Bisphosphonates in Osteoporosis:
For those not at very high risk of fracture, it may be OK to take a 2-3 years drug holiday after 3-5 years. For those at very high risk, medication can be continued up to 6-10 years. Periodic risk-benefit evaluation of both treatment and disease will guide clinical judgment.
It used to be that, for an asymptomatic disease like Osteoporosis (until a fracture occurs), it was an uphill task to convince the at-risk populace (post-menopausal, frail elderly) to undergo screening, let alone commit to longterm treatment. As testament to the runaway success of public education hyping the fear factor (a quarter die within a year of a hip fracture, another quarter become permanently disabled), we now have the problem of inappropriate screening and treatment....
Contributory factors to unnecessary treatment include:
1) assessing Bone Mass Density (BMD) in those with few or no risk factors;
2) using CT scan or ultrasound instead of DXA to measure BMD;
3) interpreting non-standard views (eg lateral spine, forearm);
4) basing decision to treat solely on "osteopaenic" range BMD, without considering whether other risk factors exist (eg fall propensity).
It's time to tweak the public (and doctors') education regarding Osteoporosis.
On the other hand, those most at risk: those who actually suffered a fragility fracture (vertebral, wrist, ribs), may not be systematically identified for screening and followed up.
While the primary care sector may be "guilty" of over-screening and over-treatment, the tertiary care sector may well be "culpable" of suboptimal follow through. An unfortunate health service delivery mismatch which can be, and should be fixed.
Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women
This is not new news. We've known this for a long while now. Unless the underlying problem of Osteoporosis predisposing to the fracture is properly treated, vertebroplasty and fracture fixation are merely temporary symptomatic fixes at best. Mortality and morbidity risks are not diminished, and a fracture is the best predictor of the next fracture, probably right round the corner.