Posts Tagged ‘Vertebral Fracture’
A patient had no idea why her doc sent her to me for a Complete Bone Health Evaluation. As a “baby-boomer”, she lives by the motto: “You are only as old as you choose to be.” And she chooses to remain young. If only it were possible…..
“I can’t have Osteoporosis. I used to drink milk. I am active and I plan to stay active!!! So I just can’t have Osteoporosis!” Unfortunately, she does have Osteoporosis by BMD on her DXA, by the multiple Vertebral Fractures on VFA, and by FRAX. Still, there are simple steps to rescue her Bone Health before she Fractures.
Patients who have already fractured may need osteoporosis medications. Adding fractures to a low BMD or T-score on DXA makes the Clinical Osteoporosis more severe and increases Fracture Risk. This is true of vertebral fractures detected on VFA, as well as clinically obvious fractures, like hip or wrist or shoulder.
Fracture Risk is the big deal. Fractures are what we want to avoid. Having suffered one fracture makes a Second Fracture 3 to 5 times as likely as the first. Bummer. Calcium, Vitamin D, Protein, Multivits and Exercise alone often cannot overcome those odds. Real bummer. Adding a medication often can avoid the Second Fracture.
Tomorrow I am at the 2014 National Osteoporosis Foundation meeting. Actually the name “National Prevent Fractures Organization” would better explain our goals. We don’t care about Osteoporosis as much as we care about Preventing Fractures.
DXA and T-score test results of “osteoporosis” only identify about 15% of the persons who will fracture. How can we identify those persons with “osteopenia” who will fracture? We use FRAX and Vertebral Fracture Assessment (VFA). My Poster # 18 tomorrow and Friday documents how adding VFA to DXA identifies additional persons at high risk for Fractures.
Recently a patient finished her half hour visit by saying, “so there is nothing you can do for me”. We had discussed Low Bone Mineral Density (BMD) on her DXA; Vertebral Compression Fractures on her VFA; correcting her Diet – Low in Calcium, Vitamin D3 and Protein; Cutting Down her Smoking; back extension Exercises; and possibly Medications that could reverse her Clinical Osteoporosis. None of these interested her.
She was not interested in what she could do to prevent future fractures. She wanted me to “delete” her current Fragility Fracture and the problems she was having from it. She did not believe that she has clinical osteoporosis. She did not believe she is at risk for future fractures. She certainly did not believe that she should be expected to take any action to help herself.