Vertebroplasy debate resurfaces

Bone health

4 Feb 2016

The controversial treatment for painful osteoporotic vertebral fractures that was branded ‘clinically inappropriate’ by high profile public health researcher Professor Stephen Duckett last year has again hit the headlines.

Writing in a debate feature in this week’s MJA, Dr William Clark, director of Interventional Radiology at Sydney’s St George Private Hospital, said the claim was based on two vertebroplasty trials that were “not relevant to the patient group that we treat with vertebroplasty.”

“We have the largest clinical vertebroplasty experience in Australia, yet our published advice was apparently ignored,” he wrote.

Dr Clark was responding to a research article Professor Duckett and fellow Grattan Institute colleagues published in the MJA last year citing examples of ‘clinically inappropriate care’ in Australian hospitals.

The 2015 article named a number of potentially ‘inappropriate’ procedures, including vertebroplasty for painful osteoporotic vertebral fractures.

In his response article, Dr Clark conceded that vertebroplasty had been controversial but remained clinically useful. However he said statistical assessment of a Sydney-based trial involving 120 patients was nearing completion, with results “soon to be published.”

Professor Duckett and his colleagues defended their article  which “recognises that health care is dynamic and the evidence often changes, so that procedures seen as inappropriate in one year could be regarded as good practice the next.”

“We took care in our study to ensure that we were only analysing treatment choices that were inconsistent with the prevailing evidence at the time our data were collected,” they wrote.

“Evidence that was outdated or published after our study year was not taken into account.”

Talking to the limbic this week, Professor Duckett played down the criticism. He said while he does not believe the criticism has invalidated the findings, he welcomed the debate.

“I was pleased that the only criticism was so easy to refute,” said.

“It’s very good that there is debate like this because we need to ensure that procedures are appropriate and clinically meaningful,” he said.

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