Archive for the ‘Evaluation and Screening’ 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.
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.
Tertiary HyperParaThyroidism is becoming common among older individuals. Or maybe we are just beginning to notice what it really is. The blood tests are the same as Primary HyperParaThyroidism – high Calcium and high PTH. But the cause and treatment are very different.
Tertiary HyperParaThyroidism happens when Secondary HyperParaThyroidism has been going on for so long that the “thermostat is reset too high”. The ParaThyroid Glands have been maintaining a high PTH level for so long that they forget to shut off when Calcium levels are high enough.