Archive for the ‘Osteoporosis’ Category
“Why did I Fracture?” and “Why do I have Osteoporosis?” are common questions I hear from older women and men. They are taking Calcium and Vitamin D3, eating a diet with Protein, Fruits and Vegetables, and Exercising regularly. They are “doing everything right”, and still they have deteriorating bones. What is wrong?
The simple answer is “Birthday Disease” – too many birthdays. Increased Fracture Risk (Clinical Osteoporosis) is totally natural as we age. Women after Menopause, and men after age 70, lose 1-2% of their Bone Mineral Density (BMD), and more of their Bone Strength, every year.
When I was in Medical School, 40 years ago, that was the end of the story. Many older women (and some older men) became kyphotic (stooped over), fractured and fell, and either died or went to a nursing home for the rest of their lives. Then, there was nothing we could do to stop it. Today we can often prevent osteoporosis, fractures and misery.
Sometimes a person breaks a hip first, then they fall. This happens a lot more often than we realize. When the break is just below the ball of the hip, the fracture may have come before the fall. Moreover, that Fragility Fracture may have gradually developed over days or weeks.
How is it possible that a person does not realize that the hip is gradually crumbling? We call it a Stress Fracture when a crack gradually developes. Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. Why?
The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007. http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse Tiny cracks slowly developed in the steel until one day……..THUD!
How can you detect who is at high Hip Fracture Risk? A very low DXA T-score, especially in the spine, is a good indication. But DXA often fails if the spine is already crumbling or has arthritis. A better indication is Vertebral Fracture Assessment (VFA). Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.
Know where you stand. Get a Complete Bone Health Evaluation. Take Control of your future.
Jay Ginther, MD
Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?
Our Amgen Medical Liaison met with us this week. Her job is to supply information which has been published or presented at major meetings. She meets only with practitioners (MD, NP in our case) and cannot market any medications.
This is good. For the first time in 5 years, I missed ASBMR (American Society for Bone & Mineral Research). She was able to show us several studies presented at that meeting that were most helpful.
NP Katie and I, like most practitioners, always approach scientific papers with a critical eye. The studies answered several questions. They also raised further questions. Perhaps those answers will come next year.
Legislators pass rules and regs to keep medical practitioners away from information supplied by persons employed by Pharma. They fail to understand the value of critcally evaluating new scientific data. Detailed information about each available medication is needed if we are to find the best osteoporosis medication for each patient each time.
No single osteoporosis medication is right for everyone all the time. Every osteoporosis medication is the best choice for someone at some time. There are times when no medication is the best choice.
The more information Katie and I have about medications, the smarter we are when helping to choose what is best for each individual. No one can go to all meetings or read all published studies. A Pharma Medical Liaison helps gather relevant information.
YOU too can gather information before and after you visit your doc. Use the left column to find blogs about topics that interest you. You can Take Control.
Jay Ginther, MD