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Dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) are the most abundant steroids in humans, but their levels fall with age. This decrease has been associated with several age related diseases such as falls, osteoporosis, depression, atherosclerosis and sexual disorders. Moreover, studies have shown positive effects of DHEA administration on several of these disorders, with a satisfying safety profile. Unfortunately, DHEA has been too frequently mediatized as a "fountain of youths, which was responsible for either inadequate prescription, or prescription refusal. Longer studies in large populations should help to better define indications, treatment modalities and long-term treatment safety.

The burden related to the ever-increasing dementia prevalence in older individuals, imposes the implementation of prevention strategies. It is now known that brain lesions related to Alzheimer's disease precede the onset of the first symptoms. Consequently, prevention strategies should be implemented early, before clinically overt dementia. Blood and spine fluid tests, electroencephalogram, brain magnetic resonance and brain nuclear imaging should help physicians to better target "high-risk" patients prone to benefit from such strategies, already in a preclinical disease stage. Since no efficient pharmacological treatments exist for the time being, lifestyle factors such as nutritionand physical exercise are the cornerstones for dementia prevention.

Muscular wasting is frequently encountered in COPD patients and is related to a decrease in exercise tolerance, a higher morbidity and mortality. One of the potential causes isa low serum testosterone, which is frequent in COPD. Various studies have explored the effect of testosterone administration alone or as part of combined pulmonary rehabilitation and nutrition protocols. Testosterone had a positive impact on muscle mass and force, and to a lesser extent on physical endurance and respiratory parameters. Future studies should better define appropriate dosage and treatment duration. In the meantime, testosterone should be administered to COPD patients with overt hypogonadism, or in multidisciplinary specialized programmes.

Epidemiological studies have shown that vitamin or trace-element deficiencies are frequent in the general population. Food intake can be incriminated, but various drugs may also precipitate micronutrient deficits. Indeed, the consequences of pharmacotherapy on micronutrients are yet modestly explored in clinical practice settings. We aim at sensitizing physicians on the impact of frequently used drugs on vitamins and trace-elements. High risk populations for micronutrient deficiencies and indications for substitution are discussed.

Staff physicians of the Division of Primary care medicine of the University Hospitals of Geneva selected 9 articles published in year 2009 based on that they either brought new insights into the handling of current medical problems or that they broadened current knowledge of complex situations in the ambulatory care setting. Their field covers medication treatment for depression, neuropathic pain, facial palsy, osteoporosis, congestive heart failure, as well as during pregnancy. Updates on cardiovascular prevention, on screening of alcohol abuse and on the impact of social determinants on health are also provided.