Posts Tagged ‘DXA’

You Don’t Have To Fall To Break A Hip

December 4, 2014 @ 7:29 pm
posted by Dr Ginther

Sometimes a person breaks a hip first, then they fall.  This happens a lot more often than we realize.  When the break is just below the ball of the hip, the fracture may have come before the fall.  Moreover, that Fragility Fracture may have gradually developed over days or weeks.

How is it possible that a person does not realize that the hip is gradually crumbling?  We call it a Stress Fracture when a crack gradually developes.  Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall.  Why?

The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses.  The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007.  http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse   Tiny cracks slowly developed in the steel until one day……..THUD!

How can you detect who is at high Hip Fracture Risk?  A very low DXA T-score, especially in the spine, is a good indication.  But DXA often fails if the spine is already crumbling or has arthritis.  A better indication is Vertebral Fracture Assessment (VFA).  Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.

Know where you stand.  Get a Complete Bone Health Evaluation.  Take Control of your future.

Jay Ginther, MD

How Hard Is It To Manage Bone Density?

November 23, 2014 @ 7:57 pm
posted by Dr Ginther

Wrong Question!  What you should be managing is Fracture Risk.  If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.

85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”.  Keeping their bone density at “only osteopenia” does them no favor.  So how can you manage Fracture Risk?

Fractures are NOT FUN.  Not something you want to repeat.  Any fracture is a Bone Attack.  It is a warning that you probably have Bone Health issues that can be improved.  Get a Complete Bone Health Evaluation and work to prevent a second fracture.  Most people can succeed in preventing that second fracture.

I see many individuals who have had a first fracture.  Often the DXA, BMD, and T-score are not that bad.  I even see many who have good DXA test scores.  But they still fractured with relatively minor trauma.  They proved that they have increased Fracture Risk.  Why?

Forteo is a daily shot.  That is a nuicence, but a small price to pay for the only Anabolic, the only osteoporosis medication which will increase bone mass in spongy (cancellous) bone.  Diabetics give themselves a daily shot for the rest of their lives.  Forteo is for only 2 years and uses a tiny insulin needle. 

People worry about the warning that lab rats got Osteosarcoma after being given very high doses of Teriparatide for the equivalent of 70 human years.  We have not seen this in humans, or chimps, or monkeys, or dogs.  Rats have bones that grow all their lives.  We do not give Forteo to growing humans, pregnant women, nursing women, persons with Paget’s Disease or unexplained elevated Alkaline Phosphatase, or persons who have had radiation to their bones.

Remember that you must take adequate Calcium, with food, spread out over 3 meals. You must take enough Vitamin D3 to be able to absorb Calcium.  You must eat enough Protein for your OsteoBlasts to make new bone matrix.