Posts Tagged ‘Vertebral Fracture’

“Treat to Target” and “Use VFA” in 2017

April 23, 2017 @ 8:50 pm
posted by Dr Ginther

Clinical Osteoporosis 2017, NOF and ISCD joint meeting had a different emphasis this year.  Fracture Risk, rather than Bone Mineral Density (BMD) is now the key metric.  Several speakers emphasizd the importance of VFA in making the diagnosis of Clinical Osteoporosis.  This is something I have presented in poster exhibits 2015, 2016 and 2017.  I am now mainstream!

“Treat to Target” was the big new message this year.  We should set a target of decreased Fracture Risk for each patient and alter treatment until we reach it.  This has been routine for years in diabetes, hypertension, cholesterol, etc.  This is recognition that Osteoporosis is a chronic disease that we can control, but never cure, just like many others.

Take Control Naturally is the necessary first step, as I have outlined over the last few months.  This is often sufficient for prevention and in mild disease.

Advanced Osteoporosis, especially after fragility fractures, or vertebral compression fractures seen on VFA, is usually beyond nutrition and exercise only.  This will usually require medications to significantly reduce fracture risk.

The huge change is the recommendation to use an Anabolic medication first, to markedly reduce fracture risk, when BMD is very low or multiple fractures have already occured.  Then follow up with an Antiresorptive to maintain a low fracture risk.  Traditionally Medicare and other insurances have demanded we try Antiresorptives first to maintain bone as it is, even when multiple fractures have proven the bone to NOT be good enough at curent BMD.

We are entering a new age of Fracture Prevention!!

Jay Ginther, MD

NOF & ISCD at “Clinical Osteoporosis 2017”

April 17, 2017 @ 5:24 pm
posted by Dr Ginther

The National Osteoporosis Foundation (NOF) and the International Society for Clinical Densitometry (ISCD) are meeting together later this week.  This will be my 10th attendance at each group.  They are both always interesting.

I will be presenting a new research project this year – “Vertebral Compression Deformities in Patients with Normal Bone Mineral Density”.

This is a further study of the 79 patients with Normal BMD by DXA alone, who were changed to Clinical Osteoporosis because of vertebral compression fractures found on VFA from last year’s study of 1259 consecutive patients with first-time VFA at our facility.

I look forward to seeing what else is new this year.

Jay Ginther, MD

Adding VFA to DXA

January 9, 2017 @ 12:14 pm
posted by Dr Ginther

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