Monday, July 8, 2013

Osteoporosis Risk Factors...What do they tell us?

If you visit the IOF (International Osteoporosis Foundation) web site you will find a short test that can help to determine your risk for osteoporosis.

Most of you know by now that I was diagnosed with severe osteoporosis at age 45 and sustained 12 fragility fractures over the next 5 years. I'm now 59 and no longer fracturing but just out of curiosity I decided to take the test. I pretended that I was still 45 and had not started breaking yet. I just wanted to see if the test would tell me I was at risk.


It is called: "The NEW Interactive IOF One-Minute Osteoporosis Risk Test"


"Are you among the one in three women, and the one in five men over the age of 50 who will be affected by osteoporosis in their lifetimes?
Osteoporosis weakens bones and leads to fractures. It causes severe disability. But osteoporosis can be detected early. It can be treated.
If you knew something that could harm you was coming, wouldn't you avoid it?"

Now this sounds great...of course I would like to know of something harmful is coming my way. Who wouldn't, especially if things can be done to avoid it. The test began by first asking for my family history:

     Had either of my parents been diagnosed with osteoporosis or broken a bone in a minor fall?    No.

     Did either of my parents have a dowager’s hump?    No.

Then it asked for my personal clinical factors:

     Am I 40 years old or older?    Yes.

     Had I ever broken a bone in a minor fall as an adult?    No.   Other than a few broken bones from major impacts such as being slugged in the jaw and having my horse fall when I was jumping a 4 foot fence while traveling 20 mph, I had never sustained what would be called a low-impact or fragility fracture.

     Did I fall frequently?    No.

     Had I lost over an inch in height?     No.

     Was I underweight?    No. I weighed 153 pounds and was 5’11” when I was 45. (I still weigh the same.)

     Had I ever taken corticosteroids?     No.   In fact, I had never taken any medications.

     Did I have rheumatoid arthritis?    No.

     Did I have over-active thyroid or parathyroid glands?    No.

     Did I have impotence or low testosterone?    No.  I had my testosterone level tested several times and it was always above 700 (high normal).

Then the questionnaire went on to lifestyle factors:

     Did I drink alcohol?    No. I once drank 3 sips of a beer when I was about 20 years old. I was out at a ranch shoeing 5 horses and had forgotten to bring water. All the rancher had to offer me was a cold beer. It tasted terrible.

     Did I smoke?    No. When I was about 8 years old my dad forced me to smoke a Japanese cigarette he had acquired while serving in the Army during the Korean War. He figured it would make me so sick I would never want to smoke. I guess his tactic worked.

     Was my level of physical activity less than 30 minutes per day?”    No.  I began running, swimming, and riding horses at age 6 and never quit. I’ve trained for elite competition including the Olympic Games and Ironman triathlon competitions my whole life…and still do.

     Did I avoid milk or was I allergic to it?    No. I literally drank gallons of milk each week. I loved milk so much growing up that I remember having dreams of diving into a swimming pool filled with milk and being able to drink in as much as I wanted. We would go to the Hess farm each week and get 4 gallons of raw milk. I’ll never forget the first time I took a sip of pasteurized homogenized milk at the school cafeteria in 5th grade. Uggghhh…it tasted awful.

     Did I spend less than 10 minutes a day out side?    No.  I practically lived outside and still do.

When I completed the test it then said to "Print the summary." A window popped-up saying that I had answered yes to one question (that I was over 40). It said "This does not mean that you have osteoporosis. Positive answers simply mean that you have clinically proven risk factors which may lead to osteoporosis and fractures." It told me that I should print out the results of this test and show my physician or health care professional.

Hmmm.... That's 15 "noes" and 1 "yes." I would venture to say that about 99.9% of doctors would say that I had a very low risk for developing osteoporosis. I would also venture to say that with those test results none of them would be willing to write me a requisition for a bone density examination. Being a male, an Olympic athlete, only 45 years old and no history of fragility fractures...nope, none of them would. Yet it is at that age that I began to sustain multiple fragility fractures due to severe osteoporosis. I had a T-score of -4.3 of my spine.

Where does this leave us? What is the point of this blog? This test may have missed me...but hey, I'm only one guy. And who cares about "just one" guy...after all, we are trying to do what is best for our society as a whole here. The individual?...  So what's the big deal?
Not sure if I mentioned an article I read back in 2001 by Watts et al. It was published in Arthritis & Rheumatism (44:S56) and mentioned a study called the IMPACT trial. Of the participants in this study, 48% with osteoporosis had no risk factors and the 53% who did have risk factors did not have osteoporosis. My take...bone density exams are for everyone. And I'm all for having one between the ages of 40 - 45. 

I think the cost of a bone density exam these days is about $250.00....even if insurance doesn't pay for it, it's worth the peace of mind.




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