The edition · Orthopaedics
Bone turnover markers, not repeat DXA, best showed whether oral bisphosphonates were working
A re-analysis of a bisphosphonate trial proposes an 'expected change' test for adherence, percutaneous reduction compares well for simpler calcaneal fractures, and revision arthroplasty is projected to grow by a third by 2060.
The edition in brief
In 108 postmenopausal women randomised to alendronate, ibandronate or risedronate for two years, bone turnover markers separated signal from noise far better than bone density. CTX and PINP exceeded their least significant change in 96% and 94% of women at three months; lumbar spine and total hip BMD did so in only 47% and 24% at two years. The authors propose an 'expected change' threshold — the fall seen in 90% of adherent patients — that only CTX and PINP could meet. A meta-analysis of eight mostly observational studies (837 patients, Sanders II-III) linked closed percutaneous reduction of calcaneal fractures to fewer complications than the mini-open sinus tarsi approach (RR 0.47, 0.27-0.83), with similar function. A 17-country registry model projects revision hip and knee arthroplasty to rise by 31% and 41% by 2060. A small Korean trial reported large symptom gains with chondroitin sulfate in mild knee osteoarthritis over 12 weeks; it is one trial in a field of inconsistent results.
Percutaneous reduction had fewer complications than sinus tarsi fixation for simpler calcaneal fractures
Consider closed percutaneous reduction for Sanders II-III calcaneal fractures where you have the experience; it was associated with fewer complications and similar function.
Revision hip and knee arthroplasty projected to rise by about a third by 2060
Plan revision capacity and training on the expectation of rising volumes, especially for knees.
A small trial reported large gains with chondroitin in mild knee osteoarthritis
One small trial is not enough to recommend chondroitin; continue to lead with exercise for knee osteoarthritis.
A fragility fracture is the indication — start bone protection before discharge
Do not discharge a fragility fracture without a bone-protection plan.
Check CTX or PINP at three months to see whether an oral bisphosphonate is working
Use a three-month CTX or PINP, not repeat DXA, as the early check that an oral bisphosphonate is being taken and working.
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