Posts Tagged ‘DXA’
Friday is the Go Red For Women in Waterloo, sponsored by the American Heart Association. Heart Disease is now recognized as a major health issue for women, as well as men. Prevention of heart attacks and strokes gets a lot of attention. Breast cancer is also well recognized. These are worthy causes, but…..
Fractures from Osteoporosis are twice as common in women as heart attacks. Fractures are more common than heart attacks, breast cancers and strokes combined. More women die from complications after hip fracture than die from heart attacks. This is also a big deal, but Osteoporosis gets no respect.
The American Society for Bone & Mineral Research 35th Annual Meeting has just concluded. Of the roughly 2000 attendees, nearly half were form other countries. Most are PhD researchers dealing in basic science issues and then moving toward answers to human maladies. Two totally new types of osteoporosis medications are in phase 3 human trials. They look promising.
Those of us who treat human patients use meetings to trade information. My poster about using Vertebral Fracture Assessment to improve the accuracy of DXA was well received. Many academic osteoporosis centers routinely use VFA, but have not yet analyzed and reported their results. I learned a lot from other attendees, much of which will help me help my patients.
If you screen by DXA alone you fail to identify most of the individuals who will fracture. Over 80% of fracture patients over age 50 have “osteopenia” or “normal” as their Bone Mineral Density (BMD) test result on DXA. Wow! DXA is a terrible stand-alone test.
Previous fractures are a much more reliable screen. Any previous fracture predicts future fractures. The best predictors of fracture risk are Vertebral (spine) fractures, but there is a problem. Most vertebral “crumble” or even “crunch” fractures are not identified as fractures until you look for them. You must do Vertebral Fracture Assessment (VFA) to identify those persons who are at increased risk of fracture because they already have fractured.
This week a patient was delighted to know she had no bone worries – based on her t-score of -2.4 in her hips. Unfortunately she was very wrong! “Osteopenia” is just a single test result. Other factors placed her at High Risk for Fracture.
One test does not tell the whole story. For instance, my total cholesterol is “normal”. That means that I have no heart worries? Wrong! I have hypertension, type-2 diabetes, and a history of congestive heart failure. I am at risk for heart problems. My patient is at risk for bone problems, specifically Fragility Fractures.