Posts Tagged ‘Bone Density’
I recently saw a patient who has not improved her Bone Mineral Density despite 2 years of Forteo followed by 3 years of Reclast. The good news is that she stopped having Fragility Fractures. But she is very disappointed that her BMD has not improved.
Her problem is obvious. She is willing to take high-powered osteoporosis medications. She is not willing to take Calcium either in her diet or in supplements.
WRONG!!!! 85% of women who suffer Fragility Fractures have “Osteopenia”. Close to 90% of men. How can this be? “Osteopenia” is NOT a Diagnosis. Unfortunately, most people do not understand that “Osteopenia” is not a Diagnosis.
Fracture Risk is not just DXA t-score or Bone Mineral Density (BMD). “Osteopenia” is a BMD t-score of minus 1.1 through minus 2.4. Increased Fracture Risk (the NIH definition of Osteoporosis) starts at minus 2.5 at age 60, but Increased Fracture Risk starts at minus 1.3 at age 80. And that is only if there are no other Risk Factors, such as previous fracture, parent with a hip fracture, smoking, inhalers, etc.
Last week we were on vacation near Ely, MN on the edge of Boundary Waters Canoe Area with our 2 year old grandson. His favorite day trip was to the Black Bear Center. RJ and black bears use very different methods to maintain bone health.
Black bears can hibernate for months on end, being very inactive, while losing very little Calcium from their bones. Their kidneys and intestines are adapted to preserving every bit of Calcium. Their bones do not decrease bone mineral density in response to the decreased stress of constant sleeping.
Humans are different. We must remain active, daily applying moderate stress to our bones by walking, mild lifting, etc, in order to keep our bones strong. 2 year old RJ does that very well. He is a perpetual motion machine. His settings are fast, faster, and nap-time.
What determines “osteoporosis”? Is it DXA and BMD? Perhaps VFA and the lateral spine? What is the importance of Kyphosis? When is a collapsed vertebra a fracture? These are all questions for ISCD 2012.
The International Society for Clinical Densitometry meets this week at the 2012 annual meeting. As a society, we began by studying DXA as a tool to identify individuals at increased Risk of Fracture. We now realize that DXA and BMD are only part of the analysis. FRAX has been a major step forward. We will be sharing our observations and advancing our collective knowledge.