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Abstract: Introduction: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved. Methods: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events. Results: One hundred and twelve patients (13.6%) aged 82 years±7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p =0.001, p =0.002, p =0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders. Conclusion: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population. [Copyright &y& Elsevier]

Abstract: Introduction. —: The term ‘primary’ osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and,in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as `secondary'' osteoporosis. Current knowledge and key points. —: This article describes the major causes and provides a framework for the diagnostic investigationof patients with suspected of having secondary osteoporosis. There are numerous causes of secondary bone loss, including endocrine disorders, disorders of the gastrointestinal or biliary tract, rheumatic diseases, haematological diseases, immobilization, adverse effects of drug therapy, and a wide miscellaneous group. Future perspectives. —: Secondary osteoporosis is potentially reversible during the treatment of the underlying disease. It must be identified and induce a symptomatic treatment in all cases plus an etiologic treatment when possible. [Copyright &y& Elsevier]

Abstract: Purpose: High variability has been observed in the estimation of the glomerular filtration rate (GFR) in older patients, according to the formula used and no single formula has been recommended to date. The aim of this study was to quantify the precision and accuracy of the GFR estimated by means of three formulas and the measurement of cystatin C. Methods: This prospective study was conducted in an acute care geriatric unit. Participants were patients, aged 70 years and over, having a possible 24-hour urine collection. The GFR was estimated using the Cockroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Creatinine Clearance (Cl-Cr) formulas. The serum level of cystatin C was also measured. Results: Eighty-one patients were included in the study. CG formula underestimated the GFR by a mean difference of 8.65ml/min, compared with MDRD formula. Cl-Cr underestimated the GFR by a mean difference of 7.56ml/min, compared with CG formula, and by a mean difference of 16.79ml/min, compared with the MDRD formula. The degree of discrepancy between CG and Cl-Cr estimates, and between Cl-Cr and MDRD estimates decreased as the estimated GFR approached normal values. MDRD best matched the measurement of cystatin C, followed by CG and Cl-Cr (Kappa coefficient=0.43, 0.22 and 0.16, respectively). Conclusion: Our study confirms the high variability of GFR in older patients and particularly in those with abnormal renal function, depending on the formula used. Serum cystatine C level and MDRD formula appear to be the most concordant estimates of GFR in this population. [Copyright &y& Elsevier]