Archive for the ‘Evaluation and Screening’ Category
If your Mom had Osteoporosis, you are also at risk for osteoporosis and fractures. If a parent had a broken hip, you are at increased risk of fracture. Choosing your parents poorly is a risk factor you cannot avoid. Your age is the biggest risk factor that you cannot control. However, you can control other risk factors.
The goal of Bone Health Evaluation and Treatment is Fracture Prevention! DXA and Bone Mineral Density (BMD) are useful tools for evaluation. But DXA and BMD are only one out of many tools for bone health evaluation. DXA t-score and BMD should never be the sole goal of treatment.
As an orthopedic surgeon, my goal is always Decreasing Fracture Risk. In the USA we sometimes seem to have forgotten that real goal. We focus too much on DXA t-scores. We should focus on the patient. We should treat “Clinical Osteoporosis”. The patient deserves a complete Bone Health evaluation.
GIOP is Glucocorticoid Induced OsteoPorosis. Cortisone, Prednisone, and many Inhalers for Asthma or COPD are glucocorticoids. Therefore, Glucocorticoid Induced OsteoPorosis is a particularly aggressive form of osteoporosis that affects all ages, not just older adults.
Glucocorticoids suppress OsteoBlasts, the cells that make new bone. Even the normal rate of bone turnover required for good bone maintenence and repair of microcracks becomes a problem when new bone formation is suppressed. Persons with GIOP have a rapid decline in bone quality and strength. What can be done?