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Posts Tagged ‘Fracture Risk’

Start with a Complete Bone Health Evaluation

June 24, 2020 @ 6:57 am
posted by Dr Ginther

You just tripped and suffered a minor fracture?  You just started menopause or male low “T”?  You are now on Medicare?  Are you concerned about your bone health?  If not, you should be.  At least concerned enough to check it out.

Don’t just get a DXA.  DXA alone misses 85% of Fracture Risk, especially in older individuals.  You should get a Complete Bone Health Evaluation to catch any problems early.  “Take Control Naturally” with enough calcium, Vitamin D, protein, and exercises every day.

What is a Complete Bone Health Evaluation?

DXA read by an ISCD Certified Clinical Densitometrist is a start.  ISCD certification assures proper reading.

Vertebral Fracture Assessment (VFA) identifies vertebrae which have collapsed, up to 80% of which are not recognized.  (I missed mine.)

FRAX calculates Fracture Risk far more accurately than DXA and Bone Mineral Density alone.

Blood tests include CBC and CMP routinely done for annual check-ups.  We add monohydroxy Vitamin D, PTH, TSH and phosphorous.

History and physical examination focused on bone health and 20-30 minutes consultation solely about bone health, fracture prevention, osteoporosis prevention, or osteoporosis treatment.

A Complete Bone Health Evaluation allows many of our patients to Take Control Naturally with proper nutrition and exercise alone.

Jay Ginther, MD

If you fracture, your risk of a second fracture within a year is 3 to 5 times as great!  If that first or second fracture is a hip, you have a 25% chance of dying and a 25% chance of spending the rest of your life in a nursing home.  Scary.

Sometimes nutrition and lifestyle changes are enough.  Often medications are needed to effect real improvement.  The anabolic medications Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity) not only prevent further fractures by increasing bone mass, but also speed healing.  The antiresorptive medications decrease fracture risk by preventing bone loss.

The NOF video at https://vimeo.com/267839997 discusses the likelihood of benefit in relation to the very small risk of harm from antiresorptive medications.

Understand the relative risks of taking a medication compared to the relative risks involved in not taking a medication.

Jay Ginther, MD

Not everyone gets osteoporosis and unnecessary fractures.  Some risk factors are genetic about which we can do nothing directly.  But we can optimize our nutrition, follow a healthy lifestyle and control chronic diseases like diabetes.

Click on the Take Control Naturally category to your left to get started on the risk factors for osteoporosis you can control, especially the “If you don’t take care of your body, where are you going to live” series from 2017.

NOF has an excellent 9 page summary at https://cdn.nof.org/wp-content/uploads/2017/04/Who-Gets-Osteoporosis-BONE-BASICS.pdf

At least you should Take Control Naturally of those things you can.  And if you are at high risk from factors you cannot control, get a Complete Bone Health Evaluation and work with your healthcare professional to change your odds.

Jay Ginther, MD

Covid-19 is quite contagious.  Patients coming into a clinic or hospital could put themselves at risk from other patients.  Patients who are not yet symptomatic can put other patients and health-care workers at risk.  How can we get essential medications, yet limit risk?  Drive-Thru.

I am on several medications which cannot be stopped because I am controlling chronic diseases (that cannot be cured).  I no longer enter my pharmacy.  Drive-Thru window.

Osteoporosis is a chronic disease we cannot cure, but can control.  We now call every Prolia and Evenity patient offering the option of being met in the parking lot.

Roll down the car window.  Roll up your sleeve and put your arm out the window.  Get your shot.  Roll up your sleeve and window.  Done with minimal exposure to another person.

Remember that skipping a Prolia shot is a very bad idea.  Recently evidence has surfaced that missing a Prolia shot by more than 2 months can increase the risk of vertebral fracture to higher than it was before starting treatment.

Most of the time we can delay the DXA/VFA or lab tests by a month or 2 or even 6.  Prolia and Evenity should not be delayed.  Forteo and Tymlos usually arrive by mail for self injection.  Changing to a different medication could be another option.  Call your doc.

Jay Ginther, MD