The three largest pharmacy benefit managers (PBMs) inflated the price of specialty generic drugs beyond their costs of acquisition, earning more than $7.3 billion in revenue from 2017 to 2022, according to a report issued by the Federal Trade Commission (FTC) on Tuesday.
“The FTC staff’s second interim report finds that the three major pharmacy benefit managers” — Caremark Rx, Express Scripts, and OptumRx — “hiked costs for a wide range of lifesaving drugs, including medications to treat heart disease and cancer,” said outgoing FTC Chair Lina Khan in a press release.
The costs of these specialty generic medications, which also included treatments for HIV and other serious illnesses, were marked up by “hundreds and thousands of percent,” the agency noted in their report.
Moreover, PBMs reimbursed affiliated pharmacies at higher rates than unaffiliated independent pharmacies for almost every one of the generic drugs that staff analyzed.
“The FTC should keep using its tools to investigate practices that may inflate drug costs, squeeze independent pharmacies, and deprive Americans of affordable, accessible healthcare — and should act swiftly to stop any illegal conduct,” Khan said.
The agency voted 5-0 to allow staff to release the report. Commissioners Melissa Holyoak and Andrew Ferguson (who is expected to replace Khan as chair after President-elect Trump takes office) were absent from a virtual meeting of the commission on Tuesday.
In the FTC’s second report — an earlier report on PBMs was released in July — agency staff looked closely at all specialty generic drugs dispensed to enrollees in commercial health plans and Medicare Part D prescription drug plans overseen by the three largest PBMs from 2017 to 2022. The inquiry included 51 specialty generic drugs in total.
Beyond the noted markups, the FTC highlighted the following key findings:A disproportionate share of the most profitable prescriptions (those marked up more than $1,000) were dispensed by the three PBMs’ own pharmacies and not independent, unaffiliated pharmacies — a pattern indicative of potential steering, the report suggested.PBM-affiliated pharmacies saw growth in dispensing revenues above the National Average Drug Acquisition Cost at a compound annual growth rate of 42% from 2017 to 2021. In total, the top 10 specialty generic drugs brought in $6.2 billion in dispensing revenue, accounting for 85% of total revenue.Additionally, the three PBMs took in another $1.4 billion from spread pricing — the practice of billing plans more than they reimburse pharmacies for dispensing medications — for the specialty drugs being investigated over the study period.Dispensing of the top specialty drugs represented a significant share of business — about 12% of operating income — reported by the three PBMs’ “parent healthcare conglomerates” (insurance companies that own the PBMs) in 2021.Drug spending by both plan sponsors and patients increased substantially over the study period. In 2021, plan sponsors paid $4.8 billion for specialty generic drugs and cost-sharing amounted to $297 million. From 2017 to 2021, the amount that plan sponsors and patients paid grew at a compound annual growth rate of 21% for commercial claims and 14% to 15% for Medicare Part D claims.
In a press release, B. Douglas Hoey, RPh, MBA, a pharmacist and CEO of the National Community Pharmacists Association, criticized the PBMs for their “wild profiteering and self-dealing.”
“While the Big 3 have consolidated and vertically integrated over the years, they increasingly declare expensive medications to be ‘specialty’ to steer patients to a PBM-affiliated specialty pharmacy to the tune of $7.3 billion above the drug cost,” he said. “They crush their competition by reimbursing their own pharmacies as much as 100% more than they reimburse independent pharmacies for the same drug, or more.”
“This exploitative behavior is bad for taxpayers who subsidize Medicare prescription coverage but the FTC report found that commercial employers are getting hosed even worse. It’s no wonder employees are questioning why their employers are listening to insurance brokers who often recommend one of the giant PBMs,” he noted, adding that patients would be “well-served” if they were able to obtain the “so-called specialty drugs” from their own preferred community pharmacy.
During the public comment period of the virtual meeting, Chris Hobart, PharmD, RPh, an independent pharmacist, described the situation at his pharmacy where patients, their children, and grandchildren have been customers for decades.
He noted that the website through which customers enrolled in health plans stated that his pharmacy would be their “premier pharmacy,” but they then received letters indicating that they would need to switch to a mail-order pharmacy or pay more for their medications if they continued to use his pharmacy. Later that year, the pharmacy closed after 65 years.
Hobart thanked the commission for its work and urged the agency to continue its investigation into PBMs.
“If plan sponsors have the full benefit of information, including how much PBMs profit from making patients use PBM-owned mail-order pharmacies versus the actual cost of allowing patients to use local pharmacies, nobody would be saying these things [asking for mandatory mail-order pharmacies]. They wouldn’t be in the contract,” he said.

Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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The FDA issued a proposed rule Tuesday that would require food manufacturers to put “Nutrition Info” labels on the front of their packages stating whether the food inside contains a high, medium, or low level of sodium, saturated fat, and added sugars.
“Chronic diseases — including heart disease, cancer, and diabetes — are the leading cause of disability and death in the U.S., with 60% of Americans having at least one chronic disease,” Rebecca Buckner, PhD, associate deputy director for human food policy at the FDA’s Human Food Program, said on a call with reporters. “A large body of research indicates that a major contributor to this problem is excess consumption of saturated fat, sodium, and added sugar, and yet the vast majority of Americans exceed current recommended limits for all these nutrients.”
“There is also a proliferation of foods in the food supply that are commonly considered ultraprocessed, which often contain high levels of saturated fat, sodium, and added sugar,” she continued. “The proposed ‘Nutrition Info’ box is focused on providing accessible information to help consumers quickly and easily identify how [various] foods can be part of a healthy diet.”
For labeling purposes, a food would be defined as having a “high” level of saturated fat, sodium, or added sugars if the amount was equal to or greater than 20% of that nutrient’s recommended daily value (RDV). A “medium” level would be between 5% and 20% of the RDV, and a “low” level would be 5% or less of the RDV.
The rule would become effective in 3 years for food manufacturers with $10 million or more in food sales, and in 4 years for manufacturers with less than $10 million in sales, explained Robin McKinnon, PhD, acting director of the Nutrition Center of Excellence at the Human Food Program. The rule incorporates results from a 2023 FDA study of nearly 10,000 adults, which looked at their responses to different types of front-of-package labels, she said, adding that the study sample “mirrored the U.S. population on age, sex, education, race, and ethnicity to ensure those most at risk for diet-related diseases were adequately represented.”
What about listing calorie information on the front of the package? “We did hear interest in including calories” from manufacturers, McKinnon told MedPage Today during a question-and-answer session. “We did not include calories in the proposal as a mandatory requirement … However, in the proposal, we have provided examples of how a manufacturer could include that information” alongside the “Nutrition Info” box.
One issue with the proposed rule is what will become of it under a Trump administration. Generally speaking, when a new president takes the oath of office, the chief of staff at the FDA — as well as those at other agencies — instructs department employees to halt work on regulations for 60 days, so the administration can decide which rules they want to pursue. This proposed rule does appear to align with the stated interest of Robert F. Kennedy Jr. — Trump’s pick to head HHS — for reducing Americans’ consumption of ultraprocessed foods.
The Center for Science in the Public Interest (CSPI), a consumer advocacy group, applauded the FDA’s move. “The incoming administration has the opportunity to finalize this important rulemaking and follow through on commitments to stand up to Big Food,” CSPI President Peter Lurie, MD, MPH, said in a statement. “We hope to see FDA continue to push forward with evidence-based public health protections, including mandatory front-of-package nutrition labeling.”
CSPI did have one quibble with the proposed label, the type of which is sometimes called “traffic light” labeling and is often accompanied by the colors red, yellow, and green for high, medium, and low nutrient levels, respectively. “The scientific literature generally favors nutrient warnings (i.e., ‘High In’ labels) over ‘traffic light’ labels for reducing selection or purchasing of foods high in sodium, sugar, and saturated fat,” he said. “Either, however, is a vast improvement on the status quo.”
The proposed rule will be open for comment through May 16.

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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While many adolescents and young adults (AYA) with cancer died in their preferred locations, about 30% who wanted to die at home were unable to do so, according to a retrospective cohort study.
Among over 500 AYA patients ages 12 to 39 with a documented discussion about preferred location of death, 75.9% died in this preferred location, reported Oreofe O. Odejide, MD, MPH, of Dana-Farber Cancer Institute in Boston, and colleagues.
Of these patients, 95.3% who preferred a hospital death died there, 70.7% who preferred a home death died at home, and 33.3% who preferred to die in inpatient hospice did so, they noted in JAMA Network Open.
“Although it is encouraging that many patients died in their preferred location, the fact that nearly 1 in 3 AYA patients who wanted to die at home received discordant care raises concerns regarding the quality of EOL (end-of-life) care for this population,” Odejide and colleagues concluded. “Our findings emphasize the need for concerted efforts to help AYA patients with cancer achieve patient-centered EOL care, where the gap between preferred and actual location of death is eliminated.”
In a commentary accompanying the study, Emily E. Johnston, MD, MS, of the University of Alabama at Birmingham, and Jennifer M. Snaman, MD, MS, of Dana-Farber Cancer Institute and Boston’s Children’s Hospital, noted that two-thirds of the entire study cohort had no documentation of preferred location of death.
“This lack of documentation is particularly shocking given that the study was conducted with AYA patients receiving care within 2 highly specialized care systems,” they wrote. “Therefore, it is likely that AYA patients receiving care outside these systems have even lower rates of documented [location of death] preferences.”
Johnston and Snaman pointed out that many clinicians find care goal discussions challenging and suggested that barriers to discussions about and documentation on location of death need to be clarified and addressed through “(1) continued development and dissemination of advanced care planning tools for AYA patients with cancer, (2) advanced communication skills training for oncologists, and (3) further development of oncology and palliative care collaborations.”
The study included 1,929 patients at Dana-Farber Cancer Institute and Kaiser Permanente Northern and Southern California who died between January 2003 and December 2019. Of these patients, 54.4% were female, 61.4% were white, 26.6% were Hispanic, 11.8% were Asian, and 8.1% were Black. Median age at death was 32.
Most (78%) had solid neoplasms, 14.7% had hematologic cancers, and 7.3% had other or unknown cancers.
A total of 1,226 patients (63.6%) had at least one documented discussion about preferred location of death, with a median of 15 days between the first documented discussion and death.
Among those with a documented discussion, 48.5% did not have a documented preference, 32.8% wanted to die at home, 14.4% preferred a hospital death, and 3.9% preferred inpatient hospice.
The timing of the last discussion was associated with the preferred location of death. When the last recorded discussion occurred more than 30 days before death (n=219), just 3.2% preferred a hospital death, 31.1% preferred a home death, and 64.8% did not have a documented preference. However, when the last documented discussion occurred within 7 days before death (n=624), 24.8% preferred a hospital death, 30.8% wanted a home death, and 39.6% did not have a documented preference.
Of the total cohort, 43% died in acute care settings (13.3% in an intensive care unit, 28.4% in a hospital, and 1.3% in an emergency department), while 33.3% died at home, and 2.4% died in an inpatient hospice.

Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Disclosures
This study was supported by grants from the National Cancer Institute (NCI) and in part by the intramural program of the NCI.The study authors reported no conflicts of interest.The commentary authors reported no conflicts of interest.

Primary Source
JAMA Network Open
Source Reference: Odejide OO, et al “Preferred and actual location of death in adolescents and young adults with cancer” JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2024.54000.

Secondary Source
JAMA Network Open
Source Reference: Johnston EE, Snaman JM “Location of death preferences in adolescents and young adults with cancer” JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2024.53972.

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The agency issued designs for front-of-package lists that food companies would be required to include.The Food and Drug Administration on Tuesday proposed requiring new nutrition labels on the front of food and beverage products, a long-awaited move aimed at changing eating habits associated with soaring rates of obesity and diet-related illness that are responsible for a million deaths each year.The new label, a small black-and-white box similar to the Nutrition Facts box on the back of packaged goods, is designed to help consumers quickly understand which products contain excessive amounts of sugar, salt and saturated fat. Those three nutrients are implicated in the nation’s skyrocketing rates of Type 2 diabetes, heart disease and high blood pressure.More than 60 percent of American adults suffer from those three chronic illnesses, which are estimated to account for $4.5 trillion in annual health care costs, according to the F.D.A.In contrast to the mandatory back-of-package Nutrition Facts panels, which list a product’s ingredients, calorie count and serving size, the front-of-package labels would rank the contents of sugar, fat and salt as high, medium or low to indicate whether the amounts exceed or fall short of the recommended daily values set by the F.D.A.“Nearly everyone knows or cares for someone with a chronic disease that is due, in part, to the food we eat,” Dr. Robert Califf, the commissioner of the F.D.A., said in a statement. “It is time we make it easier for consumers to glance, grab and go.”The proposal follows three years of research by agency scientists, who considered the front-of-package labels used by other countries. After reviewing studies on the effectiveness of those labels, the F.D.A. tested prospective designs with focus groups to determine whether the information they conveyed was easy to comprehend.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Analysis found that more than 64,000 Palestinians may have been killed by traumatic injury in the first nine months of the war.Deaths from bombs and other traumatic injuries during the first nine months of the war in Gaza may have been underestimated by more than 40 percent, according to a new analysis published in The Lancet.The peer-reviewed statistical analysis, led by epidemiologists at the London School of Hygiene and Tropical Medicine, used modeling in an effort to provide an objective third-party estimate of casualties. The United Nations has relied on the figure from the Hamas-led Ministry of Health, which it says has been largely accurate, but which Israel criticizes as inflated.But the new analysis suggests the Hamas health ministry tally is a significant undercount. The researchers concluded that the death toll from Israel’s aerial bombardment and military ground operation in Gaza between October 2023 and the end of June 2024 was about 64,300, rather than the 37,900 reported by the Palestinian Ministry of Health.The estimate in the analysis corresponds to 2.9 percent of Gaza’s prewar population having been killed by traumatic injury, or one in 35 inhabitants. The analysis did not account for other war-related casualties such as deaths from malnutrition, water-borne illness or the breakdown of the health system as the conflict progressed.The study found that 59 percent of the dead were women, children and people over the age of 65. It did not establish what share of the reported dead were combatants.Mike Spagat, an expert on calculating casualties of war who was not involved in this research, said the new analysis convinced him that Gaza casualties were underestimated.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Sana Biotechnology said a type 1 diabetes (T1D) patient received an allogeneic primary islet cell transplantation without immunosuppression. The company’s engineered cell product (UP421) uses a novel hypoimmune technology, and results of the first-in-human trial at 4 weeks showed pancreatic beta cell survival and function.
In a phase IIb/III trial of linsitinib for moderate to severe thyroid eye disease, treatment with the highest dose of the investigational, oral insulin-like growth factor 1 receptor inhibitor resulted in a statistically significant proptosis responder rate of 52% at week 24, according to maker Sling Therapeutics.
A database developed by researchers at Mass General Brigham ranked 50,000 processed foods and offers potential alternatives. (Nature Foods)
Investigational atumelnant, a once-daily oral adrenocorticotropic hormone receptor antagonist, significantly reduced morning androstenedione levels in a 12-week phase II study of people with congenital adrenal hyperplasia, said developer Crinetics Pharmaceuticals.
In the phase III OASIS 4 study, investigational elinzanetant significantly reduced frequency of moderate to severe vasomotor symptoms caused by adjuvant endocrine therapy in women with or at high risk of developing hormone receptor-positive breast cancer, said Bayer.
North Dakota became the first state to cover GLP-1 drugs for diabetes or obesity in Affordable Care Act marketplace plans. (Becker’s Payer Issues)
And Medicare will now cover tirzepatide (Zepbound) for obstructive sleep apnea in patients with obesity after last month’s FDA approval for that indication. (CNBC)
A novel injectable GLP-1/GIP receptor dual agonist (HRS9531) achieved a 21.1% placebo-adjusted weight loss at week 36 in a phase II trial of Chinese adults with obesity or overweight, said Jiangsu Hengrui Pharmaceuticals and Kailera Therapeutics.
A national survey by Orlando Health found that 56% of Americans didn’t know that bariatric surgery could boost fertility.
The FDA cleared Euroimmun’s automated chemiluminescence-based immunoassay test for free testosterone, said Revvity.
In new draft guidance for anti-obesity drug development, the FDA set an efficacy threshold of 5% weight loss over a year for future products. (Endpoints News)
Although Medicaid reimbursement for glucagon products for severe hypoglycemia increased from 2012 to 2023, less than 100,000 glucagon prescriptions were dispensed in 2023, likely only a fraction of the potential need based on the high-risk population. (JAMA)
Obesity at the time of a pediatric cancer diagnosis was independently associated with worse survival, especially for kids with acute lymphoblastic leukemia and central nervous system tumors, a large cohort study found. (Cancer)

Kristen Monaco is a senior staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

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Welcome to “Ask the Program Director,” a column from MedPage Today where your most pressing questions about residency — from the application process to life as a resident — are asked and answered. Want to submit a question? Comment below or email perspectives@medpagetoday.com.
Dear residency program director,
How should I prioritize self-care during training? I’m a first-year resident and even though I’m 7 months in at this point, I’m still struggling with the demanding hours. In-patient rotations are the toughest, and with spending 90 or more hours a week in the hospital, I feel like I have little time to do much more than eat and sleep. I feel like I’m neglecting my non-healthcare friends and family, and some of the hobbies I used to enjoy. I’m wondering if there’s a “right” approach to self-care to ensure that free time is used to recharge and not be more draining than it should.
Dear resident,
Thank you for submitting such an important question, given the high rates of burnout among clinicians throughout the country. We often hear about burnout among attending physicians, but as you’re quickly learning, burnout and mental health issues are just as relevant and real for trainees and medical students.
First of all, please know you are not alone and professional help is available if you need it. There is absolutely no shame in seeking help. Many residents struggle with the demanding hours of training and have difficulty finding time for many of their hobbies or spending time with loved ones.
In general, my best advice for improving well-being during residency is to be intentional with your tasks and time.
No matter how little time you have away from the hospital, you must set aside time to embrace your joys or modes of relaxation — this should be non-negotiable time that should never be compromised. This may mean blocking off time for exercise, reading a book, going to the movies, doing yoga, or just relaxing on the couch. Whatever the activity (or lack there of!), it should be treated as an appointment with yourself to enjoy hobbies and activities outside of work. This could be just 20 minutes a day. But when done regularly, that time adds up to 2 hours and 20 minutes of self-care time per week — with important benefits for your well-being.
Just as important as being intentional about time management is learning to say “no,” which is a skill I have only recently learned but wish I adopted earlier in my residency training. As medical professionals, we are often ambitious and like to take on many tasks; on the flip-side, we may be hesitant to decline opportunities, particularly when asked by supervisors or role models. However, sometimes it is important to take a step back and decline engagements, particularly when time is so limited.
Making the most of the small amount of free time you have is also essential. If you commute to the hospital, consider living within walking distance (if possible) or a short commute away, and use the saved time for a hobby or activity you love doing. Not only does this time saved add up, but also, the extra walking promotes cardiovascular health and well-being.
On that note, maintaining physical health and well-being should be a priority. This means prioritizing sleep (which you already seem to be doing), staying hydrated while at work, exercising when you can, and preparing energizing, nutritious meals at home when possible to avoid relying on unhealthy snacks at the hospital.
Finally, learn to recognize the signs of burnout. It is usually characterized by emotional exhaustion, a low sense of accomplishment at work, and not enjoying activities you once enjoyed. If you’re feeling this way, reach out to your program director or trusted mentors, or call the Physician Support Line to get the support you deserve.
As a residency program director myself, I must add that working 90 hours a week could be a violation of the Accreditation Council for Graduate Medical Education (ACGME) duty hours. Residents should only be working 80 hours per week, averaged over 4 weeks. However, I do understand this is not always practiced in all residency programs across the country. If you feel this has become a pervasive problem, you should consider speaking to your program director or your graduate medical education office at the hospital. At the end of the day, program directors want the best version of their residents to show up to work in order to optimize patient care, and tired sleep-deprived residents will not serve the hospital or program very well.
I hope you now feel better equipped with some strategies to improve your well-being.
Are you a medical student or resident? Please comment below or email us at perspectives@medpagetoday.com with other questions you’d like to have answered by a residency program director.

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Higher consumption of green tea, but not coffee, was associated with fewer cerebral white matter lesions in prospective studies of aging in Japan. (npj Science of Food)
Latent herpes simplex virus type 1 was reactivated by repeated mechanical injury in a three-dimensional human brain tissue model, triggering aggregated amyloid and other pathological Alzheimer’s features. (Science Signaling)
Brain hypometabolism began to evolve during the prodromal stage of dementia with Lewy bodies, with changes on 18F-fluorodeoxyglucose PET paralleling progressive symptoms. (JAMA Neurology)
Researchers identified a sex-specific deficiency in plasma free-carnitine levels in women with amnestic mild cognitive impairment and early Alzheimer’s disease, but not men. (Molecular Psychiatry)
Medicare beneficiaries waited a median of 34 days to see a neurologist after a referral, 2018-2019 data showed. (Neurology)
Glymphatic clearance in mice was activated by norepinephrine-driven oscillations during non-rapid eye movement sleep. (Cell)
The average life expectancy of people diagnosed with dementia ranged from 8 years at age 65 to 4.5 years at age 85 for women, and from 5.7 to 2.2 years, respectively, in men, a meta-analysis reported. (The BMJ)
Retinal vascular analyses predicted incident stroke, U.K. Biobank cohort data suggested. (Heart)
Boston University researchers confirmed that former NFL tight end Frank Wycheck, who died at age 52 after a fall, had stage III chronic traumatic encephalopathy. (AP)
A RECOVER initiative study showed that 4.5% of participants met criteria for myalgic encephalomyelitis/chronic fatigue syndrome after SARS-CoV-2 infection. (Journal of General Internal Medicine)
The American Academy of Neurology launched a new journal, Neurology Open Access.

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

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The Centers for Medicare & Medicaid Services will review a potential national Medicare coverage policy for renal denervation for patients with hypertension, Medtronic announced.
The FDA said Philips is recalling the monitoring service application used with mobile cardiac outpatient telemetry and offering data reprocessing for some patients.
In the RESILIENT trial, mobile health cardiac rehabilitation did not significantly improve outcomes in older adults who went home after being hospitalized for ischemic heart disease. (JAMA Network Open)
In two studies, artificial intelligence (AI) models, trained on 12-lead electrocardiogram features, were able to predict future development of heart failure in the general population and mortality in patients with acute chest pain. (European Heart Journal)
AI was also able to predict risk of stroke using measurements from the retina’s intricate vascular network in a U.K. Biobank cohort study. (Heart)
A cardiovascular polypill, containing a statin and three half-dose antihypertensives, could be considered high-value for an underserved population, according to economic modeling. (JAMA Cardiology)
Among veterans, hypertension control rates varied across the country by race and ethnicity, suggesting that areas with low rates of hypertension control would benefit from interventions to address disparities. (Journal of the American Heart Association)
For stroke patients with incomplete reperfusion after mechanical thrombectomy, adjunctive intra-arterial tenecteplase showed promise for getting them closer to complete recanalization in an observational pilot study. (Stroke)
A study showed that the changes to donor heart allocation in the last decade have not benefited infants and children with cardiomyopathy or adults with congenital heart disease. (Circulation)
In a prespecified analysis of the FINEARTS-HF trial, heart failure patients who received finerenone (Kerendia) had an initial decline in estimated glomerular filtration rate — but it was not clear that this was a predictor of poor outcomes. (Journal of the American College of Cardiology)
There was also a reduced risk of new-onset diabetes associated with use of finerenone in another FINEARTS-HF analysis. (Lancet Diabetes & Endocrinology)
Among patients with end-stage heart failure and low pulmonary capillary wedge pressure, left ventricular assist device therapy was associated with milder but significant improvements in functional capacity and quality of life compared with those with high pulmonary capillary wedge pressure. (Circulation: Heart Failure)
An international study showed that the quality of care for patients with acute heart failure is worse in lower-income countries. (eClinicalMedicine)
Preclinical work suggested that cholesterol-lowering therapy can also dampen PIN1 activity, a driver of bladder cancer. (Cancer Discovery)

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

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All women ages 65 and older and at-risk postmenopausal women under 65 should be screened for osteoporosis to prevent fractures, according to a final recommendation statement from the U.S. Preventive Services Task Force (USPSTF).
USPSTF said with “moderate certainty” that screening for osteoporosis to prevent osteoporotic fractures has a moderate net benefit in all women 65 and older and in postmenopausal women ages 40 to 64 who have at least one risk factor for osteoporosis (both grade B recommendations).
Evidence is still insufficient to assess the balance of benefits and harms of screening in men (I statement), said Wanda Nicholson, MD, MPH, MBA, of the Milken Institute of Public Health at George Washington University in Washington, D.C., and colleagues. “Clinicians should use their clinical judgment regarding whether to screen for osteoporosis” in men, the task force stated in JAMA.
The USPSTF recommendations are broadly consistent with those from 2018 — the last time the task force addressed the topic — and are meant for patients without known osteoporosis or a history of fragility fractures. The recommendations do not apply to patients with secondary osteoporosis due to underlying medical conditions or from use of medications linked to bone loss.
Data underpinning the recommendation statement included 145 unique studies assessed in a systematic evidence review, which showed that osteoporosis screening was associated with reduced hip fractures (pooled relative risk [RR] 0.83, 95% CI 0.73-0.93) and major osteoporotic fractures (pooled RR 0.94, 95% CI 0.88-0.99) compared with usual care. Absolute risk differences were five fewer hip fractures and six fewer major osteoporotic fractures per 1,000 participants screened.
While the recommendations are largely congruent with the USPSTF’s 2018 statement, there are some “subtle revisions” that “may result in substantive changes in screening of younger postmenopausal women in clinical practice,” said accompanying editorial authors Kristine Ensrud, MD, MPH, of the University of Minnesota in Minneapolis, and Carolyn Crandall, MD, MS, of the University of California Los Angeles.
“The 2018 statement recommended assessing risk of osteoporosis in these women using a formal clinical risk assessment tool, whereas the 2024 Recommendation Statement recommends screening those at increased risk for an osteoporotic fracture as estimated by clinical risk assessment,” the editorialists wrote.
“Additionally, the screening test for both younger and older postmenopausal women in the 2018 recommendation is specified broadly as bone measurement testing. By contrast, the 2024 statement is more specific and defines screening as central (hip or lumbar spine) dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) testing with or without fracture risk assessment,” they added.
When deciding which postmenopausal women under 65 to screen, the USPSTF recommended that clinicians first take stock of risk factors for osteoporosis — including low body weight, parental history of hip fracture, cigarette smoking, and excess alcohol consumption.
And then for women with at least one of those risk factors, clinicians should use a clinical risk assessment tool (without BMD assessment) to identify patients who warrant screening. These include the Fracture Risk Assessment Tool (FRAX) — the most studied tool — the Fracture Risk Calculator, and the Garvan Fracture Risk Calculator. Other risk assessment tools, like the Osteoporosis Risk Assessment Instrument and the Osteoporosis Self Assessment Tool (OST), generally require fewer risk inputs than tools designed to predict fracture risk, they added.
According to the USPSTF, “FRAX predicts the 10-year probability of hip fracture or [major osteoporotic fracture] for persons aged 40 to 90 years by using demographic and clinical factors alone or in combination with BMD measured at the femoral neck. Risks predicted by FRAX alone and by BMD alone are similar, but both are less accurate than risks predicted by FRAX plus BMD.”
Predicting fracture risk in postmenopausal women under 65 is “formidable,” said Ensrud and Crandall, and called it “surprising” that the USPSTF continues to suggest use of FRAX in its screening strategy for younger postmenopausal women given the tool’s “poor performance” in predicting osteoporosis fracture risk in this age group.
“Use of a simple time-efficient tool such as the OST appears to be a preferable strategy, although tools designed to identify osteoporosis also perform poorly in long-term fracture prediction in younger postmenopausal women,” Ensrud and Crandall suggested.
Discussing the change from screening via bone measurement testing to central DXA BMD, Nicholson and fellow task force members noted that “centrally measured DXA correlates with bone strength and clinical fracture outcomes and uses low doses of radiation. Fracture risk at a specific site is best predicted if bone density is measured at that site.”
“It is important that they did not recommend using the radius for screening,” said Susan Marie Ott, MD, of the University of Washington in Seattle, in another accompanying editorial in JAMA Network Open. She pointed out that some other organizations have recently suggested treating patients on the basis of findings of a T-score lower than -2.5 at any location, including the distal radius.
The USPSTF fell short of recommending a specific screening interval. While screening intervals tended to vary across studies reviewed, transition to osteoporosis typically occurred quicker for individuals with lower baseline T scores and older age, the task force said.
If screening indicates the patient requires treatment, the USPSTF listed the following approved drugs for treatment and prevention: bisphosphonates, denosumab, romosozumab (Evenity), parathyroid hormone, raloxifene, calcitonin, and estrogen (with or without progesterone). Clinicians should keep in mind that any treatment recommendations based on risk assessment tools that used fixed fracture risk treatment thresholds not specific to race and ethnicity may be less likely to identify Asian, Black, and Hispanic patients as high risk, making them potentially less likely to be treated compared with white patients of the same age, BMD, and clinical risk profile. Similarly, risk models that don’t take into consideration comorbidities like diabetes may underestimate risk.
When it comes to treatment, “it may be reasonable to avoid strict application of risk assessment tool treatment thresholds at the individual level to account for additional risks (e.g., fall risk) not considered in risk assessment tools like FRAX,” the task force explained.

Kristen Monaco is a senior staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

Disclosures
The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.Task Force members members received travel reimbursement and an honorarium for participating in USPSTF meetings. Nicholson had no other disclosures. One co-author reported serving as chair for the Women’s Preventive Services Initiative Multidisciplinary Steering Committee and serving as chair on the American College of Obstetricians and Gynecologist Practice Advisory Committee, and another reported grants from National Institute on Aging. No other disclosures were reported.The systematic review was funded under contract from the AHRQ, HHS to support the USPSTF. Kahwati had no additional disclosures. Co-authors reported additional support from a National Research Service Award training grant from AHRQ, by a National Research Service Award grant from the Health Resources and Services Administration, and the National Institutes of Health’s National Center for Advancing Translational Sciences.Editorialists Ensrud and Crandall reported receiving an honorarium from the American College of Physicians; in addition Crandall reported receiving grants from the National Institutes of Health.Ott reported no disclosures.

Primary Source
JAMA
Source Reference: US Preventive Services Task Force “Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement” JAMA 2025; DOI: 10.1001/jama.2024.27154.

Secondary Source
JAMA
Source Reference: Kahwati LC, et al “Screening for osteoporosis to prevent fractures: a systematic evidence review for the US Preventive Services Task Force” JAMA 2025; DOI: 10.1001/jama.2024.21653.

Additional Source
JAMA
Source Reference: Ensrud KE, Crandall CJ “Fracture risk assessment as a component of osteoporosis screening — easier said than done” JAMA 2025; DOI: 10.1001/jama.2024.27416.

Additional Source
JAMA Network Open
Source Reference: Ott SM “Research that could broaden the scope of bone density screening” JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2024.60746.

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