It’s BMJ week (again) on NCBI ROFL! After the success of our first BMJ week, we decided to devote another week to fun articles from holiday issues of the British Medical Journal. Enjoy!
Accuracy of comparing bone quality to chocolate bars for patient information purposes: observational study
“Within our area of practice relating to osteoporosis and fragility fracture we have noticed a tendency to compare normal, healthy bone to the finely honeycombed structure of a Crunchie (Cadbury Trebor Bassett; Bournville, Birmingham) chocolate bar and to compare abnormal, osteoporotic bone to the coarser structure of an Aero (Nestle UK; York) bar. Although this explanation is readily appreciated by patients and clinicians it struck us that the comparison may not be completely valid as no work has been published on the fracture potential of each bar… To enable us to provide accurate data to our patients we studied the fracture risk for each chocolate bar.
We randomly purchased 20 chocolate bars (10 Crunchie and 10 Aero) from a reputable high street confectioner; the number of bars was limited by research funds and our rural environment…
The end point of the study was fracture. Firstly, we allowed each bar to topple from its standing height in the centre of a tile. We then dropped each bar horizontally on to the centre of the tile from increasing heights until fracture, defined as a break in the cortex; we did not regard mild deformity as a fracture. The tests were carried out at a temperature of 22C after the bars had had eight hours to reach a steady state temperature. We used a bone densitometer (Discovery-C; Hologic, Bedford, MA) to carry out dual energy x ray absorptiometry (whole body) on one Aero and one Crunchie, with bone mineral density being used as a surrogate for measuring chocolate density. Height was measured with a tape measure (Olympia (5 m/16 ft) Power Return Tape; Olympia (UK); Reading, Berks)…
Our data provide evidence of the disparity between chocolate density and fracture rates. The use of Crunchie and Aero bars to explain bone health and fracture risk to patients, although palatable, is not justified. In practical terms we believe that the findings should contribute to the provision of improved patient information and education by enlightened healthcare professionals. The study serves to remind clinicians that both chocolate density and bone mineral density form but one component of fracture risk. The accurate assessment of fracture risk should ideally take into account other measurable indices that contribute to fracture risk in addition to that provided by chocolate density and bone mineral density.”
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