Posts Tagged ‘Vertebral Fracture’
I have let the regular posts to the blog lapse for quite some time, while working on other issues.
I have been reviewing my first-time Vertebral Fracture Assessment (VFA) patients. My latest research project included 1259 patients over 3 1/2 years. I analyzed the patients by FRAX, height loss, age, and fragility fractures as well. Nothing duplicated the findings by VFA.
I found that DXA alone missed many patients who have Clinical Osteoporosis if VFA (lateral spine) is taken into account. I have presented this at ISCD and ASBMR. Putting it into proper format to submit for publication took much more time than I anticipated.
This project is finished until I start the next sub-analysis.
I hope to get back to adding to the blog regularly.
Jay Ginther, MD
This week I had a patient who has decided that she does not need to treat her Osteoporosis because she does not yet have symptoms. This could be a problem for her. The first symptom of Osteoporosis usually is a Fracture. Ouch!
Actually she has had symptoms. She has 5 Vertebral Compression Fracture Deformities in her thoracic spine. As is usually the case, she had aching, but not sharp pains, from these “crumble-type” fractures. Therefore she doesn’t really believe that they are “real” fractures.
Vertebral Fractures generally occur about a decade before Hip Fractures. They are the early warning that much more obvious, and much more inconvenient, fractures may be coming. You ignore that warning at your peril.
Clinical Osteoporosis is a Silent Disease until the first major Fracture (Bone Attack). Heart disease may be silent until the first Heart Attack. High Blood Pressure may be silent until the first stroke (Brain Attack). Each of these can change your whole life.
Osteoporosis with Fracture is far easier to prevent than to treat – for the patient as well as the doc. Why wait for a fracture? Why not start treatment before ruining your life for a few weeks – or forever.
Take Control of Your Life.
Jay Ginther, MD
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