Posts Tagged ‘Spine Fracture’
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.
What determines “osteoporosis”? Is it DXA and BMD? Perhaps VFA and the lateral spine? What is the importance of Kyphosis? When is a collapsed vertebra a fracture? These are all questions for ISCD 2012.
The International Society for Clinical Densitometry meets this week at the 2012 annual meeting. As a society, we began by studying DXA as a tool to identify individuals at increased Risk of Fracture. We now realize that DXA and BMD are only part of the analysis. FRAX has been a major step forward. We will be sharing our observations and advancing our collective knowledge.
The researchers for the New England Journal of Medicine article about DXA counted only those few vertebral (spine) fractures that were recognized as fractures. Most vertebral fractures, especially in older women and in men, are mistaken for muscle pulls or arthritis.
Usually bones in the spine gradually crumble rather than suddenly crunch. These “silent” fractures count the same as (recognized) “clinical” fractures when calculating Future Fracture Risk and planning care. The researchers ignored this very important detail.
A reader asked “Why do I keep breaking?”
If you do have more than one Fragility Fracture, you certainly need to find out why! Every Fracture that you have increases the chance of another Fracture unless you find and correct the underlying problem.