Becker's Spine Review

16 Executive Briefing Risks of acrylic bone cements include cement leakage, which may cause tissue damage, nerve or circulatory problems, and other serious adverse events, such as: Cardiac arrest, Cerebrovascular accident, Myocardial infarction, Pulmonary embolism and Cardiac embolism. While Medtronic was busy improving VCF treatment with balloon kyphoplasty and supporting clinical trials, NOF built a campaign for osteoporosis awareness and educating healthcare providers about best treatment practices. In 1990, the organization began publishing the scientific journal Osteoporosis International dedicated to the diagnosis, treatment and management of osteoporosis. The organization also advocated for states to adopt legislation around osteoporosis prevention and treatment education, with success in more than 30 states. NOF published its first clinical guidelines for osteoporosis in 1998 and 10 years later released the "Clinician's Guide to Prevention and Treatment of Osteoporosis." NOF became a founding member of the National Bone Health Alliance in 2010, helping to launch a public- private partnership to address bone health in the U.S. With two powerhouse organizations — Medtronic and NOF — running parallel campaigns to address the same problem, it was a matter of time before they pooled resources to really make an impact on VCF diagnosis and treatment in the U.S. "We've built a really strong partnership with NOF and the National Bone Health Alliance, which has helped extend our message related to osteoporosis for patients that are being diagnosed and not treated through the continuum of care," said Jeff Cambra, vice president and general manager of Medtronic's interventional pain therapies – restorative therapies group. "We are trying to build awareness into what VCF is and what options are available to treat that fracture." The partnership aims to educate clinicians as well as patients about osteoporosis, VCF and available treatment options. One of the biggest opportunities for clinician education is among emergency room staff that see around half a million patients with either hip or vertebral fractures per year. "We believe that creating a pilot program to provide education to family and ER physicians, starting in eight to 10 cities, could help us understand how to make change," said Elizabeth Thompson, CEO of NOF. "We want to get the message out as people present to the ER with pain or fractures to get a complete osteoporosis workup and referral, and if they receive opioids we want to make sure that is really managed. If someone is going back for a refill after two weeks, they should likely have a bone density scan (DEXA) to rule out a vertebral fracture or osteoporosis as the underlying cause." Many times, the ER staff refers these patients to orthopedists instead of giving them an osteoporosis work-up and DEXA scan; other times, they prescribe opioids, opening the door for addiction. "We hope to provide research showing fractures due to osteoporosis isn't something that can be managed by opioids," said Claire Gill, chief marketing officer of NOF. "It becomes chronic for patients quickly, and there needs to be further diagnosis of what that pain is for the elder population." Eliminating unnecessary treatment and over prescription of opioids has a positive economic impact on the health system and can improve a patient's quality of life. "We are trying to drive opioid reduction to make sure patients don't get caught in a downward spiral; we want to make sure they get the care they need earlier," said Mr. Cambra. "Our goal here is to save dollars within the health system to avoid additional costs associated with patients who incur additional VCF if their initial problems aren't treated in a timely fashion." Some studies have shown that patients who undergo BKP procedures have had a reduction in length of stay. Becker et al., which examined 244 patients treated at a hospital between 2002 and 2005, found the average length of stay among BKP patients was 4.96 days, compared to 5.39 days for non-surgical management patients. 5 Chen et al., which examined 68,752 Medicare patients who underwent treatment in 2006, found much greater length of stay among non-surgical patients — 7.38 days — when compared with BKP patients, who reported average length of stay at 3.74 days. 6 On the other hand, there were studies that reported slightly extended length of stay for BKP patients. Specifically, Zampini et al., which examined 5,766 patients had 6.0 days with BKP patients when compared to 5.3 days with non-surgical management patients. 8 Claire Gill Chief Marketing Officer National Osteoporosis Foundation Elizabeth Thompson Chief Executive Officer National Osteoporosis Foundation

• Cover