The American Medical Association added phlebology to their list of self-designated practice specialties in 2005. In 2007 the American Board of Phlebology (ABPh), subsequently known as the American Board of Venous & Lymphatic Medicine (ABVLM), was established to improve the standards of phlebologists and the quality of their patient care by establishing a certification examination, as well as requiring maintenance of certification. Although As of 2017 [update] not a Member Board of the American Board of Medical Specialties (ABMS), the American Board of Venous & Lymphatic Medicine uses a certification exam based on ABMS standards.
If you have had a previous fragility fracture, you will usually be offered treatment with medicines to prevent steroid-induced osteoporosis if you are prescribed long-term steroid tablets. This is regardless of your age. If you are an older person, you will also usually be offered preventative treatment with medicines even if you have not had a previous fragility fracture. The medicine usually used to prevent steroid-induced osteoporosis is one of a group of medicines called bisphosphonates. For more information about these medicines, see the separate leaflet called Bisphosphonates. There is evidence that these medicines can improve bone strength and reduce the risk of some fractures for people taking steroid medicines.
A total of 29 reports indicative of osteonecrosis of the external auditory canal in association with bisphosphonates have been identified worldwide, including 11 cases reported in the clinical literature. 2 3 4 5 6 7 8 Cases have been reported with use of both intravenous or oral bisphosphonates for both cancer-related or osteoporosis indications; there is currently insufficient evidence to determine whether there is any increased risk with higher doses used for cancer-related conditions. Most cases were associated with long-term bisphosphonate therapy for 2 years or longer, and most cases had possible risk factors including: steroid use; chemotherapy; and possible local risk factors such as infection, an ear operation, or cotton-bud use. Bilateral osteonecrosis of the external ear canal was reported in some patients, as was osteonecrosis of the jaw.