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In episode 91, yet again we bring in Mike K and Tina K to help us out with some very useful clinical information surrounding the issue of bone density and osteoporosis. We look at studies from the BMJ (Bowel Medical Journal), one of Mike A’s favourite journal, and we all agree that simple models should be used and repeat BMDs are basically not needed. Unfortunately we also come to the realisation that in a similar fashion, Mike A and James are basically not needed for the podcast as they are too simple.
Show notes
1) Simple models vs more complex models – simple is just as good
Arch Intern Med 2009;169:2087-94
2) Repeat bone density – is it needed – likely not
3) Only measure BMD once
Arch Intern Med 2007;167:155-60
4) An RCT of vertebroplasty for vertebral fractures
{ 4 comments… read them below or add one }
Dear All
Great podcast. What I want to know is how you have gotten into my computer to know that I am having an issue with osteoporosis and collapse.
I have a patient who has gone into hospital and the acute back pain she has seems to be due to an acute osteoporotic collapse at ? L2 … they are going to do a vertebroplasty. They seem keen , and a relative of hers who is a pain specialist has phoned me from the USA explaining how good this procedure is. It made me think. Everyone is doing this prcedure with NO double blind randomised evidence of benefit. Why? Maybe it is because not to do it would mean that they were not ‘current’ and ahead of the curve. And you boys knows what that would ‘mean’. It would mean they were a bad doctor. The pressure to do stuff before you have the faintest idea whether it is 1/ useful or 2/ safe must be strong….
My colleague from the states also says I should consider nasal Calcitonin … at £800/ year. Do we have good evidence for this in bone pain?
Also how we do we tell the difference between Osteoporosis and Osteomalacia …. I never knew this could be so complicated !!!
None the less thanks for the pod. Seems to me that the neg trial may not be perfect , but it remains up to others to show clear benefit rather than the other way round. Why do we allow a state where we use a potentially dangerous procedure , without good evidence and then ignore evidence against it …. crazy crazy
How I appreciate the clarity you guys bring to things
Once the study came out about the sham procedures being just as good as vertebroplasty, the big radiology group in town sent out a letter about how their patients found vertebroplasty valuable. They included a pie chart with a 90+% customer satisfaction rate. What a great study
It was so comical.
What do u expect from us? One of our true founding fathers, George Washington died from hypovolemic shock from repeated blood-letting to treat his “severe throat”??
http://xnet.kp.org/permanentejournal/spring04/time.html
It happens every day here in the States as we’re convinced that we will be living forever, and will not have any bodily discomfort EVER.
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