Archive for the ‘Healthcare Professionals’ Category
Katie Bries, ARNP, taught the Bone Health section for the Nurse Practitioner students at Allen College this year. She did a great job covering the basics. Unfortunately, she had time only for the basics. This is true in teaching NPs everywhere. It is true of all aspects of medicine when teaching MDs, DOs, PAs, and all others. There is only time for the basics.
Any Healthcare Provider who wants to fully master a subject must take “Electives” for additional training in the field they plan to focus on in practice. With MDs and DOs there are formal “Residencies” lasting 3 or more years after graduation. NP and PA students take “Clinicals” in various fields before, and sometimes after, graduation. Cedar Valley Bone Health has hosted clinicals for local and out-of-state Providers.
Katie Bries, ARNP, has joined our staff as a Nurse Practitioner. Her expertise is in Adult and Geriatric Medicine. This will allow us to make the most of the time we have with each patient. She began seeing patients on her own Friday. At last!
Katie has been a nurse for 18 years. She now has completed her Masters degree as a Nurse Practitioner at Allen College. Last spring she did a clinical rotation in our office. Impressed with our success in bone health, osteoporosis prevention and treatment, she accepted a position with us.
Vertebral Fracture Assessment (VFA) identifies many persons with Clinical Osteoporosis who are missed by DXA testing alone. How many? I reviewed my first 941 patients to have VFA with their DXA (Feb 2010 – Sept 2012). I was amazed.
25% of the total had at least one Genant grade 2 or 3 Vertebral Deformity on VFA but were not identified as Osteoporosis by DXA. This is Clinical Osteoporosis missed by DXA alone in 25% of my total patients.
The vertebrae (bones in the spine) can gradually crumble or suddenly crunch. The resulting minor ache is often mistaken for arthritis or a pulled muscle. Gradual crumbles are “morphometric” (detected by x-ray) fractures, and just as valid as “clinical” (recognized) fractures in predicting Fracture Risk and future fractures.
Vertebral Fracture Assessment (VFA) looks at the spine from the side with a DXA machine or a standard x-ray. Each vertebra is evaluated for wedging (crunching or crumbling in the front) or biconcave deformity (from the discs punching in the center of the vertebra from top and bottom). A single vertebral deformity by 25% or more diagnoses “Clinical Osteoporosis” pre-empting DXA, BMD, and FRAX. VFA is an additional standard for assessing Fracture Risk.
VFA requires a human to look at each vertebra from T4 through L4 for deformity. VFA by DXA machine requires 2 more pictures than the 3 standard DXA pictures. VFA is a different technology from DXA and is not part of a basic DXA report. VFA is additional information that supplements DXA.
Humpback deformity in a patient is a strong hint that VFA will probably find multiple vertebral wedge compression fracture deformities. Wedge deformities can often be suspected by finding humpback (kyphosis). But multiple biconcave compression fracture deformities can hide in a patient with a straight spine. VFA is usually required to find biconcave deformities. VFA needs to be part of a Complete Bone Health Evaluation to fully assess fracture risk.
Last time we discussed DXA. Today we discussed VFA. Thursday we discuss what I discovered by combining the two in a Complete Bone Health Evaluation on every patient.
Jay Ginther, MD