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Osteoporosis Treatment Controversy

Posted by Jane Akre
Thursday, August 06, 2009 1:45 PM EST
Category: Major Medical
Tags: Osteoporosis, Fractures, NEJM, National Osteoporosis Foundation, Vertebroplasty, Mayo Clinic

Does using cement to treat painful osteoporotic vertebral fractures work? New research says no.

Does Cement Work? 

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IMAGE SOURCE: ©iStockphoto/ spine x-rays/ author: FotografiaBasica

It is a treatment that uses an acrylic cement to harden bones in the spinal column weakened by the bone-thinning disorder, osteoporosis.

Vertebroplasty, is the common treatment for painful osteoporotic vertebral fractures. Doctors began performing it in the 1990s, leading to successful outcomes in pain reduction, or so they thought.

As part of a review of medical procedures for cost-effectiveness as part of sweeping health reforms, a New England Journal of Medicine (NEJM) article, published Thursday, finds the treatment no more effective than a placebo.

A review of the treatment began several years ago at medical centers in Australia, Britain, and the U.S. Patients were, at random, selected to have vertebroplasty or a placebo with no cement.

The results - The vertebroplasty group and the placebo group both had pain relief.

The head of the National Osteoporosis Foundation says there needs to be more study.

Dr. David Kallmes, a professor of radiology at the Mayo Clinic who has been performing it for 15 years says his team was “shocked at the results”.

The leader of the Australian team, Dr. Rachelle Buchbinder says, “it does not work” and she would not recommend the treatment to any patient.

What’s unclear is whether the placebo effect may be influencing that group, or whether the numbing drugs used during the placebo procedure might have delivered some relief.

Medicare currently covers vertebroplasty and Dr. Marcel Salive, who is a director in the Medicare division, tells the New York Times, the study provides “the kind of evidence we look for when making coverage policy”.

The procedure costs an average of $2,500 to $3,000 and additional MRI scans can add another couple thousand dollars for the procedure.

The downside of the procedure appears to be leaking cement that can damage heart, lungs and has caused some deaths. There are questions whether the cement can actually cause more breaks and fractures elsewhere.

Congress has agreed to provide $1.1 billion to research the comparative effectiveness of some standard health care procedures to ensure health care dollars are being spent wisely. #


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