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Posts Tagged ‘Vertebral Fracture’

I was told last week about the mother of an acquaintance in Chicago.  His mother has had Vertebral Fractures again and again and again.  After each fracture she has been told that nothing can be done to prevent another vertebral fracture.  She is turning into a pretzel as her spine crumbles.

After 2 vertebral fractures, she is odds on favorite to fracture another vertebra within the year.  She is also unlikely to respond well to an antiresorptive such as Fosamax, Actonel, Boniva, Reclast, Prolia or their generics because of her severe osteoporosis.  Game over?  Not at all.

Multiple vertebral fractures make her an ideal candidate for an anabolic medication.  Forteo (2002), Tymlos (2017), and Evenity (2019) all can salvage her bone health and increase her bone matrix by 20% or more.  I recommended she see someone up to date in the options available.  There are several in Chicago.  And several here in Iowa.

She needs a Complete Bone Health Evaluation and anabolic treatment.  Of course that includes enough absorbable calcium, enough Vitamin D3, and other nutrition.  Anabolic medications specifically require enough protein to work because they build new bone matrix, which is collagen, which is protein.

You don’t have to fracture again and again.  We can help.

Jay Ginther, MD

NOF Tip for 20 May – Vertebral Fractures

May 20, 2020 @ 7:00 am
posted by Dr Ginther

Vertebral Compression Fractures are often not recognized as anything more than a seriously pulled muscle.  I personally made that mistake 30+ years ago.  Only when I was tested on our new DXA machine which made Vertebral Fracture Assessment (VFA) easy to obtain, did I recognize that I had actually suffered a 30% compression fracture.  Oops.

We do VFA on every patient we evaluate.  VFA added to DXA improves accuracy in assessing bone health.  I have published the largest single center, single provider study of 1259 patients comparing DXA alone to DXA + VFA in Endocrine Practice 2017:23:1375-8.  We use our DXA machine because it is quick and easy.  Lateral Spine X-rays also work.

NOF has an excellent summary of VFA and vertebral fractures at https://cdn.nof.org/wp-content/uploads/2017/04/Vertebral-Fractures-BONE-BASICS.pdf

If you are losing height or are developing a humped back (kyphosis) or simply want a more complete evaluation, ask for a VFA along with your DXA.  Know more, do more to prevent more Vertebral Compression Fractures.

Jay Ginther, MD

Bone Health Gets No Respect

April 24, 2020 @ 5:32 pm
posted by Dr Ginther

As testing increases, we are finding many individuals have been infected with Covid-19.  Many have no symptoms.  Many do not know that they have it.  The overall death rate when counting everyone infected is looking like less than 1%.

The same is true regarding Clinical Osteoporosis.  Many do not know that they have it.  There are no symptoms except a fracture.  Up to 80% of those with thoracic vertebral fractures do not know they have had one.  Up to 20% of those with a recognized vertebral fracture die within 6 months from complications of their osteoporosis.

A hip fracture is hard to miss.  Hip fracture can be the first symptom of severe clinical osteoporosis.  Like Covid-19, hip fracture (Clinical Osteoporosis) is most dangerous in those who are older and/or have pre-existing chronic diseases (co-morbidities).

Over 20% of older men who fracture a hip die of complications within 6 months and many die within weeks.  This is comparable to older men with Covid-19 who require a ventilator.  Yet osteoporosis gets no respect.  More than half the time osteoporosis is not even listed as a contributing factor.  And rarely is the hip fracture listed as the cause of death.

We consider Covid-19 to be the cause of death even if we only suspect it.  Perhaps it is time to consider a treatable chronic disease like osteoporosis in the same way.

Jay Ginther, MD

Covid-19 is quite contagious.  Patients coming into a clinic or hospital could put themselves at risk from other patients.  Patients who are not yet symptomatic can put other patients and health-care workers at risk.  How can we get essential medications, yet limit risk?  Drive-Thru.

I am on several medications which cannot be stopped because I am controlling chronic diseases (that cannot be cured).  I no longer enter my pharmacy.  Drive-Thru window.

Osteoporosis is a chronic disease we cannot cure, but can control.  We now call every Prolia and Evenity patient offering the option of being met in the parking lot.

Roll down the car window.  Roll up your sleeve and put your arm out the window.  Get your shot.  Roll up your sleeve and window.  Done with minimal exposure to another person.

Remember that skipping a Prolia shot is a very bad idea.  Recently evidence has surfaced that missing a Prolia shot by more than 2 months can increase the risk of vertebral fracture to higher than it was before starting treatment.

Most of the time we can delay the DXA/VFA or lab tests by a month or 2 or even 6.  Prolia and Evenity should not be delayed.  Forteo and Tymlos usually arrive by mail for self injection.  Changing to a different medication could be another option.  Call your doc.

Jay Ginther, MD