Posts Tagged ‘Bone Mineral Density’
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!
Several years ago researchers discovered that women with breast cancer had much lower blood levels of Vitamin D than women without breast cancer. Another study showed that, among women being treated for breast cancer, those with low Vitamin D levels were only half as likely to survive. Patients with other cancers show similar patterns.
Now we have a study which points out that this does not prove that low Vitamin D causes cancer. True. The new theory is that cancer causes low Vitamin D levels. However, there is no proof of that either, and I find it hard to believe. What does this all mean?
Recently a patient finished her half hour visit by saying, “so there is nothing you can do for me”. We had discussed Low Bone Mineral Density (BMD) on her DXA; Vertebral Compression Fractures on her VFA; correcting her Diet – Low in Calcium, Vitamin D3 and Protein; Cutting Down her Smoking; back extension Exercises; and possibly Medications that could reverse her Clinical Osteoporosis. None of these interested her.
She was not interested in what she could do to prevent future fractures. She wanted me to “delete” her current Fragility Fracture and the problems she was having from it. She did not believe that she has clinical osteoporosis. She did not believe she is at risk for future fractures. She certainly did not believe that she should be expected to take any action to help herself.