John T. Schousboe, MD, MS, Park Nicollet Osteoporosis Center, Park Nicollet Health Services, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

Fractures related to osteoporosis are increasingly recognized as a serious public health problem among older men. As in women, bone densitometry has substantial utility to aid in the identification of older men at high risk of fracture and for whom fracture prevention therapies are indicated. This article briefly reviews the epidemiology of osteoporosis and associated fractures in men, the association of bone mineral density with fractures in men, indications for bone densitometry among older men, and the interpretation of bone mineral density test results in men.
Key words: osteoporosis, bone mineral density, densitometry, men, fractures.

Sanjeev Rastogi, MD, CAc, Consulting Physician, Department of Holistic Medicine,BMCRC, Vatsala Hospital,Tulsi Das Marg, Lucknow, UP, India.
Rajeev Rastogi, MSc, BNYS, Assistant Director (Naturopathy), Central Council for Research in Yoga and Naturopathy, Department of AYUSH, Ministry of Health, Government of India, New Delhi, India.
Ranjana Rastogi, MD, Head, Department of Obstetrics and Gynecology, State Ayurvedic College and Hospital, Lucknow, India.

The shoulder is one of the most versatile but also most unstable and vulnerable joints of the body. It is vulnerable to a variety of injuries, of which rotator cuff injuries predominate. These require specific tissue-targeted therapy to heal the point injuries. Conventional physiotherapy has been found to be limited in its efficacy as it offers superficial physical measures that cannot reach the traumatized tissue. Acupuncture, by virtue of its mode of application, can reach deeper in the traumatized tissue and offer substantial pain relief along with rapid healing of the trauma through ways that are yet to be fully understood. Acupuncture therapy for the management of rotator cuff injury seems to be the most productive way to reduce the intervention time and improve the net outcome, as observed in the case studied.
Key words: acupuncture, rotator cuff, macrotrauma, tendon sheath.

Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Research Department of Primary Care, University College London, UK.

Long-term benzodiazepine use in older adults with sleep disorders is potentially hazardous, but it is also becoming easier to manage as approaches to withdrawal become feasible in primary care, without adverse consequences. This article reviews the evidence and describes practical approaches to reducing consumption of benzodiazepine hypnotics.
Key words: benzodiazepines, insomnia, older adults, primary care, hypnotics.

R.A. Harrison, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.
T.J. Marrie, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.

Among older adults, aspiration pneumonia is associated with higher rates of morbidity and mortality than community-acquired pneumonia. Individuals admitted to acute care from continuing care facilities are at increased risk for aspiration pneumonia. Risk factor assessment forms a cornerstone in diagnosing aspiration pneumonia syndromes. Monitoring for timely clinical response to therapy and for potential complications is an important step in the care of patients with aspiration pneumonia. Further high-quality research is needed to better delineate the effects of risk factor modification on the incidence of aspiration pneumonia. Aiming to prevent aspiration pneumonia poses health care providers with an opportunity for ongoing development, study, and implementation of preventive strategies for older adults.
Key words: aspiration, pneumonia, older adults, geriatric, risk factor.

David F. Tang-Wai, MDCM, FRCPC, Assistant Professor, Department of Medicine, University of Toronto; University Health Network Memory Clinic, University of Toronto, Toronto, ON.
Naida L. Graham, PhD, Research Associate, Department of Speech-Language Pathology, University of Toronto; University Health Network Memory Clinic, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.

Impairment in language is a common finding among individuals with dementia and can be a presenting symptom, particularly in Alzheimer’s dementia and primary progressive aphasia. Early recognition of language dysfunction can help with an accurate diagnosis, management, and prognosis. There are numerous established and validated language evaluation protocols. This article provides a simple means for the primary care physician to identify and evaluate language disorders in dementia, but it is not meant to replace established protocols.
Key words: aphasia, dementia, primary progressive aphasia, semantic dementia, Alzheimer’s disease.

Marc Schermerhorn, MD, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Kristina Giles, MD, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Peripheral arterial disease (PAD) is a common disorder among older adults. Recognition of the signs and symptoms and appropriate referral of patients to a vascular surgeon can improve functional outcomes and limb salvage. Behavioural, medical, and percutaneous endovascular or open surgical therapies may all be used, depending upon the severity of symptoms and likelihood of limb loss. Cardiovascular comorbidities are common with PAD, and appropriate treatment to minimize cardiovascular mortality is important.
Key words: peripheral arterial disease, claudication, critical limb ischemia, endovascular treatment, lower extremity bypass.

Linda M. Rapson, MD, CAFCI, Rapson Pain and Acupuncture Clinic, Toronto; Consultant, Acupuncture Program, Toronto Rehabilitation Institute Lyndhurst Centre, Toronto, ON.
Robert Banner, MD, CCFP, FRCP(C), Dip AAPM/CAPM, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON.

Acupuncture, an ancient form of medicine that originated in China several thousand years ago, has been used by Canadian physicians since the 1970s. Research on the neurophysiology of acupuncture analgesia supports the theory that it is mediated primarily via the selective release in the central nervous system of neuropeptides. Evidence of its anti-inflammatory effects is emerging. Meta-analyses of randomized controlled trials provide evidence for acupuncture’s effectiveness in treating back pain, neck pain, and osteoarthritis. Applications of electroacupuncture using transcutaneous electrical nerve stimulation can provide good pain relief via home treatment and make management of cancer pain using acupuncture knowledge realistic.
Key words: acupuncture, pain, TENS, endorphin, anti-inflammation.

Mary Xiumei Wu, MD, TCM (China), MSc, Dipl OM, RAc, President, Toronto School of Traditional Chinese Medicine, Toronto, ON.

Traditional Chinese medicine (TCM) is a distinct and comprehensive medical system deeply rooted in Chinese philosophy. It is composed of fundamental theory, unique diagnostic methods, and a variety of treatment modalities primarily including acupuncture, Chinese herbal medicine, tuina massage, and taiji qigong. Traditional Chinese medicine has a wide range of clinical applications encompassing health promotion, disease prevention, and treatment and may be used for pain management either as an alternative or complement to allopathic medicine. An advantage of TCM is that it improves the patient’s general health in addition to controlling pain; therefore, it usually provides long-lasting effects and results in the relief of other accompanying symptoms such as fatigue, poor circulation, anxiety, depression, and insomnia, which are common comorbidities of pain in older adults.
Key words: traditional Chinese medicine (TCM), acupuncture, herbal medicine, tuina massage, taiji qigong, chronic pain.

Grant Chen, MD, FRCPC, Clinical Associate, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, ON.

Chronic abdominal pain is a common problem that is frustrating for both the patient and the physician. This article provides a general approach to chronic abdominal pain, including diagnostic considerations (both organic and functional) as well as important features for diagnosis and management of the common chronic functional abdominal pain syndromes.
Key words: chronic abdominal pain, functional abdominal pain, irritable bowel syndrome, functional dyspepsia.

Neeraj Bhala, MBChB, MRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Oxford, UK.
Angel Lanas, MD, PhD, Service of Gastroenterology, Instituto Aragones de Ciencias de la Salud, University Hospital, CIBERehd. Zaragoza, Spain.

Low-dose acetylsalicylic acid (ASA) is widely used in the prevention of cardiovascular events but can be associated with upper gastrointestinal (GI) complications, including ulcers. In this article, the range of effects of GI toxicity and the epidemiology of ASA-associated events are discussed, as well as risk factors, such as increasing age, that predict bleeding. Strategies to minimize upper GI events in older adults include the use of mucosal protectants such as proton pump inhibitors. The use of alternative antiplatelet agents including clopidogrel or Helicobacter pylori infection eradication may not provide sufficient protection in at-risk individuals who need low-dose ASA.
Key words: low-dose ASA, upper gastrointestinal events, older adults, gastroprotection, proton pump inhibitor.