L1 fx 50% loss, 8 M out, not healing, Kypho?
L1 fx 50% loss, 8 M out, not healing, persistent edema, Kypho?. no h/o malignancy. known osteoporosis
for Kypho, is there a hard deadline after fx. ? (Source: Student Doctor Network)
Source: Student Doctor Network - January 24, 2024 Category: Universities & Medical Training Authors: specepic Tags: Pain Medicine Source Type: forums
What would you do?
I have an 80 year old woman with osteoporosis and prior compression fractures. She developed significant acute axial low back pain February 18th without any inciting event. This was so severe that it resulted in a short hospitalization for pain control. Workup was negative except for chronic L3 and L4 compression fractures (I have included sagittal STIR and T2 lumbar spine MRI images below from 2/19/2023). Patient was referred to me in March. Pain was facetogenic on examination. I ended up...
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Source: Student Doctor Network - June 14, 2023 Category: Universities & Medical Training Authors: No_Pain_No_Gain Tags: Pain Medicine Source Type: forums
Re: Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials
(Source: BMJ Comments)
Source: BMJ Comments - May 6, 2023 Category: General Medicine Source Type: forums
Kypho coding
Our Medicare guidelines are stating vertebral augmentation is only for patients with known osteoporosis. With DEXA missing up to 50 percent of these cases, how are you guys showing medical necessity and demonstrating known osteoporosis? (Source: Student Doctor Network)
Source: Student Doctor Network - February 2, 2022 Category: Universities & Medical Training Authors: Vie221 Tags: Pain Medicine Source Type: forums
Prostate case: What is appropriate for reirradiation and how?
78 y/o with osteoporosis and good PS now 6 years out from EBRT alone for favorable intermediate risk prostate cancer. (T1c, PSA ~6, Gleason 3+4=7). Now with biochemical progression (most recent PSA 5.6 with PSA doubling time ~10.7 months). Restaging imaging, including axumin, demonstrates isolated activity at prostate base with involvement of SV.
What to do?
1. Observe (risk to life still low and DMFS probably pretty high at 7 years based on PSA doubling time)
2. ADT (pt with osteoporosis)...
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Source: Student Doctor Network - November 29, 2021 Category: Universities & Medical Training Authors: communitydoc13 Tags: Radiation Oncology Source Type: forums
5 level kypho - possible?
55 yo with prior compression fracture, osteoporosis on Ca Vit D prolia, 1 month of acute LBP
MRI showing strong stir on T11 L1 L2 L3 L4. 20-30% compression fracture on each level, no retropulsion.
pt begging for kypho - i am ambivalent about this given extensive levels
anyone with more than 3 level experience? (Source: Student Doctor Network)
Source: Student Doctor Network - October 7, 2021 Category: Universities & Medical Training Authors: TIVAndy Tags: Pain Medicine Source Type: forums
Lost battle with the SIJ
A lost battle with my arch nemesis the SI joint today. Very petite 82 year old with osteoporosis s/p L4-S1 PLIF with transitional anatomy manifesting as lumbarized S1. Old fashioned right side iliac crest bone graft harvest scar. Right buttock pain. Weight bearing LS spine x-ray showing right SIJ and axial MRI image showing only cross sectional view of SIJ. On fluoro straight AP there was what looked to be a long radiolucent “stripe”. The remainder of the sacrum was just a gray ground glass...
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Source: Student Doctor Network - October 2, 2021 Category: Universities & Medical Training Authors: NJPAIN Tags: Pain Medicine Source Type: forums
Prolia (denosumab) vs Zometa (zolendronic acid) for bisphos-refractory (or intolerant) Osteoporosis
:
Which do you prefer?
Prolia is a q 6mo injection, Zometa a q12month infusion. Patients have to be compliant with both, and it's life-long therapy. Though, I've heard that the consequences of mal-compliance with Prolia are more severe, more prone to fractures if you stop the Prolia. True? Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - August 7, 2021 Category: Universities & Medical Training Authors: DrMetal Tags: Internal Medicine and IM Subspecialties Source Type: forums
Iatrogenic osteoporosis?
(Source: BMJ Comments)
Source: BMJ Comments - December 26, 2020 Category: General Medicine Source Type: forums
Osteoporosis, fracture risk and association with pharmacological treatments
(Source: BMJ Comments)
Source: BMJ Comments - August 8, 2019 Category: General Medicine Source Type: forums
Do you workup and treat painful diseases (not just the pain)?
This is perhaps more of a nuance question, but do you workup and treat painful diseases?
For example, of you suspect RA/Lupus/etc, do you do the bloodwork and manage DMARDs, biologics, etc or simply refer to Rheumatology?
If you think the patient has osteoporosis, do you do the bone density/DEXA and give Calcium/Vit D, bisphosphonates, etc?
If the patient is having possible side effects from opiates, (which may be related to other medical problems as well) such as low testosterone...
Do you workup and treat painful diseases (not just the pain)? (Source: Student Doctor Network)
Source: Student Doctor Network - June 21, 2019 Category: Universities & Medical Training Authors: Ferrismonk Tags: Pain Medicine Source Type: forums
Hip osteonecrosis
Hey guys. Young attending here 1 year out of fellowship. My fellowship was spine heavy and now dealing with a lot of large joint issues as well. I have a large very old population/nursing home with severe hip pain and x ray findings. Most have subchondral sclerosis/findings consistent with osteoporosis and not surgical candidate. Other than the more conservative stuff, do we still feel comfortable injecting them knowing that high concentration of intra-articular steroids and progress...
Hip osteonecrosis (Source: Student Doctor Network)
Source: Student Doctor Network - May 8, 2018 Category: Universities & Medical Training Authors: thecentral09 Source Type: forums
How can corticosteroids cause osteoporosis?
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How can corticosteroids cause osteoporosis?
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Source: The Student Room - November 23, 2017 Category: Universities & Medical Training Authors: ecolier Tags: Medicine Source Type: forums
UK NICE multimorbidity guidance will increase osteoporosis treatment gap
(Source: BMJ Comments)
Source: BMJ Comments - October 3, 2016 Category: Journals (General) Source Type: forums
Osteoporosis or osteomalacia after bariatric surgery?
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Source: BMJ Comments - July 28, 2016 Category: Journals (General) Source Type: forums
