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Vertebral Augmentation for Spinal Fractures

Vertebral Augmentation for Spinal Fractures

Medical management of vertebral compression fractures costs patients and healthcare systems nearly $14 billion annually, according to recent estimates. Percutaneous vertebroplasty and balloon kyphoplasty procedures are being used increasingly for the treatment of these osteoporotic fractures, but the effectiveness and safety of these options are unclear, especially with regard to long-term survival. “Recently, there have been concerns about whether healthcare funding agencies should support these vertebral augmentation procedures as treatment modalities,” says Richard L. Skolasky, ScD. “Evaluating the role of these surgeries on survival, complications, and other parameters may help determine optimal treatment methods.” New Research on Vertebral Augmentation Dr. Skolasky and colleagues had a study published in the Journal of Bone & Joint Surgery that compared various aspects of the management of 69,000 Medicare patients in whom new vertebral compression fractures were treated with vertebroplasty, kyphoplasty, or non-operative modalities. The investigators examined differences in survival at 6 months, 1 year, 2 years, and 3 years in addition to complications, length of hospital stay, charges, 30-day readmission rates, and repeat procedures. According to the results, the overall survival rate for the entire study population was 77.8% at 1 year and 49.6% at 3 years. The kyphoplasty group had the highest survival rates at 1 and 3 years. Patients treated without surgery were hospitalized on average about 8 days longer than patients treated with surgery. However, total charges for kyphoplasty and vertebroplasty were $12,032 and $7,805 more than for non-operative treatment. There was no statistically significant difference in post-operative infections and neurologic complications between surgical and non-surgical patients. Surgically treated patients were less likely to be diagnosed with pneumonia or...
New Guidelines on Osteoporosis in Men

New Guidelines on Osteoporosis in Men

This week, the Endocrine Society issued guidelines on managing osteoporosis in men. Published in the June 1, 2012 issue of Journal of Clinical Endocrinology & Metabolism, the guidelines recommend the following: Men at increased risk for osteoporosis should be tested by measurement of bone mineral density (BMD). Men at high risk for osteoporosis should be screened with dual-energy x-ray absorptiometry (DXA). This includes those aged 70 and older and younger men with risk factors. Risk factors for osteoporosis in younger men (aged 50-69) include: – History of fracture after age 50 – low body weight – Diseases such as delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, or COPD – Drugs such as glucocorticoids or GnRH agonists – Life choices such as alcohol abuse or smoking Measure forearm DXA (1/3 or 33% radius) when spine or hip BMD cannot be interpreted and for men with hyperparathyroidism or receiving androgen-deprivation therapy for prostate cancer. FRAX, Garvan, or other fracture risk calculators can improve the assessment of fracture risk and the selection of patients for treatment. Men with low levels of vitamin D (less than 30 ng/mL) should take vitamin D supplements. Those with or at risk for osteoporosis should consume 1,000 to 1,200 mg of calcium every day, ideally from dietary sources. Men aged 50 and older with prior spine or hip fracture, low bone mineral density, or other clinical risk factors (eg, those receiving long-term glucocorticoid therapy in pharmacological doses) should receive drug therapy. Those receiving treatment should have their bone mineral density assessed by DXA at the spine and hip every 1 to 2 years. Pharmacological therapy is recommended for all...

Osteoporosis & Bone-Density Testing

An American investigation suggests that osteoporosis would likely develop in less than 10% of postmenopausal women aged 67 or older during rescreening intervals of about 15 years for those with normal bone density or mild osteopenia. Osteoporosis would likely develop in less than 10% of such women during rescreening intervals of 5 years for those with moderate osteopenia and 1 year for women with advanced osteopenia. Abstract: New England Journal of Medicine, January 19,...

Improving Boomeratric Care Services

The population of baby boomers and geriatric adults—the “boomeratric”™ generation—is continuing to increase in the United States. Roughly 40 million Americans are 65 or older, representing 12.9% of the total population (or one in every eight people). There will also be about 72.1 million older Americans by 2030, a growth of about 19%. As the boomeratric™ generation continues to age, they become increasingly prone to falls and fractures because of their frailty. Timely evaluation and treatment after bone fractures lead to better outcomes. At Geisinger Health System and other medical centers throughout the country, hospitals are starting to establish geriatric fracture care programs. These initiatives utilize evidence-based medicine to address the aging population and a complete team approach to provide quality comprehensive care. Using the latest research, a series of protocols is followed to deliver best practice medicine throughout the entire care process. Geriatric fracture care programs connect patients with the resources they need to expedite recovery and help them take steps to stay healthy and prevent future injury. Coordinated, Evidence-Based Care Members of the geriatric fracture care team include nurse coordinators, emergency physicians, physical and occupational therapies, orthopedic surgeons, hospitalists, pharmacists, care managers, physician assistants, rheumatologists, dietitians, blood conservation services, and nurses. Nurse coordinators play an integral role in streamlining processes—speaking with patients regularly, keeping track of their progress, and guiding them throughout the care process. It’s their job to facilitate family involvement in the care of patients to improve outcomes. They also help maintain centralized electronic medical records and order sets. These enable all members of the geriatric fracture care team to stay up to date and...

Conference Highlights: 2010 Society of Interventional Radiology Meeting

The Society of Interventional Radiology held its 2010 annual meeting from March 13 to 18 in Tampa, Florida. The features below highlight some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.sirmeeting.org. » Preventing Strokes During Carotid Artery Stenting » Abnormal ABI Indicative of Cardiovascular Events » Vertebroplasty Relieves Pain for Osteoporotic VCFs Preventing Strokes During Carotid Artery Stenting The Particulars:Until recently, most carotid artery stenting procedures have been performed with filters in order to remove debris. The FDA has cleared a proximal cerebral protection device (Mo.Ma, Invatec) for use during carotid artery stenting. It suspends blood flow and prevents debris from traveling to the brain. Data Breakdown:Investigators evaluated the safety and effectiveness of the proximal cerebral protection device in 262 patients with carotid artery disease considered high risk. The 30-day major adverse cardiac and cerebrovascular events rate was 2.7%, a finding below the performance goal of 13% set before the start of the study. The major stroke rate was 0.9% through to the end of the trial; the death rate was also 0.9%. Take Home Pearls: Use of a proximal cerebral protection device may be able to prevent strokes during carotid stenting procedures. Results add to the body of data to support stenting as an alternative to surgery. Abnormal ABI Indicative of Cardiovascular Events [back to top] The Particulars:The ankle-brachial index (ABI) test is a noninvasive blood pressure reading in the ankle used to screen for peripheral artery disease (PAD). The ABI may provide another way to identify cardiovascular risks in older patients not considered...
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