The kyphosis angle of the thoracic spine tends to increase with aging. Hyperkyphosis is a kyphosis angle, exceeding the normal range. This narrative literature review aims to provide an overview of the current literature concerning kyphosis measurement methods, the etiology and adverse health effects of hyperkyphosis. As of yet, a well-defined threshold for hyperkyphosis is lacking. To attain more generalizability and to be able to compare study results in older adults, we propose to define age-related hyperkyphosis as a Cobb angle of 50 • or more in standing position. Hyperkyphosis may be a potentially modifiable risk factor for adverse health outcomes, like fall risk and fractures. Additionally, hyperkyphosis may indicate the presence of osteoporosis, which is treatable. Prospective and intervention studies, using a Cobb angle of 50 • as a clear and uniform definition of hyperkyphosis, are warranted to investigate the clinical relevance of hyperkyphosis.

Recently somatostatin analogues were successfully used to control insulin-induced hypoglycemia in patients with insulinoma. We observed a transient decrease in glucose levels and symptomatic hypoglycemia after administration of the long-acting somatostatin analogue octreotide (Sandostatin\s=r\) in two insulinoma patients. We studied the acute effects of octreotide (administered before breakfast) on blood glucose and glucoregulatory hormones in these patients. In one patient, we studied the effects of glucagon replacement and changing the time of breakfast (relative to octreotide administration) on octreotide-associated changes in blood glucose and glucoregulatory hormones. Compared with control levels, octreotide therapy reduced insulin levels. During hypoglycemia glucagon and growth hormone levels were suppressed, but cortisol levels appropriately increased. The increase in catecholamine levels was normal in one patient, but markedly attenuated in the other. A transient decrease in serum glucose after octreotide was absent after glucagon replacement, but present when breakfast was taken before administration of octreotide. We conclude that in patients with insulinoma, octreotide therapy may be associated with clinically important hypoglycemia, during which counterregulatory hormone secretion may be attenuated.Patients with insulin-secreting islet cell tumours are at risk for severe hypoglycemia. Surgical remo¬ val of the tumour is the treatment of choice. Medi¬ cal therapy is often required in the period preced¬ ing surgery and in patients with metastatic disease. Recently, long-acting somatostatin analogues were successfully used to control insulin-induced hypo¬ glycemia in patients with insulinoma (1-5).Important advantages of long-acting somatos¬ tatin analogues compared with native somatos¬ tatin are their prolonged half life, the possibility of subcutaneous administration, and the lack of a re¬ bound increase in insulin levels after discontinu¬ ing treatment. Furthermore, no clinically import¬ ant adverse effects during short-term therapy have been reported in insulinoma patients (1-5). We re¬ cently observed a transient aggravation of hypo¬ glycemia associated with treatment with the longacting somatostatin analogue octreotide (SMS 201-995, Sandostatin®) in a patient with malignant in¬ sulinoma (6). We here report the acute effects of oc¬ treotide on blood glucose and glucoregulatory hormones in this patient and in a second one in whom we observed a similar worsening of hypo¬ glycemia after administration of octreotide. Patients and MethodsPatient A, a 77-year-old woman, was admitted with a hy¬ poglycémie coma (blood sugar 2.0 mmol/1) at 05.00 h. After iv administration of glucose she regained con¬ sciousness. There was no history of liver disease, alcohol abuse, use of hypoglycémie drugs or prolonged (> 10 h) fasting. Results of diagnostic fasting, abdominal ultra¬ sound and computed tomography were compatible with a diagnosis of fasting hypoglycemia due to a pancreatic insulinoma.

A panel of European experts was convened to establish consensus on a treat-to-target strategy in osteoporosis. Panellists agreed that the ultimate goals of treating osteoporosis are recovering pre-fracture functional level and reducing subsequent fracture risk; there was consensus that total hip bone mineral density is currently the most appropriate treatment target in clinical practice. Introduction A modified Delphi approach was convened to establish consensus among European experts on best practice management for patients with fragility fractures and whether a treat-to-target (T2T) strategy is applicable in osteoporosis. Methods A panel of 12 clinical experts (from eight European countries) voted on 13 final statements relating to a T2T strategy for osteoporosis across three rounds of blinded, remotely conducted electronic surveys (Likert scale: 'strongly disagree', 'disagree', 'unable to answer', 'agree', 'strongly agree'). When panellists disagreed, they were asked how the statement could be adjusted to allow for a positive response, which was used to refine the statement for the following round. Consensus was defined as ≥ 75% agreement with a statement. Panellists were selected by UCB Pharma, which provided financial and logistical support. Results Consensus was reached for 13/13 statements. Panellists agreed that the most important goals for fragility fracture patients are recovery of pre-fracture functional level and reduction of subsequent fracture risk. There was also consensus that a T2T strategy is applicable to osteoporosis and that bone mineral density (BMD) is currently the most clinically appropriate target. With regard to the definition of a specific BMD treatment target and timeframes applicable to T2T in osteoporosis, no clear consensus was reached; panellists emphasised that these would need to be individually determined. Conclusions According to a panel of European experts, the main goals of fracture management are to recover pre-fracture functional level and reduce fracture risk. Total hip BMD seems to be the most clinically appropriate treatment target within a T2T strategy.

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