Posts Tagged ‘Vertebral Fracture’
You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
Jay Ginther, MD
Friday, the University of Wisconsin “The Bare Bones of Osteoporosis Care” Symposium had a lot of practical information. This included:
John Belizekian, MD summarized the latest research on HyperParathyroidism. While most of what we see is Secondary HyperParathyroidism, long term Secondary can morph into traditional Tertiary, or into a newly defined type of Primary HyperParathyroidism.
Joseph Shaker, MD explored new insights into Secondary Osteoporosis. These are separate medical conditions which cause osteoporosis and must be addressed if we are to succeed in treating the resulting osteoporosis.
Fergus McKiernan discussed the success of Vertebroplasty and Kyphoplasty – if you choose patients with the right Vertebral Fracture problems to operate on.
Dr Belizekian discussed new therapies which avoid the problems of current medications. Odanocatib, Abaloparatide, and Rososumab are all in FDA phase 3 trials and could be available within 5 years. FRAX can now incorporate TBS (Trabecular Bone Score).
I will cover these topics, along with those discussed at NOF, over the next few weeks.
Jay Ginther, MD
Ann spends a week in Florida each winter with several friends and was stronger, more agile and more confident this year than last. She stepped in and out of the hot-tub easily instead of slowly and awkwardly. She zoomed up and down stairs. She had to slow down when walking with her friends. What has happened?
A year ago she followed a fragility fracture with below average and decreasing BMD on DXA, and a newly crumbling vertebral fracture on VFA. She has Clinical Osteoporosis. That got her attention. She was determined to play on the floor with her active preschool grandchildren. You cannot do that if you are crumbling. She was ready to do whatever it took to get back in the game.
She added Adora Chocolates (500mg calcium in each) to her usual diet. She added Protein shakes (chocolate) and increased intake of chicken, fish, and beef to meet the new protein guidelines. She remembered to take extra Vitamin D3 and her Multiple Vitamins & Minerals almost every day.
She got serious about her “10,000 steps” every day and went up and down stairs frequently instead of saving up things for a single trip. She did not actually join an exercise class as promised.
She started the anabolic, Forteo, to build her bone density and strength. A daily little shot is a nuisance, especially keeping it cold while travelling, but she wanted results.
This year repeat DXA showed increased BMD. VFA confirmed no further crumbling. She zoomed through airports and left her friends in the dust in Florida. These results have made her even more determined.
She has Taken Control of her Future Life. You can too.
Jay Ginther, MD
DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer. DXA alone is less good at predicting Fracture Risk. But, Fractures are what we want to avoid.
At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy. Vertebral Fracture Assessment (VFA) helps evaluate bone quality. FRAX was specifically designed to predict Fracture Risk. QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.
ISCD will discuss adding TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT. We are constantly pushing toward our goal – Prevent Fractures.
Preventing Fractures is not just DXA. Get a Complete Bone Health Evaluation.
Take Control of your future. Check your bone health.
Jay Ginther, MD