Archive for the ‘Fracture’ Category
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!
Fracturing once is enough. No one wants to fracture a second time. Yet, if you fracture once, you have proven that you probably have inadequate bone health, and you are twice as likely to fracture a second time. Fracture twice and you are 5 times as likely to have a third fracture. The future is grim, unless you evaluate and improve your bone health.
Cedar Valley Bone Health Institute of Iowa is now offering a Fracture Liaison Service. We will offer a Complete Bone Health Evaluation to all patients who have fractured, attempting to prevent a second fracture. The tricky part is getting patients to recognize that a “Bone Attack” fracture is a warning.
If you screen by DXA alone you fail to identify most of the individuals who will fracture. Over 80% of fracture patients over age 50 have “osteopenia” or “normal” as their Bone Mineral Density (BMD) test result on DXA. Wow! DXA is a terrible stand-alone test.
Previous fractures are a much more reliable screen. Any previous fracture predicts future fractures. The best predictors of fracture risk are Vertebral (spine) fractures, but there is a problem. Most vertebral “crumble” or even “crunch” fractures are not identified as fractures until you look for them. You must do Vertebral Fracture Assessment (VFA) to identify those persons who are at increased risk of fracture because they already have fractured.