Posts Tagged ‘Fracture’
Recently a patient finished her half hour visit by saying, “so there is nothing you can do for me”. We had discussed Low Bone Mineral Density (BMD) on her DXA; Vertebral Compression Fractures on her VFA; correcting her Diet – Low in Calcium, Vitamin D3 and Protein; Cutting Down her Smoking; back extension Exercises; and possibly Medications that could reverse her Clinical Osteoporosis. None of these interested her.
She was not interested in what she could do to prevent future fractures. She wanted me to “delete” her current Fragility Fracture and the problems she was having from it. She did not believe that she has clinical osteoporosis. She did not believe she is at risk for future fractures. She certainly did not believe that she should be expected to take any action to help herself.
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.
Aunt Henrietta looked like half a raccoon with her entire left eye blackened. She dismissed her looks as not a problem saying, “I fall all the time, but I don’t break anything.” This is a change on both counts. Five years ago, falls were infrequent. Even so, she broke one wrist, then the other wrist, then her shoulder.
Two wrists, one shoulder, and half a dozen vertebral fragility fractures indicated Very Severe Osteoporosis. That was before she took the Anabolic, Forteo, for 2 years. She was the ideal patient for serious measures to stop her fractures. And it has worked!!
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.