Posts Tagged ‘Bone Mineral Density’
Fracture Prevention – Not Bone Mineral Density
The goal of Bone Health Evaluation and Treatment is Fracture Prevention! DXA and Bone Mineral Density (BMD) are useful tools for evaluation. But DXA and BMD are only one out of many tools for bone health evaluation. DXA t-score and BMD should never be the sole goal of treatment.
As an orthopedic surgeon, my goal is always Decreasing Fracture Risk. In the USA we sometimes seem to have forgotten that real goal. We focus too much on DXA t-scores. We should focus on the patient. We should treat “Clinical Osteoporosis”. The patient deserves a complete Bone Health evaluation.
DXA – The Old Standard
DXA has been the standard screening test for Osteoporosis in the USA for two decades. DXA is easy to obtain and the computer print-out makes it look very simple to read. Too simple if all you do is look at the computer print-out. DXA is not the whole story. And that is not the only difficulty.
DXA measures Bone Mineral Density (BMD). Calcium is the usual mineral in bone, and the one we intend to measure. The computer reads out calcium g/cm2 (a bit hard to understand) and also gives a “t-score” comparing the test result to a healthy 30 year old woman. That makes it simple – “normal”, “osteopenia”, or “osteoporosis”. Again, much too simple if what you really want to know is Fracture Risk.
Men Too
“Men are from Mars”, so March is a good time to think about men, the overlooked minority in osteoporosis. The American Journal of Men’s Health has published a study of osteoporosis screening rates for men over age 70. The results are discouraging.
Osteoporosis screening at age 70 for men with no identified risk factors, and earlier for those with known risk factors, has been recommended by the National Osteoporosis Foundation (NOF) and Medicare since 2008. 25 % of persons known to have osteoporosis are men. Yet we still perceive osteoporosis to be women only . We ignore the male minority.