Q. I heard about a surgery I can get for the crushed vertebrae in my back. Do you recommend it?
A. Vertebroplasty is used to repair fractured vertebrae by injecting bone cement into the bone to strengthen and stabilize it. However, recent studies found no difference in long-term outcomes between this surgical procedure and noninvasive treatments like medication, exercise and physical therapy, although the surgery carried greater risks.31-33 At this point, I would probably not recommend vertebroplasty for my patients. Other options for painful vertebral fractures include calcitonin (Calcimar, Miacalcin), a hormone that can prevent further bone loss and reduce the pain; bracing; pain management approaches; and antiosteoporosis medications.
—Richard M. Dell, MD
Q. I have been taking ibrupofen for my osteoarthritis. Now I have stomach pain. What are my options?
Ibuprofen (Motrin, Advil) are nonsteroidal anti-inflammatories (NSAIDs). Other NSAIDs include aspirin and naproxen (Aleve), as well as more than a dozen prescription-only medications. All have the potential to cause stomach problems ranging from mild upset to bleeding. That’s why people with a history of ulcers or other gastrointestinal bleeding should only use these medicines under the close supervision of their doctor or not at all— even the over-the-counter types. Try stopping the medication for a couple of days and see if the symptoms go away. If so, try taking your medicine with food or at a different time of the day (morning instead of evening). If you still have pain, call your health care professional. A switch to a different medication might make all the difference. One alternative that doesn’t cause stomach problems is acetaminophen (Tylenol). Prescription pain medications that don’t contain NSAIDs are also available.
If you have severe symptoms that persist more than a day or two, vomiting or bleeding with a bowel movement, call your health care professional immediately.
Q. My doctor recommends surgery for my arthritic knee. How successful is this procedure?
A. When the normal knee is injured and the damage is limited to a tear of the meniscal cartilage located between the two surfaces of the knee joint, repair or removal of the damaged fragment of meniscus with arthroscopic surgery can produce dramatic results and often allows return to normal activities.
The outcome is very different and much less predictable when problems occur in a joint that has been gradually wearing out for many years, which is more typical with osteoarthritis. Then, arthroscopic treatment is very often disappointing. If it helps at all, benefits are often short lived. For this reason, most surgeons offer arthroscopy in arthritic knees only if there are obvious mechanical symptoms such as occasional locking.
—David G. Lewallen, MD