Episode 121: An atraumatic way to break down the evidence around bone density measurements
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In episode 121, Mike, James and Tina tackle the issue of who needs a bone density measurement and describe a simple tool that will help you with that decision.
However, at the end, Mike threatens to jump out of his building and James and Tina talk him down by promising not to measure his BMD more than once.
Show notes
1) Tools for Practice
Comments
My Dexa Hurts
It took 121 episodes, but I finally disagree with you guys (and gal, sorry Tina). I think you missed the point. Do we even need the crappy DEXA in the first place (I know the answer is obvious if you have one in your office)?
I know the FRAX is complicated, but you can figure it out without a DEXA and treat just based on that alone (20%/3%).
I guess it's okay to make a mistake once every 121 episodes, that's like 99% effective, but I think that's a relative term, absolute benefit is a bit smaller but the commercials will make people love you anyway and you can hire some good looking reps to push it on doctors.
Treating based on fracture risk score
While fracture risk tools are validated in terms of predicting future fracture risk, they have not yet been validated in terms of predicting who will respond to bisphosphonate therapy. There is an absence of prospective RCT data indicating that patients defined as "high risk" on the basis of CAROC or FRAX (these tools are used in vaious guidelines to select patients for treatment in the primary prevention setting) benefit from bisphosphonate therapy with respect to fracture risk reduction.
Hi and thanks for the comment
Hi and thanks for the comment - very much agree but I'm not aware of any risk tool that has been shown to predict who will respond to any therapy. When these drugs reduce risk by numbers like 2-3% and that means 97% get no benefit I don't know how one could ever figure out who will "respond" to therapy if respond means to reduce the risk of a bad outcome. If you have any ideas please let me know. Thanks.
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