Musculoskeletal diseases

Follow-up surgical interventions are frequent in people with spinal cord stimulators, and they are very expensive

Caitlin MP Jones · Christopher G Maher · Rachelle Buchbinder · Ian A Harris · Chung‐Wei Christine Lin · Christopher Hayes · Alexandra Gorelik

Evidence-based profiling could identify people most likely to benefit from interventions for reducing the risk of hospitalisation

Yuqi Zhang · Susanna M Cramb · Steven M McPhail · Rosana Pacella · Jaap J Netten · Ewan M Kinnear · Peter A Lazzarini

Increasing bone health awareness by a co-created Community education program was valued by Indigenous people

Troy Walker (Yorta Yorta) · Karan P Singh · Vanessa Gan · Brooke Conley (Ngiyampaa) · Jessica Bravo · Nigel Smith (Weilwan) · April Clarke (Eastern Maar, Kirrae Whurrung, Djap Wurrung) · Jackson Baker · Louise J Maple‐Brown · Robin M Daly · Jennifer Browne · Jesse Zanker · Cat Shore‐Lorenti · David Scott · Peter R Ebeling · Ayse Zengin

Poor bone health is highly treatable with appropriate widely available lifestyle and dietary measures and pharmacological agents; the updated guideline is an evidence-based pragmatic tool to assist general practitioners in the day-to-day care of such patients in partnership with bone specialists

Peter Wong · Weiwen Chen · Dan Ewald · Christian Girgis · Morton Rawlin · John Tsingos · Justine Waters

Phased introduction of an injury prevention program, supported by a national ACL registry, would facilitate best practice

Chris Schilling · Siddharth Rele

Investing in a national, evidence-based program for averting ACL injuries in amateur footballers is economically justifiable

Andrew Ross · Joosup Kim · Marnee McKay · Evangelos Pappas · Natalie Hardaker · Matt Whalan · Kerry Peek

A national approach to reducing waiting time for public elective joint replacements is urgently needed

Christopher J Wall · Christopher J Vertullo · David RJ Gill · Richard S Page · Carl Holder · Paul N Smith

Changing key FLS operational characteristics would only moderately reduce minimal trauma fractures among people aged 50 years or more

Alicia R Jones · Danielle Currie · Cindy Peng · Peter R Ebeling · Jackie R Center · Gustavo Duque · Sean Lybrand · Greg Lyubomirsky · Rebecca J Mitchell · Sallie Pearson · Markus J Seibel · Jo‐An Occhipinti

Prosthetic joint infection diagnostic criteria have been progressively refined in recent decades, and novel approaches are emerging

Joshua S Davis · David Dewar · Laurens Manning

A 53-year-old Indigenous male farmer presented with several weeks of fluctuating lumbar back pain while physically supporting an older family member

Michael D Riceman · Caitlyn Sun · John Pierides · Jennifer Catford · Renjy Nelson · Anushia Ashokan

Despite the large national DFD burden, Australian regions implementing guideline-based care have demonstrated large reductions in their regional DFD burdens and costs

Peter A Lazzarini · Anita Raspovic · Jenny Prentice · Robert J Commons · Robert A Fitridge · James Charles · Jane Cheney · Nytasha Purcell · Stephen M Twigg

We need to get serious about collecting data, using robust definitions of diagnoses, surgical indications, and patient-important outcomes

Susan Liew

Differences in procedure rates suggest that too many private or too few publicly funded spinal procedures are undertaken

Duong Thuy Tran · Adriane M Lewin · Louisa Jorm · Ian A Harris

Lack of clinician knowledge, poor access to services, negative attitudes, and lagging research have led to substandard menopause-related health care

Susan R Davis · Karen Magraith

A new clinical care standard provides evidence-based guidance to help clinicians deliver best care for people with low back pain

Christopher G Maher · Aline Archambeau · Rachelle Buchbinder · Simon D French · Julie Morphet · Michael K Nicholas · Peter O'Sullivan · Marie Pirotta · Michael J Yelland · Leo Zeller · Nivene Saad · Elizabeth Marles · Alice L Bhasale · Christina Lane

A 78-year-old man with hypertension, dyslipidaemia, hypothyroidism and gout presented with two weeks of migratory polyarthritis and fever

Hannah Poole · Amy Crowe · John Daffy

Health care professionals caring for men with prostate cancer starting ADT should ensure that their bone health is routinely assessed

Mariya F Hamid · Amy Hayden · Tania Moujaber · Sandra Turner · Howard Gurney · Mathis Grossmann · Peter Wong

The role of spinal surgery in the management of degenerative low back pain is not supported by the studies currently available

Lachlan Evans · Thomas O’Donohoe · Andrew Morokoff · Katharine Drummond

A 41-year-old man presented with right knee pain for 3 months

Te‐Feng A Chou · Ching‐Hua Hsiao

A 21-year-old man presented to the emergency department with a 2-week history of thoracic back pain

Royston Ponraj · Jenna Langfield · Louise Wong · Ian Kerridge · William S Stevenson

Translating guidelines into practice is required to maintain the balance between practitioner autonomy and accountability

Peter FM Choong

To the Editor: Khatri’s and Stuckey’s1 article, Vertebral fractures after denosumab discontinuation for dental procedures: a consequence of distorted perceptions of risk, sums up the authors’ knowledge and experience of medication‐related osteonecrosis of the jaws (MRONJ) in the latter part of the title. They quote the risk of MRONJ as being very low and equal for denosumab and oral bisphosphonates. This is incorrect. The risk of MRONJ is 0.3%.2 In our study we found the risk following extractions at 1.8%.3 The recent 2022 update of the position paper on MRONJ4 found that the risk with denosumab is an order of magnitude higher than for bisphosphonates. There is no discussion in Khatri’s and Stuckey’s article1 of the effect of MRONJ on patients. A patient with stage 3 or end‐stage MRONJ has months of severe pain and requires jaw resection with or without microvascular reconstruction similar to that required for advanced jaw cancer.4,5 The impact of this is similar to vertebral collapse, both largely avoidable disasters. The current Australian recommendations for dental extractions for patients taking denosumab for osteoporosis are to delay extractions to 6 months after the last injection of denosumab and then to allow 4weeks for initial socket healing before the next injection.6 The risk is greater if the patient has been taking antiresorptives for more than 4years and if they are immunocompromised.4,7 We would agree that education and communication between prescribers, patients and dentists are key. This can only be achieved by close, mutually respectful communication and understanding between medical, dental, oral and maxillofacial surgeons and patients. However, this is easier to say than put into meaningful practice. Most definitive articles on MRONJ are in oral and maxillofacial surgery journals, which are not commonly read by physicians who prescribe antiresorptives. The most likely reason that the patient was taken off denosumab for 5 months was that the dental plan was not only to extract the teeth but to replace them with dental implants. Implants require time for osseointegration.8 Hopefully, this letter helps correct the distorted precepts expressed by Khatri and Stuckey for prescribers of this, otherwise, useful drug.

Alastair Goss