Archive for March, 2013
In nature, green things are springing from the dead earth. Jews celebrate Passover, the rebirth of the Jewish people as a nation instead of laborers in Egypt. Christians celebrate Easter, and Jesus rising from death. Other religions have similar festivals of rebirth and renewal.
“The Blue Zones” and “Thrive” both documented that religious beliefs and practices are associated with longer and happier lives. Whether people focus on Jehovah, God, Christ, Allah, Vishnu, Buddha, or another human explanation of the devine is apparently less important than the fact that they do believe and lead their lives accordingly.
Faced with a multi-hour “weather delay” Sunday returning from the ISCD meeting in Florida, I wandered through the airport bookstore looking for something interesting. My brain was full of information from the presentations, so I wanted something easy to read and fun. I found the latest book by Gavin Menzies.
“1421: the year China discovered America” was his first book. He assembled evidence that the Chinese had circumnavigated the world in 1421-24, charting the Straits of Magellan. His next book “1434: the year the magnificent Chinese fleet sailed to Italy and ignited the Renaissance” tells of knowledge brought to Italy (including maps showing the Americas) well before 1492.
Vertebral Fracture Assessment (VFA) identifies many persons with Clinical Osteoporosis who are missed by DXA testing alone. How many? I reviewed my first 941 patients to have VFA with their DXA (Feb 2010 – Sept 2012). I was amazed.
25% of the total had at least one Genant grade 2 or 3 Vertebral Deformity on VFA but were not identified as Osteoporosis by DXA. This is Clinical Osteoporosis missed by DXA alone in 25% of my total patients.
The vertebrae (bones in the spine) can gradually crumble or suddenly crunch. The resulting minor ache is often mistaken for arthritis or a pulled muscle. Gradual crumbles are “morphometric” (detected by x-ray) fractures, and just as valid as “clinical” (recognized) fractures in predicting Fracture Risk and future fractures.
Vertebral Fracture Assessment (VFA) looks at the spine from the side with a DXA machine or a standard x-ray. Each vertebra is evaluated for wedging (crunching or crumbling in the front) or biconcave deformity (from the discs punching in the center of the vertebra from top and bottom). A single vertebral deformity by 25% or more diagnoses “Clinical Osteoporosis” pre-empting DXA, BMD, and FRAX. VFA is an additional standard for assessing Fracture Risk.
VFA requires a human to look at each vertebra from T4 through L4 for deformity. VFA by DXA machine requires 2 more pictures than the 3 standard DXA pictures. VFA is a different technology from DXA and is not part of a basic DXA report. VFA is additional information that supplements DXA.
Humpback deformity in a patient is a strong hint that VFA will probably find multiple vertebral wedge compression fracture deformities. Wedge deformities can often be suspected by finding humpback (kyphosis). But multiple biconcave compression fracture deformities can hide in a patient with a straight spine. VFA is usually required to find biconcave deformities. VFA needs to be part of a Complete Bone Health Evaluation to fully assess fracture risk.
Last time we discussed DXA. Today we discussed VFA. Thursday we discuss what I discovered by combining the two in a Complete Bone Health Evaluation on every patient.
Jay Ginther, MD