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If your Mom had Osteoporosis, you are also at risk for osteoporosis and fractures. If a parent had a broken hip, you are at increased risk of fracture. Choosing your parents poorly is a risk factor you cannot avoid. Your age is the biggest risk factor that you cannot control. However, you can control other risk factors.
The goal of Bone Health Evaluation and Treatment is Fracture Prevention! DXA and Bone Mineral Density (BMD) are useful tools for evaluation. But DXA and BMD are only one out of many tools for bone health evaluation. DXA t-score and BMD should never be the sole goal of treatment.
As an orthopedic surgeon, my goal is always Decreasing Fracture Risk. In the USA we sometimes seem to have forgotten that real goal. We focus too much on DXA t-scores. We should focus on the patient. We should treat “Clinical Osteoporosis”. The patient deserves a complete Bone Health evaluation.
Increased Fracture Risk is Clinical Osteoporosis. Clinical Osteoporosis is a diagnosis. It is a chronic medical condition that you have for the rest of your life, like high blood pressure. It can never be fully “cured”, but it can be fully controlled. That is what we do. We help you to Take Control.
Confusion arises because”osteoporosis” is also a Bone Mineral Density (BMD) test result, as measured by DXA. Persons with “osteoporosis” for a test result are at high risk, but so are many with “osteopenia”. In fact 6 times as many people with “osteopenia” have Fragility Fractures as people with “osteoporosis” test scores. Fractures and fracture risk matter more than test scores.
A fragility fracture is a fracture which happens from minor trauma. A stress fracture happens from repeated normal daily activities, like walking or going up or down stairs. This is a fracture from no trauma.
Bone must be at very high risk of fracture to develope a stress fracture. Clinical Osteoporosis was defined by NIH in 2001 as increased risk of fracture. Therefore, a Stress Fracture is defined as Clinical Osteoporosis.