The Clinical Picture
Causes include nutritional deficiencies, local and systemic factors, and drug treatment.
Internists can reduce the risks by optimizing glycemic control before conception and providing effective counseling.
Options: volume repletion, antiemetics, antiepileptics, NSAIDs, corticosteroids, and magnesium sulfate. Avoid opioids.
Set modest calcium targets, maximize dietary intake, and make up the deficit with calcium citrate.
From the Editor
I do not believe we truly understand the ideal amount of dietary and supplemental calcium or vitamin D for a given patient.
There is no need to continue Pap testing after hysterectomy for a benign indication.
Current Drug Therapy
This antimalarial drug is now approved to treat discoid lupus, systemic lupus erythematosus, and rheumatoid arthritis.
Half of all postmenopausal women experience these symptoms. Most do not seek relief.
Medical Grand Rounds
Fibromyalgia is a defined syndrome of neuronal dysregulation and can be diagnosed and managed in a primary care setting.
An energy deficit from increased exercise, decreased intake, or both can suppress the menstrual cycle and lead to bone loss.