Posts Tagged ‘BMD’
The International Society for Clinical Densitometry (ISCD) met last week. Our society has been dedicated to properly evaluating DXA to determine Bone Mineral Density (BMD) and t-score. Now ISCD is taking the next step.
The recurring theme at the 2014 ISCD joint meeting with the International Osteoporosis Foundation (IOF) was that DXA, BMD, and t-score are only tools to reach the real goal. The real goal is Preventing Fractures. DXA, BMD, and t-score alone do not get us to that goal. As health care providers, we can best prevent fractures by evaluating the reasons for Fracture Risk, and correcting those issues.
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!
Again we have a patient whose Spine BMD has dropped despite good osteoporosis medication. She takes 500 mg Calcium at breakfast and at supper. She remembers that you can only absorb 5-600 mg Calcium at a meal. But what about lunch? She needs at least 200 mg more calcium in her day.
She plans to eat a yogurt for lunch. This would get her to her minimum of 1200 mg Calcium daily – if only she remembered more than once a week. We need to entice her with a “nooner”. We need her to crave her calcium. Adora Premium Chocolates could do it.
Secondary HyperParaThyroidism is the result of the ParaThyroid glands doing their job. Their job is to keep the calcium in the blood “just right”. Too often this requires stealing calcium from the bones. This is necessary to make up for not absorbing enough calcium every day. But stealing too much Calcium from bones can cause Fractures.
Most of us need 1200 mg calcium in 3 doses spread across every day. Older individuals absorb less well and can require 1500 mg. We also need high enough Vitamin D levels to absorb the calcium. This usually means 1000 to 5000 units of Vit D3 daily. Many of us fail to absorb enough calcium daily. We need Secondary HyperParaThyroidism to keep our blood calcium high enough.