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Letters to the Editor to:

Scientific Articles:
Jeff E. Schulman, Susan Williams, Oner Khera, Tina Sahba, James Michelson, and Kenneth Fine
Effective Osteoporosis Education in the Outpatient Orthopaedic Setting
J Bone Joint Surg Am 2007; 89: 301-306 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read Letter to the Editor] Response to "Is the educational change in post menopausal women being ignored"
Jeff E Schulman, Susan Williams MD   (27 June 2007)
[Read Letter to the Editor] Is the educational change in post menopausal women being ignored?
George Ampat, Cassandra Hallam, Levant Bayam   (26 June 2007)

Response to "Is the educational change in post menopausal women being ignored" 27 June 2007
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Jeff E Schulman,
Orthopaedic Trauma Fellow
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD,
Susan Williams MD

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Re: Response to "Is the educational change in post menopausal women being ignored"

schulmje{at}yahoo.com Jeff E Schulman, et al.

Dear Sir,

We would like to thank Dr. Ampat and his colleagues for their comments and questions regarding the recent publication of "Effective Osteoporosis Education in the Outpatient Orthopaedic Setting." In response to their question, we would reiterate what is stated in the article. Post menopausal women in the study exhibited a much poorer response than the pre menopausal group. And the next sentence further states that this is perhaps because of the relatively small number of subjects in the post menopausal group (n=26). Our statement was intended to imply that a type II statistical error is distinctly possible as a flaw of this study, which could have been stated more explicitly.

Unfortunately, our study was only able to unclude 26 post menopausal women and this certainly signifies the need for further research into this sub-group. Indeed, we did demonstrate overall improvements with education, but they did not achieve statistical significance. Overall, we sought to educate women in a novel way that has not been tried in the world of orthopaedics and we feel that this opens the door to a variety of further interventions as well as research endeavors within the orthopaedic community.

Is the educational change in post menopausal women being ignored? 26 June 2007
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George Ampat,
Orthopaedic Surgeon
Southport Hospitals NHS Trust,
Cassandra Hallam, Levant Bayam

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Re: Is the educational change in post menopausal women being ignored?

geampat{at}aol.com George Ampat, et al.

Dear Sir

We read with great interest the article entitled "Effective Osteoporosis Education in the Outpatient Orthopaedic Setting (2007 89-A • 2 • February 301-306) by Schulman, Williams, Khera, Sahba, Michelson and Fine".1

We commend the authors for doing an excellent study regarding a prime opportunity for education regarding osteoporosis prevention and lifestyle modification that can be performed in an inexpensive fashion.

The current report states “In contrast, the postmenopausal group exhibited a much poorer response to the educational intervention (Table IV).”

This requires clarification. In the pre menopausal group the percent change between "before education" and "after education" is 20 % (69% to 89%) (Table III) and the authours have stated that it is statistically significant at P = <0.001. In the post menopausal group the percentage change is greater at 42 % ( 27% to 69%) (Table IV). The authours however state that statistical significance has not been reached as p = 0.006. Could this have occured because of the relatively few numbers in the post menopausal group. Is it possible that a Type II statistical error has occurred2?

1. Schulman JE, Williams S, Khera O, Sahba T, Michelson J, Fine K. Effective Osteoporosis Education in the Outpatient Orthopaedic Setting. JBJS-A Vol 89-A • No 2 • Feb 2007 301-306

2. Szabo RM. Current Concepts Review Principles of Epidemiology for the Orthopaedic Surgeon. JBJS-A, Vol. 80-A, No. 1, Jan 1998 111-119

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.