James Deardorff
speaker
224 appearances
2 recordings
1 series
first heard Feb 2022
last heard Oct 2022
James Deardorff’s voice in public audio — every appearance, attributed to the second.
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For statin therapy and preventing heart attacks and strokes is probably in the range of two and a half, three years as well.
So in terms of other interventions that we commonly do, the spasimates seem like a pretty reasonable option.
Yeah.
So I think, uh, the implications are, are pretty interesting and, and this is where I, I wish that there was more space in the article to, to really dive into the details on this because it is, it is challenging.
I think the numbers that we, that we show in our paper suggests that really the short-term benefits of this phosphate therapy are going to outweigh the short-term harms for the vast majority of postmenopausal older women.
Um,
And really that these numbers can be used to guide discussions among patients in terms of their values and preferences.
One of the limitations of analysis like this is that a lot of the women in these clinical trials were relatively healthy in the range of 60 to 70.
And in a geriatrics clinic, we're seeing some of the oldest old 80 to 90 year olds with frailty and comorbidities.
And so the question inevitably becomes like, if we're talking about people with limited life expectancy, how do I know that these results can apply to them?
And I think that's one of the most challenging parts about this.
And what I would say to that is that, one, we do have limited evidence from other subgroup analyses and clinical trials suggesting that these drugs are still effective in older adults with like the oldest old and with advanced frailty.
And so I think that
These numbers likely still apply to them.
Yeah, I think that's exactly right, is that even like a single dose of
the IV zoledronic acid can decrease bone resorption for several years.
And so you can really still derive some benefit.
It's kind of far out from that initial dose.
And especially it becomes even more interesting when you're dealing with things like hospice patients or nursing home patients where as they start to get approached near the end of life, they may be more bedbound and just not have as many opportunities to really have a fracture.
And so it becomes challenging in that sense that a lot of the models that we're using might overestimate their fracture risk if they have functional impairments where they're bed bound for most of the day.
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