title: Patient variables and referral paradigms associated with osteoporosis screening and treatment in neurosurgical patients undergoing kyphoplasty.
abstract: OBJECT Vertebral fractures are the most common osteoporotic fracture. Bone density testing and medical treatment with bisphosphonates or parathormone are recommended for all patients with an osteoporotic fracture diagnosis. Inadequate testing and treatment of patients presenting with low-impact fractures have been reported in various specialties. Similar data are not available from academic neurosurgery groups. The authors assessed compliance with treatment and testing of osteoporosis in patients with vertebral compression fractures evaluated by the authors' academic neurosurgery service, and patient variable and health-systems factors associated with improved compliance. METHODS Data for patients who underwent percutaneous kyphoplasty for compression fractures was retrospectively collected. Diagnostic and medical interventions were tabulated. Pre-, intra-, and posthospital factors that had been theorized to affect the compliance of patients with osteoporosis-related therapies were tabulated and statistically analyzed. RESULTS Less than 50% of patients with kyphoplasty received such therapies. Age was not found to correlate with other variables. Referral from a specialist rather than a primary care physician was associated with a higher rate of bone density screening, as well as vitamin D and calcium therapy, but not bisphosphonate/parathormone therapy. Patients who underwent preoperative evaluation by their primary care physician were significantly more likely to receive bisphosphonates compared with those only evaluated by a hospitalist. Patients with unprovoked fractures were more likely to undergo multiple surgeries compared with those with minor trauma. CONCLUSIONS These results suggest poor compliance with current standard of care for medical therapies in patients with osteoporotic compression fractures undergoing kyphoplasty under the care of an academic neurosurgery service.
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Morr
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: Hakeem J
authors.initials: HJ
authors.lastname: Shakir
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Lipinski
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: Vassilios G
authors.initials: VG
authors.lastname: Dimopoulos
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: Jody
authors.initials: J
authors.lastname: Leonardo
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Kaleida Health, Buffalo, New York.
authors.forename: John
authors.initials: J
authors.lastname: Pollina
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D015519:Bone Density / Q000502:physiology; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D010045:Outpatients; D012017:Referral and Consultation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D001843:Bone Cements; D014807:Vitamin D
keywords: DEXA = dual energy x-ray absorptiometry; kyphoplasty; osteoporosis; vertebral compression fracture