Orthopedics
26 Mar Psoriasis Patients At Higher Risk for Multiple Pathological Fractures
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 [caption id="attachment_24142" align="alignleft" width="128"]
Dr. Jonathan Silverberg[/caption]
Response: Psoriasis is associated with a number of potential risk factors for developing osteoporosis and pathological fractures, including including low vitamin D, chronic inflammation, higher rates of cigarette smoking and systemic corticosteroid usage. We hypothesized that adults with psoriasis have higher rates of osteoporosis and pathological fractures.
We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that psoriasis was associated with higher odds of osteopenia, osteoporosis, osteomalacia, ankylosing spondylitis, and pathological fractures. In particular, psoriasis was associated with vertebral, pelvic, femoral and tibial/fibular fractures. The associations between psoriasis and pathological fractures were more pronounced in women than men.
23 Mar Regular, Long-term Resistance Training or Jump-Training Increases Bone Mass
MedicalResearch.com Interview with: [caption id="attachment_33251" align="alignleft" width="117"]
Dr. Hinton[/caption]
Pamela S. Hinton, Ph.D.
Associate Professor & Director of Graduate Studies
Department of Nutrition and Exercise Physiology
Columbia MO 65211
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study builds on our previous work showing that weight-bearing, high-impact physical activity throughout the lifespan is associated with greater bone mass in men. We previously conducted a 12-month randomized trial of the effectiveness of resistance training versus jump training to increase bone mass in men with low bone density of the hip or lumbar spine.
The current study is a follow up study investigating how exercise might work to increase bone mass.
The main findings are that exercise reduced circulating levels of a bone protein that inhibits bone formation (sclerostin) and increased levels of insulin-like growth factor-I (IGF-I), a hormone with osteogenic effects.
20 Mar Patients Can Expect To Return To Normal Function Relatively Quickly After Knee Arthroscopy
MedicalResearch.com Interview with: [caption id="attachment_33141" align="alignleft" width="100"]
Dr. Colvin[/caption]
Alexis Colvin, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
[caption id="attachment_33142" align="alignleft" width="100"]
Dr. Gladstone[/caption]
James N. Gladstone, MD
Co-Chief, Sports Medicine Service, The Mount Sinai Hospital
Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity.
We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early.
19 Mar Tennis Elbow: Is the Problem the Joint or the Tendon?
MedicalResearch.com Interview with: [caption id="attachment_32956" align="alignleft" width="130"]
Dr. Michael Hausman[/caption]
Michael Hausman, MD
Chief, Hand and Upper Extremity Surgery
Mount Sinai Health System
Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Lateral epicondylitis has traditionally been thought of as a tendon problem, but tendon pathology has not been well documented. Our study supports our hypothesis that the problem lies within the elbow joint, rather than in the tendon outside the joint.
19 Mar Evolution of Surgery for Adolescent Idiopathic Scoliosis over 20 Years
MedicalResearch.com Interview with: [caption id="attachment_33134" align="alignleft" width="200"]
Dr. Baron Lonner[/caption]
Dr. Baron Lonner MD
Professor of Orthopaedic Surgery
Mount Sinai Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience.
Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients.
17 Mar Risk Factors For Adverse Events After Total Shoulder Replacement
MedicalResearch.com Interview with: [caption id="attachment_33051" align="alignleft" width="130"]
Dr. Parsons[/caption]
Brad Parsons, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target.
Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA.
Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively.
16 Mar The Short Form KOOS, Jr Is Valid for Revision Knee Arthroplasty
MedicalResearch.com Interview with: [caption id="attachment_32879" align="alignleft" width="155"]
Dr. McLawhorn[/caption]
Alexander S. McLawhorn, MD, MBA
Orthopedic Surgery, Hip and Knee Replacement
Hospital for Special Surgery
New York, NY 10021
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hospital for Special Surgery (HSS) researchers saw the need for a shorter, more patient friendly outcome survey for revision knee replacement surgery. This is an area where patient-reported outcomes data are essential to improving quality of care. In fact, knee replacement revisions, which are more complex and heterogeneous than primary knee surgery, are under-studied in this regard.
A commonly used knee replacement survey, the KOOS (Knee Injury and Osteoarthritis Outcome Score), is 42 questions and often leaves physicians with partial and unusable information secondary to patient burden and fatigue. Previously, researchers at HSS created the KOOS, JR, which is a shorter, 7-question survey that accurately measures “knee health”, meaning it reflects aspects of pain, symptom severity, and activities of daily living relevant and difficult for patients with knee arthritis. The current research presented at AAOS showed that the KOOS, JR can be extended to knee replacement revision patients and that it is a valid and efficient tool for assessing knee health in this challenging patient population.
16 Mar How Does Spinal Deformity Impact Hip Stability?
MedicalResearch.com Interview with: [caption id="attachment_33024" align="alignleft" width="200"]
Dr. Aaron Buckland[/caption]
Dr Aaron J. Buckland
Spinal and scoliosis surgeon and
Assistant professor
Orthopedic surgery
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study?
Response: For decades, surgeons performing hip replacements have placed the acetabular component adjacent to the pelvis in a “safe zone” which has been shown to reduce dislocation risk. However, beginning in residency, I would notice that several of my patients with spinal deformities or lumbar fusions, would experience dislocations despite the safe zone placement of these implants. Our initial research demonstrated that there was an increased dislocation risk in patients with lumbar fusions, particularly if they underwent spinal realignment. We investigated this phenomenon further by retrospectively reviewing 107 patients who met the criteria for sagittal spinal deformity, including 139 hip replacements collectively.
15 Mar Men and Women Have Different Post-Op Risks After Joint Replacement
MedicalResearch.com Interview with: [caption id="attachment_32959" align="alignleft" width="130"]
Dr. Darwin Chen[/caption]
Darwin Chen, MD
Assistant Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Total hip and knee replacement surgery are among the most commonly performed orthopaedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement.
14 Mar Home-Based Rehabilitation Found As Effective As Inpatient After Knee Replacement
MedicalResearch.com Interview with: Justine M. Naylor, PhD Braeside Hospital, HammondCare, Australia South West Sydney Clinical School, University of New South Wales, Liverpool Hospital South West Sydney Local Health District, Liverpool 2170, NSW, Australia MedicalResearch.com: What is the background for this study? Response: Total knee arthroplasty (replacement) for end-stage arthritis is a very successful procedure for relieving the associated pain and functional impairments. Formalized rehabilitation following the surgery is also considered an essential adjunct to optimise recovery. World-wide, the volume of knee arthroplasty surgeries is increasing each year. In the US, for example, the prevalence of this surgery increased 11-fold from 1980 to 2010. The costs of the procedures (including the acute and rehabilitation costs) are also increasing. Because of these trends, there is concern for the future sustainability of these procedures. Research devoted to identifying the most cost-effective strategies in this field is required. Our group conducted a randomized trial comparing 10-days of inpatient rehabilitation to a simple, clinician-monitored home program in people who underwent total knee arthroplasty for end-stage osteoarthritis. Inpatient rehabilitation in a rehabilitation facility is commonly provided after knee arthroplasty in various countries including Australia, the US and Switzerland, and is comparatively expensive. In particular, it is a commonly available option for people with private healthcare insurance. Essentially, we wanted to compare 2 extremes – a resource-intensive program to one with far less resource requirements. Because patients who experience complications immediately after surgery may require inpatient rehabilitation to aid their recovery, we only included patients who did not experience a significant complication while in hospital, thus, were otherwise deemed able to be discharged directly home.23 Feb Testosterone Therapy Improves Bone Mineral Density In Men With Low T
MedicalResearch.com Interview with: [caption id="attachment_32296" align="alignleft" width="152"]
Dr. Tony Keaveny[/caption]
Tony M. Keaveny, Ph.D.
Professor, Departments of Mechanical Engineering and Bioengineering;
Co-Director, Berkeley BioMechanics Laboratory
University of California
Berkeley, CA 94720-1740
MedicalResearch.com: What is the background for this study?
Response: As men age, they experience decreased serum testosterone concentrations, decreased bone mineral density (BMD) and increased risk of fracture. While prior studies have been performed to determine the effect of testosterone treatment on bone in older men, for various reasons those studies have been inconclusive.
The goal of this study was to overcome past limitations in study design and determine if testosterone treatment — versus a placebo — in older men with low testosterone would improve the bone. Specifically, we used 3D quantitative CT scanning to measure changes in BMD and engineering “finite element analysis” to measure changes in the estimated bone strength, both at the spine and hip. The study was performed on over 200 older men (> age 65) who had confirmed low levels of serum testosterone.
12 Feb Bisphosphonates Can Be Reduced In Second Year of Breast Cancer Metastases
MedicalResearch.com Interview with: [caption id="attachment_31942" align="alignleft" width="114"]
Dr. Gabriel Hortobagyi[/caption]
Gabriel N. Hortobagyi, MD, FACP, FASCO
Professor, Department of Breast Medical Oncology
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX 77230-1439
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Bisphosphonates have been commercially available for several decades as supportive care for patients with bone metastases. They reduce the frequency and severity of bone-related complications. While the optimal dose and short-term scheduling of zoledronic acid (and previously, pamidronate) have been determined, there has been no research to determine how long these drugs need to be maintained nor the optimal dose and schedule beyond the first year of therapy. These questions are particularly important for this family of drugs, since they are incorporated into bone and not excreted from the body for many years.
We set out to determine whether a reduction in the frequency of administration of zoledronic acid (every 12 weeks) was able to maintain the therapeutic efficacy of this intervention when compared to the “standard” schedule of administration (every 4 weeks). It was a prospective, randomized, non-inferiority trial that recruited patients with metastatic breast cancer with bone metastases and who had previously received 9 or more doses of zoledronic acid or pamidronate. The primary endpoint was the proportion of patients with one or more skeletal-related events. Four hundred and sixteen patients were randomized in a 1:1 ratio. The two groups were comparable at baseline. After the first year of follow-up, there was no statistically significant difference in SRE rate between the two arms, confirming the non-inferiority fo the every-12-week schedule of zoledronic acid.
09 Feb Hip vs Lumbar Spine Pain Can Be Difficult to Differentiate
MedicalResearch.com Interview with: [caption id="attachment_31877" align="alignleft" width="96"]
Dr. Afshin Razi[/caption]
Afshin E. Razi MD
Clinical Assistant Professor
NYU Hospital for Joint Diseases
Department of Orthopaedic Surgery
New York, N.Y. 10016
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We did an extensive literature search and through our two previous seminars on this topic we were able to gather information to aid our colleagues on best ways of differentiating causes of hip and back pain. As an orthopaedic surgeon specializing in spine surgery I encounter many patients who present with concomitant back and hip pain. Many of these patients are also referred to me by surgeons who solely take care of hip problems such as total hip replacement or sport medicine specialist who treat younger patients with hip pain. It can be very difficult to properly diagnose the main issue and as such some patients go on to have unnecessary treatments, including surgery, because of their persistent symptoms. It was our goal to try to educate physicians, including orthopaedic surgeons, on the common differential diagnoses, appropriate clinical history and physical examination, diagnostic tools and their evaluations appropriately, as well as treatment options and priorities of which one to be treated first. More recently, it has been noted that some patients who have undergone total hip replacement with significant curvature of the spine had postoperative dislocation of the hip after reconstruction of the spinal malalignment. This article also talks about this newly seen problem.
09 Feb Hip Fractures Increase Mortality Risk in Cognitively Impaired Men
Posted at 01:56h
in Author Interviews, Cognitive Issues, Gender Differences, Hip Fractures, Orthopedics
MedicalResearch.com Interview with:
[caption id="attachment_31853" align="alignleft" width="180"]
Dr. Ann Gruber-Baldini[/caption]
Ann L. Gruber-Baldini, Ph.D.
Professor, Division of Gerontology
Director, Program in Epidemiology and Human Genetics
Department of Epidemiology & Public Health
University of Maryland School of Medicine
MedicalResearch.com: What is the background for this study?
Response: While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture. It is also known that those with cognitive impairments, typically due to delirium and Alzheimer's disease and related dementia, are more likely to do more poorly after the fracture. The impact of both sex and cognition on outcomes after hip fracture has not been fully explored.
08 Feb Is the Benefit of Arthroscopic Meniscus Surgery a Placebo Effect?
MedicalResearch.com Interview with: [caption id="attachment_31841" align="alignleft" width="109"]
Dr. Jonas Thorlund[/caption]
Jonas Bloch Thorlund
Associate Professor (MSc, PhD)
Department of Sports Science and Clinical Biomechanics
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.
16 Jan More Hip Fractures in Elderly on Antidepressants
MedicalResearch.com Interview with: [caption id="attachment_34480" align="alignleft" width="133"]
Sanna Torvinen-Kiiskinen[/caption]
Sanna Torvinen-Kiiskinen
MSc (Pharm.), PhD student,
Kuopio Research Centre of Geriatric Care and School of Pharmacy
University of Eastern Finland
MedicalResearch.com: What is the background for this study?
Response: Antidepressants are widely used among elderly persons, especially persons with Alzheimer’s disease. They are used not only for treatment for major depression, but for treatment of anxiety, insomnia and chronic pain as well as behavioral symptoms caused by dementia.
However, antidepressants, as well as other psychotropic drugs, may cause sedation, confusion, orthostatic hypotension and hyponatremia, which increase the risk of falling and fractures. Because of changes in pharmacodynamics and pharmacokinetics due to aging, older persons are at the higher risk of those adverse events.
The aim of our study was to investigate whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer’s disease.
06 Jan Bisphosphonates For Bone Metastases May Be Given Less Frequently
MedicalResearch.com Interview with: [caption id="attachment_31008" align="alignleft" width="130"]
Dr. Charles Shapiro[/caption]
Charles L. Shapiro, MD
Professor of Medicine
Co-Director of Dubin Breast Center
Director of Translational Breast Cancer Research
Director of Cancer Survivorship, Tisch Cancer Institute
Mount Sinai Health System
Division of Hematology / Medical Oncology: Tisch Cancer Institute
New York, NY 10029
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Metastases to bone are frequent in many cancers and cause pain, pathological fractures, necessitate surgical and/or radiation treatments, cause spinal chord compression that can lead to paralysis, and significantly increase health care costs.
Zoledronic acid, a bisphosphonate that inhibits bone resorption, is used in standard practice because it reduces the risks skeletal-related events including cancer-related pathological fractures, the need for surgery and/or radiation to bone metastases, and spinal chord compression in patients with breast cancer, prostate cancer and multiple myeloma.
However, the optimal dosing interval for zoledronic acid is unknown and based on prior studies and empiricism it is administered monthly along with anti-cancer treatments.
In this trial, over 1800 breast cancer, prostate cancer and multiple myeloma patients with bone metastases were randomized to the standard dosing interval of monthly zoledronic acid versus every 3-months zoledronic acid for a duration of two years.
The results overall, and in each specific disease site, show that giving zoledronic acid once every 3-months as opposed to monthly did not result in any increase in skeletal-related
events.
06 Jan Bundled Payment For Joint Replacements Saved Hospitals and CMS Money
Posted at 13:22h
in Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania
MedicalResearch.com Interview with:
[caption id="attachment_30994" align="alignleft" width="180"]
Dr. Amol Navathe[/caption]
Amol Navathe, MD PhD
University of Pennsylvania
Staff Physician, CHERP,
Philadelphia VA Medical Center
Assistant Professor of Medicine and Health Policy, Perelman School of Medicine
Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School
Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation
MedicalResearch.com: What is the background for this study?
Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
02 Jan Psoriasis Associated With Increased Risk of Avascular Bone Death
MedicalResearch.com Interview with: [caption id="attachment_18200" align="alignleft" width="266"]
Psoriasis[/caption]
Hsien-Yi Chiu, MD/
Tsen-Fang Tsai, MD
Department of Dermatology, National Taiwan University Hospital
Taipei, Taiwan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities.
Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN.
Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group.
31 Dec Cardiac Disease Linked To Elevated Risk of Shoulder Pain and Rotator Cuff Tendinitis
MedicalResearch.com Interview with: [caption id="attachment_30872" align="alignleft" width="142"]
Dr. Kurt Hegmann[/caption]
Kurt T. Hegmann, M.D., M.P.H.
Director, Rocky Mtn. Center for Occupational and Environmental Health
Chief, Division of Occupational and Environmental Health
The University of Utah Health Care
MedicalResearch.com: What is the background for this study?
Response: This line of work for us began approximately 20 years ago.
Normal tendons never rupture, as the weak point when loading the muscle-tendon unit is either the muscle-tendon junction (i.e., a true muscle strain) or bone-tendon junction. Researchers in the 1960s reported there is poor blood supply in the area of rotator cuff tendon tears, providing one of the two main etiological theories of rotator cuff tears. The other main theory is “impingement syndrome” or a biomechanical impingement in the shoulder joint. Though who experience this might find that they need something similar to this shoulder dislocation surgery. Naturally, both theories could co-exist.
Next, we noted rotator cuff tendinitis and shoulder risks from tobacco in other studies. We also reported prior research of increased risks with obesity. These led us to the theory that these rotator cuff tears are likely vascular in etiology. The next problem was to show this.
28 Dec Shock-Absorbing Insoles Probably Don’t Prevent Injuries
MedicalResearch.com Interview with: Daniel Bonanno Lecturer & 3rd Year Podiatry Co-ordinator Discipline of Podiatry, College of Science, Health, and Engineering La Trobe University Victoria Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Foot orthoses and shock-absorbing insoles are commonly used for the prevention of many musculoskeletal disorders of the lower extremity, so this review summarized the findings of existing clinical trials that evaluated their effectiveness for preventing such injuries. The main findings of our review were that foot orthoses were found to be effective for preventing overall injuries and stress fractures, but not soft-tissue injuries. Regarding shock-absorbing insoles, there is no evidence to date to support their use for the prevention of injury.06 Dec Only High Risk Patients May Require Anticoagulation After Arthroscopic Knee Surgery
MedicalResearch.com Interview with: [caption id="attachment_30279" align="alignleft" width="187"]
Dr. Suzanne Cannegieter,[/caption]
Suzanne C. Cannegieter, M.D., Ph.D.
Einthoven Laboratory
Leiden University Medical Center
The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients who undergo arthroscopic knee surgery and patients who are treated with casting of the lower leg are at increased risk for venous thromboembolism (VTE). It is uncertain whether thromboprophylaxis is effective in these situations to prevent VTE. For both indications, several trials have been performed to evaluate the effectiveness of anticoagulant prophylaxis. However, an overall risk–benefit balance could not be established because of methodologic shortcomings; hence, there has been reluctance to establish international guidelines regarding the use of anticoagulant therapy for either of these indications.
22 Nov Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect
Posted at 12:00h
in Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_29895" align="alignleft" width="200"]
Dr. Joshua I. Barzilay[/caption]
Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096
MedicalResearch.com: What is the background for this study?
Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.
Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.
After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.
20 Nov Menopausal Hormone Therapy Benefits Bone Health For Several Years After Discontinuation
Posted at 13:03h
in Author Interviews, Endocrinology, Hormone Therapy, JCEM, Menopause, Osteoporosis
MedicalResearch.com Interview with:
[caption id="attachment_29927" align="alignleft" width="131"]
Dr Georgios Papadakis[/caption]
Dr Georgios Papadakis
FMH, Médecin InternenMédecin assistant
Service d'endocrinologie, diabétologie et métabolisme
Lausanne
MedicalResearch.com: What is the background for this study?
Response: This study was mainly motivated by the absence of available data on the effect of menopausal hormone therapy (MHT) on bone microarchitecture, as well as contradictory results of previous trials regarding the persistence of a residual effect after MHT withdrawal.
We performed a cross-sectional analysis of 1279 postmenopausal women aged 50-80 years participating in OsteoLaus cohort of Lausanne University Hospital. Participants had bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA) at lumbar spine, femoral neck and total hip, as well as assessment of trabecular bone score (TBS), a textural index that evaluates pixel grey-level variations in the lumbar spine DXA image, providing an indirect index of trabecular microarchitecture.
31 Oct Smoking Reduces Surgical Improvement for Cervical Myelopathy
MedicalResearch.com Interview with: [caption id="attachment_29280" align="alignleft" width="140"]
Dr. David Kusin[/caption]
Dr. David Kusin MD
University of Nebraska Medical Center
Omaha
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further.
We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms.
27 Oct Physical Activity Doesn’t Increase After Hip Replacement
MedicalResearch.com Interview with: Tom Withers Research Student, School of Health Sciences University East Anglia Norwich, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a lot of subjective evidence to suggest that physical activity does not improve following hip replacement we wanted to therefore synthesise the current evidence to come to a more objective conclusion. The main finding from this study is that physical activity does not significantly change pre-operatively compared to up to one year post-operatively.27 Oct Clinical Practice Guidelines For Diagnosis and Treatment of Postmenopausal Osteoporosis
MedicalResearch.com Interview with: [caption id="attachment_29173" align="alignleft" width="165"]
Dr. Pauline Camacho[/caption]
Pauline Camacho, MD, FACE
Professor, Endocrinology
Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center
MedicalResearch.com: What is the background for this report? What is the prevalence and significance of osteoporosis in US women?
Response: Osteoporosis is widely prevalent and is increasing in prevalence not only in the US but also around the world. 10.2 million Americans have osteoporosis and that an additional 43.4 million have low bone mass. More than 2 million osteoporosis-related fractures occur annually in the US, more than 70% of these occur in women ( from National Osteoporosis Foundation (NOF) estimates).
26 Oct Patients Greatly Underestimate Reimbursement For Orthopedic Procedures
MedicalResearch.com Interview with: [caption id="attachment_29160" align="alignleft" width="125"]
Dr. Kelechi Okoroha[/caption]
Kelechi Okoroha, M.D.
Orthopaedic Surgery House Officer
Henry Ford Health System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training.
• Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut.
• 61 percent of patients say a surgeon’s salary should not be tied to outcomes.
• 79 percent of patients say reimbursement to drug and device companies should be reduced.
26 Oct Low-Intensity Ultrasound Not Effective In Accelerating Healing of Tibial Fractures
MedicalResearch.com Interview with: [caption id="attachment_29117" align="alignleft" width="150"]
Jason Busse[/caption]
Jason Busse PhD
Associate Professor, Department of Anesthesia
McMaster University
Hamilton, ON
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our group previously reviewed the evidence regarding the effectiveness of low-intensity pulsed ultrasound (LIPUS) for fracture healing. We found moderate to very low quality evidence for LIPUS in accelerating functional recovery among patients with fracture, and that most trials only explored effects on surrogate outcomes (e.g. radiographic healing); only five of 13 trials directly assessed functional end points - of these, one was positive. We concluded that large trials of high methodological quality, focusing on patient important outcomes such as quality of life and return to function, were needed to establish the role of LIPUS in fracture healing.
We have now completed such a study. Our large, international trial of LIPUS for surgically managed tibial fractures found the addition of LIPUS does not improve functional recovery or accelerate radiographic healing.