Highlights

Thiazolidinediones and fractures

Loke and colleagues report in a systematic review and meta-analysis that long-term use of thiazolidinediones doubles the risk of fractures among women with type 2 diabetes. See Research, page 32

In a related commentary, Lipscombe says that thiazolidinediones are no longer appropriate as first-line agents for managing type 2 diabetes. See Commentary, page 16

Diabetes and cardiovascular disease

Men with diabetes without cardiovascular disease and men with cardiovascular disease have similar long-term cardiovascular mortality. Dagenais and colleagues used incident, rather than prevalent, cases of diabetes and cardiovascular disease in their study, which included a random sample of men from Quebec who were followed for 24 years. See Research, page 40

Pneumococcal vaccination in adults

Pneumococcal vaccination may not be effective in adults, even in populations for whom the vaccine is recommended. Huss and colleagues come to this conclusion from their meta-analysis of 22 trials with over 100 000 participants. See Research, page 48

The evidence from the meta-analysis by Huss and colleagues is not enough to change policies regarding pneumococcal vaccination, say Andrews and Moberley. See Commentary, page 18

Acute monoarthritis

An approach to the diagnosis of acute monoarthritis is described by Ma and colleagues, who carried out a systematic review of the existing research. See Review, page 59

Migratory pulmonary infiltrates

A 24-year-old man has severe anemia, dry cough, chest pain and breathlessness on exertion. His chest radiographs show pulmonary infiltrates that appear to migrate. Which test should you do next? What is your diagnosis? See Practice, page 75

Diabetic muscle infarction

A 52-year-old woman with diabetes has severe pain and swelling in her left thigh, which prevents her from walking. Magnetic resonance imaging shows increased signal intensity in the quadriceps of her left leg. The diagnosis is diabetic muscle infarction, and her condition improved over 2 months. See Practice, page 72

Series on clinical trials

The first article in a new series on clinical trials examines trends in Canadian trials. See News, page 23

Obama's health care reforms

Although there are high expectations that US President-Elect Barack Obama will introduce wholesale reforms in health care, incremental change is far more likely. See News, page 26