Overview
Dr. Ray O’Connor reviews several recent clinical studies that have broad relevance for everyday health decisions. The topics span menopausal hormone therapy (HRT) and fracture risk, the impact of post-hospital discharge exercise on older adults, the effectiveness of brief alcohol counseling in primary care, and current insights into COVID-19 treatments. Here, we distill the main findings, their practical implications, and lingering uncertainties.
Risk of fracture after stopping menopausal hormone therapy
A nested case–control study using UK primary and secondary care data examined fracture risk after discontinuing menopausal hormone therapy (MHT). The cohort included women aged 40 and older with a first fracture event between 1998 and 2023, matched to controls on age and practice. Findings showed a nuanced risk pattern. Current users of MHT had a reduced overall fracture risk—odds ratios (OR) of 0.76 for estrogen-only and 0.75 for estrogen–progestin therapy compared with never-users. Risk rose 1–10 years after cessation, with ORs around 0.99 for estrogen-only and 1.06 for estrogen–progestin, but dropped again beyond 10 years post-cessation (ORs of 0.93 and 0.95, respectively).
The study estimates extra fracture cases per 10,000 women-years 1–10 years after stopping MHT as 14 cases for those with less than five years of exposure, and five cases for those with five or more years of exposure. These results underscore the complexity of risk counseling: women on MHT may experience early fracture benefits that wane after stopping but gradually return to baseline risk over time. Clinicians can use this data to discuss the balance of benefits and risks when considering initiating or discontinuing MHT and to tailor follow-up based on exposure duration.
Effectiveness of an exercise program post-hospital discharge
Older adults face heightened risk of disability following acute hospitalization. A systematic review and meta-analysis evaluated whether post-discharge exercise interventions improve health outcomes. The researchers searched multiple databases for randomized controlled trials conducted from 2000 to 2025, including 17 trials with 1,458 participants that met quality criteria.
The evidence indicates that post-discharge exercise improves physical function, with significant gains in muscular strength and endurance. However, the interventions did not show clear benefits for health-related quality of life or readmission risk, and effects on cognitive function, frailty, or mortality were less conclusive due to limited data. These findings suggest that exercising after hospital discharge can help older adults regain functional independence, but expect mixed effects on broader outcome measures. Practitioners should integrate structured exercise programs into discharge planning where feasible and monitor individual progress to optimize functional recovery.
Brief alcohol counselling in primary care
Harmful alcohol use remains a major global health issue, contributing to millions of deaths annually. A large-scale pragmatic cluster randomized trial in Japan assessed whether doctor-delivered screening followed by ultra-brief intervention (<1 minute) reduces hazardous drinking compared with a simplified assessment alone. The study enrolled 1,133 outpatients aged 20–74 with hazardous drinking (AUDIT-C thresholds: ≥5 for men, ≥4 for women).
The primary outcome was total alcohol consumption at 24 weeks. Results showed no evidence that the ultra-brief intervention produced a greater reduction in intake than the simplified assessment alone. This finding challenges assumptions about the effectiveness of ultra-short, doctor-delivered counseling in primary care when compared to concise assessment strategies. It highlights the need for ongoing exploration of how to optimize brief interventions for reducing hazardous drinking in diverse healthcare settings.
COVID-19 treatment update
As of late 2024, more than seven million deaths have been attributed to COVID-19. A comprehensive systematic review and network meta-analysis focused on mild to moderate COVID-19 patients, incorporating 187 trials across 40 treatments. The analysis suggests that nirmatrelvir–ritonavir and remdesivir are likely to reduce hospital admissions in these patients. Molnupiravir and systemic corticosteroids may also help lower admission risk, while some therapies principally reduce symptom duration. Importantly, the effects vary by disease stage, underscoring the importance of stage-appropriate treatment choices. Overall, the evidence base is continually updating, and clinicians should stay informed about evolving trial data to guide early outpatient therapy decisions.
Practical takeaways
- HRT decisions should consider long-term fracture risk alongside menopausal symptoms and individual risk factors. Discuss duration and follow-up with a healthcare provider.
- Post-discharge exercise programs can improve physical function in older adults; integrate activity plans into discharge care where possible.
- Brief alcohol counselling may need to be tailored beyond ultra-brief advice; alternative or additional strategies could be considered for reducing hazardous drinking.
- COVID-19 treatment guidelines continue to evolve. Early treatment choices should align with current trial data and disease stage.
These updates collectively emphasize personalized care, ongoing monitoring, and the value of practical, evidence-based interventions for everyday health.
