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Posts Tagged ‘ISCD’

“Treat to Target” and “Use VFA” in 2017

April 23, 2017 @ 8:50 pm
posted by Dr Ginther

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

NOF & ISCD at “Clinical Osteoporosis 2017”

April 17, 2017 @ 5:24 pm
posted by Dr Ginther

The National Osteoporosis Foundation (NOF) and the International Society for Clinical Densitometry (ISCD) are meeting together later this week.  This will be my 10th attendance at each group.  They are both always interesting.

I will be presenting a new research project this year – “Vertebral Compression Deformities in Patients with Normal Bone Mineral Density”.

This is a further study of the 79 patients with Normal BMD by DXA alone, who were changed to Clinical Osteoporosis because of vertebral compression fractures found on VFA from last year’s study of 1259 consecutive patients with first-time VFA at our facility.

I look forward to seeing what else is new this year.

Jay Ginther, MD

Adding VFA to DXA

January 9, 2017 @ 12:14 pm
posted by Dr Ginther

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

Can you still do all the physical activities you want to do?  Activities of Daily Living (ADLs) are the key to enjoying your life, especially as we grow older.  At ISCD last month we learned some tricks to maintain our ability to do everything we need to do for a full life.

As we age, we lose muscle mass (Sarcopenia).  Loss of muscle mass leads to even faster loss of muscle strength (Dynopenia).  Loss of muscle strength is a strong predictor of Fall Risk and Fracture Risk.  Bummer!

Get your butt off the couch!  You should be able to stand, then sit, then stand again for 5 cycles in 15 seconds.  If you cannot, you are in danger of losing your ability to live independently.  Loss of the knee extension strength needed to stand, even once, predicts mortality.  Huge bummer!

There is no medication for loss of strength.  We do have natural activities: Balance exercises (standing on one leg); Aerobic exercises (walking for distance, not speed); Progressive strength exercises (sit to stand to partial squat to stand….).  Enough extra Vitamin D3 to get your level above 40ng/ml helps your muscles.  And you MUST get enough Protein in your diet.

Take Control Naturally.  Exercises, Protein, Vitamin D3, Calcium, and Multiple Vitamins & Minerals.  Remain strong and independent.

Jay Ginther, MD