51
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Caitriona C, Mark MG, Elaine H, Claire G, Michelle F, Persson UM, Sherrington C, Blake C. Management of hospitalised osteoporotic vertebral fractures. Arch Osteoporos 2020; 15:14. [PMID: 32078057 DOI: 10.1007/s11657-020-0687-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Management of hospitalised osteoporotic vertebral fracture patients was explored across all major trauma orthopaedic hospitals in Ireland. Findings, based on a survey of orthopaedic doctors and physiotherapists, indicate a lack of standardised clinical care pathways. This study will inform development of clinical audit mechanisms and health service development for this large and growing fracture population in both Ireland and internationally. PURPOSE To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. METHODS A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). RESULTS Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. CONCLUSION Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.
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Affiliation(s)
- Cunningham Caitriona
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mc Gowan Mark
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,St James's Hospital, James's Street, Dublin 8, Ireland
| | - Hughes Elaine
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Gallagher Claire
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,City Physio, Chartered Physiotherapy Practice, Vesey Terrace, Lucan, County Dublin, Ireland
| | | | - Ulrik McCarthy Persson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
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52
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Jennings JW. Vertebral Augmentation Is More than Just Pain Palliation, It Is about Improved Mortality. Radiology 2020; 295:104-105. [PMID: 32073380 DOI: 10.1148/radiol.2020192806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jack W Jennings
- From the Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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53
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Roux C, Briot K. The crisis of inadequate treatment in osteoporosis. THE LANCET. RHEUMATOLOGY 2020; 2:e110-e119. [PMID: 38263657 DOI: 10.1016/s2665-9913(19)30136-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 01/25/2024]
Abstract
The number of fractures related to osteoporosis is expected to increase dramatically in the next few decades because of an increase in the number of elderly patients at high risk of falls and fractures. Developments in the diagnosis and treatment of osteoporosis might change our strategies for management of patients with osteoporosis: the imminent risk of fracture concept, the issue of how to correctly sequence treatment, the potential effectiveness of screening, and goal-directed treatment strategies. Despite advances, few patients receive appropriate treatment for osteoporosis, even after a fracture. The crisis in the treatment of osteoporosis is related to several factors, including the fears and beliefs that patients and physicians have about the adverse effects of treatments. Strategies to address this crisis pose a considerable challenge; nonetheless, prevention of fragility fractures is within our reach. To that end, careful selection of patients at high risk of fracture, selection of the best therapeutic strategy, and accurate communication about fracture risk and bone fragility must be improved.
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Affiliation(s)
- Christian Roux
- Université de Paris, Centre de Recherche Epidémiologie et Statistiques, Unité Mixte de Recherche 1153, Institut National de la Santé et de la Recherche Médicale, Paris, France; Service de Rhumatologie, Assistance Publique-Hopitaux de Paris, Hospital Cochin, Paris, France.
| | - Karine Briot
- Université de Paris, Centre de Recherche Epidémiologie et Statistiques, Unité Mixte de Recherche 1153, Institut National de la Santé et de la Recherche Médicale, Paris, France; Service de Rhumatologie, Assistance Publique-Hopitaux de Paris, Hospital Cochin, Paris, France
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54
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Abstract
The 11 existing FDA-approved osteoporosis drug treatments include hormone replacement therapy, 2 SERMs (raloxifene and bazedoxifene), 5 inhibitors of bone-resorbing osteoclasts (4 bisphosphonates and anti-RANKL denosumab), 2 parathyroid hormone analogues (teriparatide and abaloparatide), and 1 WNT signaling enhancer (romosozumab). These therapies are effective and provide multiple options for patients and physicians. As the genomic revolution continues, potential novel targets for future drug development are identified. This review takes a wide perspective to describe potentially rewarding topics to explore, including knowledge of genes and pathways involved in bone cell metabolism, the utility of animal models, targeting drugs to bone, and ongoing advances in drug design and delivery.
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55
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Ning L, Wan S, Fan S. Some Questions About the Article "The Efficacy and Safety of Vertebral Augmentation: A Second ASBMR Task Force Report". J Bone Miner Res 2020; 35:211. [PMID: 31743486 DOI: 10.1002/jbmr.3907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/19/2019] [Accepted: 09/07/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Lei Ning
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuanglin Wan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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56
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Buchbinder R, Ebeling PR, Akesson K, Bauer DC, Eastell R, Fink HA, Giangregorio L, Guanabens N, Kado D, Kallmes D, Katzman W, Rodriguez A, Wermers R, Wilson HA, Bouxsein ML. Response to: Some Questions About the Article "The Efficacy and Safety of Vertebral Augmentation: A Second ASBMR Task Force Report". J Bone Miner Res 2020; 35:212-213. [PMID: 31743502 DOI: 10.1002/jbmr.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Rachelle Buchbinder
- Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - Howard A Fink
- Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, and Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lora Giangregorio
- Department of Kinesiology and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Nuria Guanabens
- Department of Rheumatology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Deborah Kado
- Department of Medicine, University of California, San Diego, CA, USA
| | - David Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Alexander Rodriguez
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Robert Wermers
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
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57
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Hirsch JA, Chandra RV, Carter NS, Beall D, Frohbergh M, Ong K. Number Needed to Treat with Vertebral Augmentation to Save a Life. AJNR Am J Neuroradiol 2019; 41:178-182. [PMID: 31857326 DOI: 10.3174/ajnr.a6367] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Evidence from randomized controlled trials for the efficacy of vertebral augmentation in vertebral compression fractures has been mixed. However, claims-based analyses from national registries or insurance datasets have demonstrated a significant mortality benefit for patients with vertebral compression fractures who receive vertebral augmentation. The purpose of this study was to calculate the number needed to treat to save 1 life at 1 year and up to 5 years after vertebral augmentation. MATERIALS AND METHODS A 10-year sample of the 100% US Medicare data base was used to identify patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, and vertebroplasty. The number needed to treat was calculated between augmentation and nonsurgical management groups from years 1-5 following a vertebral compression fracture diagnosis, using survival probabilities for each management approach. RESULTS The adjusted number needed to treat to save 1 life for nonsurgical management versus kyphoplasty ranged from 14.8 at year 1 to 11.9 at year 5. The adjusted number needed to treat for nonsurgical management versus vertebroplasty ranged from 22.8 at year 1 to 23.8 at year 5. CONCLUSIONS Both augmentation modalities conferred a prominent mortality benefit over nonsurgical management in this analysis of the US Medicare registry, with a low number needed to treat. The calculations based on this data base resulted in a low number needed to treat to save 1 life at 1 year and at 5 years.
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Affiliation(s)
- J A Hirsch
- From the Neuroendovascular Program (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - R V Chandra
- Faculty of Medicine (R.V.C., N.S.C.).,Nursing and Health Sciences, and Neuroinverventional Radiology (R.V.C., N.S.C.), Monash Imaging, Monash Health, Melbourne, Australia
| | - N S Carter
- Faculty of Medicine (R.V.C., N.S.C.) .,Nursing and Health Sciences, and Neuroinverventional Radiology (R.V.C., N.S.C.), Monash Imaging, Monash Health, Melbourne, Australia.,Alfred Hospital (N.S.C.), Melbourne, Australia
| | - D Beall
- Clinical Radiology of Oklahoma (D.B.), Edmond, Oklahoma
| | - M Frohbergh
- Exponent Inc (M.F., K.O.), Philadelphia, Pennsylvania
| | - K Ong
- Exponent Inc (M.F., K.O.), Philadelphia, Pennsylvania
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58
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Zhou J, Xue Y. Could Teriparatide Replace Percutaneous Vertebral Augmentation for Patients with Osteoporotic Vertebral Compression Fracture to Some Extent? [Letter]. Clin Interv Aging 2019; 14:2095-2096. [PMID: 31819390 PMCID: PMC6897261 DOI: 10.2147/cia.s234553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jiaming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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59
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Wong SPY, Mok CC. Update on Symptomatic Treatment of Acute Vertebral Compression Fracture. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2019. [DOI: 10.1142/s2661341719300039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The vertebral column is the most common site of osteoporotic fracture in older individuals and in those using long-term glucocorticoids. Vertebral compression fracture leads to significant morbidities such as acute and chronic pain, spinal deformities and neurological complications, resulting in reduced mobility and quality of life. As a previous vertebral compression fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews the management of osteoporotic vertebral compression fracture and provides evidence-based treatment options.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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60
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Penet C, Grados F, Cottenet J, Michel D, Deramond H, Fardellone P. [Identification of the predictive factors of new vertebral fractures in a cohort of patients who underwent a vertebroplasty for osteoporotic fracture]. Presse Med 2019; 48:1175-1177. [PMID: 31668422 DOI: 10.1016/j.lpm.2019.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/25/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Clémence Penet
- CHU d'Amiens, université de Picardie-Jules-Verne, service de rhumatologie, 80054 Amiens, France
| | - Franck Grados
- CHU d'Amiens, université de Picardie-Jules-Verne, service de rhumatologie, 80054 Amiens, France.
| | - Jonathan Cottenet
- CHU de Dijon, service de biostatistique et d'informatique médicale, 21000 Dijon, France
| | - David Michel
- CHU d'Amiens, université de Picardie-Jules-Verne, service de radiologie, 80054 Amiens, France
| | - Hervé Deramond
- CHU d'Amiens, université de Picardie-Jules-Verne, service de radiologie, 80054 Amiens, France
| | - Patrice Fardellone
- CHU d'Amiens, université de Picardie-Jules-Verne, service de rhumatologie, 80054 Amiens, France
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61
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Plea for continuing but rational use of vertebroplasty for osteoporotic vertebral fractures. Joint Bone Spine 2019; 87:281-283. [PMID: 31520737 DOI: 10.1016/j.jbspin.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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62
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Diamond T, Clark W, Bird P, Gonski P. Percutaneous Vertebroplasty for Acute Painful Osteoporotic Vertebral Fractures-Benefits Shown in VAPOUR Trial Masked When Pooled With Other Clinical Trials. J Bone Miner Res 2019; 34:1182-1184. [PMID: 31136012 DOI: 10.1002/jbmr.3725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Terrence Diamond
- Department of Endocrinology, St George Public and Private Hospital and University of NSW, St George Clinical School, Kogarah, Australia
| | - William Clark
- Department of Interventional Radiology, St George Private Hospital, Kogarah, Australia
| | - Paul Bird
- Department of Rheumatology, St George Private Hospital and University of NSW, St George Clinical School, Kogarah, Australia
| | - Peter Gonski
- Department of Geriatrics, Sutherland Hospital, Caringbah, Australia
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63
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Ebeling PR, Akesson K, Bauer DC, Buchbinder R, Eastell R, Fink HA, Giangregorio L, Guanabens N, Kado D, Kallmes D, Katzman W, Rodriguez A, Wermers R, Wilson HA, Bouxsein ML. Response Letter to the Editor-Diamond et al, JBMR. J Bone Miner Res 2019; 34:1185-1186. [PMID: 31135998 DOI: 10.1002/jbmr.3724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, California, USA
| | - Rachelle Buchbinder
- Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash, Monash University, Melbourne, Australia
| | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Howard A Fink
- Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Nuria Guanabens
- Department of Rheumatology and Schlegel Research Institute for Aging, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Deborah Kado
- Department of Medicine, University of California, San Diego, California, USA
| | | | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Alexander Rodriguez
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Robert Wermers
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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64
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On Patient Safety: Differential Standards for Medical Evidence Risks Patient Safety. Clin Orthop Relat Res 2019; 477:698-699. [PMID: 30844833 PMCID: PMC6437358 DOI: 10.1097/corr.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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65
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Dyer O. Vertebral augmentation in osteoporosis: common procedures for spinal fractures show no benefit. BMJ 2019; 364:l515. [PMID: 30705023 DOI: 10.1136/bmj.l515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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66
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