Whitney Palmer

Healthcare. Politics. Family.

Fracture Assessment Tools Underutilized, Study Shows

Published on the Sept. 19, 2016, RheumatologyNetwork.com Website

By Whitney L. Jackson

Using the fracture assessment tool with older, community-dwelling women can help reduce their risk of hip fracture over time, according to a randomized controlled trial.

Currently, although the cost of fractures is high for both society and individuals, the use of fracture risk tools to identify at-risk patients — and potentially stave off future fractures — is relatively low. The FRAX assessment tool identifies high-risk individuals in primary care environments in an effort to reduce fracture incidence.

The FRAX study was developed by the World Health Organization to evaluate fracture risk based on individual patient models that integrate risk associated with clinical risk factors, as well as bone mineral density at the femoral neck. The FRAX algorithms provide a 10-year fracture probability.

In fact, according to a 2010 study, the National Osteoporosis Foundation Guide recommends treating patients who have a FRAX 10-year score of ≥3 percent for hip fractures or ≥ 20 percent for major osteoporotic fractures to reduce future fracture risks.

In a Sept. 19, presentation at the 2016 American Society of Bone Mineral Research conference, lead author E.V. McCloskey, M.D., from the University of Sheffield in the United Kingdom, discussed a five-year, two-arm study into the efficacy of using the FRAX tool to pinpoint women with osteoporosis who are also at high fracture risk in the community.

Of the 12,483 women identified in primary care environments, 6,233 were randomized into the study’s screening arm. In that group, 898 women (14.4 percent) were identified as high risk using the FRAX tool. By the end of the first year, exposure to osteoporosis medication was higher in the screening group compared to the control group – 15.3 percent versus 4.5 percent, respectively. High treatment uptake occurred in the high-risk group (78.3 percent) at six months.

Results showed the incidence of major osteoporosis fractures – comprising hip, waist, humerus, and clinical vertebral fractures — reduced by 12 percent (2 percent to 21 percent, p=0.018). Screening was associated with a significant reduction in hip fractures (RRR 27 percent, 10 percent – 41 percent, p=0.003).

Based on these findings, researchers wrote, a systematic, community-based screening fracture risk program that uses the FRAX tool in older women can be both feasible and effective in lowering hip fracture risk.

To read the article at its original location: http://www.rheumatologynetwork.com/news/fracture-assessment-tools-underutilized-study-shows

September 20, 2016 Posted by | Healthcare | , , | Leave a comment

Hip Fractures No Longer on a Downward Trend in the U.S.

Published on the Sept. 19, 2016, RheumatologyNetwork.com Website

By Whitney L. Jackson

The 15-year trend of decreasing hip fractures due to osteoporosis is coming to a close in the United States, according to an observational study of Medicare claims data. A drop in reimbursement for a common screening technique could be to blame.

Since 2001, hip fracture rates have dropped thanks to improvements in osteoporosis evaluation and fracture predictions via dual-energy X-Ray absorptiometry (DXA), as well as new drugs, such as oral bisphosphate. DXA uses to X-ray beams to measure bone mineral density and diagnose osteoporosis.

In a Sept. 17, presentation at the 2016 American Society of Bone Mineral Research conference, lead study author E. Michael Lewiecki, M.D., of the New Mexico Clinical Research and Osteoporosis Center, discussed investigators’ analysis of hip fracture rates to determine if the downward trend still existed.

Researchers used Medicare claims and enrollment data from 2002-2014, approximately 900,000 annually, for the analysis. It was five percent sample of Medicare’s fee-for-service beneficiaries who had at least one Medicare-paid DXA scan per year. DXA providers were either office-based, free-standing or hospital-based. Analysts identified hip fractures with ICD-9 codes 820.0x, 820.2x, and 820.8x, excluding trauma-associated fractures.

While the analysis showed a downward trend in osteoporosis-caused hip fractures from 2002-2012, the data revealed a reversal, beginning in 2013. The uptick coincides with a drop in Medicare reimbursement for DXA screening. Reimbursement levels dropped to below cost, Dr. Lewiecki said in an interview with Rheumatology Network.

“The analysis suggests the downward trend for hip fractures in the United States could be over,” he said. “We can’t say that declines in DXA reimbursement are directly responsible for the higher than expected hip fractures, but it makes sense when you look at other contributing factors.”

To combat the drop in screening and, potentially, provide better treatment for osteoporosis, Dr. Lewiecki said patients should educate themselves about the benefits and risk of DXA screening. In addition, he said, patients and providers should support a bill in the U.S. Congress that would create a reimbursement floor for DXA payments that would make providing screening more profitable – or at least less costly – for doctors who have offered the service.

To read the article at its original location: http://www.rheumatologynetwork.com/news/hip-fractures-no-longer-downward-trend-us

 

September 20, 2016 Posted by | Healthcare | , , , , , | Leave a comment

How One Class of Bisphosphonates Could Predict Vertebral Fractures

Published on the Sept. 19, 2016, RheumatologyNetwork.com Website

By Whitney L. Jackson

Using biomarkers to assess the efficacy of existing bisphosphonate drugs in predicting fracture risk could pave the way for improved osteoporosis treatment, according to a new study.

Currently, little analysis exists into how bisphosphonate drugs can relate bone turnover markers to fracture reduction. With the cost of drug development so high — and with the time to get new drugs approved so long — researchers looked into how available drugs can help reduce fracture risk.

In a Sept. 19 presentation at the America Society of Bone Mineral Research conference, lead study author Douglas Bauer, M.D., from the University of California-San Francisco, discussed how biomarkers, such as blood and urine, can help identify how one class of bisphosphonates can predict vertebral — but not non-vertebral — fractures.

Based on the National Institutes of Health Bone Quality project, investigators analyzed data on more than 120,000 participants from 11 clinical trials, including bone turnover markers, dual-energy X-Ray absorptiometry and fracture outcomes. They recorded baseline data from 2,268 individuals with vertebral fractures, 3,286 with non-spine fractures (including 514 hip fractures), and 6,729 N-telopeptide of type 1 collagen fractures.

Researchers compared the mean effect of the bisphosphonate to the placebo over a three-to-four-year period. Results indicate there’s a high statistically-significant relationship between short-term change and bone markers for vertebral fractures compared to the placebo group (p=0.005, r=0.84). However, no such strong relationship exists for non-vertebral fractures. The findings suggest that non-fragile factors, such as falling, come into play for non-vertebral fractures.

For instance, for two hypothetical bisphosphonates with 10 percent versus 30 percent reductions in bone-specific alkaline phosphatase, the model predicted a 19 percent versus 66 percent reduction in vertebral fractures (r2-0.84, p=0.001). The relationship is weaker and not significant for non-vertebral fractures. The comparable risk reductions were 12 percent versus 21 percent (r2=0.06, p=0.27).

Ultimately, Dr. Bauer told Rheumatology Network, the study results can, hopefully, be useful in developing medications for the same bisphosphonate classes and extending the effects to other populations.

“The hope is that this overall effect can be observed in all anti-absorptive medications that will be developed in the future,” Dr. Bauer said. “Hopefully, all this data will be used to fill in predictive efficacy.”

To read the article at its original location: http://www.rheumatologynetwork.com/news/how-one-class-bisphosphonates-could-predict-vertebral-fractures

September 20, 2016 Posted by | Healthcare | , , , , | Leave a comment

Radiologists in Private Practice

Published on the Sept. 15, 2016, DiagnosticImaging.com website

By Whitney L. Jackson

It’s an iconic image for a young child who wants to be a doctor someday – that sign on a building that announces he or she is available to see patients. For many, being that solo physician is a dream they chase for years.

After finishing residency, not every new radiologist wants to stay close to academia. Many opt to strike out on their own, either launching a solo practice or joining an existing practice of any size. Instead of devoting time and energy to research and teaching the next radiological generation, you’re focused on using your skills to provide the best patient care possible within your community.

According to Stefano Bartoletti, MD, clinical director of radiology at the Children’s Hospital of Pittsburgh, private practice offers practitioners a great amount of leeway, but its safety net is small.

“Private practice allows significant involvement on the part of radiologists managing their own practice and being involved in the decision-making that will shape a group in the future,” he said. “However, this involves some degree of risk taking.”

Given that a private practice option offers less shelter than the umbrella of an academic institution, there are characteristics anyone considering this route should consider.

Benefits
The ideal of being a doctor in private practice wouldn’t be popular if the career option didn’t offer upsides.

1. Choice of focus: Many private practices do offer some flexibility in how radiologists can choose to focus their time. Even though a significant portion of a provider’s time will be spent reading a myriad of studies from various specialties, it is possible to carve out a niche and grow your business in your chosen subspecialty area within the practice.

2. Face-to-face relationships: Working in the same environment on a daily basis with the same people offers you the opportunity to create strong partnerships within your group.

3. Personal service: Simultaneously, working in a practice opens the door for you to interact frequently and directly with the referring physicians who send you their patients. Building these relationships helps secure your future financial stability.

4. Greater latitude: New radiologists are frequently attracted to private practice because the path offers greater autonomy and greater schedule flexibility. In addition, compensation is often higher than in academia. According to the Association of American Medical Colleges Careers in Medicine Survey, starting salaries are approximately $285,000.

Having such close working relationships with both in-office colleagues and referring physicians will make your day-to-day work flow easier, said Brandon Selle, practice administrator for Northeast Missouri Imaging Associates. It can build your reputation as a highly-respected provider in a private practice upon which they can depend.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/radiologists-private-practice

September 20, 2016 Posted by | Healthcare | , , , , , , , | Leave a comment

   

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