Posts Tagged ‘kyphosis’
Vertebral Compression Fractures are often not recognized as anything more than a seriously pulled muscle. I personally made that mistake 30+ years ago. Only when I was tested on our new DXA machine which made Vertebral Fracture Assessment (VFA) easy to obtain, did I recognize that I had actually suffered a 30% compression fracture. Oops.
We do VFA on every patient we evaluate. VFA added to DXA improves accuracy in assessing bone health. I have published the largest single center, single provider study of 1259 patients comparing DXA alone to DXA + VFA in Endocrine Practice 2017:23:1375-8. We use our DXA machine because it is quick and easy. Lateral Spine X-rays also work.
NOF has an excellent summary of VFA and vertebral fractures at https://cdn.nof.org/wp-content/uploads/2017/04/Vertebral-Fractures-BONE-BASICS.pdf
If you are losing height or are developing a humped back (kyphosis) or simply want a more complete evaluation, ask for a VFA along with your DXA. Know more, do more to prevent more Vertebral Compression Fractures.
Jay Ginther, MD
Treat to Target of NO NEW FRACTURES. How do we find that target? DXA >-2.5 is a start. Fragility fractures increase new fracture risk. FRAX adds many more risk factors to the calculation and TBS refines FRAX.
Vertebral Fracture Assessment (VFA) looks at the spine from the side and independently identifies additional fracture risk. This can be done on a DXA machine or by x-ray. A single vertebral compression fracture of 25% or more pre-empts DXA, BMD, and FRAX in diagnosing Clinical Osteoporosis and recommending treatment.
VFA should be done because the majority of vertebral compression fractures are first noticed by x-ray or DXA VFA imaging. If you do not personally view the images, be sure the radiologist specifically checked for vertebral deformities as described by Genant.
I recently published my retrospective review of 1259 sequential first time VFA patients in Endocrine Practice 2017:23:1375-8.
VFA identified many patients not identified as high fracture risk (Clinical Osteoporosis) by DXA or fragility fracture or height loss or kyphosis or FRAX.
We should consider including VFA in every first time Complete Bone Health Evaluation.
And how should we treat? Next time…
Jay Ginther, MD
“I want to treat my bone health entirely naturally – without any “artificial” medications.” That might be possible if you are among the less than half of all women not destined to suffer one or more fragility fractures without medication. Your odds are certainly better if you take all the measures outlined over the past weeks.
Years ago Osteoporosis was rarely a problem. 100 years ago most people died before age 65. 200 years ago most people died before age 40. We live too long to avoid the natural decline in bone health. (I would rather live long and deal with medications).
When I was in medical school (45 years ago) we lived entirely naturally in terms of bone health. Most woman, and some men, became stooped forward with “humpback” kyphosis until they fell, broke a hip and either died or were shipped to a nursing home forever. There was nothing we could do to prevent that.
Now we know a bunch of natural things we can do to postpone that scenario, but we cannot prevent it entirely in many people without adding medication. Adding medication may be “cheating”, but I would rather stay active and enjoy life.
Take Control Naturally as long as you can, but evaluate your bone health periodically and add osteoporosis medication when your fracture risk rises.
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