Archive for February, 2014
The International Society for Clinical Densitometry (ISCD) met last week. Our society has been dedicated to properly evaluating DXA to determine Bone Mineral Density (BMD) and t-score. Now ISCD is taking the next step.
The recurring theme at the 2014 ISCD joint meeting with the International Osteoporosis Foundation (IOF) was that DXA, BMD, and t-score are only tools to reach the real goal. The real goal is Preventing Fractures. DXA, BMD, and t-score alone do not get us to that goal. As health care providers, we can best prevent fractures by evaluating the reasons for Fracture Risk, and correcting those issues.
Dr Neil Binkley took this line from politics in his address to the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) joint meeting yesterday. Dr Binkley is known for his blunt style and his ability to go directly to the heart of the matter.
As an orthopedic surgeon, I agree completely that the real issue is Fractures and how to Prevent them. A Fracture is a Bone Attack. It is a warning that the patient needs evaluation of their Bone Health. After a Heart Attack, nearly 100% of patients get an evaluation of their heart health. After a Bone Attack, barely 20% of patients in the USA get an evaluation of bone health – and that is for life changing hip fractures! Other fractures are far less likely to get an evaluation.
Increasing numbers of patients are reluctant to consider pharmaceuticals for their Osteoporosis and Fracture Risk. You may agree with that. If you do you MUST be prepared to Take Control Naturally of those issues you can control: Calcium, Vitamin D, Protein, Vitamins and Minerals, and Exercises for Balance, Strengthening and Posture.
These Natural measures are things that everyone should do for best results, whether taking Osteoporosis Medications or not. For some individuals they can be enough by themselves.
Several patients in the last month have decided not to take the “unnatural” risk of taking medication for their Postmenopausal Osteoporosis. They have been scared by the media emphasis on rare possible risks and side effects of taking osteoporosis medication. They are not aware of the much greater Natural Fracture Risk of being a Post-menopausal Woman.
One patient specifically cited the risk of OsteoNecrosis of the Jaw (ONJ) as her reason. Her risk of ONJ if she takes an Antiresorptive is less than 1 /10,000 per year. Her FRAX calculation shows a total fracture risk of 1/10 per year and hip fracture of 1/35 per year if she does not take medication. She is 1000 times more likely to fracture without medication as she is to have ONJ with medication. Natural Risk can be a Bummer!