The authors lament the fact that “Despite the widespread clinical use of orthoses, for many spinal indications there are no high-quality controlled trials demonstrating that they are effective” (1).
I have been treating patients with fracture-causing osteoporosis for more than 40 years and have conducted studies to elucidate the pathophysiology and therapy of this epidemic. In the early days this was laborious, since specialists for bone and joint disorders were mostly convinced that osteoporosis is a sign of aging and had to be accepted as such; the view was also that it was a “fashionable” diagnosis, and did not require, or respond to, treatment.
Clinical experience in those days reflected primarily that the available aids were inappropriate, which, among others, became obvious through the fact that compliance on the patients' part was woeful. Most of the orthoses that were custom-made at great expense and mostly immobilizing were found on, in, or behind patients' wardrobes after a very short time.
This prompted us to develop an orthosis especially for patients with osteoporotic vertebral fractures, in spite of the fact that, as specialists in internal medicine, we were not in any way entitled to do so, as the “genuine specialists” soon assured us.
As specialists in internal medicine, we are used to investigate new treatment methods in clinical studies in order to confirm their efficacy; naturally we did this with regard to our new orthosis (Spinomed R), although the “real specialists” were of the opinion that clinical studies were redundant for orthoses and, furthermore, were not even possible. This did, however, not stop us from carrying on, and our studies resulted in two original articles that were published in one of the leading speciality journals (2, 3).
The situation is therefore not as desolate as the authors of the article fear. All that is required is the planning and conducting of further studies. This will, however, be a task for specialists for the remaining disorders of bones and joints, because as internists we would not wish to enter into the subject of arthritis, scoliosis, and narrow spinal canals.
Footnotes
Conflict of interest statement
Spinomed R was developed and tested by Bad Pyrmonter AG around Professor Minne, in collaboration with affected patients and the medi company.
Prof Minne owns a patent for Spinomed and receives annual licensing fees. He has received delegate fees, and travel and hotel expenses from the Umbrella Organization of German Speaking Scientific Societies of Osteology (DVO). He has received honoraria for conducting commissioned clinical studies and for a research project initiated by himself from Spinomed.
References
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