This Week in JAMA FREE

The effect of cholecalciferol supplementation on the risk of falls and fractures is not clear. Sanders and colleagues Article assessed whether an annual dose of cholecalciferol (500 000 IU) would be associated with a reduced risk of falls and fractures in a randomized placebo-controlled trial that enrolled community-dwelling women aged 70 years or older who were at high risk of fracture. Cholecalciferol was administered in the autumn or winter for 3 to 5 years, and the authors found that compared with placebo, annual high-dose cholecalciferol was associated with an increased risk of falls and fractures. In an editorial, Dawson-Hughes and Harris Article discuss clinical implications of the study's findings.

Studies of children with sickle cell anemia have revealed unrecognized brain injury and impaired neurocognitive function. In a cross-sectional study, Vichinsky and colleagues Article examined neuropsychological function and neuroimaging findings in neurologically asymptomatic adults with sickle cell anemia and healthy controls stratified by age and sex. The authors report that compared with healthy controls, adults with sickle cell anemia had poorer cognitive performance, which was associated with age and anemia. In an editorial, Ballas Article discusses neurological complications of sickle cell anemia.

In analyses of data from new and recently published genome-wide association studies of late-onset, sporadic Alzheimer disease (AD), Seshadri and colleagues Article identified 2 new loci with genome-wide significance, replicated these findings in an independent population, and confirmed 2 loci previously reported to be associated with AD. The investigators also assessed the clinical utility of the newly identified gene loci and found they did not improve AD risk prediction beyond that obtained with models based on age, sex, and apolipoprotein E status. In an editorial, Pedersen Article discusses the limited contribution of genome-wide association data to understanding AD pathogenesis and prevention.

To identify factors associated with declines in coronary heart disease (CHD) mortality, Wijeysundera and colleagues analyzed data relating to CHD mortality rates, risk factors, and treatment uptake in Ontario, Canada. The authors found that from 1994 to 2005, the age-adjusted CHD mortality rate decreased 35%. They estimate that approximately half the mortality reduction was related to improvements in traditional CHD risk factors and 43% to improvements in CHD treatments.

In a systematic review of the literature, Schneider Chafen and colleagues assessed the quality of evidence relating to the prevalence, diagnosis, management, and prevention of food allergies. The authors report that the paucity of high-quality studies and the lack of uniform criteria to diagnose food allergy compromise estimates of food allergy prevalence and determinations of treatment efficacy.

“One day, [Mr M] asked to learn more about me. I felt uncomfortable. He was my patient, not my friend.” From “With Appreciation.”

Conflicting data about whether long-term use of bisphosphonates contributes to femur fractures pose a dilemma for clinicians and patients in weighing potential risks vs benefits.

Bring back home economics

Why health care expenditures matter

Join Roger Chou, MD, Wednesday, May 19, from 2 to 3 PM eastern time to discuss predicting whether low back pain may become persistent and disabling. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you counsel a 42-year-old man with hypercholesterolemia who is considering whether to drink alcohol to improve his cardiovascular health? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is May 23.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Theme Issue on Mental Health

For your patients: Information about food allergies.