Fracture Risk!!!!!!!! Not DXA Alone

September 20, 2013 Leave your thoughts

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. 

I am an orthopedic surgeon.  I know about Fracture Risk.  Bone Mineral Density (BMD) by DXA is only one factor in assessing bone health and fracture risk.  That’s why a Complete Bone Health Evaluation is needed if you want to know your true fracture risk and how to decrease it.

My patient’s Vertebral Fracture Assessment (VFA) showed several Vertebral Compression Fractures.  She has already fractured although she doesn’t know it!  Her Calcium and Vitamin D3 intakes were minimal.  I expect a low 25-hydroxy Vit D level and a high PTH (Secondary Hyperparathyroidism).  And she is old enough that age is a factor.  She has Clinical Osteoporosis = High Fracture Risk.

DXA, BMD, and t-score alone are terrible at predicting who will fracture.  85% of the patients who fracture have “osteopenia” or “normal” DXA test results.  They thought they were safe.

You can AVOID Fractures by getting the whole picture, then acting to correct individual issues.

Jay Ginther, MD

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