Posts Tagged ‘Fracture Prevention’
Clinical Osteoporosis 2017, NOF and ISCD joint meeting had a different emphasis this year. Fracture Risk, rather than Bone Mineral Density (BMD) is now the key metric. Several speakers emphasizd the importance of VFA in making the diagnosis of Clinical Osteoporosis. This is something I have presented in poster exhibits 2015, 2016 and 2017. I am now mainstream!
“Treat to Target” was the big new message this year. We should set a target of decreased Fracture Risk for each patient and alter treatment until we reach it. This has been routine for years in diabetes, hypertension, cholesterol, etc. This is recognition that Osteoporosis is a chronic disease that we can control, but never cure, just like many others.
Take Control Naturally is the necessary first step, as I have outlined over the last few months. This is often sufficient for prevention and in mild disease.
Advanced Osteoporosis, especially after fragility fractures, or vertebral compression fractures seen on VFA, is usually beyond nutrition and exercise only. This will usually require medications to significantly reduce fracture risk.
The huge change is the recommendation to use an Anabolic medication first, to markedly reduce fracture risk, when BMD is very low or multiple fractures have already occured. Then follow up with an Antiresorptive to maintain a low fracture risk. Traditionally Medicare and other insurances have demanded we try Antiresorptives first to maintain bone as it is, even when multiple fractures have proven the bone to NOT be good enough at curent BMD.
We are entering a new age of Fracture Prevention!!
Jay Ginther, MD
Fracture Prevention was the theme at NOF (National Osteoporosis Foundation) this year. This has always been their goal, but it has not been well communicated.
Fractures are bad. Fractures are painful. They keep you from doing things you want to do. For weeks. Or months. Or even forever.
Fractures ruin your finances. They cost a lot to treat. They cost even more if you cannot work.
Fractures can disable you temporarily, or even permanently. You can lose your Independence. You could spend the rest of your life in a Nursing Home.
Clinical Osteoporosis is an Increased Risk of Fracture.
One fracture doubles your risk of a second. Two fractures increases the risk 5 times. Fracture Risk is multiplied 9 times by 3 fractures.
You can decrease Fracture Risk. A Complete Bone Health Evaluation will identify nutrition and lifestyle details that you can improve for better Bone Health.
Many Fractures can be prevented by simple non-medication measures. You can start with proper Calcium, Vitamin D3, Protein, Balance and Strengthening Exercises, Multiple Vitamins & Minerals. These measures are necessary even if you also take osteoporosis medications. Often they alone are enough, at least for a few years.
Take Control of your Future. Prevent Fractures and all the misery they can bring.
Jay Ginther, MD
Falls are the immediate cause of most “wrist”, shoulder and ankle fractures, and of many Hip fractures. Two or more falls in a year indicate a need for more than basic balance and strength training. You need to analyze why you fell. Then work to avoid repetition. Formal Physical Therapy, teaching exercises to do at home, is best.
Major Fall Risk Factors: loose rugs and minor step-ups into a room; the scuffing gait needed for slippers, sandals or clogs; poor vision and bifocals; bending to pick something off the floor without hanging on to support; not using chair arms; slow gait; and not using a cane or walker on uneven surfaces (out-of-doors). If you have any of these, work to eliminate them.
Walking for exercise does NOT reduce falls. Even walking over a mile daily. Balance and strength training DO reduce falls. The simplest to do at home is to stand on one leg. The goal is 30 seconds. Many of us need to hang on to something solid at first and gradually work up to “no hands”. PT will teach additional exercises as you improve.
Lifestyle Integrative Functional Exercises! Look at all daily activites, then modify your lifestyle to avoid Fall Opportunities. Avoiding Falls is just as important as taking osteoporosis medications for Avoiding Fractures.
Take Control Naturally. Avoid Falls. Avoid Fractures.
Jay Ginther, MD
My wife and I visited the tropics during January. We did Tai Chi every morning while watching the sun rise. A Blue Zone experience. Worth getting up early!
Tai Chi is mostly about balance and co-ordination. (Difficult to appreciate if you watched our group of rookies.) Improving balance, co-ordination, and core muscle strength helps to prevent falls as well as strengthen muscles and bones. We found it interesting and invigorating and plan to continue now that we are back in Iowa snow country.
Tai Chi is ideal for older individuals, like myself. Yoga is easier for those younger and more flexible. Ballroom dancing is a favorite of those who can do it. Recreational sports work too, as long as you are careful and avoid collisions. All have the advantage that they can be group activites.
Exercise is a necessity for optimal bone health. Balance training and fall prevention are very helpful for fracture prrevention. Along with enough Calcium, Vitamin D3, Protein, and Multiple Vitamins & Minerals, this may be all you need to prevent osteoporosis and fractures.
Take Control Naturally.
Jay Ginther, MD