BackTable / VI / Podcast / Episode #209

Primer on Medical Treatment of Osteoporosis and Non-Surgical Management

with Dr. Douglas Beall

In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty.

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Primer on Medical Treatment of Osteoporosis and Non-Surgical Management with Dr. Douglas Beall on the BackTable VI Podcast)
Ep 209 Primer on Medical Treatment of Osteoporosis and Non-Surgical Management with Dr. Douglas Beall
00:00 / 01:04

BackTable, LLC (Producer). (2022, May 24). Ep. 209 – Primer on Medical Treatment of Osteoporosis and Non-Surgical Management [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Douglas Beall discusses Primer on Medical Treatment of Osteoporosis and Non-Surgical Management on the BackTable 209 Podcast

Dr. Douglas Beall

Dr. Douglas Beall is the Chief of Radiology Services at Clinical Radiology of Oklahoma.

Dr. Jacob Fleming discusses Primer on Medical Treatment of Osteoporosis and Non-Surgical Management on the BackTable 209 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Show Notes

In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. This is the second installment of our 4-part BackTable VI series on osteoporosis treatment.
As we continue our conversation from Ep. 208, Dr. Beall outlines his typical follow up protocol for his patients. This includes DEXA scans in the first and second years, prescriptions for antiresorptive and/or osteoanabolic agents, and possible Romosozumab injections. Dr. Beall emphasizes that thoroughness is key to treating the disease process, and each encounter is a reimbursable event that can benefit both the patient and the practice.

Next, we shift to talking about the American Association of Clinical Endocrinologists (AACE) diagnostic criteria for osteoporosis. Dr. Beall highlights the fact that there are 4 categories that encompass information about DEXA (T-scores), FRAX scores, and fragility fractures. Sole reliance on DEXA score cutoffs can lead to under-diagnosis and increased mortality risk for patients. Notably, any past fragility fracture in a postmenopausal woman is sufficient for an osteoporosis diagnosis. Dr. Beall shares that 82% of patients with fragility fractures do not have T-scores in the osteoporotic range. On the other hand, there are confounding factors that can give a falsely elevated T-score.

As we shift to discussing medications for osteoporosis, Dr. Beall emphasizes the need to consider the order in which they are prescribed. He advocates for initially using osteo anabolics (specifically a PTH analog) for 2 years to build up bone mineral density, and then maintaining that density with antiresorptives afterwards. He notes that with the risk of bisphosphonate side effects like osteonecrosis of the jaw and atypical femur fracture, it is unwise to prescribe these antiresorptives as an initial treatment.

Finally, we begin the conversation about vertebroplasty and recent trials proving its efficacy in reducing pain and improving function for patients. Tune in to our next 2 installments to learn about Dr. Beall’s clinical pearls for vertebral augmentation!

Resources

Dr. Douglas Beall Twitter:
@DougBeall

BackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:
https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventions

Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial (2009):
https://pubmed.ncbi.nlm.nih.gov/19769510/

Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial (2014):
https://pubmed.ncbi.nlm.nih.gov/25471910/

The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis (2015):
https://pubmed.ncbi.nlm.nih.gov/25725810/

Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture (2019):
https://pubmed.ncbi.nlm.nih.gov/30837413/

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Topics

Kyphoplasty Procedure Prep
Osteoporosis Condition Overview
Vertebral Augmentation Procedure Information

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