This Week in JAMA FREE

A number of recent case reports describe women who developed subtrochanteric or femoral shaft fractures in the setting of long-term bisphosphonate therapy. In a population-based, nested case-control study of Ontario, Canada, women aged 68 years or older who initiated therapy with an oral bisphosphonate between 2002 and 2008, Park-Wyllie and colleagues found that compared with transient use, bisphosphonate treatment for 5 years or more was associated with an increased risk of subtrochanteric or femoral shaft fractures.

Women with a personal history of breast cancer have an increased risk of second breast cancers. Houssami and colleagues examined the accuracy and outcomes of screening mammography among 19 078 women with a prior early-stage breast cancer and 55 315 women without breast cancer. They found that among women with prior breast cancer, mammography screening detects early-stage second breast cancers but has lower sensitivity and is associated with a higher interval cancer rate than among women without prior breast cancer.

Some data suggest that nitroglycerin stimulates bone formation and inhibits bone resorption and that women who take nitrates have a lower risk of fractures. To assess whether nitroglycerin increases bone mineral density (BMD), Jamal and colleagues Article randomly assigned postmenopausal women without osteoporosis to 24 months' treatment with nitroglycerin ointment (15 mg/d) or placebo. The authors report that nitroglycerin ointment was associated with a modest increase in BMD and decreased bone resorption. In an editorial, Khosla Article discusses nitroglycerin's effects on bone and its potential as a novel treatment for osteoporosis.

It is unclear whether brain exposure to cell phone radiofrequency-electromagnetic fields may be harmful. Volkow and colleagues Article assessed regional brain glucose metabolism—a marker of brain activity—in a study involving 47 healthy participants who underwent 2 positron emission tomography scans performed on separate days. During 1 scan the phone was activated (“on” with sound muted); during the other, the phone was “off,” with the participants blinded to the condition. The authors found that compared with no exposure, 50-minute cell phone exposure was associated with increased brain glucose metabolism in the region closest to the phone antenna—a finding of unknown clinical significance. In an editorial, Lai and Hardell Article highlight the need for continued investigation of the effects of wireless phone radiofrequency emissions on the brain.

Olnes and Sloand discuss the case of a 56-year-old woman with a myelodysplastic syndrome—a heterogeneous group of bone marrow disorders characterized by ineffective hematopoiesis—who was treated with an investigational protocol using alemtuzumab, a monoclonal antibody directed against a surface antigen on B and T cells. Her blood counts had normalized with treatment, and she has been in remission for 2 years. The authors discuss the pathobiology of immune dysregulation and the role of immunosuppressive therapy in myelodysplastic syndromes.

“A physician really doesn't want to have ‘favorites’ and for good reason strives daily to treat everyone with equal effort and compassion.” From “The Leopard-Skin Bra.”

Despite conflicting results, 2 clinical studies prompt a new hypothesis that adjuvant treatment with the bisphosphonate zoledronic acid might improve survival in some postmenopausal women with breast cancer.

Switching glucose-lowering drugs

Index event bias

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Join Gabriela Schmajuk, MD, MS, Wednesday, March 16, from 2 to 3 PM eastern time to discuss disease-modifying antirheumatic drugs for patients with rheumatoid arthritis. To register, go to http://www.ihi.org/AuthorintheRoom.

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

How would you manage a 27-year-old woman who is in her second trimester of pregnancy, is addicted to heroin, and receives a 1-year jail sentence? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is February 27.

For your patients: Information about knee replacement.