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.
A Hip Fracture over age 70 is Very Bad. About 20% of women and over 30% of men die from their hip fracture. Some consider these to be the lucky ones. Nearly half of those who survive a hip fracture spend the rest of their lives in a nursing home.
Many hip fractures should be preventable. There were warnings! Half of the people who break a hip had another Fragility Fracture a few months or years before. Most warnings go unheeded. Hip Fractures that could have been prevented destroy quality of life for too many individuals.
This week a patient was delighted to know she had no bone worries – based on her t-score of -2.4 in her hips. Unfortunately she was very wrong! “Osteopenia” is just a single test result. Other factors placed her at High Risk for Fracture.
One test does not tell the whole story. For instance, my total cholesterol is “normal”. That means that I have no heart worries? Wrong! I have hypertension, type-2 diabetes, and a history of congestive heart failure. I am at risk for heart problems. My patient is at risk for bone problems, specifically Fragility Fractures.
12 years later I remember 9-11-2001. The vivid proof that the ideals of democracy and personal freedoms are violently opposed by some in the world. The conflict between the ideals of radical Islam and Western democratic ideals is more obvious and widespread today.
My country is far from perfect. There are many things I would change. Yet I firmly believe that “democracy is the worst form of government, except for all the others.” We know that human beings are imperfect, but we should strive to do our best.