Arising from: Lin JT and Lane JM (2008) Nonpharmacologic management of osteoporosis to minimize fracture risk. Nat Clin Pract Rheum 4: 20–25

Author's response: Author response to "Kyphoplasty is not a nonpharmacologic management option for the minimization of fracture risk in osteoporosis" Lin JT and Lane JM (2008). E2 10.1038/ncprheum0793

Editor's note: E3 10.1038/ncprheum0794

In a Review published in the January 2008 issue of Nature Clinical Practice Rheumatology, Lin and Lane1 discussed nonpharmacologic strategies to minimize osteoporotic fracture risk. The relevance of kyphoplasty to this Review is questionable. Kyphoplasty has not been shown to minimize fracture risk. In fact, kyphoplasty (and vertebroplasty) might even increase subsequent vertebral fracture risk, although this controversy remains unresolved. Additionally, the authors' search criteria included “kyphoplasty” but did not include “vertebroplasty”, a similar procedure that is performed more frequently and less expensively than kyphoplasty, but for the same purpose. I find this search strategy troubling given that the authors have previously acknowledged research funding from, and served on the scientific/clinical advisory board of, Kyphon,2,3 the manufacturer of the kyphoplasty device favorably reviewed in this Review. These relationships are not disclosed within the Review. The fact that kyphoplasty is one of five “KEYWORDS”, is the focus of two of five “Learning objectives” and is referred to as a “treatment” for osteoporosis is deeply disturbing.