Yesterday I attended the Wisconsin Osteoporosis Symposium: “The Bare Bones of Osteoporosis Care”. This was an excellent overview of all aspects of diagnosis and treatment presented by by a dozen specialists in different fields which deal with osteoporosis. Hardly the bare bones, it was fully fleshed out. Evaluation and treatment of the whole person is the key to all medical issues. We learned to evaluate the whole person.
We started by moving beyond DXA and BMD alone to FRAX. FRAX estimates Fracture Risk. Fracture Risk is what we really need to identify and treat. We discussed the compounding effect of prior fractures and falls, which can be underestimated by FRAX when multiple or severe. A new calculator named Garvan addresses this issue. This was one of several new things I learned at this meeting.
Fall prevention is very important if we are to avoid fractures. If a person is falling frequently, the causes must be identified and treated to the extent possible. Many medications for blood pressure, etc may increase fall risk in the first few weeks unless the patient is very careful. Physical Therapy teaching balance and strengthening exercises is often very helpful, but often NOT considered medically necessary by Medicare and others.
Perhaps as many as half of all osteoporosis patients have a condition other than simple “old age osteoporosis” contributing to their condition. We spent considerable time going over various causes of “secondary osteoporosis” and learning how to identify and treat them.
We discussed the absolute necessity of each person having enough Calcium and vitamin D actually absorbed from diet and supplements.
Finally, we discussed the risk to reward ratio of going without medications or taking medications. This needs to be individualized for each person. When Fracture Risk can be kept low with proper nutrition, balance and strengthening, no further measures are needed. When Fracture Risk is high, there is usually a medication which can help.
Jay Ginther, MD
11 June 2011