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Comment & Response |

Treatment of Osteoporotic Vertebral Fractures—Reply

Brendan J. McCullough, MD, PhD1; Richard A. Deyo, MD, MPH5,6,7,8,9; Jeffrey G. Jarvik, MD, MPH1,2,3,4
[+] Author Affiliations
1Department of Health Services, University of Washington, Seattle
2Department of Radiology, University of Washington, Seattle
3Department of Neurological Surgery, University of Washington, Seattle
4Department of Pharmacy, University of Washington, Seattle
5Department of Family Medicine, Oregon Health and Science University, Portland
6Department of Medicine, Oregon Health and Science University, Portland
7Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland
8Center for Research in Occupational and Environmental Toxicology, Oregon Health and Science University, Portland
9Kaiser Permanente Center for Health Research, Portland, Oregon
JAMA Intern Med. 2014;174(4):642-643. doi:10.1001/jamainternmed.2013.13481.
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In Reply We appreciate the comments of Edidin and colleagues as they touch on key elements of our study,1 and their previous article2 provides insightful contrast to our own.

We included the “preprocedure subgroup” analysis to illustrate that a substantial proportion of the augmented group (29%) had a markedly lower risk of complications compared with controls despite being “theoretically” equivalent—both groups had the same treatment during this time (no augmentation), and we controlled for baseline characteristics, including Quan comorbidity scores, prior inpatient admissions, and chronic pulmonary disease, among others, using traditional multivariate models. Edidin et al are right to be concerned that these traditional multivariate models might not adequately account for acute differences in health at the time, such as patients needing emergent care. We agree. There are many other clinical details available in real-time that are not evident in billing claims data. The entire clinical picture at presentation, past and present, will influence therapeutic decisions as well as eventual patient outcomes. We suggest selection bias is the unmeasured factor allowing 2 “theoretically” equivalent groups to have such different outcomes.


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April 1, 2014
Michaël Laurent, MD
1Division of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
JAMA Intern Med. 2014;174(4):641-642. doi:10.1001/jamainternmed.2013.13482.
April 1, 2014
Avram Allan Edidin, PhD; Steven M. Kurtz, PhD; Kevin L. Ong, PhD
1School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
2Exponent Inc, Philadelphia, Pennsylvania
JAMA Intern Med. 2014;174(4):642. doi:10.1001/jamainternmed.2013.13490.
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