Osteoporis med in need of a change
Dear Dr. Roach: I have osteoporosis. I’ve had a five-year-long Reclast prescription, and I worry about my chance of a femur fracture. My T-score for my hip is -3.4 and has worsened despite the Reclast. Prolia scares the heck out of me. I just wonder if you know anything about Evenity. I’m really struggling with deciding which course of action to take.
R.C.
Answer: Reclast is in the most common class of osteoporosis treatments: the bisphosphonates. These have been proven to reduce fracture risk in both men and women with osteoporosis. However, they do not work for everybody.
Evenity, like teriparatide (Forteo), works by increasing bone growth through stimulating osteoblasts. Many experts prefer this type of agent in someone with severe osteoporosis as the first-line therapy, as well as in your case, when the bisphosphonates have not worked. It would absolutely be an appropriate therapy for you.
Dear Dr Roach: I will be needing a surgery/invasive procedure soon. I have a top-rated physician, but they are at a low-rated facility. I have another toprated physician who works through a nationally ranked hospital group. Is it reasonable to say that the choice is clear to go with the toprated physician who works at a top-rated facility?
H.C.
Answer: I am very cautious about ratings of individual physicians. These ratings may predict a physician’s likability, but do not correlate well with a physician’s objective abilities and outcomes, nor with peerreviewed evaluations. There is the potential for conflict of interest: As a physician, imagine that a patient asks you for antibiotics when you know they are not appropriate. Doing the right thing for your patient by not prescribing them would be likely to give you a worse rating.
Nevertheless, I would still tend to prefer a morehigher-rated facility than a lower-rated one. The site I use when asked about rating facilities is www. tinyurl.com/AHRQratings, which gives links to ratings by Medicare, the Joint Commission on Hospital Accreditation and other respected rating systems.