Posts Tagged ‘Vertebral Fracture’
Ann spends a week in Florida each winter with several friends¬†and was stronger, more agile and more confident this year than last. ¬†She stepped in and out of the hot-tub easily instead of slowly and awkwardly. ¬†She zoomed up and down stairs. ¬†She had to slow down when walking with her friends. ¬†What has happened?
A year ago she followed a fragility fracture with below average and decreasing BMD on DXA, and a newly crumbling vertebral fracture on VFA. ¬†She has Clinical Osteoporosis. ¬†That got her attention. ¬†She was determined to play¬†on the floor with her active preschool grandchildren. ¬†You cannot do that if you are crumbling. ¬†She was ready to do whatever it took to get back in the game.
She added Adora Chocolates (500mg calcium in each) to her usual diet. ¬†She added Protein shakes (chocolate) and increased intake of chicken, fish, and beef to meet¬†the new protein guidelines. ¬†She remembered to take extra Vitamin D3 and her Multiple Vitamins & Minerals almost every day.
She got serious about her “10,000 steps” every day and went up and down stairs frequently¬†instead of saving up things for a single trip. ¬†She did not actually join an exercise class as promised.
She started the anabolic, Forteo, to build her bone density and strength. ¬†A daily little shot is a nuisance, especially keeping it cold while travelling, but she wanted results.
This year repeat DXA showed increased BMD. ¬†VFA confirmed no further crumbling. ¬†She zoomed through airports and left her friends in the dust in Florida. ¬†These results have made her even more determined.
She has Taken Control of her Future Life. ¬†You can too.
Jay Ginther, MD
DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer.¬† DXA alone is less good at predicting Fracture Risk.¬† But, Fractures are¬†what we want to avoid.
At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy.¬† Vertebral Fracture Assessment (VFA) helps evaluate bone quality.¬† FRAX was specifically designed to predict Fracture Risk.¬† QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.
ISCD¬†will discuss adding ¬†TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT.¬† We are constantly pushing toward our goal – Prevent Fractures.
Preventing Fractures is not just DXA.¬† Get a Complete Bone Health Evaluation.
Take Control of your future. ¬†Check your bone health.
Jay Ginther, MD
Fractures get no respect. ¬†20% of women and over 30% of men over 65 die within 6 months of a Hip Fracture. ¬†But nobody is worried about hip fractures!
Hip Fracture is never mentioned on the death certificate. ¬†The complications of the hip fracture get all the credit. ¬†Pneumonia, pulmonary embolis (blood clots), worsening heart failure, kidney failure or even septicemia (infection in the blood stream) from bed sores might make the list, but not the initial event, the hip fracture.
Nearly 80% of Vertebral Fractures are mistaken for pulled muscles or arthritis in the back. ¬†Yet vertebral collapse fractures are a strong indicator of death within the year in men and women. ¬†Again, pneumonia, heart failure, respiratory failure (shortness of breath), malnutrition from inability to eat enough get the blame. ¬†The vertebral fractures and resulting kyphosis (humpback) never get credit for the misery and death they cause.
More women die each year from complications of fractures than from breast cancer or stroke or heart attack. ¬†Nobody seems to care, because the fracture itself is never blamed for the complications it causes.
If we identified the original fracture starting the rapid decline, we would be more concerned with bone health and fracture risk. ¬†As it is we ignore fracture risk at our peril, especially as we get older like me (60’s).
Respect Fracture Risk. ¬†Take Control of your future.
Jay Ginther, MD
Sometimes a person breaks a hip first, then they fall. ¬†This happens a lot more often than we realize. ¬†When the break is just below the ball of the hip, the fracture may have come before the fall. ¬†Moreover, that Fragility Fracture may have gradually developed over days or weeks.
How is it possible that a person does not realize that the hip is gradually crumbling? ¬†We call it a Stress Fracture when a crack gradually developes. ¬†Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. ¬†Why?
The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. ¬†The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007.¬† http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse ¬† Tiny cracks slowly developed in the steel until one day……..THUD!
How can you detect who is at high Hip Fracture Risk? ¬†A very low DXA T-score, especially in the spine, is a good indication. ¬†But DXA often fails¬†if the spine is already crumbling or has arthritis. ¬†A better indication is Vertebral Fracture Assessment (VFA). ¬†Looking at the spine from the side,¬†Vertebral Compression Deformities can¬†indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.
Know where you stand. ¬†Get a Complete Bone Health Evaluation. ¬†Take Control of your future.
Jay Ginther, MD