https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768888 Serial Bone Density Measurement and Incident Fracture Risk Discrimination in Postmenopausal Women Carolyn J. Crandall, MD, MS1; Joseph Larson, MS2; Nicole C. Wright, PhD3; et al OBJECTIVE To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. In this prospective observational study 7419 women from The Women’s Health Initiative with a mean (SD) follow-up of 12.1 (3.4) years Incident major osteoporotic fracture (ie, hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD were assessed a second bone mineral density (BMD) assessment approximately 3 years after the initial measurement was not associated with improved risk discrimination, beyond the initial BMD assessment, between women who did and did not experience hip fracture or major osteoporotic fracture. . I hate this because it add nothing!! The uspstf came out in 2018 and said in their guidelines titled Screening for Osteoporosis to Prevent FracturesUS Preventive Services Task Force Recommendation Statement THEY SAID AND I QOUTE!! However, limited evidence from 2 good-quality studies found no benefit in predicting fractures from repeating bone measurement testing 4 to 8 years after initial screening. Do the trial we all want to see with follow up for 10 or 12 or 15 yrs or don’t do the trial you are just wasting time and money on what we already know! Next article Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates Nejm 196,129 women 50 years of age or older who were receiving bisphosphonates and who were enrolled in the Kaiser Permanente Southern California health care system; women were followed from January 1, 2007, to November 30, 2017 primary outcome was atypical femur fracture- usually defined as fractures in the subtrochanteric region and along the femoral diaphysis 277 atypical femur fractures occurred hazard ratio went from 8.86 at 3-5 yrs (95% confidence interval [CI], 2.79 to 28.20) up to 43.51 (95% CI, 13.70 to 138.15) for 8 years or more. (likely why guidelines say stop at 5 yrs or at least take a drug holiday) when you look at the data it appears to be exponential that longer you on a biphosphonate the more likely you are to have an atypical fracture. But the thing I like most about this study is a huge data set that tells us on average since there was 196,129 women, and 277 atypical femur fractures occurred then baseline normal is (1.74 fractures per 10,000 patient-years) They also used a computer model to try and figure out how many fractures were prevented and depending on your race at 5 years there were anywhere from 500-800 fracture prevented We don’t have information like what was the baseline dexa, how were these people started on bisphosphonate but we can say they do prevent fractures and if you are concerned about atypical fractures the data would say it happens about 1 in every 5000 women. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21628 “All participants (GDG members, ACS staff, expert advisors) were required to disclose financial and nonfinancial (personal, intellectual, practice‐related) relationships and activities related to cervical cancer and screening that might be perceived as posing a conflict of interest.” The American Cancer Society (ACS) now says average-risk individuals should begin cervical cancer screening at age 25 — rather than at age 21, as recommended in 2012. The group's guideline update appears in CA: A Cancer Journal for Clinicians. The other major change from 2012: The preferred screening approach is primary human papillomavirus (HPV) testing (i.e., stand-alone testing for high-risk HPV types) every 5 yea(continued)