Addiction Risk: No One Opioid Safer Than Other After Surgery

MedicalResearch.com Interview with:

Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School

Dr. Heng

Marilyn M. Heng, MD, MPH, FRCSC
Orthopaedic Trauma Surgeon
Assistant Professor of Orthopaedic Surgery
Harvard Medical School 

MedicalResearch.com: What is the background for this study?  

Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids.

The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that.  Continue reading

Roux-en-Y Gastric Bypass Linked to More Hip Fractures

MedicalResearch.com Interview with:

Elaine W. Yu, MD, MMSc Assistant Professor,  Harvard Medical School Director, Bone Density CenterEndocrine Unit, Massachusetts General Hospital 

Dr. Elaine Yu

Elaine W. Yu, MD, MMSc
Assistant Professor,  Harvard Medical School
Director, Bone Density Center
Endocrine Unit, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Roux-en-Y gastric bypass (RYGB) is a popular surgical weight loss procedure.  We have previously shown that gastric bypass leads to rapid high-turnover bone loss.

Bariatric procedures are being increasingly performed in older adults, and the clinical consequences of gastric bypass-associated skeletal changes in this vulnerable population have been unclear to date.  Thus, we used Medicare claims data to investigate fracture risk among older adults after gastric bypass, and in comparison to adults who received another bariatric procedure called adjustable gastric banding (AGB), which is thought to have fewer negative bone effects.

In our analysis, we found that patients undergoing Roux-en-Y gastric bypass were 73% more likely to fracture than those undergoing AGB. Importantly, we found that hip fracture risk increased nearly 180% after RYGB, and that fracture rates in patients aged 65 or older were similar to the overall group.  Continue reading

Excessive Supplements Linked to Increased Risk of Hip Fractures

MedicalResearch.com Interview with:

Prof. Haakon E Meyer, PhDDepartment of Public Health and Global HealthNorwegian Institute of Public HealthOslo, Norway

Prof. Meyer

Prof. Haakon E Meyer, PhD
Department of Public Health and Global Health
Norwegian Institute of Public Health
Oslo, Norway

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of high dose vitamin supplementation is popular in parts of the population, often without any clear indication and in the absence of clear evidence of benefit.

However, side effects can occur, and in a previous published secondary analysis of double blinded randomized controlled trials, we found to our surprise an increased risk of hip fracture in those supplemented with high doses of vitamin B6 in combination with vitamin B12.

This finding was re-assessed in the current study employing data from the large observational Nurses’ Health Study. As in the previous study, we found that a combined high intake of vitamin B6 and B12 was associated with increased risk of hip fracture. Continue reading

Hip Replacement Surgery Pain: No Benefit To IV Acetaminophen over Pills

MedicalResearch.com Interview with:

Geoffrey Westrich, MDDirector of ResearchAdult Reconstruction and Joint Replacement ServiceHospital for Special SurgeryNYC

Dr. Westrich

Geoffrey Westrich, MD
Director of Research
Adult Reconstruction and Joint Replacement Service
Hospital for Special Surgery
NYC 

MedicalResearch.com: What is the background for this study?

Response: Recent mortality trends in the U.S. associated with opioid use disorders have brought to the forefront of national debate the desirability of minimizing the use of potentially addictive pain management therapies.  Pain management after hip replacement surgery is an important part of patient care, and  opioids are frequently given as a major part of postoperative pain management.

At the same time, multimodal analgesia, the administration of anesthetic agents and medications agents targeting multiple pain pathways, has seen increased popularity in pain management after hip replacement surgery.  At Hospital for Special Surgery (HSS), the multimodal protocol entails the use of several different anesthetic agents and medications both during and after surgery to control pain, minimize the use of opioids and reduce side effects.

The use of non-opioid analgesics such as acetaminophen allows for a reduction in opioid administration after surgery [1]. Acetaminophen, commonly known as Tylenol, has traditionally been administered orally, but more recently an intravenous (IV) preparation has become available.  IV acetaminophen after major orthopedic surgery was shown to provide effective analgesia and reduce morphine administration by 33%, compared to placebo [2].

Unless a patient is unable to take acetaminophen, it is commonly used as part of the multimodal protocol due to its efficacy and minimal contraindications. Although intravenous (IV) acetaminophen presents pharmacokinetic benefits, such as increasing both serum blood and cerebrospinal fluid levels more rapidly, there is limited analysis of its potential clinical advantages compared to oral acetaminophen.  We hypothesized that there could be a reduction in pain with activity, opioid usage, or opioid- related side effects among patients receiving IV acetaminophen compared to oral acetaminophen following hip replacement surgery  Continue reading

Upper Arm Fractures: Comordid Conditions Linked to More Opioids and Longer Hospital Stays

MedicalResearch.com Interview with:

Paul Cagle, Jr. MDAssistant Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Cagle

Paul Cagle, Jr. MD
Assistant Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings ie What are some of the significant comorbidities? 

Response: In this study our goal was to better understand what medical issues (medical comorbidities) can cause trouble or issue for patients with a proximal humerus fracture (shoulder fracture).  To tackle this issue we used a large national sample of patients and sorted our the different medical issues the patients had.

We found that patients with increased medical issues had longer hospital stays and higher use of opioid medications (pain medications).

Continue reading

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

MedicalResearch.com Interview with:

Dr. Alexis Colvin, MDAssociate Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai 

MedicalResearch.com: What is the background for this study?

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids.  Set guidelines for post surgery opioid prescriptions have not been established.  Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures.  The purpose of this study was to determine how many opioids were being prescribed  among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

Continue reading

Injectable Zilretta for Knee Osteoarthritis

MedicalResearch.com Interview with:

Dr. Andrew Spitzer MDCo-director Joint Replacement ProgramCedars-Sinai Orthopedic CenterLos Angeles, CA

Dr. Spitzer

Dr. Andrew Spitzer MD
Co-director Joint Replacement Program
Cedars-Sinai Orthopedic Center
Los Angeles, CA

MedicalResearch.com: What is the background for this study? How does this product differ from other steroid injections for inflammatory arthritis?

Dr. Spitzer: Many patients receive repeat injections of intra-articular corticosteroids to manage recurrent osteoarthritis pain and other symptoms. However, in most clinical trials to date, patients only received a single corticosteroid injection, and patients were only followed for 12 to 24 weeks after treatment. For trials that have evaluated repeated injections of corticosteroids over a longer period of time—2 years, for example—injections were administered every 3 months, regardless of the timing of the return of OA symptoms. This is not reflective of what is done in clinical practice, where corticosteroids are administered again in response to the return of pain or a flare of inflammation in the knee. In this study, we used a flexible dosing schedule based on the patients’ symptoms, meaning that patients received the second injection of a recently approved extended-release corticosteroid only when their pain and/or symptoms returned, not before. Safety was monitored for 52 weeks—this length of time should be sufficient to identify any associated side effects, including any potential impact on the knee tissue.

Triamcinolone acetonide extended-release (TA-ER; Zilretta®) was approved in late 2017 as an intra-articular injection for the management of osteoarthritis pain of the knee. The formulation utilizes microspheres which enable a slow release of the active agent (triamcinolone acetonide) into the synovial fluid for 12 weeks following injection. Previously, a Phase 3 study demonstrated safety and efficacy of a single injection of TA-ER (Conaghan PG, et al. J Bone Joint Surg Am. 2018;100:666-77). This is the first study evaluating the safety and patient response to repeat administration of TA-ER. This study also included patients that were more typical of who we see in the clinic—those who have higher body mass index, more severe disease, and received prior treatments for their osteoarthritis pain.

Continue reading

Knee Implants: Electrical Energy Harvested From Walking Can Power Sensors

MedicalResearch.com Interview with:

Professor Sherry Towfighian PhD Mechanical Engineering Binghamton University  

Prof. Towfighian

Professor Sherry Towfighian PhD
Mechanical Engineering
Binghamton University  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We wanted to avoid using batteries in a load monitor that can be placed in total knee replacement. We looked into energy scavenging technologies and studied the most appropriate one for this application. Energy scavenging is converting wasted energy such as walking to electricity for low power sensors.

Our research study showed walking can provide enough electrical energy (about 6 microwatts) for low power load sensors. These load sensors are important in providing information about the mechanical load throughout different activities. It can be used in the future to create a self -awareness device for the patient to avoid certain activities.  Continue reading

Shorter Casting Period May Be Sufficient For Many Ankle Fractures

MedicalResearch.com Interview with:

Tero Kortekangas, MD, PhD Orthopaedic trauma surgeon Oulu University Hospital Oulu, Finland

Dr. Kortekangas

Tero Kortekangas, MD, PhD
Orthopaedic trauma surgeon
Oulu University Hospital
Oulu, Finland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Isolated, stable, Weber B type fibula fracture is by far the most common type of ankle fracture. Traditionally these fractures are treated with below the knee cast for six weeks. Although the clinical outcome of this treatment strategy has been shown to be generally favourable, prolonged cast immobilisation is associated with increased risk of adverse effects, prompting attempts to streamline the treatment. However, perhaps because of absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation still remains the “gold standard” treatment of stable Weber B type fractures.

Continue reading

Adolescents: Comparison of Recovery from Concussions vs Fractures

MedicalResearch.com Interview with:

Kelly Russell PhD Department of Pediatrics and Child Health University of Manitoba

Dr. Russell

Kelly Russell PhD
Department of Pediatrics and Child Health
University of Manitoba

MedicalResearch.com: What is the background for this study?

Response: Health-related quality of life (HRQOL) is an important patient-reported outcome that measures the patient’s perception on how their condition effects various aspects of their life, such as their physical, emotional, social and school quality of life.  HRQOL can measure the more subtle or hidden consequences of a condition, such as concussion.  Patient reported outcomes are important because they give a more complete picture of the patient’s condition than just reporting symptoms or outcomes that are only measured by their clinician.  We wanted to compare the effects of sport-related concussions versus sport-related limb fractures on HRQOL in adolescents after their injury and during their recovery.

We chose to compare adolescents with sport-related concussions to a sport-related limb fracture group because we wanted to be able to attribute the results to having a concussion since not being able to play sports with their friends and teammates may decrease HRQOL regardless of the actual type of injury.  We also wanted to identify which clinical variables were associated with worse HRQOL in adolescent patients with sports-related concussion.

Continue reading

Lumbar Spinal Stenosis: Non-Surgical Options Compared

MedicalResearch.com Interview with:

Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh

Dr. Schneider

Dr. Michael Schneider DC, PhD
Associate Professor
School of Health and Rehabilitation Sciences
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient.

We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 

Continue reading

Reclast, Zometa (zoledronate) Reduced Fractures in Osteopenic Older Women

MedicalResearch.com Interview with:

Prof Ian Reid Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand

Prof. Reid

Prof Ian Reid MD
Faculty of Medical and Health Sciences
University of Auckland
Auckland New Zealand


MedicalResearch.com: What is the background for this study? 

Response: Bisphosphonates prevent fractures in patients with osteoporosis, but their efficacy in women with osteopenia is unknown. Most fractures in postmenopausal women occur in osteopenic patients, so therapies with efficacy in osteopenia are needed.

Continue reading

Bone Growth Stops Earlier in Today’s Children

MedicalResearch.com Interview with:

Dana L. Duren, PhD Professor, Director of Orthopaedic Research Director of Skeletal Morphology Laboratory Thompson Laboratory for Regenerative Orthopaedics Department of Orthopaedic Surgery Missouri Orthopaedic Institute, University of Missouri Columbia, MO 6521

Dr. Duren

Dana L. Duren, PhD
Professor, Director of Orthopaedic Research
Director of Skeletal Morphology Laboratory
Thompson Laboratory for Regenerative Orthopaedics
Department of Orthopaedic Surgery
Missouri Orthopaedic Institute, University of Missouri
Columbia, MO 6521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The motivation for this study is the apparent accelerated maturity in children in the United States.

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates. Wikipedia Image

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates.
Wikipedia Image

 

We previously demonstrated that skeletal maturity (bone age) is more advanced in today’s children compared to children born in the first half of the 20thCentury (Duren et al., 2015).

n the current study (Boeyer et al., 2018) we show that a significant component of this advanced maturity status is the timing of epiphyseal fusion. In our study, nearly half of the epiphyses of the hand and wrist began or completed fusion significantly earlier in children born after 1995 than those born in the early part of the century, with differences as great as six to ten months for some bones, and mean differences on the order of 4 months in boys and 6 months in girls.  Continue reading

Fluoxetine (Prozac) Did Not Reduce Risk of Depression After Stroke, But Did Raise Risk of Fractures

MedicalResearch.com Interview with:

Prof .Gillian Mead Chair of Stroke and Elderly Care Medicine

Prof. Mead

Prof. Gillian Mead
Chair of Stroke and Elderly Care Medicine

Prof Martin Dennis Chair of Stroke Medicine

Prof. Dennis

Prof. Martin Dennis
Chair of Stroke Medicine

Centre for Clinical Brain Sciences
The University of Edinburgh

 


MedicalResearch.com: What is the background for this study?

Response: We are both practicing stroke physicians as well as clinical trialists. Therefore our interest in this area was triggered by the exciting results of the FLAME trial in 2011. This appeared to indicate that fluoxetine might boost the recovery of stroke patients. Potentially this was very important given the increasing numbers of people having disability due to stroke, and the fact that fluoxetine is inexpensive and could be introduced very easily into clinical practice. We were further encouraged by the large numbers of small RCTs we identified when we carried out a Cochrane systematic review on the topic. These trials provided more evidence of potential benefit but there was evidence that trials of greater quality showed less benefit, and benefits were greater in patients who were depressed. We felt there was a need for more evidence derived from much larger numbers of patients.

Continue reading

For Most Patients, Tennis Elbow is Self-Limiting

MedicalResearch.com Interview with:

Amin Mohamadi, MD, MPH Research Fellow Harvard Medical School Center for Advanced Orthopaedic Studies Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Mohamadi

Amin Mohamadi, MD, MPH
Research Fellow
Harvard Medical School
Center for Advanced Orthopaedic Studies
Beth Israel Deaconess Medical Center
Boston, MA 02215 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  “Tennis elbow” is a painful conditions caused by overuse of the tendons in the forearm, typically in a patient’s dominant arm. Overuses syndromes are resulted from repetitive stress injury without signs of inflammation. Tennis elbow afflicts more than 200,000 new patients in the United States every year, which is not only limited to athletes, but also laborers, food industry workers, manufacturers and office workers – anyone who uses the hands and wrists for hours each day. In addition, many clinicians and scientists believe that tennis elbow is a self-limited condition in which, the majority of patients will be symptom-free after a period of time. However, no meta-analysis has evaluated this notion.

Numerous treatments are available for patients to alleviate their pain and restore their pain-free grip strength but few high quality trials and meta-analyses have compared these treatments. In this largest meta-analysis to date, we compared results of 11 different treatment modalities evaluated in 36 randomized to identify if any of these treatments are more effective and safer than the others. Overall,  2746 patients were evaluated in our meta-analysis and we found that all of the evaluated treatments only showed a modest effect, at best , on pain relief and strength of grip. While there was only modest effect for some treatments, all of interventions increased risk of adverse events in comparison with placebo and none of them seemed to be safer than others.

In the next step we were curious to find out what will be outcome of patients who were treated with only placebo, a pill or injection without effective medication or sham treatment— when the therapeutic device was not turned on. Interestingly, we found that across all of clinical trials,  totally 92% of patients experienced substantial pain relief after a month of receiving only placebo or sham treatment. 

MedicalResearch.com: What should readers take away from your report?

Response: Our results imply that for most patients, tennis elbow is a self-limiting condition.  Based on this analysis, our overall recommendation is “wait and see”. However, for some groups “wait and see” may not be a feasible option, so we recommend for these groups an intervention that is most effective in short-term. Because almost all patients reported only minimal pain after the first four weeks, clinicians treating patients with tennis elbow may consider opting for a pain relief regimen to manage symptoms on a patient-to-patient basis. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should investigate the outcome rest in comparison with those who continued their actives with same intensity. There are also some evidence showing particular exercises may be beneficial and finally future research can identify if any particular patients group are at higher risk for none pain resolutions.  

MedicalResearch.com: Is there anything else you would like to add?

Response: We evaluated almost all of the non-surgical treatments available for tennis elbow and showed that they provide only minimal effect over placebo. For example corticosteroids were more effective than placebo within the first 4 weeks but this effect was transient and did not seem to be effective after 4 weeks. In addition, 47 patients would be needed to get corticosteroid injections so that only 1 less patient suffer from pain compared with those who received placebo.

Citation:

Jayson Lian, Amin Mohamadi, Jimmy J. Chan, Phillip Hanna, David Hemmati, Aron Lechtig, Ara Nazarian. Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. The American Journal of Sports Medicine, 2018; 036354651880191 DOI: 10.1177/0363546518801914 

Nov 7, 2018 @ 9:28 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

MedicalResearch.com Interview with:

Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School 

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

Continue reading

Zoledronate (Reclast, Zometa) Reduced Fractures in Older Women with Osteopenia

MedicalResearch.com Interview with:

Prof Ian Reid Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand 

Prof. Reid

Prof Ian Reid
Faculty of Medical and Health Sciences
University of Auckland
Auckland New Zealand 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bisphosphonates prevent fractures in patients with osteoporosis, but their efficacy in women with less marked bone loss (referred to as osteopenia) is unknown.

Most fractures in postmenopausal women occur in osteopenic patients, so therapies with efficacy in osteopenia are needed.

Continue reading

In Non-Locking Meniscal Knee Tears, Physical Therapy May Be As Good As Surgery

MedicalResearch.com Interview with:
"Meniscus adalah tisu/rawan berbentuk huruf C yang berfungsi mencegah dua tulang bergesel di antara satu sama lain di bahagian lutut. Tisu meniscus yang koyak berpunca kebiasaannya daripada bersukan yang melibatkan pergerakan lutut yang banyak. Warga emas" by Rawatan Alternatif Shah Alam is licensed under CC BY 2.0
Victor A. van de Graaf, MD
OLVG Ziekenhuis
Amsterdam

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment.

In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy. 

Continue reading

Number of Knee Arthroscopic Procedures Declines

MedicalResearch.com Interview with:

Dr-David-Howard

Dr. Howard

Prof. David H. Howard PhD
Department of Health Policy and Management
Emory University
Atlanta, GA 30322

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There is a lot of skepticism that physicians respond to evidence, especially when trials report that widely-used, separately-reimbursed procedures are not effective.

Physicians are reluctant to abandon treatments. This study shows that in the case of knee arthroscopy, evidence has made a difference. The use of knee arthroscopy declined by 23% in Florida between 2002 and 2015. This change occurred despite increases in the prevalence of osteoarthritis.  Continue reading

Genetic Testing Could Identify Individuals At Risk of Osteoporosis

MedicalResearch.com Interview with:

Stuart Kim - PhD Professor of Developmental Biology, Emeritus Bio-X Affiliated Faculty James H. Clark Center Stanford University

Dr. Kim

Stuart Kim PhD
Professor of Developmental Biology, Emeritus
Bio-X Affiliated Faculty
James H. Clark Center
Stanford University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoporosis is caused by a reduction in bone mass, and leads to a high incidence of bone fracture because the weakened bone is less able to withstand the stress of slips and falls. Osteoporosis affects millions of elderly, is responsible for as many as 50% of fractures in women and 25% of fractures in men over the age of 50, and accounts for $19 billion in annual health care costs in the US. Identification of people with an increased genetic risk for osteoporosis could reduce the incidence of bone fracture. Low BMD is also a risk factor for stress fractures. For athletes and military personnel undergoing harsh rigors of training, stress fractures are common injuries that limit playing time, military effectiveness and competitive success.

Using data from UK Biobank, a genome-wide association study identified 1,362 independent SNPs that clustered into 899 loci of which 613 are new. These data were used to train a genetic algorithm using 22,886 SNPs as well as height, age, weight and sex as predictors. Individuals with low genetic scores (about 2% of those tested) showed a 17-fold increase in risk for osteoporosis and about a 2-fold increase in risk of fractures. Continue reading

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

MedicalResearch.com Interview with:

Beatrice Ugiliweneza, PhD, MSPH Assistant Professor Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science School of Public Health and Information Sciences University of Louisville

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

MedicalResearch.com: What should readers take away from your report? 

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

MedicalResearch.com: Is there anything else you would like to add?

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures. 

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH1, Zaid Aljuboori, MD1, Miriam A.Nuño, PhD2, Doniel Drazin, MD3, and  Maxwell Boakye, MD, MPH, MBA1

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

USPSTF: Women 65 and Older Should Be Screened for Osteoporosis to Prevent Fractures

MedicalResearch.com Interview with:

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. Hawaii Medical Service Association Endowed Chair in health services and quality research Associate professor, and the Associate research director Department of Family Medicine and Community Health University of Hawaii John A. Burns School of Medicine

Dr. Chien-Wen Tseng

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E.
Hawaii Medical Service Association Endowed Chair in health services and quality research
Associate professor, and the Associate research director
Department of Family Medicine and Community Health
University of Hawaii John A. Burns School of Medicine 

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations?

Response: Osteoporosis is a condition where bones become weak and can break or fracture more easily. These fractures can happen at the spine, hip, and other locations, and can have serious health consequences such as pain, limited mobility, or even death. By 2020, more than 12 million Americans over the age of 50 are expected to have osteoporosis and two million fractures occur yearly.

Since people often may not know they have osteoporosis until they have a fracture, the U.S. Preventive Services Task Force looked at the evidence to see if screening for osteoporosis can help to prevent fractures. We found that screening for and treating osteoporosis can prevent fractures in women ages 65 and older and in younger women who have been through menopause and have additional factors that put them at increased risk for osteoporosis.

In men, more research is needed to know if routine screening and treatment for osteoporosis can prevent fractures. Continue reading

Atopic Dermatitis (Eczema) Patients Have Higher Likelihood of Osteoporosis

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Persons with atopic dermatitis have a number of risk factors for osteopenia and osteoporosis, including systemic atopy and inflammation, being less physically active and using a lot of topical and/or systemic corticosteroids. We aimed to determine whether adults with atopic dermatitis in fact have higher rates of physician-diagnosed osteopenia and osteoporosis.

Continue reading

Number of Joint Replacements Drop in Rheumatoid Arthritis Patients 

MedicalResearch.com Interview with:

Hip Replacement NIH Image

Hip Replacement
NIH Image

Samuel Hawley | Research Assistant (NIHR PhD Project) |
Pharmaco- and Device Epidemiology Group |
Centre for Statistics in Medicine | NDORMS |
University of Oxford 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The aim was to disentangle some of the potential reasons for the recent decline in joint replacement rates among rheumatoid arthritis (RA) patients in the developed world.

The main findings from our UK patient-level analysis indicated that joint replacement rates were not significantly different for users of TNF inhibitors versus the patients who remained only on conventional synthetic DMARDS, however we did find that TNF inhibitor use amongst older RA patients was associated with a 40% reduction in hip replacement rates. Continue reading

Study Compares Hospitals Enrolled in Medicare’s Voluntary vs Mandatory Bundled Payment Programs

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study?

Response: Bundled payment is a key Medicare Alternative Payment Model (APM) developed by the Centers for Medicare and Medicaid Services (CMS) to increase health care value by holding health care organizations accountable for spending across an episode of care. The model provides financial incentives to maintain quality and contain spending below a predefined benchmark.

In 2013, CMS launched the Bundled Payments for Care Improvement (BPCI) initiative to expand bundled payment nationwide. BPCI’s bundled payment design formed the basis for CMS’s Comprehensive Care for Joint Replacement (CJR) Model beginning in 2016. While the programs are similar in design, BPCI is voluntary while CJR is mandatory for hospitals in selected markets. Moreover, CJR is narrower in scope, focusing only on lower extremity joint replacement (LEJR) and limiting participation to hospitals.

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2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

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Urinary Biomarkers Identify Early Problems With Hip Replacements

MedicalResearch.com Interview with:

Rick Sumner, PhD, FAAA The Mary Lou Bell McGrew Presidential Professor for Medical Research Chair, Department of Cell & Molecular Medicine (formerly, Anatomy and Cell Biology) Rush University Medical Center Chicago, IL  60612

Dr. Sumner

Rick Sumner, PhD, FAAA
The Mary Lou Bell McGrew Presidential Professor for Medical Research
Chair, Department of Cell & Molecular Medicine (formerly, Anatomy and Cell Biology)
Rush University Medical Center
Chicago, IL  60612

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main cause of failure for total hip replacements is implant loosening which is often a consequence of particle-induced peri-implant osteolysis. Unfortunately, this condition is usually not diagnosed until it has progressed to the point of needing a revision surgery.

We discovered two biomarkers that may be useful for identifying at risk patients much earlier than is currently possible. Continue reading

Does Chiropractic Care Benefit Low Back Pain?

MedicalResearch.com Interview with:
“Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD

Vice Chancellor for Research and Health Policy
Palmer College of Chiropractic

MedicalResearch.com: What is the background for this study?

Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel.

Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military.

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Drug Holidays From Osteoporosis Meds Linked to More Broken Bones

MedicalResearch.com Interview with:
“Just a hairline fracture...” by Gloria Bell is licensed under CC BY 2.0Brittany Bindon, MD

Department of Internal Medicine
University of Chicago
Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Bisphosphonates are commonly used in the treatment of osteoporosis, however, they have been associated with rare, severe side effects such as osteonecrosis of the jaw and atypical femoral fractures.

As a result, bisphosphonate drug holidays have become common in clinical practice though currently, there are minimal data on the safe duration of these drug holidays. We sought to further characterize the clinical and laboratory parameters associated with increased fracture risk in patients on bisphosphonate drug holiday.

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Sciatica: Biomarker Demonstrates Inflammation, Not Just Compression of Nerve Roots

MedicalResearch.com Interview with:

“osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD
Research Fellow in Radiology, Harvard Medical School
Research Fellow, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury.

This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited.

In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots.

Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation.

While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain.  Continue reading