Over 85% of patients with multiple myeloma (MM) have bone disease, mostly affecting thoraco-lumbar vertebrae. Vertebral fractures can lead to pain and large spinal deformities requiring application of vertebroplasty (PVP). PVP could be enhanced by use of Coblation technique to remove lesions from compromised MM vertebrae prior to cement injection (C-PVP). 28 cadaveric MM vertebrae, were initially fractured (IF) up to 75% of its original height on a testing machine, with rate of 1mm/min. Loading point was located at 25% of AP-diameter, from anterior. Two augmentation procedure groups were investigated: PVP and C-PVP. All vertebrae were augmented with 15% of PMMA cement. At the end of each injection the perceived injection force (PIF) was graded on a 5-point scale (1 very easy to 5 almost impossible). Augmented MM vertebrae were re-fractured, following the same protocol as for IF. Failure load (FL) was defined as 0.1% offset evaluated from load displacement curves.INTRODUCTION
METHODS
Subjects who have incurred an osteoporotic fracture are at high risk of further fracture. Recent publications by the Department of Health, the National Osteoporosis Society and the Royal College of Physicians have recommended that these patients should receive appropriate life-style advice and treatment for osteoporosis. The study aims to determine whether patients who had incurred a fracture of the hip or wrist were aware of the term osteoporosis and whether they had received advice or treatment for this condition following their fracture. All patients attending Stepping Hill hospital, Stock-port, with a fracture wrist or hip between 1 Jan and 31 May 2000 were identified. A postal questionnaire was sent to these patients in Jan 2001 (at least 6 months following their fracture). The questionnaire sought information on awareness, investigations, advice and treatment received for osteoporosis. After exclusion of patients who had died, 191 patients (102 wrist fractures, 89 fractured hip) were sent a questionnaire. Response rate was 87%. Although 79% of patients were aware of the term osteoporosis, only 22% had received any investigations, 21 % were given lifestyle advice and only 18% received treatment. Despite the strong evidence that early treatment decreases the incidence of subsequent fractures, the results from this study continue to confirm that most patients are neither investigated nor treated for osteoporosis. This illustrates the wide discrepancy between knowledge and action in this field. All the patients with minimal trauma fractures will pass through an orthopaedic department at some point in their ongoing management for the fracture – however little responsibility is taken for the management of osteoporosis within the orthopaedic departments – a missed opportunity.
