Posts Tagged ‘Vertebral Fracture’
Aunt Henrietta looked like half a raccoon with her entire left eye blackened. She dismissed her looks as not a problem saying, “I fall all the time, but I don’t break anything.” This is a change on both counts. Five years ago, falls were infrequent. Even so, she broke one wrist, then the other wrist, then her shoulder.
Two wrists, one shoulder, and half a dozen vertebral fragility fractures indicated Very Severe Osteoporosis. That was before she took the Anabolic, Forteo, for 2 years. She was the ideal patient for serious measures to stop her fractures. And it has worked!!
If you screen by DXA alone you fail to identify most of the individuals who will fracture. Over 80% of fracture patients over age 50 have “osteopenia” or “normal” as their Bone Mineral Density (BMD) test result on DXA. Wow! DXA is a terrible stand-alone test.
Previous fractures are a much more reliable screen. Any previous fracture predicts future fractures. The best predictors of fracture risk are Vertebral (spine) fractures, but there is a problem. Most vertebral “crumble” or even “crunch” fractures are not identified as fractures until you look for them. You must do Vertebral Fracture Assessment (VFA) to identify those persons who are at increased risk of fracture because they already have fractured.
This week a patient was delighted to know she had no bone worries – based on her t-score of -2.4 in her hips. Unfortunately she was very wrong! “Osteopenia” is just a single test result. Other factors placed her at High Risk for Fracture.
One test does not tell the whole story. For instance, my total cholesterol is “normal”. That means that I have no heart worries? Wrong! I have hypertension, type-2 diabetes, and a history of congestive heart failure. I am at risk for heart problems. My patient is at risk for bone problems, specifically Fragility Fractures.
Fracture Risk is much more than Bone Mineral Density (BMD) or t-score. Many medical conditions cause osteoporosis and fractures. Blood tests can detect those medical problems. This is the post on CMP.
Albumin is the major protein in the blood. A large portion of the calcium in the blood is bound to albumin. What is important is “free calcium”, so a mildly low calcium combined with a low albumin is less of a problem for heart and nerves. However, a low albumin generally means poor nutrition, especially too little protein intake, and protein is the major component of bone, so too little protein is a problem.