title: Pharmacotherapy guidelines for the aged by family doctors for the use of family doctors: part C--Special pharmacology.
abstract: The part "Special pharmacology of the aged" of this guideline contains recommendations for typical conditions in the family doctors practice: in the January issue 2009 dementia and Morbus Parkinson, in this issue osteoporosis and urinary incontinence and in the next issue rectal incontinence and obstipation. This issue of the IJCPT contains the third part of the Pharmacotherapy guidelines for the aged by family doctors for family doctors. Part 3: Osteoporosis and urinary incontinence. Osteoporosis is a systematic disease characterized by low bone mass and declining bone structure. Exercise, adequate diet, nicotine abstinence as well as reduction of alcohol consumption may counteract the progression of the disease. Osteoporosis manifests in bone fractures with minimal trauma. Attention must be given to the risk of falling, e.g., by avoiding drugs that increase the risk of falling: e.g., psychotropic agents, analgesic drugs and antiarrhythmic agents. Specific osteoporosis medication e.g. calcium, vitamin D, biphosphonates and SERM (selective estrogen receptor modulators) is evaluated by family doctors according to indication, dosage, contraindications, long-term therapy and nature of any fracture. Duration of therapy is at least 3 - max. 5 years followed by reassessment of indication. There are 3 types of urine incontinence (urge-, stress-, and overflow-incontinence). Another standardization of urinary incontinence follows dysfunctions of the pelvic floor: detrusor muscle-dependent, due to sphincter spasm, prostate gland dependent. Urge incontinence with a dysfunction of the detrusor muscle is the most common type. Mixed types are frequent. Non-drug measures (e.g. pelvic muscle training, bladder training, toilet training are first choice treatments. Drug therapy (estrogen, imipramine) are without proven effect.
authors.affiliation: General practitioners, Association of Statuatory Health Insurance Physicians in Hesse (Kassenärztliche Vereinigung in Hessen (KVH) Frankfurt (Main)), Germany.
authors.forename: F W
authors.initials: FW
authors.lastname: Bergert
authors.forename: D
authors.initials: D
authors.lastname: Conrad
authors.forename: K
authors.initials: K
authors.lastname: Ehrenthal
authors.forename: J
authors.initials: J
authors.lastname: Fessler
authors.forename: J
authors.initials: J
authors.lastname: Gross
authors.forename: K
authors.initials: K
authors.lastname: Gundermann
authors.forename: B
authors.initials: B
authors.lastname: Kluthe
authors.forename: W
authors.initials: W
authors.lastname: Lang Heinrich
authors.forename: A
authors.initials: A
authors.lastname: Liesenfeld
authors.forename: P G
authors.initials: PG
authors.lastname: Loew
authors.forename: E
authors.initials: E
authors.lastname: Luther
authors.forename: R
authors.initials: R
authors.lastname: Pchalek
authors.forename: J
authors.initials: J
authors.lastname: Seffrin
authors.forename: A
authors.initials: A
authors.lastname: Sterzing
authors.forename: H-J
authors.initials: HJ
authors.lastname: Wolfring
authors.forename: U
authors.initials: U
authors.lastname: Zimmermann
mesh_terms: D000368:Aged; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D014549:Urinary Incontinence / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D004164:Diphosphonates; D020845:Selective Estrogen Receptor Modulators; D014807:Vitamin D; D002118:Calcium