Posts Tagged ‘Take Control Naturally’
Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades. These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure them.
Bone health joins the Treat to Target club in 2017. Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.
What is our target? Traditionally it has been maintaining the T-score found at the first assessment. This does not necessarily make sense, especially if there already are fractures. The target should be NO NEW FRACTURES. This is a game changer.
This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured. How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.
This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles. (I did that a few years back.)
THE TARGET IS NO NEW FRACTURES.
Jay Ginther, MD
May is National Osteoporosis Month. That should be National Osteoporosis Prevention Month. Or perhaps National Bone Health Optimization Month.
Click on the helpful link to National Osteoporosis Foundation to learn more.
Take Control Naturally by following the posts from earlier this year. And get a Complete Bone Health Evaluation.
Jay Ginther, MD
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
So how do you find out what aspects of your bone health are pretty good already, what will be easy to fix, and what will take some real work? Start with a Complete Bone Health Evaluation.
DXA is about 1/3 of the story and should include both hips and spine. When you are as old as I am, the spine probably is too arthritic to be really accurate, but helps complete the picture. If you have had a total hip replacement, you should use the non-dominant forearm.
VFA will pick up many persons at increased fracture risk who are missed by DXA alone. You should ask for VFA, especially if you or a parent have kyphosis (humpback) or have lost height.
The FRAX calculation picks up different individuals at high fracture risk.
Blood tests should include CBC, CMP, TSH, PTH, and 25-hydroxy Vitamin D as a start. Further testing may be needed.
A medical history and examination focused on bone issues is a critical part of the full consultation. We allot a minimum of 30 minutes for discussion. Often a follow-up visit is needed to be sure both we and our patients are clear on the whole picture.
DXA alone misses over half of the individuals who need to improve their bone health. Get a Complete Bone Health Evaluation.
Jay Ginther, MD