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Spine, Sex and Surgery; AJRR 2016 Registry Data Released; Study Confirms Hormone Therapy for Bone Health

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, November 29th, 2016

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Spine, Sex and Surgery

A new study published in the November 15, 2016 issue of Spine indicates that surgery is a better option than nonsurgical treatment for some spine patients when it comes to dealing with sex-related pain. Researchers from the University of California-San Francisco (UCSF) analyzed data from the Spine Outcomes Research Trial (SPORT). Patients with spinal stenosis or degenerative spondylolisthesis were randomly assigned to surgical or nonsurgical groups.

Shane Burch, M.D., an orthopedic surgeon with UCSF, told OTW, “We don’t have a thorough understanding of how people’s sex lives are affected by surgery (specifically lumbar spine surgery). We assume that this is important to people who undergo surgery, but we have no scientific data to use in discussions with them…what we have is all anecdotal. We sought to determine whether sex-related pain is actually relevant to patients undergoing surgery; then, in those who had surgery versus no surgery did it change the way they perceived issues with back pain and sexual function.”

“Roughly 30% of patients surveyed indicated that sexual function was not relevant to them. Of the 825 patients who said that sexual function was relevant, 531 underwent some kind of surgery (spinal decompression or spinal fusion) and 294 received nonsurgical treatment.”

“We found that three months after surgery, less than 20% of patients still had sex life-related pain. In the nonsurgical group, however, about 40% of patients still had pain with sexual activity. The improvement persisted through four years' follow-up.”

"We now know that sexual functioning is relevant to patients with spinal pathology and should be addressed. Now we need a more well-designed study using a validated sexual functioning survey. That way we can gain a better understanding of the nuances involved. For example, when you do a long fusion (lumbar area to the pelvis) it changes the mechanics of sexual functioning…and we don’t yet understand how that affects someone after surgery.”

AJRR Releases 2016 Annual Report

The American Joint Replacement Registry (AJRR) has debuted its 2016 Annual Report on hip and knee arthroplasty data, a publication that is much more extensive than those of previous years. This annual report, which includes data from 3, 710 surgeons at 416 hospitals, is the third such report that AJRR has released. There are now over half a million procedures in the registry. Also, says the November 11, 2016 news release, a separate California Joint Replacement Registry (CJRR) Annual Report was released today. AJRR and CJRR merged in March 2015, and the CJRR 2016 Annual Report features patient-reported outcome completion rates for the first time, in addition to addressing the length of stay, comorbidities and adverse events, and other patient factors influencing the results of hip and knee replacement surgeries for the state of California.

Asked if there were any challenges in determining what data to include, Daniel Berry, M.D., chair of the AJRR Board of Directors, told OTW, “Our third Annual Report was created with the help of our new editor Dr. Terence Gioe. We strive to take into consideration the opinions of our participants on what would be most helpful for them. Dr. Gioe is an orthopaedic surgeon, so he was able to compile the data from the perspective of what our stakeholders in the orthopaedic community are looking for.”

“Our goal is to provide a resource for surgeons and other hospital staff to utilize to improve patient outcomes. The data contained in our 2016 Annual Report includes trends in hip and knee replacement procedures that could aid the decision making process. New technology and medical breakthroughs have led to the field of orthopaedics to constantly evolve, so it’s important for physicians to sit down and analyze the national data.”

James I. Huddleston III, M.D., is medical director of the CJRR California Data Use Group. He commented to OTW, “It’s important for orthopaedic surgeons to know that registry participation can lead to not only an easier experience for the patient, but also save money for surgeons and their institutions. The AJRR is a Centers for Medicare & Medicaid Services (CMS) designated Qualified Clinical Data Registry (QCDR), and can help physicians meet the requirements for initiatives like Meaningful Use and the Physician Quality Reporting System (PQRS).”

“This marks the first time that AJRR hospitals’ participation has led to automatic insurance preauthorization approval, ” continued Dr. Huddleston. “Government programs continue to focus on the importance of quality care, and the AJRR and CJRR work to provide as much assistance to our participants as possible. Registries are an essential part of modern health care, and we aim to always be relevant to surgeons and their institutions.”

Hormone Therapy Improves Bone Structure

In addition to getting help for, say, hot flashes, menopausal women can also increase their bone mass and bone structure by having hormone therapy, says new work from the Lausanne University Hospital in Switzerland.

While the benefits of menopausal hormone therapy (MHT) on bone mineral density have been documented, this is the first study showing that MHT also can improve bone mass and structure…and that these benefits last for at least two years after stopping treatment. According to the November 17, 2016 news release, the study's first author, Georgios Papadakis, M.D., of the Lausanne University Hospital in Lausanne, Switzerland, used data from the OsteoLaus cohort. The cohort consisted of 1, 279 women ages 50 to 80 residing in the city of Lausanne, Switzerland. The participants were divided into three categories: 22% were undergoing MHT during the study, 30% were past users and 48% of women had never used MHT.

“The researchers found higher Trabecular Bone Scores in current MHT users compared to past users or women who had never used MHT. All bone mass density values were significantly higher in current users compared to past users or participants who had never used MHT. Past users of the therapy exhibited higher bone mass density and a trend for higher bone microarchitecture values compared to women who had never used MHT. The researchers note that the duration of MHT had no effect on bone health.”

Dr. Papadakis told OTW, “I think it is important to keep in mind that women on menopausal hormone treatment benefit by an improvement in both bone mass and bone micro architecture. The treatment's protective effect seems to persist at least two years after its withdrawal.”

“There were no previous data on the effect of MHT. Our encouraging data may renew the interest on the link between estrogen and bone microarchitecture, given the increasing recognition of the role that the latter plays for bone fragility. It was also interesting to explore the presence of a residual effect after MHT discontinuation, a theme for which substantial controversy exists in the literature.”

“We aim to perform a longitudinal analysis of the women of the OsteoLaus cohort and to further explore the mechanisms of the MHT effects on bone.”

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