Canadian Primary Care Today

Essential Osteoporosis Management for the Primary Care Provider

David Kendler — 2024-09-09

Most individuals will experience deterioration in bone with advancing age, with consequent increases in fragility fractures. In addition, falls become more frequent with age, further increasing fracture risk. It is important to note that osteoporotic fractures impair quality of life and lead to increased dependency to a much greater degree in elderly individuals. Because of menopause-related declines in estrogen, women have greater bone loss and increases in fragility fracture compared to men. Our increased understanding of osteoporosis, its epidemiology, fracture risk, and expanding management options provide excellent opportunities for clinicians to benefit patients and maintain quality of life in aging individuals.

The Latest Updates in Obesity Management in Primary Care

Megha Poddar — 2024-09-09

The Canadian Obesity Clinical Practice Guidelines, published in 2020, have significantly shifted the dialogue around obesity management. These guidelines place substantial emphasis on patient-centered care, reducing stigma and bias, and recognizing obesity as a chronic disease, and have set a new global standard for obesity management. Most recently, Ireland and Chile have adapted these guidelines in their own countries

COPD 2024: Applying the Canadian Thoracic Society (CTS) 2023 Chronic Obstructive Pulmonary Disease (COPD) Guideline for Preventing Exacerbations, Improving Health Status, and Preventing Mortality

Sacha Bhinder — 2024-09-09

Chronic Obstructive Pulmonary Disease (COPD) is a common, chronic respiratory condition that is associated with the risk of morbidity and mortality. Approximately 2 million Canadians live with COPD, and as many as 1 million suffer while remaining undiagnosed and untreated. COPD exacerbations represent the most expensive cause of hospitalization with the highest likelihood of hospital readmission.

Exacerbations are the primary driver of mortality in patients with COPD. These exacerbations are the second leading cause of hospitalization in Canada with an average length of stay of 7 days. In fact, 1 in 5 patients with COPD will die within 1 year of their first hospitalization due to an exacerbation. For those 65 or older in Ontario, the overall 365-day mortality stands at nearly 28% following their first hospitalization due to an exacerbation. The best indicator of the risk of future exacerbations is a history of exacerbations.

The time has come to end the stepwise pharmacologic escalation that has defined the treatment paradigm in COPD. The call to action is to shift from the slow promotion of inhaled pharmacotherapy based on exacerbations to a direct escalation to inhaled pharmacotherapy with demonstrated evidence to prevent the exacerbations.

Management and Treatment of Red Eyes in Primary Care

Jamie Bhamra — 2024-09-09

Red eyes are a common complaint in primary care settings, with a plethora of causes and implications. Some etiologies are benign and self-limiting, while others are sight threatening and require urgent referral to an ophthalmologist. Therefore, it is important for primary care physicians to be able to carry out a diligent eye exam, recognize the signs and symptoms of different types of red eye presentations, to initiate appropriate management and treatment and to refer to ophthalmology when needed.

Navigating the Maze: A Mini-Guide for the Management and Therapy of Metabolic Dysfunction-associated Steatotic Liver Disease

Giada Sebastiani — 2024-09-09

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Nonalcoholic Fatty Liver Disease (NAFLD), poses a significant global health challenge with a prevalence of 30% worldwide. Alarming projections anticipate a substantial increase in MASLD cases, highlighting the urgent need for preparedness and effective policies. The pathophysiology of MASLD involves a complex interplay of metabolic, genetic and lifestyle factors. Although liver biopsy remains the gold standard for the diagnosis of MASLD, non-invasive methods such as abdominal ultrasound, transient elastography with controlled attenuation parameter, shear wave elastography, and non-invasive serum fibrosis scores have been developed and validated. Effective risk stratification in primary care with non-invasive fibrosis scores, such as fibrosis 4 (FIB-4) index and NAFLD fibrosis score (NFS), optimizes healthcare resource utilization, ensuring appropriate referrals for high-risk patients while minimizing unnecessary referrals. Lifestyle intervention, including diet and physical activity, remains the primary therapy for MASLD. Notably, with the FDA approval of resmetirom, the first authorized medication for fibrotic metabolic dysfunction-associated steatohepatitis (MASH), and several antifibrotic agents under investigation, the therapeutic landscape for MASLD is rapidly evolving. Despite its increasing prevalence, morbidity and mortality, MASLD is frequently underdiagnosed in primary care. In this review, we aim to provide primary care physicians an update on the diagnosis, management and treatment
of MASLD.