Posts Tagged ‘Bone Mineral Density’
“Why did I Fracture?” and “Why do I have Osteoporosis?” are common questions I hear from older women and men. They are taking Calcium and Vitamin D3, eating a diet with Protein, Fruits and Vegetables, and Exercising regularly. They are “doing everything right”, and still they have deteriorating bones. What is wrong?
The simple answer is “Birthday Disease” – too many birthdays. Increased Fracture Risk (Clinical Osteoporosis) is totally natural as we age. Women after Menopause, and men after age 70, lose 1-2% of their Bone Mineral Density (BMD), and more of their Bone Strength, every year.
When I was in Medical School, 40 years ago, that was the end of the story. Many older women (and some older men) became kyphotic (stooped over), fractured and fell, and either died or went to a nursing home for the rest of their lives. Then, there was nothing we could do to stop it. Today we can often prevent osteoporosis, fractures and misery.
Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?
Fracture Risk is the elephant in the room. Fractures can keep you from doing what you want for weeks or months. Fractures can put you in a Nursing Home, sometimes forever. Complications of fractures can kill you. Fractures are what you want to avoid if at all possible.
Increased Fracture Risk was defined as Clinical Osteoporosis by NIH in 2000. We may still think of Osteoporosis as a T-score of -2.5 on DXA. This is inaccurate. Fracture Risk increases with age and other factors at any given T-score. Over 80% of the persons who fracture have a T-score better than -2.5 !!! Accurately calculating your true Fracture Risk requires a Complete Bone Health Evaluation.
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.