Posts Tagged ‘Complete Bone Health Evaluation’
The vertebrae (bones in the spine) can gradually crumble or suddenly crunch. The resulting minor ache is often mistaken for arthritis or a pulled muscle. Gradual crumbles are “morphometric” (detected by x-ray) fractures, and just as valid as “clinical” (recognized) fractures in predicting Fracture Risk and future fractures.
Vertebral Fracture Assessment (VFA) looks at the spine from the side with a DXA machine or a standard x-ray. Each vertebra is evaluated for wedging (crunching or crumbling in the front) or biconcave deformity (from the discs punching in the center of the vertebra from top and bottom). A single vertebral deformity by 25% or more diagnoses “Clinical Osteoporosis” pre-empting DXA, BMD, and FRAX. VFA is an additional standard for assessing Fracture Risk.
VFA requires a human to look at each vertebra from T4 through L4 for deformity. VFA by DXA machine requires 2 more pictures than the 3 standard DXA pictures. VFA is a different technology from DXA and is not part of a basic DXA report. VFA is additional information that supplements DXA.
Humpback deformity in a patient is a strong hint that VFA will probably find multiple vertebral wedge compression fracture deformities. Wedge deformities can often be suspected by finding humpback (kyphosis). But multiple biconcave compression fracture deformities can hide in a patient with a straight spine. VFA is usually required to find biconcave deformities. VFA needs to be part of a Complete Bone Health Evaluation to fully assess fracture risk.
Last time we discussed DXA. Today we discussed VFA. Thursday we discuss what I discovered by combining the two in a Complete Bone Health Evaluation on every patient.
Jay Ginther, MD
Aunt Henrietta finished her 2 years of the Anabolic, Forteo. It worked. Just to prove it, she fell all the way down the stairs and didn’t break anything. What osteoporosis medication should she take next?
The FDA specifically does not allow persons marketing Forteo to recommend any other medication to follow Forteo because no prospective, blinded, randomized trial involving at least hundreds of individuals switching to one specific medication has been done. A separate trial would be needed for each Antiresorptive medication.
Forteo must be followed by an Antiresorptive medication in order to preserve the gains achieved by increased bone matrix formation. Determining the best medication for each individual requires a full osteoporosis evaluation.
This week I spent 2 days advising Orthopedic Surgeons about how to deal with Osteoporotic patients. Identifying the Osteoporotic (Fragility) Fracture is the easy part. Correcting the Osteoporosis is more challenging.
Orthopods are often too busy treating the recent fracture to do a complete work-up and initiate correction of the Osteoporosis. Unfortunately, many pimary care docs are also too busy treating (now out of control because of the fracture) diabetes, hypertension, heart failure, pulmonary problems, etc in the weeks after a fracture. Setting up a system is key to getting a complete bone health evaluation and treatment before everyone, patient included, forgets to try to prevent further fractures.
Fragility Fractures are fractures caused by osteoporosis. Fragility Fractures cost an enormous amount of money. They also cause pain, suffering, disability, nursing home stays, and death.
The estimated total cost of Fragility Fractures in the European Union for 2010 was 39 billion Euros. That is $52 billion US! Real money! That is a lot to pay for fractures that might have been prevented by screening and preventive treatment.