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Posts Tagged ‘Complete Bone Health Evaluation’

Treat to Target #5 – VFA

February 25, 2018 @ 7:45 pm
posted by Dr Ginther

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

Calcium and Vitamin D3 Can Help !!

January 21, 2018 @ 9:43 pm
posted by Dr Ginther

Once again we have been treated to statisticians mushing together multiple disparate previous studies to “prove” that calcium alone, or vitamin D alone, or both together in one of many different combinations will not prevent fractures.  All mushed together in a carefully selected meta-analysis, you can prove anything depending on which studies are included.

More important, asking if adding a specific dose of calcium, or vitamin D, or both, will prevent fractures, misses the entire point.  Most studies did not properly account for the nutrients in each day’s diet in individual test subjects – or in individual control subjects, many of whom also consumed the nutrients being studied.

And how can you ethically ask a patient to limit their diet in a way you believe will put them at risk for fractures?  You have to settle for encouraging patients who are inadvertently short on some nutrients to improve their diet.  But then they do not fracture and you cannot prove that they would have if only you had withheld the information!

We help individuals improve their bone health.  One size does not fit all. We do a Complete Bone Health Evaluation.  Then we adjust nutrition and lifestyle as needed for that individual.  In about half of women and three-quarters of men, this is enough.

Jay Ginther, MD

National Osteoporosis Prevention Month

May 5, 2017 @ 10:40 pm
posted by Dr Ginther

May is National Osteoporosis Month.  That should be National Osteoporosis Prevention Month.  Or perhaps National Bone Health Optimization Month.

Click on the helpful link to National Osteoporosis Foundation to learn more.

Take Control Naturally by following the posts from earlier this year.  And get a Complete Bone Health Evaluation.

Jay Ginther, MD

So how do you find out what aspects of your bone health are pretty good already, what will be easy to fix, and what will take some real work?  Start with a Complete Bone Health Evaluation.

DXA is about 1/3 of the story and should include both hips and spine.  When you are as old as I am, the spine probably is too arthritic to be really accurate, but helps complete the picture.  If you have had a total hip replacement, you should use the non-dominant forearm.

VFA will pick up many persons at increased fracture risk who are missed by DXA alone.  You should ask for VFA, especially if you or a parent have kyphosis (humpback) or have lost height.

The FRAX calculation picks up different individuals at high fracture risk.

Blood tests should include CBC, CMP, TSH, PTH, and 25-hydroxy Vitamin D as a start.  Further testing may be needed.

A medical history and examination focused on bone issues is a critical part of the full consultation.  We allot a minimum of 30 minutes for discussion.  Often a follow-up visit is needed to be sure both we and our patients are clear on the whole picture.

DXA alone misses over half of the individuals who need to improve their bone health.  Get a Complete Bone Health Evaluation.

Jay Ginther, MD