Jennifer Schneider

An online voluntary association of individuals who had incurred one or more atypical femur fractures (AFFs) while taking bisphosphonates for prevention or treatment of osteoporosis provided an opportunity to collect long-term histories. Individuals from a nationwide general community completed an anonymous survey documenting their history. Within a larger cadre, cases were selected where the documentation, including fracture radiographs, verified the diagnosis based on published standards. Eighty-one of this group responded to the anonymous survey. We describe passively collected observational data only. The incidence of a large number of potential variations was determined. The mean duration of bisphosphonate treatment was 9.5 yr. Prevention was the initial indication in 68% of the subjects; 94% started on alendronate, 77% reported prodromal pain, only 16% of these were diagnosed with incident stress fractures, and 39.5% experienced a contralateral AFF from less than 1 month to 49 months after the first. Of 71 subjects with a completed first AFF, 38% reported delayed healing, 11% had a complete contralateral AFF, and 22% underwent prophylactic rodding for a contralateral stress AFF. Forty-four percent of subjects with complete AFFs were continued on a bisphosphonate after the fracture. Thirty-five percent incurred a metatarsal fracture. AFF patients experienced delayed healing, prodromal pain, and persisting risk of a contralateral and/or other fracture. Femur pain evaluation in patients on long-term bisphosphonates may facilitate early diagnosis of stress AFFs, permitting intervention, thus reducing completed and/or contralateral or other fracture risk. The details of these histories will assist in counseling regarding prognosis after an initial AFF.

First-person reports of oocyte donors, years after their donation, can give valuable information about medical complications of oocyte donation, as well as changes potentially required in procedures and priorities of US-based in vitro fertilization (IVF) centers. This paper reports findings from an online survey of former oocyte donors. The instrument was an author-constructed questionnaire completed online on the Donor Sibling Registry website. Questions assessed women's accounts of medical complications, contact with the infertility clinic through which they had provided ova, and information exchange or contact with people conceived from their ova. Responses were received from 49.1% of the 287 donors with valid e-mail addresses. The 155 respondents completed the survey an average of 9.4 years after their first donation. Reported medical complications included ovarian hypersensitivity syndrome (30.3%) and infertility (9.6%). Subsequent to ova donation, 2.6% of women reported that they had been contacted by the IVF clinic for medical updates. On the questionnaire, 34.2% of women reported that medical changes they thought would interest donor children; half said that they had attempted to report these changes to the clinic with variable results. Many, who did not report such information, did not realize they could or should. Donors said that they frequently had not sought information about pregnancy outcomes because of confusion about the definition of ‘anonymity’ or ‘confidentiality’. US-based IVF clinics need to give clearer guidelines to anonymous oocyte donors about follow-up information exchange. Additional long-term studies are needed to ascertain oocyte donors' risks of infertility or cancer.

Despite some skepticism about the existence of sexual addiction, the addiction model has proven very useful for treating compulsive sexual behaviors. Addictive sexual disorders often coexist with c...