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Archive for the ‘Fracture’ Category

I was told last week about the mother of an acquaintance in Chicago.  His mother has had Vertebral Fractures again and again and again.  After each fracture she has been told that nothing can be done to prevent another vertebral fracture.  She is turning into a pretzel as her spine crumbles.

After 2 vertebral fractures, she is odds on favorite to fracture another vertebra within the year.  She is also unlikely to respond well to an antiresorptive such as Fosamax, Actonel, Boniva, Reclast, Prolia or their generics because of her severe osteoporosis.  Game over?  Not at all.

Multiple vertebral fractures make her an ideal candidate for an anabolic medication.  Forteo (2002), Tymlos (2017), and Evenity (2019) all can salvage her bone health and increase her bone matrix by 20% or more.  I recommended she see someone up to date in the options available.  There are several in Chicago.  And several here in Iowa.

She needs a Complete Bone Health Evaluation and anabolic treatment.  Of course that includes enough absorbable calcium, enough Vitamin D3, and other nutrition.  Anabolic medications specifically require enough protein to work because they build new bone matrix, which is collagen, which is protein.

You don’t have to fracture again and again.  We can help.

Jay Ginther, MD

NOF Tip for 20 May – Vertebral Fractures

May 20, 2020 @ 7:00 am
posted by Dr Ginther

Vertebral Compression Fractures are often not recognized as anything more than a seriously pulled muscle.  I personally made that mistake 30+ years ago.  Only when I was tested on our new DXA machine which made Vertebral Fracture Assessment (VFA) easy to obtain, did I recognize that I had actually suffered a 30% compression fracture.  Oops.

We do VFA on every patient we evaluate.  VFA added to DXA improves accuracy in assessing bone health.  I have published the largest single center, single provider study of 1259 patients comparing DXA alone to DXA + VFA in Endocrine Practice 2017:23:1375-8.  We use our DXA machine because it is quick and easy.  Lateral Spine X-rays also work.

NOF has an excellent summary of VFA and vertebral fractures at https://cdn.nof.org/wp-content/uploads/2017/04/Vertebral-Fractures-BONE-BASICS.pdf

If you are losing height or are developing a humped back (kyphosis) or simply want a more complete evaluation, ask for a VFA along with your DXA.  Know more, do more to prevent more Vertebral Compression Fractures.

Jay Ginther, MD

If you fracture, your risk of a second fracture within a year is 3 to 5 times as great!  If that first or second fracture is a hip, you have a 25% chance of dying and a 25% chance of spending the rest of your life in a nursing home.  Scary.

Sometimes nutrition and lifestyle changes are enough.  Often medications are needed to effect real improvement.  The anabolic medications Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity) not only prevent further fractures by increasing bone mass, but also speed healing.  The antiresorptive medications decrease fracture risk by preventing bone loss.

The NOF video at https://vimeo.com/267839997 discusses the likelihood of benefit in relation to the very small risk of harm from antiresorptive medications.

Understand the relative risks of taking a medication compared to the relative risks involved in not taking a medication.

Jay Ginther, MD

Proper body mechanics for bending and lifting will prevent unnecessary fractures.

NOF has visual aids in learning good body mechanics at https://cdn.nof.org/wp-content/uploads/2016/04/SherriBetz_Osteoporosis_Graphic.pdf

If you need help learning proper bending and lifting techniques, CVMS Physical Therapy can assist you.

Most of us know exactly what we should do to minimize risk of injury when bending or lifting.  The hard part is remembering to do it right every time.  Practice will make it a habit.

Jay Ginther, MD