Posts Tagged ‘Fracture Risk’
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
“I want to treat my bone health entirely naturally – without any “artificial” medications.” That might be possible if you are among the less than half of all women not destined to suffer one or more fragility fractures without medication. Your odds are certainly better if you take all the measures outlined over the past weeks.
Years ago Osteoporosis was rarely a problem. 100 years ago most people died before age 65. 200 years ago most people died before age 40. We live too long to avoid the natural decline in bone health. (I would rather live long and deal with medications).
When I was in medical school (45 years ago) we lived entirely naturally in terms of bone health. Most woman, and some men, became stooped forward with “humpback” kyphosis until they fell, broke a hip and either died or were shipped to a nursing home forever. There was nothing we could do to prevent that.
Now we know a bunch of natural things we can do to postpone that scenario, but we cannot prevent it entirely in many people without adding medication. Adding medication may be “cheating”, but I would rather stay active and enjoy life.
Take Control Naturally as long as you can, but evaluate your bone health periodically and add osteoporosis medication when your fracture risk rises.
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
The purpose of good bone health is to prevent fractures. Most fractures happen as a result of a fall. If you do not fall, you decrease your fracture risk. How do you prevent falls?
Regular exercise will strengthen your muscles. Strong muscles are part of the solution. But you also need good balance. Good balance requires exercises to strengthen the muscles required for balance.
Balance exercises have been used for centuries to keep people limber and free from falling, and thereby, free from fractures. They are often taught in group sessions, but can be performed alone on any flat surface.
Tai Chi and Yoga are the best known ancient balance exercises. Daily, or at least 3 times weekly, sessions of 20-30 minutes will gradually improve your balance and prevent falls.
Less interesting, but easier to do anywhere, is simply walking on your toes for several minutes. More challenging is walking on your heels, like a penguin. If you can do that for 2 minutes straight, you have great muscles, strong ankles, and are unlikely to stumble, even on uneven ground.
Take Control Naturally by working on your Balance. Remember that proper nutrition is necessary for strong muscles and bones.
Jay Ginther, MD