Thursday, May 28, 2015

Do You Know Your Level of Risk?

May is Osteoporosis Awareness and Prevention month ~ Do You Know Your Level of Risk?
It is my opinion that every woman and man should have a bone density examination (dual-energy x-ray absorptiometry or DXA) between the ages of 40 and 45...even if there are no risk factors for osteoporosis. THAT is a bold statement considering the National Osteoporosis Foundation (NOF) and the U.S. Preventive Services Task Force (USPSTF) only recommend osteoporosis screening with DXA for women 65 years and older, and for men over 70. (Earlier for both groups if risk factors are present.) (Risk factors are such things as family history of osteoporosis, weight under 127 pounds, history of smoking or excessive alcohol consumption, poor diet, etc.) So why would I go so much against the grain and recommend such an early screening? 

My recommendation comes not just from my own tussle with this disease but also from clinical experience. My personal story (which many of you are already aware of) is that I had no risk factors for osteoporosis but was diagnosed at age 45 with severe bone loss. It wasn't an examination of any kind that alerted me to my "silent" was just that I began to...crumble. (I had a -4.3 T score of the spine and suffered 12 fragility fractures over a five year period.) I REALLY wish I would have had a DXA scan 5 years earlier. Maybe all those fractures could have been avoided. In the clinical setting, I see quite a few patients in my office under the age of 50 with osteoporosis. How did they find out they had weak bones? Well, initially it wasn't because they had a safe, non-invasive, in-expensive procedure (DXA) was because they broke a bone doing...well...not much...

Here are some facts that will make the reasoning for my recommendation more clear: 
1) 48% of patients with osteoporosis have no risk factors (Watts, N.B., et al. 2001)
2) 10 million Americans have osteoporosis
3) 50% of women and 20% of men will sustain an osteoporosis-related fracture
4) There is a 24% increase in mortality rate within 12 months of a hip fracture
5) There are over 1,200,000 osteoporosis-related fractures each year
6) Retaining bone density is WAY easier than regaining it once lost.
7) Bone density exams are inexpensive and radiation exposure is minimal. 

A recent review (Amarnath, A.L. et al., 2015) published in the Journal of General Internal Medicine determined that too few women are getting bone density scans. Researchers examined the medical records of 51,000 women aged 40 to 85 living in California and determined that only 57.8% of women aged 65 - 74 and 42.7% of women over age 75 received DXA screenings. Even with women age 60 to 64 with at least one risk factor, only 58.8% had a DXA. The researchers concluded that DXA screening is being underutilized.

My plea to you is to MAKE SURE YOU AND ALL YOUR FRIENDS AND FAMILY get DXA scans. If you can’t convince your doctor to order it at age 40 or 45 then please, at least by age 50...women and men...whether or not there are any risk factors for osteoporosis.

Fractures can dramatically impact your life. Fractures of the spine can cause pain, reduced mobility, thoracic kyphosis (Dowagers hump), and reduced lung and heart function. Hip fractures are typically repaired through surgery and when a partial or total hip replacement is performed on an osteoporotic hip there is much greater risk of failure. The more osteoporotic a person is, the more risk of complications (hip dislocations, inflammation and loosening of the implant, infections, blood clots, etc.) from the surgery. Couple this risk with the possibility of faulty implants such as the Stryker-Rejuvenate device that was pulled off the market in 2012 and the Zimmer Persona knee replacement device that just had a piece of it (the trabecular metal tibial plate) recalled this February, and there is considerable cause for concern. Osteoporosis is a major pubic health problem; PREVENTION of osteoporosis is the way to go.

With May being Osteoporosis Awareness and Prevention Month please help us get the word out to friends, family, colleagues - to anyone who will listen. It is important to find out early if bone loss is present because some day it may dramatically impact the quality of a person's life. We have compiled a great deal of information on risk factors over the last few years. Many of these factors can be reduced by individual action, and those that cannot be reduced through lifestyle changes can be lessened by taking measures to increase bone health. The key is knowing your level of risk and making a plan.

To find out more about osteoporosis and how it can be approached naturally through changes in life style and diet, strategic exercise, and supplemental nutrition go to  
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