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.
Once again we are warned of the dangers of calcium supplements. Once again those studies cited prescribed supplements without regard to total calcium intake, including diet. What matters is total calcium intake, including diet.
I prescribe a lot of Calcium Citrate for my patients. I would prefer not to. Dietary Calcium is more easily digested than supplements, and appears to hold fewer dangers than Calcium Carbonate or other calcium supplements. Unfortunately, we have lost our taste for calcium rich foods. There are tasty choices.
This is post # 200 in a little over 2 years. Our audience has grown. Last month we averaged over 200 visitors and 600 pages daily. We had a total of 1911 unique internet addresses visit during March. April is running over 250 visitors daily. We must be filling a need for easily understood Bone Health information.
Thank you for your interest.
Jay Ginther, MD
Glucocorticoid Induced OsteoPorosis is more common than we thought. Individuals with Rheumatoid arthritis, fibromyalgia, and other inflamatory diseases often need Prednisone and other steroids (glucocorticoids). 3 months of Prednisone 5 mg or more daily induces GIOP. 3-6 months of Prednisone at over 2.5 mg daily can also lead to GIOP. And both of these are total lifetime dose.
Many inhalers for asthma and COPD also contain steroids. Steroids suppress OsteoBlasts, the cells that make new bone to replace resorbed bone. A year or more of inhalers is thought to be the threshhold for ill effects.
Now we are finding out about “Cortisone” (glucocorticoid) Injections into knees and other joints.