Posts Tagged ‘Fragility Fracture’
I have let the regular posts to the blog lapse for quite some time, while working on other issues.
I have been reviewing my first-time Vertebral Fracture Assessment (VFA) patients. My latest research project included 1259 patients over 3 1/2 years. I analyzed the patients by FRAX, height loss, age, and fragility fractures as well. Nothing duplicated the findings by VFA.
I found that DXA alone missed many patients who have Clinical Osteoporosis if VFA (lateral spine) is taken into account. I have presented this at ISCD and ASBMR. Putting it into proper format to submit for publication took much more time than I anticipated.
This project is finished until I start the next sub-analysis.
I hope to get back to adding to the blog regularly.
Jay Ginther, MD
You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
Jay Ginther, MD
Sometimes a person breaks a hip first, then they fall. This happens a lot more often than we realize. When the break is just below the ball of the hip, the fracture may have come before the fall. Moreover, that Fragility Fracture may have gradually developed over days or weeks.
How is it possible that a person does not realize that the hip is gradually crumbling? We call it a Stress Fracture when a crack gradually developes. Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. Why?
The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007. http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse Tiny cracks slowly developed in the steel until one day……..THUD!
How can you detect who is at high Hip Fracture Risk? A very low DXA T-score, especially in the spine, is a good indication. But DXA often fails if the spine is already crumbling or has arthritis. A better indication is Vertebral Fracture Assessment (VFA). Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.
Know where you stand. Get a Complete Bone Health Evaluation. Take Control of your future.
Jay Ginther, MD
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.