Archive for the ‘Osteoporosis’ Category
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.
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!
Primary HyperParaThyroidism is the result of one of the 4 Parathyroid glands going completely out of control. It grows in size and puts out increasing amounts of Parathyroid hormone. This steals calcium from bone and raises calcium levels in the blood. This tumor is called an Adenoma. The good news is that it is NOT a cancer. The bad news is that it can and will destroy your bones.
Primary Hyperparathyroidism and Tertiary Hyperparathyroidism both have high PTH and high Calcium levels. The treatments are very different; so it is necessary to tell them apart. This is done by Parathyroid Scan.