Posts Tagged ‘BMD’
You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
Jay Ginther, MD
Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD). This is good? WRONG !!
High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen. This means that glucose (sugar) molecules are incorporated into the collagen protein chains. This distorts and stiffens the Bone Matrix.
Normally, stiffer is better, Calcium stiffens the bone matrix, which strengthens the bone. But too much of a good thing is bad. Too stiff becomes brittle. Brittle bones break more easily than “stiff enough” bones.
Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics. Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.
We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves. Now we know that high blood sugars in diabetics are bad for bones too.
Take Control of Your Future. If you have diabetes, work with your primary doc to get your blood sugars under control.
Jay Ginther, MD
Ann spends a week in Florida each winter with several friends and was stronger, more agile and more confident this year than last. She stepped in and out of the hot-tub easily instead of slowly and awkwardly. She zoomed up and down stairs. She had to slow down when walking with her friends. What has happened?
A year ago she followed a fragility fracture with below average and decreasing BMD on DXA, and a newly crumbling vertebral fracture on VFA. She has Clinical Osteoporosis. That got her attention. She was determined to play on the floor with her active preschool grandchildren. You cannot do that if you are crumbling. She was ready to do whatever it took to get back in the game.
She added Adora Chocolates (500mg calcium in each) to her usual diet. She added Protein shakes (chocolate) and increased intake of chicken, fish, and beef to meet the new protein guidelines. She remembered to take extra Vitamin D3 and her Multiple Vitamins & Minerals almost every day.
She got serious about her “10,000 steps” every day and went up and down stairs frequently instead of saving up things for a single trip. She did not actually join an exercise class as promised.
She started the anabolic, Forteo, to build her bone density and strength. A daily little shot is a nuisance, especially keeping it cold while travelling, but she wanted results.
This year repeat DXA showed increased BMD. VFA confirmed no further crumbling. She zoomed through airports and left her friends in the dust in Florida. These results have made her even more determined.
She has Taken Control of her Future Life. You can too.
Jay Ginther, MD
Driving to Chicago in February was cold and snowing. But it was hot indoors at the ISCD (International Society for Clinical Densitometry) Annual Meeting and Position Development Conference (PDC).
While no new technologies were introduced, the PDC evaluated the scientific studies of several recent innovations. Most are best done in research centers. One recent innovation could make it to clinical centers. Trabecular Bone Score (TBS) is a software addition to DXA that adds information about the quality of bone by re-analyzing the L1, L2, L3 vertebrae.
We have discussed how adding Vertebral Fracture Assessment (VFA) to a DXA Bone Mineral Density (BMD) improves Fracture Risk calculation. TBS has the same potential. The main issues blocking TBS are software cost, added time, and the fact that all insurances (including Medicare) currently do not pay for it.
We also attended presentations about patient treatment issues. Fracture Prevention is much more than just checking a T-score with DXA. National experts shared their knowledge of medical issues that can strongly influence Bone Health and Fracture Risk. More about these sessions next time.
You can Take Control of your Future with action to decrease your fracture risk.
Jay Ginther, MD