Posts Tagged ‘Vertebral Compression Fracture’
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
Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?
How do you know when an Antiresorptive medication is best? First, the situation needs to be beyond the capability to Take Control Naturally with Calcium Citrate and Vitamin D3 alone. A dropping Bone Mineral Density (BMD) or a worsening Vertebral Fracture Assessment (VFA) despite adequate Calcium and Vit D3 indicates the need for medication.
Second, the bone needs to be Good Enough that preserving it at current levels will prevent fractures. Good enough means no Fragility Fractures and no Vertebral Compression Fractures detectable on the VFA by DXA machine or by lateral spine x-ray.
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.