Posts Tagged ‘ISCD’
Vertebral Fracture Assessment (VFA) identifies many persons with Clinical Osteoporosis who are missed by DXA testing alone. How many? I reviewed my first 941 patients to have VFA with their DXA (Feb 2010 – Sept 2012). I was amazed.
25% of the total had at least one Genant grade 2 or 3 Vertebral Deformity on VFA but were not identified as Osteoporosis by DXA. This is Clinical Osteoporosis missed by DXA alone in 25% of my total patients.
DXA has been the standard screening test for Osteoporosis in the USA for two decades. DXA is easy to obtain and the computer print-out makes it look very simple to read. Too simple if all you do is look at the computer print-out. DXA is not the whole story. And that is not the only difficulty.
DXA measures Bone Mineral Density (BMD). Calcium is the usual mineral in bone, and the one we intend to measure. The computer reads out calcium g/cm2 (a bit hard to understand) and also gives a “t-score” comparing the test result to a healthy 30 year old woman. That makes it simple – “normal”, “osteopenia”, or “osteoporosis”. Again, much too simple if what you really want to know is Fracture Risk.
How can we make Bone Health patient education more effective? An entire office visit only about bone health / osteoporosis prevention and treatment, is an effective start. This I have done since 2007. Now national leaders are looking for the next step. The answer surprised me.
In 2012, presenters at National Osteoporosis Foundation (NOF), International Society for Clinical Densitometry (ISCD), and American Society for Bone and Mineral Research (ASBMR) have said the same thing: Spend less time on each visit, but increase the number of visits. Studies are showing that this works.
Today I taught the Nurse Practitioner class at Allen College. Their Bone Health – Osteoporosis section included 3 hours of classroom lecture and discussion. We also spent an hour teaching the basics of DXA, VFA, and how to read them correctly. This is not a full ISCD course, but enough to get the students pointed in the right direction.
Teaching is stimulating. Trying to distill the 250+ hours of Continuing Medical Education I have taken in the last 5 years down to 3 hours is challenging. Students always have thought-provoking questions. They make me think, and when I think, I learn too.