Journals Watch - Vertebral fractures and tinnitus

Not had time to catch up on the latest research? Dr Jonathan Holliday brings you up to date.

Vertebroplasty was better at reducing pain than analgesia in patients with vertebral compression fractures (Photograph: SPL)
Vertebroplasty was better at reducing pain than analgesia in patients with vertebral compression fractures (Photograph: SPL)

Vertebroplasty for acute osteoporotic vertebral compression fractures
Lancet 2010; doi:10.1016/S0140-6736(10)60954-3
I understand that vertebroplasty for osteoporotic vertebral compression fractures is well tolerated and the Dutch authors of this paper claim that it is cost effective.

Benefit was assessed at one month and one year using a visual analogue scale for pain (VAS score). It was a randomised trial comparing analgesia with vertebroplasty in over 50-year-olds with proven vertebral compression (more than 15 per cent loss of vertebral height on X-ray and bone oedema on MRI). Patients with pain for more than six weeks and a VAS score of less than five were excluded.

Vertebroplasty was better at reducing pain, with a greater reduction in VAS scores both at one month (-5.2 for vertebroplasty versus -2.7 for pain control) and at one year (-5.7 and -3.7 respectively). Furthermore, pain reduction was immediate following vertebroplasty. The authors suggest its use in the group of patients with persisting significant pain.

Tinnitus: prevalence and characteristics in the US
Am J Med 2010; 123: 711-8

This study examined prevalence, and the relationship between potential risk factors and self-reported tinnitus. The source was the national health and nutrition examination surveys between 1999 and 2004. Approximately 25 per cent of the population reported some tinnitus with 9 per cent of males and 6 per cent of females suffering daily symptoms. Incidence peaked in the 60-69 age range.

Significant associations were found with smoking and hypertension, suggesting a link with cardiovascular health.

However, environmental risk seemed to be more important, with loud leisure time, occupational and firearm noise exposure almost doubling the incidence. Occupational noise exposure is associated both with hearing loss and tinnitus but leisure time exposure was associated with tinnitus in those without hearing loss.

Talking about weight at home and dieting in teenage girls
J Adolesc Health 2010; 47: 270-36

This study was carried out with 356 girls from 12 state high schools in the US. The mean age was 15.8 years, 46 per cent were overweight and more than 75 per cent came from ethnic minorities.

A high percentage of girls reported 'weight talk' at home. What I found surprising was that this was all bad; 45 per cent of girls reported that their mothers encouraged them to diet, while 58 per cent reported teasing. Teasing was strongly associated with high BMI, body dissatisfaction and unhealthy or extreme weight control.

'Weight talk', particularly by mothers, was associated with many disordered eating behaviours and mothers' dieting was associated with unhealthy weight control in the girls.

Parents should be discouraged from making weight-based comments. They might intend to be helpful but can have unintended harmful effects.

Decision making for carers of people with dementia
BMJ 2010; 341: c4184

This study set out to explore the decisions that carers made on behalf of relatives with dementia. The information was gathered from focus groups involving 43 family carers, and individual interviews of 46 carers.

Five problematic areas of decision making were identified: accessing dementia-related health and social services, care homes, legal and financial matters, non-dementia related health care, and making plans for the person with dementia if the carer became too ill to care for them.

Family carers pointed to the difficulty of being the patient care manager while still being a family member.

Various coping strategies were found to be helpful. These were: introducing change slowly; organising legal changes for the carer as well as the patient; involving a professional to persuade the patient to accept services and the reassurance that accepting services optimises independence rather than diminishing it.

This commendable paper is a very helpful overview of the 'soft end' of dementia management.

Oral contraceptives and venous thromboembolism
J Fam Plann Reprod Health Care 2010; 36: 117-122

This report of an international workshop held in Berlin in December 2009 gives us the current most authoritative view on oral contraceptives and venous thromboembolism (VTE).

The current evidence is that we underestimated the true incidence of VTE in women not using a combined oral contraceptive (COC). Perhaps we now have a greater awareness of VTE or possibly the rate has genuinely increased. The figure that used to be quoted as 1 in 10,000 woman-years is now 4-5 in 10,000 woman-years. The figure doubles to 9-10 in 10,000 woman-years for COC users.

By comparison during pregnancy the rate of VTE goes up to about 29 in 10,000 woman-years and in the postpartum period may reach 300-400 in 10,000 woman-years. Of course there are the other non-contraceptive benefits of COC to consider, including reduction in menstrual bleeding and dysmenorrhoea.

Statin use and unhealthy dietary choices
Am J Cardiol 2010; 106: 587-92

This study aimed to identify whether unhealthy diet choices can be offset by taking a statin.

The values for risk reduction of statins were based on a meta-analysis of seven RCTs. The researchers calculated the total fat and trans-saturated fat content in a typical fast food meal.

The cardiovascular risk increase associated with excess dietary fat, and the risk reduction caused by taking a statin were quantified to see if the risk associated with a high-fat diet could be offset by taking a statin.

The authors found that the risk reduction associated with the daily consumption of most statins is greater than the risk increase caused by unhealthy diet.

  • Dr Holliday is a GP in Berkshire and a member of our team who regularly review the journals
The Quick Study

Vertebral collapse treatment with vertebroplasty has better pain outcomes than normal pain control.

Tinnitus risk doubled with exposure to environmental noise.

Discussing body weight at home was shown to have a negative effect on teenage girls.

Dementia carers identified five problematic areas of decision making, including social care, legal and financial issues.

Venous thromboembolism risk doubles for women taking the combined oral contraceptive pill.

Risky dietary behaviour was shown to be offset by statin intake.

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