Posts Tagged ‘VFA’
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
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
So how do you find out what aspects of your bone health are pretty good already, what will be easy to fix, and what will take some real work? Start with a Complete Bone Health Evaluation.
DXA is about 1/3 of the story and should include both hips and spine. When you are as old as I am, the spine probably is too arthritic to be really accurate, but helps complete the picture. If you have had a total hip replacement, you should use the non-dominant forearm.
VFA will pick up many persons at increased fracture risk who are missed by DXA alone. You should ask for VFA, especially if you or a parent have kyphosis (humpback) or have lost height.
The FRAX calculation picks up different individuals at high fracture risk.
Blood tests should include CBC, CMP, TSH, PTH, and 25-hydroxy Vitamin D as a start. Further testing may be needed.
A medical history and examination focused on bone issues is a critical part of the full consultation. We allot a minimum of 30 minutes for discussion. Often a follow-up visit is needed to be sure both we and our patients are clear on the whole picture.
DXA alone misses over half of the individuals who need to improve their bone health. Get a Complete Bone Health Evaluation.
Jay Ginther, MD
True in the 1960’s – even more true today. We expect to live into our 80’ and 90’s. We expect to enjoy those extra years. We can, with a little planning and action NOW.
If YOU don’t take care of your body, where ARE you going to live? That is the real question. Women start to rapidly lose bone at Menopause. This is totally natural and used to be unavoidable. Without action on your part, you could develop Clinical Osteoporosis and Fractures and wind up in a nursing home. You can avoid these complications of natural aging.
Cedar Valley Bone Health Institute of Iowa offers a Complete Bone Health Evaluation. DXA, VFA, specific blood tests not usually done in annual check-ups, full history, an examination and full consultation usually take 30 minutes focused on bone health alone. We can Prevent Osteoporosis if we start early enough. Prevention is far better than treatment, and ideally should start decades before menopause.
You must be prepared to Take Control of those issues you can control: Calcium, Vitamin D, Protein, Vitamins & Minerals, and Exercises for Balance, Strengthening and Posture. Everyone should do these Natural measures for best results, whether taking Osteoporosis Medications or not. For younger persons and for some individuals over 50, they are enough all by themselves.
More next time about how YOU can Take Control of your future.
Jay Ginther, MD