Breaking Down Osteoporosis with Dr. Altin Stafa

Altin Stafa, MD - NeuroradiologistSuffering a broken hip may seem somewhat common for aging adults, but it can actually be a warning sign for a serious medical condition called osteoporosis, affecting 1 in 5 women over 50. May is Osteoporosis Month, and to gain an understanding of how the disease is prevented and treated, we spoke with Altin Stafa, MD, neuroradiologist at Ca’ Foncello Hospital of Treviso (Italy).

What is osteoporosis, and who is most at risk?

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality or structure of bone changes, decreasing bone strength and increasing the risk of fractures or broken bones.

Some consider osteoporosis a “silent” disease, because people with osteoporosis typically do not learn of their diagnosis until first breaking a bone. Fractures can occur in any bone but are most common in bones of the hip, wrist, and vertebrae in the spine.

“Osteoporosis mainly affects women at menopause when levels of bone-bolstering estrogen fall rapidly,” Dr. Stafa explains. “However, it should not be forgotten that men of the same age, even though much less frequently, can also suffer from osteoporosis. In addition, pathological conditions, such as hyperparathyroidism and chronic kidney disease, can cause gender-independent osteoporosis even at a younger age.”

If a parent experiences a broken hip or other broken bone, one may be at higher risk and should discuss with a doctor if screening for osteoporosis is recommended.

What types of fractures are most common among patients with osteoporosis?

Spinal Fractures L1 & L2Fractures are often the first sign of the disease for people living with osteoporosis, and vertebral fractures are among the most frequent type. Why does this happen? “The static and dynamic load which the spine is subjected to is much higher than the one of other bone segments. The spinal segment most frequently affected by compression fractures is the lumbar one, in the lower back region, due to its higher static and dynamic load. Also, the last two thoracic vertebrae, in the mid-back region, are frequently a fracture target because of higher dynamic load, consequent to spinal torsion, flexion, and extension,” Dr. Stafa clarifies.

For some patients with more severe osteoporosis, Dr. Stafa shares that “the mid thoracic vertebrae can also fracture.” He advises giving special attention to the sacrum, that sits below the lumbar vertebrae, which frequently has underdiagnosed fractures. “Compression fractures of the cervical spine in the neck region and of the upper thoracic region are rare,” Dr. Stafa adds.

How are fractures diagnosed and treated?

People experiencing significant, sudden, localized back pain that interferes with daily life should consider seeking medical expertise to evaluate their spine for possible diagnosis of a vertebral fracture. “Even when they are not painful, osteoporotic vertebral fractures may cause a gradual and severe reduction of the vertebral body height, which can negatively impact the biodynamics of the whole spine, causing spinal deformity (i.e., kyphosis), chronic back pain, consequent chest and abdominal space reduction with overall negative impact on the patient’s quality of life,” Dr. Stafa explains.

A number of treatments are available for patients with fractures, according to Dr. Stafa. “Vertebral compression fracture treatments include pain medication, bed rest, and bracing as well as physiotherapy. Although these approaches may help some patients, most of them have found little to no relief or clinical improvement.”

What is vertebral augmentation treatment?

“People with serious pain from fractures may benefit from vertebral augmentation. This minimally invasive procedure has provided substantial, immediate pain relief while reducing progressive vertebral body height reduction and consequent spinal deformity,” Dr. Stafa explains. Vertebral augmentation involves one or two very small incisions in the skin (less than 1 cm in length) to access the vertebral body affected by the fracture, creating channels or cavities inside the vertebral body, and delivering bone cement to stabilize the fracture.

Merit has designed cutting-edge vertebral augmentation products for physicians that address patient-specific needs when treating vertebral compression fractures. “Good clinical outcomes are a result of the ability to control the size, shape, and location of channels and cavities in the vertebrae, using steerable devices, to allow for optimal amount and location of cement, to stabilize the fracture,” Dr. Stafa shares.

Merit Medical is dedicated to collaborating with physicians to innovate the tools needed to help create a better quality of life for people living with osteoporosis. Learn more about our Spine portfolio of diagnostic and interventional products that target spine pathology and reduce pain with minimally invasive precision. Contact our Customer Support Center to learn how you can implement these and more into your practice.


References:

  1. Centers for Disease Control and Prevention. 2022. “Does Osteoporosis Run in Your Family?” https://www.cdc.gov/genomics/disease/osteoporosis.htm
  2. National Institutes of Health. 2022. “Osteoporosis Overview.” https://www.bones.nih.gov/health-info/bone/osteoporosis/overview
Uterine Fibroid Embolization - Embosphere Microspheres

Embosphere® Results in Less Inflammatory Response, Lower Rates of Analgesic Use Compared to PVA After UFE

Every July, our team at Merit Medical recognizes Fibroid Awareness Month as a time to bring attention to a very common yet under-discussed condition that will affect most women at some point in their lifetime.

We do this by supporting a minimally invasive fibroid treatment called uterine fibroid embolization (UFE), also called uterine artery embolization (UAE), through a portfolio of embolotherapy products we offer.

Uterine Fibroid Embolization - Embosphere MicrospheresTo shed light on the performance of UFE embolic agents and to help physicians ensure women receive the best fibroid treatment experience possible, a randomized controlled trial by Han et al. compared post-UFE pain using nonspherical polyvinyl alcohol (PVA) particles versus Merit Medical’s Embosphere® Microspheres.

Published in Radiology, the study enrolled 54 women with fibroids (mean age, 44 ± 4 years [standard deviation]) and assigned UFE treatment with either nonspherical PVA (355–550 μm) or Embosphere (500–700 μm). There were 27 women in each group, and both participants and investigators collecting data were blinded to the embolic material used. Women with concomitant disease (e.g., adenomyosis) were excluded from the study.

Both groups were given fentanyl-based intravenous patient-controlled analgesia within the first 24 hours after UFE as well as rescue analgesics. The investigators measured neutrophil-to-lymphocyte ratio to assess inflammatory response, and contrast-enhanced MRI was performed 1 day after the procedure to evaluate dominant fibroid necrosis and ischemia of normal myometrium. Symptom severity score and health-related quality-of-life score were assessed before and 3 months after UFE.

Results showed that pain scores and fentanyl dose were not different during the first 24 hours, but the use of rescue analgesics was higher in the PVA group (33% vs 11%; P = 0.049). After embolization, symptom severity score and health-related quality-of-life score were not different between groups (symptom severity score: 16 [interquartile range, 6–22] for PVA vs 19 [interquartile range, 9–34] for Embosphere, P = .45; health-related quality-of-life score: 93 [interquartile range, 80–97] for PVA vs 89 [interquartile range, 84–96] for Embosphere, P = .41).

In addition, changes in neutrophil-to-lymphocyte ratio from before to 24 hours after UFE were greater in the PVA group (3.9 [interquartile range, 2.7–6.8] compared to the Embosphere group (2.5 [interquartile range, 1.5–4.6]; P = .02). Rates of complete dominant fibroid necrosis were not different between groups, but transient global uterine ischemia of normal myometrium was more frequent in the PVA group (44% vs 15%; P = .04).

The investigators of the study concluded that when used in UFE, PVA particles and Embosphere resulted in similar pain scores and fentanyl dose. However, PVA resulted in a greater inflammatory response, higher rates of rescue analgesic use, and more frequent transient global uterine ischemia compared to Embosphere.

Watch How UFE Works

Fibroids (also known as uterine fibroids, leiomyomas, and myomas) are non-cancerous tumors that grow within the muscle tissue of the uterus. Although some fibroids cause no symptoms at all, common symptoms can include excessive menstrual bleeding, pelvic pain and pressure, and frequent urination. Depending on the size and location of the fibroids, other symptoms can include anemia, leg pain, pain during sexual intercourse, constipation, and an enlarged abdomen. Up to 80% of women develop fibroids by the time they reach age 50.

Approximately, 600,000 hysterectomies are performed in the US each year, with fibroids listed as the most common reason. A report by the Society of Interventional Radiology found that 1 in 5 women believe hysterectomy is the only treatment option for fibroids and that 44% of women with fibroids have never heard of UFE. Although hysterectomy is a treatment for fibroids, there are many other treatment options available, many of which are minimally invasive.

44% of women have never heard of Uterine Fibroid Embolization

To encourage women to seek out all treatment options and help physicians educate patients, we offer an educational patient-awareness site called Ask4UFE with information about treatment options—with focus on UFE—as well as patient and physician testimonials and researched blog entries.

Join us in recognizing July as Fibroid Awareness Month. We look forward to working together to increase awareness surrounding the condition, helping to provide the best resources, products, and care for patients worldwide.


Before using, refer to Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use.


ARTICLE REFERENCE
Han K et al. 2020. “Nonspherical Polyvinyl Alcohol Particles verusus Tris-Acryl Microspheres.” Radiology 298, no. 2 (Feb): 458–465. PMID: 33350893.

May is National Osteoporosis Month

Merit Recognizes National Osteoporosis Month

May is National Osteoporosis MonthMay is National Osteoporosis Month, an important time we recognize at Merit Medical. Although honored in the US, osteoporosis is a global issue. Osteoporosis causes bones to weaken, and recent statistics show that worldwide, 1 in 3 women and 1 in 5 men over the age of 50 years will experience osteoporotic fractures in their lifetime.

Vertebral compression fractures, or VCFs, are the most common osteoporotic fracture—almost twice as common as other fractures caused by osteoporosis. Osteoporotic fractures can lead to long-term pain and even be life threatening.

1 in 3 Women & 1 in 5 Men Over 50 Years Old

To help care for this patient population, we provide a wide range of innovative tools for vertebral augmentation (kyphoplasty) and vertebroplasty treatments.

Listen in as Mrs. Steiner, a patient who suffered from a painful VCF, explains in her own words how treatment with Merit’s steerable Arcadia™ Balloon-Assisted Vertebral Augmentation System helped her resume an active lifestyle.

Browse helpful osteoporosis month resources:



Before using any of the Merit products mentioned above, refer to Instructions for Use for indications, contraindications, warnings, precautions, and directions for use.

Sharon Huff - SCOUT Radar Localization Patient

“When You Are Informed, You Hold the Power” – Sharon Huff, SCOUT® Patient

Sharon Huff - SCOUT Radar Localization PatientSharon Huff is a retired schoolteacher in Ontario, California, where she and her husband live and enjoy an active lifestyle. Like many women around the world, the pandemic disrupted her routine mammography screening, delaying her appointment by a few months. When Sharon was finally able to have a mammogram, a suspicious lesion was discovered. She underwent a biopsy and learned she would need a lumpectomy to remove an early stage cancerous tumor.

“A close friend and I are going through this breast cancer journey together. She is a few weeks ahead of me in her diagnosis, so I have learned a lot from her experience,” Sharon said. “She had a wire localization and told me, in her words, it was going to freak me out. She had the wire put in very early the morning of her surgery and had to be still, so the wire wouldn’t move. Moving the wire could result in not being able to accurately locate the cancer.”

It came time for Sharon’s surgical consult with Dr. Jonsson at Kaiser Ontario Medical Center, and she was expecting to learn of her surgery date and hear about the wire localization procedure. This weighed heavily on Sharon’s mind. When Dr. Jonsson told her she would be having a wire-free localization, she was pleasantly surprised and relieved.

Although Sharon has an extensive educational background and is an avid reader and researcher, she had never heard of a reflector placement with SCOUT®. She immediately turned to the internet. Sharon read everything she could find about the procedure and watched videos to familiarize herself with what the reflector looked like and how it was placed.

When it was time for her reflector placement with Dr. Nguyen of the radiology department at Kaiser Fontana Medical Center, she was well informed and prepared. “The procedure to implant the reflector was easy and did not take long at all,” Sharon commented. “I was very impressed.”

COVID-19 adds additional stress to any medical procedure. In Sharon’s case, her husband was not allowed to accompany her and instead had to wait in the car. On the day of surgery, she only had to arrive two hours prior to the surgery start time, making her husband’s wait time much shorter than if she would have needed a wire localization on the day of surgery. “Having that little reflector made our day so much smoother and shorter,” Sharon recounted.

Size of a SCOUT Reflector versus a US Dime.

SCOUT Radar Localization - Preferred Solution to Treat More Patients - Merit OncologyThe surgery was a success. Sharon happily reported that her surgeon had removed all the cancer, so her margins were clear, and her lymph nodes were negative. She can now quickly move on to any additional treatments. “I can only imagine that being able to precisely find that little cancer played a big part in my good outcome,” Sharon said.

When asked to share pearls of wisdom for individuals going through the breast cancer journey, Sharon had three: inform yourself, make your own decisions, and advocate for yourself.  “When you are informed, you hold the power,” Sharon said. “And you can feel better about your choices.”

Disclaimer: This information is not intended nor recommended as a substitute for medical advice, diagnosis or treatment. Always seek the advice of a qualified physician regarding any medical questions or conditions.

Updated Spine Resources for Your Practice

Spine Resource Center - Merit medical

Merit Medical has recently updated its online Spine Resource Center as a way to support you in your spine practice as well as to help provide the best possible outcomes for patients undergoing vertebral augmentation (kyphoplasty), vertebroplasty, and spinal tumor ablation treatments. By inserting your email address, you’ll have access to a wide range of valuable tools and helpful information available for download.

Simplifies Treatment - Resolve ConvertX

Patient Education

Educate patients and increase awareness about interventional spine procedures with both digital and printed resources.

Digital Patient Resources
Use Merit’s digital tools on your practice website and social media as well as to boost your overall patient education efforts. With a licensing agreement, you’ll have access to treatment-related text, illustrations, and videos.

Printed Patient Resources
Order printed patient collateral, such as informational brochures and other patient awareness materials, simply by filling out an order form. The materials will be shipped to you at no cost.

Referring Physician Education

Referring Physician Education

Collaborate with fellow physicians using Merit’s peer-to-peer presentations that address important topics, including patient selection, clinical evidence supporting interventional spine procedures, and more.

Clinical Ideas

Clinical Resources

Throughout your day-to-day, take advantage of Merit’s many clinical resources. Product and procedure visual guides, disease management sheets, and prep and administration instructions are right at your fingertips.

Resources for Physicians

Physician Support

To make your life easier, Merit provides updated coding and reimbursement information. A CMS Physician Fee Schedule look-up tool provides information for more than 10,000 physician services.

Data and Studies

Data & Studies

Browse our list of key therapy studies that include quick links to abstracts and useful data summaries.

Merit Medical is committed to helping you care for your patients by offering the most up-to-date information available on interventional spine treatments. Visit the Merit Spine Resource Center today and explore the many tools you can use to enhance your practice.

Merit Addresses Growth in Home Dialysis Care with Patient and Physician Tools

There has been a recent shift in kidney care with both industry leaders and the White House showing support of home dialysis. This forward momentum is due to several advantages home dialysis offers patients, such as lower mortality rates,1 flexible treatment schedules,2 and reduced cost.3 Merit Medical is pleased to support this transition by providing dialysis patient education, clinician training, and a number of therapeutic products.

Heading the movement are international industry leaders DaVita® Kidney Care and Fresenius Kidney Care with an initiative called 20% by 2020, a program that aims to have 20% of dialysis patients on home dialysis therapy by the year 2020. Both DaVita and Fresenius provide two types of home dialysis options: peritoneal dialysis (PD) and hemodialysis.

“The initiative is important from several standpoints,” says John H. Crabtree, MD, general surgeon, chair of PD University for Surgeons-North America, and visiting clinical faculty at Harbor-UCLA Medical Center in Torrance, CA. “Number one, patients do better on home dialysis.”

Patients on PD therapy in particular, a group that comprises the majority of the home dialysis-treatment population, “have improved survival over the early years on treatment,” Dr. Crabtree told Merit Medical.4 Moreover, for individuals who receive a kidney transplant, “the results tend to be better when they were on peritoneal dialysis prior to the surgery as opposed to hemodialysis.”5

Home dialysis also offers greater autonomy. Because patients are properly trained and therapy can be done overnight, home dialysis allows for a regular work schedule.3 Moreover, the average cost of care for home dialysis is less.3 PD in particular, Dr. Crabtree went on to explain, is approximately $15,000 less per patient per year compared to hemodialysis.6

The White House recently announced a new government-sponsored payment approach for treating kidney disease that favors lower cost home dialysis. The U.S. Centers for Medicare and Medicaid Services is considering a trial program design that would improve care in the early stages of kidney disease, increase access to kidney transplants, and favor home dialysis over clinic-based treatment.3 It is particularly looking at the benefits of PD.3

Despite these advantages and the fact that many physicians believe 25%–35% of patients would do better on home dialysis therapy, the number of people receiving home dialysis in the US still remains low, with only 7% receiving PD and less than 1% choosing home hemodialysis.7 The 20% by 2020 initiative plans to change this through several avenues.

“The way that we can drive this is by improving patient education…Many patients aren’t provided information about home dialysis,” Dr. Crabtree explains. In addition to patient education, Dr. Crabtree says many physician education programs lack the training needed to take care of PD patients. “[I]t’s important to provide courses [and] educational opportunities that allow them to have hands-on training.”

Merit Medical is ready to address these needs through its Ask4PD™ patient education site and ThinkDialysisAccess™ hands-on physician training experiences. Merit also offers high-quality dialysis products, such as the Flex-Neck® Peritoneal Dialysis Catheter, a premium catheter that allows for up to 30% higher flow rates than other catheters currently on the US market.8

The support for home dialysis is expanding. By providing the tools and education needed to advance the 20% by 2020 initiative, Merit shows its ongoing evolution as a healthcare company as well as its vision to continually find ways to improve patient care.

Watch Dr. Crabtree’s interview to learn more about the benefits of home dialysis and how Merit supports it.

Dr. Crabtree is a paid consultant of Merit Medical.

REFERENCES

  1. DaVita® Kidney Care. (n.d.). Top 5 benefits of home dialysis treatment. Retrieved from https://www.davita.com/treatment-services/home-dialysis/home-benefits/top-5-benefits-of-home-dialysis-treatment.
  2. Fresenius Kidney Care. (2019). Learn more about home dialysis treatment options. Retrieved from https://www.freseniuskidneycare.com/ckd-treatment/benefits-of-home-dialysis.
  3. Copley, C., & Humer, C. (2019, March 3). U.S. seeks to cut dialysis costs with more home care versus clinics. Retrieved from https://www.reuters.com/article/us-usa-healthcare-dialysis/us-seeks-to-cut-dialysis-costs-with-more-home-care-versus-clinics-idUSKCN1QL0G6.
  4. Teixeira, J.P., Combs, S. A., & Teitelbaum, I. (2015). Peritoneal dialysis: Update on patient survival. Clin Nephrol, Jan;83(1):1-10.
  5. Joachim, E., Gardezi, A. I., Chan, M. R., et al. (2017). Association of pre-transplant dialysis modality and post-transplant outcomes: A meta-analysis. Perit Dial Int, May-Jun;37(3):259-265.
  6. United States Renal Data System. (2018). 2018 annual data report (Chapter 9: Healthcare expenditures for persons with ESRD). Retrieved from https://www.usrds.org/2018/view/v2_09.aspx
  7. DaVita Kidney Care. (n.d.). Majority of nephrology professionals prefer home dialysis. Retrieved from https://www.davita.com/treatment-services/home-dialysis/recommended-approach.
  8. Data on file.