Archive for June, 2017
Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades. These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure them.
Bone health joins the Treat to Target club in 2017. Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.
What is our target? Traditionally it has been maintaining the T-score found at the first assessment. This does not necessarily make sense, especially if there already are fractures. The target should be NO NEW FRACTURES. This is a game changer.
This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured. How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.
This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles. (I did that a few years back.)
THE TARGET IS NO NEW FRACTURES.
Jay Ginther, MD
University of Wisconsin hosts biennially the Bare Bones of Osteoporosis Care Symposium. This year the Wisconsin Bone Club followed the symposium.
Felicia Cosman, MD from Helen Hayes in New York was the guest speaker at both. She expanded on the new thoughts and guidelines presented at NOF in April. These were a complete change of approach from just a few years ago.
Treat to Target. Anabolics first to build bone and then preserve with Antiresorptives. Reconsider VFA for all first time DXA evaluations.
More detail about these in the weeks to come.
Jay Ginther, MD