Archive for the ‘Evaluation and Screening’ Category
Friday is the Go Red For Women in Waterloo, sponsored by the American Heart Association. Heart Disease is now recognized as a major health issue for women, as well as men. Prevention of heart attacks and strokes gets a lot of attention. Breast cancer is also well recognized. These are worthy causes, but…..
Fractures from Osteoporosis are twice as common in women as heart attacks. Fractures are more common than heart attacks, breast cancers and strokes combined. More women die from complications after hip fracture than die from heart attacks. This is also a big deal, but Osteoporosis gets no respect.
If you screen by DXA alone you fail to identify most of the individuals who will fracture. Over 80% of fracture patients over age 50 have “osteopenia” or “normal” as their Bone Mineral Density (BMD) test result on DXA. Wow! DXA is a terrible stand-alone test.
Previous fractures are a much more reliable screen. Any previous fracture predicts future fractures. The best predictors of fracture risk are Vertebral (spine) fractures, but there is a problem. Most vertebral “crumble” or even “crunch” fractures are not identified as fractures until you look for them. You must do Vertebral Fracture Assessment (VFA) to identify those persons who are at increased risk of fracture because they already have fractured.
A Hip Fracture over age 70 is Very Bad. About 20% of women and over 30% of men die from their hip fracture. Some consider these to be the lucky ones. Nearly half of those who survive a hip fracture spend the rest of their lives in a nursing home.
Many hip fractures should be preventable. There were warnings! Half of the people who break a hip had another Fragility Fracture a few months or years before. Most warnings go unheeded. Hip Fractures that could have been prevented destroy quality of life for too many individuals.
This week a patient was delighted to know she had no bone worries – based on her t-score of -2.4 in her hips. Unfortunately she was very wrong! “Osteopenia” is just a single test result. Other factors placed her at High Risk for Fracture.
One test does not tell the whole story. For instance, my total cholesterol is “normal”. That means that I have no heart worries? Wrong! I have hypertension, type-2 diabetes, and a history of congestive heart failure. I am at risk for heart problems. My patient is at risk for bone problems, specifically Fragility Fractures.