Clinical Inquiries, 2016
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Item Does vitamin D without calcium reduce fracture risk?(Family Physicians Inquiries Network, 2016) Daly, Sarah; Allison, Cami; Nashelsky, JoanQ: Does vitamin D without calcium reduce fracture risk? Evidence-based answer: No. Supplemental vitamin D without calcium -- in doses averaging as much as 800 IU per day -- doesn't reduce the risk of hip, vertebral, or nonvertebral fractures in postmenopausal women and older men (strength of recommendation [SOR]: A, large, high-quality meta-analysis of randomized or quasirandomized placebo-controlled trials). The vitamin D analogs alfacalcidol and calcitriol also don't reduce hip or nonvertebral fractures (SOR: A, multiple randomized, controlled trials [RCTs]), although alfacalcidol (but not calcitriol) does reduce vertebral fractures by 43% (SOR: B, one RCT and one quasi-randomized trial with potential for bias) Vitamin D supplementation, with or without calcium, doesn't affect mortality. It does double the risk of mild hypercalcemia (about 2.7 mmol/L increase), raise the risk of renal calculi or mild renal insufficiency by 16%, and slightly increase (4%) gastrointestinal adverse effects (SOR: A, meta-analysis of RCTs or quasi-randomized trials).Item Does breastfeeding affect the risk of childhood obesity?(Family Physicians Inquiries Network, 2016) Gunnell, Lindsay; Neher, Jon O.; Safranek, SarahQ: Does breastfeeding affect the risk of childhood obesity? Evidence-based answer: Yes. Even having breastfed during the first year of life is associated with a 15% lower risk of overweight or obesity over the next 2 to 14 years compared with never having breastfed. Breastfeeding exclusively for 6 months is associated with a 30% to 50% reduction in risk (strength of recommendation [SOR]: B, meta-analysis of cohort studies and subsequent cohort studies). However, interventions that increase breastfeeding rates during the first 3 to 6 months of life don't appear to alter body mass index (BMI) at 11 to 12 years of age (SOR: B, randomized clinical trial [RCT]). Introducing complementary (solid) foods before 3 months is associated with a 30% greater risk of childhood obesity than later introduction; starting solid foods after 4 months isn't linked to increased obesity. High caloric density of complementary feedings may be associated with greater childhood obesity (SOR: C, systematic reviews of heterogeneous cohort studies). Scheduled feeding doubles the risk of rapid infant weight gain compared with on-demand feeding, although it's unclear whether a direct relationship exists between rapid infant weight gain and childhood obesity (SOR: B, cohort study).Item Does knuckle popping lead to arthritis?(Family Physicians Inquiries Network, 2016) Powers, Tye; Kelsberg, Gary; Safranek, SarahQ: Does knuckle popping lead to arthritis? Evidence-based answer: No, habitual knuckle popping, or cracking (over the course of several decades) isn't associated with clinical or radiographic evidence of osteoarthritis (strength of recommendation [SOR]: B, retrospective cohort and case control studies). However, attempting to pop the knuckles can produce acute soft tissue injury (SOR: C, case reports).Item Which SSRIs most effectively treat depression in adolescents?(Family Physicians Inquiries Network, 2016) DeLucia, Valory; Kelsberg, Gary; Safranek, SarahQ: Which SSRIs most effectively treat depression in adolescents? Evidence-based answer: We don' t know which selective serotonin reuptake inhibitors (SSRIs) are the most effective and safe because no studies have compared these antidepressants with each other. Three SSRI antidepressant medications--fluoxetine, sertraline, and escitalopram--produce modest improvements (about 5% to 10%) in standardized depression scores without a significant increase in the risk of suicide-related outcomes (suicidal behavior or ideation) in adolescent patients with major depression of moderate severity. As a group, however, the newer-generation antidepressants, including SSRIs, increase suicide-related outcomes by 50%. Citalopram, paroxetine, venlafaxine, and mirtazapine don' t improve depression scores (strength of recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs]). An updated national guideline recommends specific psychological therapy for adolescents with mild depression and combined psychotherapy and fluoxetine for moderate or severe depression, with sertraline or citalopram as second-line agents (SOR: A, RCTs).Item Which treatments are safe and effective for chronic sinusitis?(Family Physicians Inquiries Network, 2016) Over, Darrell R.Q: Which treatments are safe and effective for chronic sinusitis? Evidence-based answer: for adults with chronic rhinosinusitis (crs), intranasal steroid (ins) therapy is more likely than placebo to improve symptoms (50% vs 32%; strength of recommendation [SOR]: A, systematic reviews). Nasal saline irrigation (SI) alleviates symptoms better than no therapy (SOR: A, systematic reviews), but it's probably not as effective as INS treatment (SOR: B, randomized controlled trial [RCT] with wide confidence interval). Long-term (12 weeks) macrolide therapy doesn't alter patient-oriented quality-of-life measures (SOR: A, systematic reviews). Endoscopic sinus surgery improves CRS symptoms -- nasal obstruction, discharge, and facial pain -- over baseline (SOR: A, systematic reviews). Surgery and medical therapy appear about equivalent in terms of symptom improvement and quality-of-life measures (SOR: B, systematic reviews of low-quality RCTs).