In 2000, the United Nations set a number of Millennium Development Goals (MDGs), although mention of family planning and population was still considered to controversial to include. In 2006, a report by the British parliament concluded, “The evidence is overwhelming: the MDGs are difficult or impossible to achieve with the current levels of population growth in the least developed countries and regions." 110 Whether polices will respond to this sober conclusion remains to be seen, but whatever the future holds it is likely to remain influenced by a web of events in the West, reaching back to the nineteenth century and even earlier. As Aristotle once said, “If you would understand anything, observe its beginning and its development.”
A clinical practice guideline on osteoporosis in men issued by the American College of Physicians (ACP) (Qaseem et al, 2008) recommended that physicians periodically assess elderly men for risk factors for osteoporosis. Although osteoporosis is often viewed as a disease of women, studies show that osteoporotic factures in men are associated with significant morbidity and mortality, resulting in substantial disease burden, death, and healthcare costs. The prevalence of osteoporosis is estimated to be 7 % in white men, 5 % in black men, and 3 % in Hispanic men. Data on prevalence of osteoporosis in Asian-American men and other ethnic groups are lacking. The guideline recommended that clinicians assess risk factors for osteoporosis in older men and obtain a DXA scan for men at increased risk for osteoporosis who are candidates for drug therapy. Risk factors for osteoporosis in men include age greater than 70 years, low body weight (body mass index [BMI] less than 20 to 25 kg/m2 or lower), weight loss (greater than 10 %), lack of regular physical activity, such as walking, climbing stairs, carrying weights, housework, or gardening, use of oral corticosteroids, previous osteoporotic fracture, and androgen deprivation therapy. The ACP also recommended further research to evaluate osteoporosis screening tests in men and that, presently, non-DXA tests are either "too insensitive or have insufficient data to reach conclusions."
In the WHIMS estrogen plus progestin ancillary study of WHI, a population of 4,532 postmenopausal women aged 65 to 79 years was randomized to daily CE ( mg) plus MPA ( mg) or placebo. After an average follow-up of 4 years, 40 women in the CE plus MPA group and 21 women in the placebo group were diagnosed with probable dementia . The relative risk of probable dementia for CE plus MPA versus placebo was (95 percent CI, –). The absolute risk of probable dementia for CE plus MPA versus placebo was 45 versus 22 cases per 10,000 women-years. It is unknown whether these findings apply to younger postmenopausal women. (See Clinical Studies and PRECAUTIONS , Geriatric Use .)