falling for professional environmental assessment�for example, to occupational therapy. 34 People who have difficulty in performing a simple sit to stand test or taking over 13 seconds to complete a simple timed "up and go test" 35 should be referred to a geriatrician or falls clinic for a more comprehensive evaluation.The physiological profile assessment instrument is a useful, inexpensive tool for evaluating risk of falling. 36Among older people living in the community, this well validated instrument has a 75% positive predictive accuracy for distinguishing multiple fallers in the next year from those who will fall once or less. 36Another question is whether general practitioners should prescribe hip protectors to prevent hip fractures related to falls. Hip protectors are designed to shunt the force and energy of impact away from the greater trochanter, thus preventing fracture. 37 The first ranThe first randomised clinical trials of hip protectors showed good efficacy, but later, more inconsistent, study results have been attributed to differences in study designs, variation in the devices� capacity to attenuate biomechanical forces, and widely varying user compliance.20 37 Like antiresorptive drugs, hip protectors seem to have poor long term compliance. 37Nevertheless, current meta-analyses and systematic reviews suggest that in institutions with high rates of hip fracture, the use of hip protectors may reduce hip fractures by 23-60%.23 37-39 However, there is no evidence of benefit from hip protectors for lower risk people living in the community. 38 �n summary, it is time to shift the focus in fracture prevention from osteoporosis to falls. Falling is an under-recognised risk factor for fracture, it is preventable, and prevention provides additional health benefits beyond avoiding fractures. Contributors and sources:The authors have a long experience and research interest in methodological issues of bone densitometry, epidemiology, and prevention of osteoporosis, falls, and fractures in elderly people. This article arose out of discussions at several meetings on osteoporosis and hip fracture prevention including, most recently, the Paulo symposium on preventing bone fragility and fractures in Tampere, Finland, May 2006. TLNJ conceived the paper and wrote the first draft with KMK. all authors contributed to the initial critical review of the literature, planned the rationale for the article, contributed to the serial drafts and agreed the final submission. TLNJ is guarantor.Competing interests: None declared.Provenance and peer review: Not commissioned; externally peer reviewed.References are on bmj.com after looking at data used to support treatment of women with slightly lowered bone mineral density, pablo Alonso-coello and colleagues argue that proponents have overstated the benefits and underplayed the harms Pablo alonso-Coello family practitioner, Iberoamerican SummARY poINTS

Point-of-Care Ultrasound is a method of performing a rapid clinical ultrasound, with the aim of responding to a clinical question immediately. This is not an ultrasound performed systematically as the radiologists do, nor does it pretend to replace it. It is useful in some kind of screening (abdominal aortic aneurysm) and is of special interest in ultrasound-guided procedures (joint infiltration by injection). It allows to adapt the derivations, minimising the uncertainty, ruling out certain pathologies due to its high diagnostic precision. It can also lead to overdiagnosis, if the examinations carried out are not limited to the organs on which our clinical suspicion is based. Ultrasound is one tool more in the diagnostic process, but its use must be limited to certain clinical situations. Its use in early detection of prevalent diseases in Primary Care should be properly evaluated. On the other hand with more evidence of a high diagnostic accuracy in a large list of pathological conditions.

No abstract

Background: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. Methods:We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre-specified characteristics. Results:We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P = .001 and 58.3

No abstract