Posts Tagged ‘Clinical Osteoporosis’
Men can develop osteoporosis. In fact, 1 in 4 men over age 50 will experience unnecessary fractures due to clinical osteoporosis.
Fractures can often be prevented by treating the underlying reason for osteoporosis. Common risk factors for osteoporosis and fractures include: smoking; cortisone inhalers for asthma or COPD, Androgen Deprivation Therapy for prostate cancer; insufficient calcium and/or vitamin D in diet.
A complete bone health evaluation will reveal if you have one of these. Most men do. At least the inadequate nutritional intake. I did before studying bone health and changing my ways.
NOF has published The Man’s Guide to Osteoporosis at https://cdn.nof.org/wp-content/uploads/2016/02/Mans-Guide-to-Osteoporosis-1.pdf
We men can have osteoporosis and unnecessary fractures. Let’s avoid that.
Jay Ginther, MD
As testing increases, we are finding many individuals have been infected with Covid-19. Many have no symptoms. Many do not know that they have it. The overall death rate when counting everyone infected is looking like less than 1%.
The same is true regarding Clinical Osteoporosis. Many do not know that they have it. There are no symptoms except a fracture. Up to 80% of those with thoracic vertebral fractures do not know they have had one. Up to 20% of those with a recognized vertebral fracture die within 6 months from complications of their osteoporosis.
A hip fracture is hard to miss. Hip fracture can be the first symptom of severe clinical osteoporosis. Like Covid-19, hip fracture (Clinical Osteoporosis) is most dangerous in those who are older and/or have pre-existing chronic diseases (co-morbidities).
Over 20% of older men who fracture a hip die of complications within 6 months and many die within weeks. This is comparable to older men with Covid-19 who require a ventilator. Yet osteoporosis gets no respect. More than half the time osteoporosis is not even listed as a contributing factor. And rarely is the hip fracture listed as the cause of death.
We consider Covid-19 to be the cause of death even if we only suspect it. Perhaps it is time to consider a treatable chronic disease like osteoporosis in the same way.
Jay Ginther, MD
Treat to Target of NO NEW FRACTURES. How do we find that target? DXA >-2.5 is a start. Fragility fractures increase new fracture risk. FRAX adds many more risk factors to the calculation and TBS refines FRAX.
Vertebral Fracture Assessment (VFA) looks at the spine from the side and independently identifies additional fracture risk. This can be done on a DXA machine or by x-ray. A single vertebral compression fracture of 25% or more pre-empts DXA, BMD, and FRAX in diagnosing Clinical Osteoporosis and recommending treatment.
VFA should be done because the majority of vertebral compression fractures are first noticed by x-ray or DXA VFA imaging. If you do not personally view the images, be sure the radiologist specifically checked for vertebral deformities as described by Genant.
I recently published my retrospective review of 1259 sequential first time VFA patients in Endocrine Practice 2017:23:1375-8.
VFA identified many patients not identified as high fracture risk (Clinical Osteoporosis) by DXA or fragility fracture or height loss or kyphosis or FRAX.
We should consider including VFA in every first time Complete Bone Health Evaluation.
And how should we treat? Next time…
Jay Ginther, MD
Our goal is NO NEW FRACTURES. Cancellous (spongy, like the ends of the drumstick) bone should be a strong latticework of struts called trabeculi. Clinical Osteoporosis, an increased fracture risk, occurs when some of the struts disappear.
Trabecular Bone Score (TBS) evaluates the spongy bone in the DXA images of the vertebrae (spine) looking for irregularities. When TBS finds uneven bone mineral density within the spine DXA, that indicates a higher fracture risk, regardless of the total BMD.
Adding the TBS feature to a DXA machine allows the quality of bone in the spine to influence the FRAX score, just like the BMD in the femoral neck part of the hip influences the FRAX score. Adding TBS detects more patients at high fracture risk who should be treated to avoid fractures.
Diabetes increases a person’s fracture risk for any given DXA BMD or T-score. Controlled diabetes adds about the same risk as rheumatoid arthritis, so we usually check that box in FRAX. Uncontrolled diabetes is more serious requiring further adjustment to FRAX.
FRAX is pre-empted by a hip fracture. “Do not pass GO, do not collect $200, start a pharmaceutical” Vertebral (spine) Fracture is the same, but the majority of spine fractures are not noticed clinically. “Morphometric” (first noticed on x-ray) vertebral fractures count, but how to find them?
VFA next time
Jay Ginther, MD