Archive for the ‘Evaluation and Screening’ Category
The American Society of Clinical Oncology received bad news about Breast Cancer Patients this week. A study of women with breast cancer, being treated with Aromatase Inhibitors (AI), was presented at the 2014 Breast Cancer Symposium. AI is a great treatment for breast cancer, however…
AI is known to decrease bone strength and to increase Fracture Risk. How many of these patients were evaluated for their bone health? Only 54%. How many got a repeat evaluation to check to be sure that their bone health was not deteriorating? Only 46%.
Of those tested, 43% had a DXA T-score in the “osteopenia” range. In this situation, FRAX is needed to calculate Fracture Risk. 41% of this group met guidelines for treatment with medication to prevent bone loss and Fractures. Of those who should have been treated, only 23% were.
A patient had no idea why her doc sent her to me for a Complete Bone Health Evaluation. As a “baby-boomer”, she lives by the motto: “You are only as old as you choose to be.” And she chooses to remain young. If only it were possible…..
“I can’t have Osteoporosis. I used to drink milk. I am active and I plan to stay active!!! So I just can’t have Osteoporosis!” Unfortunately, she does have Osteoporosis by BMD on her DXA, by the multiple Vertebral Fractures on VFA, and by FRAX. Still, there are simple steps to rescue her Bone Health before she Fractures.
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.