 2015 suggests that such commonly cited medical issues may account only partly for high cesarean rates.