Posts Tagged ‘Bone Mineral Density’
Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades. These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure them.
Bone health joins the Treat to Target club in 2017. Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.
What is our target? Traditionally it has been maintaining the T-score found at the first assessment. This does not necessarily make sense, especially if there already are fractures. The target should be NO NEW FRACTURES. This is a game changer.
This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured. How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.
This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles. (I did that a few years back.)
THE TARGET IS NO NEW FRACTURES.
Jay Ginther, MD
Clinical Osteoporosis 2017, NOF and ISCD joint meeting had a different emphasis this year. Fracture Risk, rather than Bone Mineral Density (BMD) is now the key metric. Several speakers emphasizd the importance of VFA in making the diagnosis of Clinical Osteoporosis. This is something I have presented in poster exhibits 2015, 2016 and 2017. I am now mainstream!
“Treat to Target” was the big new message this year. We should set a target of decreased Fracture Risk for each patient and alter treatment until we reach it. This has been routine for years in diabetes, hypertension, cholesterol, etc. This is recognition that Osteoporosis is a chronic disease that we can control, but never cure, just like many others.
Take Control Naturally is the necessary first step, as I have outlined over the last few months. This is often sufficient for prevention and in mild disease.
Advanced Osteoporosis, especially after fragility fractures, or vertebral compression fractures seen on VFA, is usually beyond nutrition and exercise only. This will usually require medications to significantly reduce fracture risk.
The huge change is the recommendation to use an Anabolic medication first, to markedly reduce fracture risk, when BMD is very low or multiple fractures have already occured. Then follow up with an Antiresorptive to maintain a low fracture risk. Traditionally Medicare and other insurances have demanded we try Antiresorptives first to maintain bone as it is, even when multiple fractures have proven the bone to NOT be good enough at curent BMD.
We are entering a new age of Fracture Prevention!!
Jay Ginther, MD
The National Osteoporosis Foundation (NOF) and the International Society for Clinical Densitometry (ISCD) are meeting together later this week. This will be my 10th attendance at each group. They are both always interesting.
I will be presenting a new research project this year – “Vertebral Compression Deformities in Patients with Normal Bone Mineral Density”.
This is a further study of the 79 patients with Normal BMD by DXA alone, who were changed to Clinical Osteoporosis because of vertebral compression fractures found on VFA from last year’s study of 1259 consecutive patients with first-time VFA at our facility.
I look forward to seeing what else is new this year.
Jay Ginther, MD
Calcium is responsible for the stiffness and strength in bones. Calcium is what we measure when we measure Bone Mineral Density. Without sufficient calcium intake you cannot have strong bones.
Most people can absorb 500-600 mg Calcium at a time, if taken with food containing Protein. This only works if your Vitamin D level is high enough.
You need to consume 400-500 mg in each of 3 meals to reliably get 1200-1500 mg every day. This is necessary because most people will pee and poop and sweat out at least 1000 mg of calcium daily.
Calcium is best absorbed when eaten in foods.
You can Take Control Naturally with diet alone.
Milk, Cheese, and Yogurt are all high in Calcium, but amounts can vary. Check the label to see how many ounces are needed to make at least 200 mg. (Check “serving size” and remember that “20%” is 200 mg when dealing with calcium.)
Some vegetables are high in Calcium. One cup of cooked Collards, Black-eyed Peas, or 1.25 cups cooked or finely chopped Kale or Okra each have 200 mg. 4 cups of chopped Broccoli is 200 mg. Of course you can eat these raw, if you prefer.
If you do not get enough calcium in your diet alone, Calcium Supplements are needed.
Jay Ginther, MD