Yes, its great to talk about hard facts and numbers, only when you include all of them for a reasonable patient
Dear Editors
I am writing in response to some readers' comments which are well-illustrated by the recent rapid response by Dr Simon Tobin.
I am sure Dr Tobin will clearly differentiate the groups of patients with the diagnosis of osteoporosis defined solely by BMD without prior fragility fracture, as opposed to the those osteoporotic patients diagnosed simply by the presence of prior fragility fracture without need for BMD measurement.
I am also certain readers will be aware that the disputed NNT figure of 175 for 3 years is for primary prevention by bisphosphonates to avoid one hip fracture in patients with osteoporosis by BMD without prior fragility fracture. Whereas even the most passionate critic of bisphosphonate therapy has to acknowledge that NNT for secondary prevention of hip fracture is easily under 100 or less (even lower for non-hip fragility fracture).
As for hip fractures, when providing information using Järvinen et al's disputed NNT=175 for 3 years for primary prevention, readers should also ensure that the following numbers are discussed.
Of all patients admitted to hospital with the diagnosis of hip fractures, 1 in 10 die as an inpatient, and overall between 1 in 6 and 1 in 3 patients die in the next 12 months since diagnosis.
It has been estimated that for elderly women, the mortality rate from the diagnosis of hip fracture is at least twice that of those with diagnosis of breast cancer.
Of the community ambulators (ie patients who can independently mobilise with or without aid) who sustain a hip fragility fracture, 4 out of 10 require increased reliance on using walking aids or are dependent on assistance long term compared with pre-fracture status; 1 in 4 requires institutionalisation.
And of course readers discussing the efficacy of primary prevention of complication of osteoporosis by bisphosphonate should include discussion about the more common non-hip fragility fractures. Though less serious compared to hip fractures, they are nevertheless by no means benign; they include low energy fractures of the vertebae, neck of humerus and ankle amongst the examples.
After all the law now expects the patient to be fully informed if they ask you, even though you are not proposing the treatment.
Rapid Response:
Yes, its great to talk about hard facts and numbers, only when you include all of them for a reasonable patient
Dear Editors
I am writing in response to some readers' comments which are well-illustrated by the recent rapid response by Dr Simon Tobin.
I am sure Dr Tobin will clearly differentiate the groups of patients with the diagnosis of osteoporosis defined solely by BMD without prior fragility fracture, as opposed to the those osteoporotic patients diagnosed simply by the presence of prior fragility fracture without need for BMD measurement.
I am also certain readers will be aware that the disputed NNT figure of 175 for 3 years is for primary prevention by bisphosphonates to avoid one hip fracture in patients with osteoporosis by BMD without prior fragility fracture. Whereas even the most passionate critic of bisphosphonate therapy has to acknowledge that NNT for secondary prevention of hip fracture is easily under 100 or less (even lower for non-hip fragility fracture).
As for hip fractures, when providing information using Järvinen et al's disputed NNT=175 for 3 years for primary prevention, readers should also ensure that the following numbers are discussed.
Of all patients admitted to hospital with the diagnosis of hip fractures, 1 in 10 die as an inpatient, and overall between 1 in 6 and 1 in 3 patients die in the next 12 months since diagnosis.
It has been estimated that for elderly women, the mortality rate from the diagnosis of hip fracture is at least twice that of those with diagnosis of breast cancer.
Of the community ambulators (ie patients who can independently mobilise with or without aid) who sustain a hip fragility fracture, 4 out of 10 require increased reliance on using walking aids or are dependent on assistance long term compared with pre-fracture status; 1 in 4 requires institutionalisation.
And of course readers discussing the efficacy of primary prevention of complication of osteoporosis by bisphosphonate should include discussion about the more common non-hip fragility fractures. Though less serious compared to hip fractures, they are nevertheless by no means benign; they include low energy fractures of the vertebae, neck of humerus and ankle amongst the examples.
After all the law now expects the patient to be fully informed if they ask you, even though you are not proposing the treatment.
Competing interests: No competing interests