Assessing & Treating Bone Loss #2

Assessing & Treating Bone Loss: Seven Tips For Improving Outcomes

Here are a few evaluation and management tips that Dr. Vargo & her colleagues have gathered over their years of practice focused on osteoporosis:

Test Early, Test Repeatedly:

DEXA is still the gold standard method for evaluating BMD. Qualitative Computed Tomography (QCT) may be better, but it involves a hefty dose of radiation, and it is still too costly for widespread use.

As a rule, get central (hip & spine) DEXAs on all women aged 65 years or more, and all men from age 70 and over. Bear in mind that women tend to lose BMD at the fastest rate in the 3-5 years after menopause, so it makes sense to test peri-menopausal women, especially if they have significant osteoporosis risk factors (family history, recent fracture, taking bone-depleting medications, etc). Likewise, start getting DEXAs on men over 50 if they have high-risk profiles.

Since bone loss is gradual but progressive, one DEXA by itself really does not tell you much. The true picture emerges with repeated scans. Generally, intervals of 2-3 years make sense, unless there’s a specific change in a patient’s life (ie, he or she starts a course of steroids or other bone-depleting drug).

Anyone already on a bisphosphonate or some other bone-building therapy should be re-tested every couple of years, to determine if treatment is having any impact. If there are no significant improvements after 5 or 6 years, despite diligent compliance, you need to re-think your treatment strategy.

Urine n-teleopeptide, a marker of bone turnover and osteoclast activity, is not diagnostic but it is useful for figuring out who’s losing bone rapidly. It is also good for monitoring treatment response. “I get this test for all people who have been on a drug for 5 years or more. If the number is over 7 despite continuous treatment, I stop the drug.”

https://holisticprimarycare.net/topics/topics-h-n/healthy-aging/954-assessing-a-treating-bone-loss-seven-tips-for-improving-outcomes

http://www.depsyl.com

http://back2basicnutrition.com/

http://bionutritionalresearch.olhblogspace.com/