Vertebroplasty for spinal compression fractures
Arch Orthop Trauma Surg. 2007 Sep 4, Clinical evaluation of vertebroplasty for multiple-level osteoporotic spinal compression fracture in the elderly. Yu SW and others. PMID: 17768634. Vertebroplasty is often a treatment of choice when one or two adjacent vertebrae are involved, but this study evaluated the results in 18 elderly patients with fractures at multiple spinal levels. The compression fractures were diagnosed with preoperative MRI and Denis pain scale (a subjective pain level on a scale of 1-10) and Roland-Morris score (a self-administered disability questionnaire) were also done. The authors found that the patients' clinical activity level increased and the Denis and Roland-Morris results improved significantly after vertebroplasty. The authors conclude that, "The use of vertebroplasty with cement to treat multiple-level osteoporotic spinal compression fractures in the elderly does have value . . " They also note the importance of a preoperative MRI to evaluate non-union levels and determine which levels needed vertebroplasty. Editor's comments: The authors don't mention kyphoplasty as an alternative. This procedure adds the step of inserting and inflating a small balloon into the vertebra body. This regains lost vertebral body height. It is possible that due to multiple vertebral involvement, the clinicians didn't want to add the extra step, as well the patients may have been enfeebled enough that the goal was simply pain relief, but that is conjecture. Having myself had a spinal compression fracture that was quite painful, I can imagine that three or four simultaneous fractures could be extremely painful. So this vertebroplasty procedure makes available a beneficial procedure for those with multiple spinal compression fractures.
Osteoporosis medication profile preference
Health Expect. 2007 Sep;10(3):211-23, Osteoporosis medication profile preference: results from the PREFER-US study. Weiss TW, McHorney CA. PMID: 17678510. This study assessed patient preference for two osteoporosis medications, Drug A and Drug B, consistent with ibandronate (Boniva) and alendronate (Fosamax), respectively. Using several variables among 999 respondents, it was found that Drug B was preferred by 96%, with effectiveness being the most important determinant by 79%. Other results: Time on market (14%), dosing procedure (4%), and dosing frequency (3%). The authors conclude: "The drug profile showing reductions in non-vertebral and hip fracture risk was chosen by almost all respondents. Drug effectiveness was the most important determinant of preference, while dosing frequency was the least important determinant. Incorporation of patient preferences in the medication decision-making process could enhance patient compliance and clinical outcomes. Editor's comments: This is a very interesting result, and one I wouldn't have expected. Drug A, ibandronate is a once-monthly oral medication, whereas alendronate is once-weekly. I would have thought that this more convenient dosing would have ranked high on the patient preference chart. That's why we do good science, to find out if researcher's hypotheses can withstand close clinical scrutiny. Obviously patients are much more concerned about the proven effectiveness than they are dosing regimen. Here is an update showing how poor patient compliance is regarding osteoporosis medications. As I mentioned in that update, it appears important to include patients in the process somehow when prescribing them osteoporosis medications. That's exactly what the authors did in this study, giving the patients a choice regarding which medication to take, and showing them the variables that are important in each decision. This, and perhaps some graphic information regarding exactly what is involved after a hip/spine fracture, might do wonders to increase patient compliance, and thus prevent fractures. Certainly patients would thus benefit, but taxpayers and group health insurance participants would also.