Assessing & Treating Bone Loss #4
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:
Get Hip:
You need to look carefully at total hip and femoral neck density. “The femoral neck will actually give you the cleanest and best BMD numbers.” Dr. Vargo said. The three key measurement sites are the lumbar spine, total hip and femoral neck, and you should make your treatment decisions based on the lowest, not the highest score.
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/
Showing posts with label Treating Bone Loss;. Show all posts
Showing posts with label Treating Bone Loss;. Show all posts
Thursday, January 27, 2011
Tuesday, January 25, 2011
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/
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/
Monday, January 24, 2011
Assessing & Treating Bone Loss #1
Assessing & Treating Bone Loss: Seven Tips For Improving Outcomes
Because of its very slow and insidious nature, osteoporosis is challenging to evaluate. Bone loss begins years if not decades before patients suffer fractures. Yet long-term daily drug therapy carries significant risk of side effects, a big price tag, and major compliance challenges.
The key is to determine early on who is at greatest risk for fracture, and who truly needs intensive therapy. “We’re all concerned about long-term use of bisphosphonates. The questions are, who really needs them, who does not, and when to stop therapy once it’s begun?” said Jill Vargo, MD, Co-Director of the Asheville Arthritis & Osteoporosis Center.
Speaking at the annual winter meeting of the North Carolina Academy of Family Physicians, Dr. Vargo said these are important questions given that an estimated 34 million Americans have low bone mineral density (BMD) of the hip, and there are roughly 300,000 hip fractures annually. That number is going to soar in the next decade, as the population ages.
In general, anyone at risk for osteoporosis and bone fractures should:
--Take Vitamin D (and Calcium) Daily: Aim for serum vitamin D levels of 50 ng/ml. For most patients that means 1,000-2,000 IU per day.
--Engage in Regular Weight-Bearing Exercise: Not only does it strengthen bone and muscle, it also improves coordination and balance. Exercise need not be strenuous or intensive, just frequent and enjoyable.
--Get Involved in a Fall Prevention Program: It is not osteoporosis itself that disables someone, it is the falls and fractures. Patients and their families need to learn how to minimize fall risk.
--Avoid Alcohol & Tobacco: Smoking accelerates bone loss, to say nothing of its other health compromising effects. Heavy alcohol intake can impair balance, coordination and reflex speed, increasing risk of falls.
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/
Because of its very slow and insidious nature, osteoporosis is challenging to evaluate. Bone loss begins years if not decades before patients suffer fractures. Yet long-term daily drug therapy carries significant risk of side effects, a big price tag, and major compliance challenges.
The key is to determine early on who is at greatest risk for fracture, and who truly needs intensive therapy. “We’re all concerned about long-term use of bisphosphonates. The questions are, who really needs them, who does not, and when to stop therapy once it’s begun?” said Jill Vargo, MD, Co-Director of the Asheville Arthritis & Osteoporosis Center.
Speaking at the annual winter meeting of the North Carolina Academy of Family Physicians, Dr. Vargo said these are important questions given that an estimated 34 million Americans have low bone mineral density (BMD) of the hip, and there are roughly 300,000 hip fractures annually. That number is going to soar in the next decade, as the population ages.
In general, anyone at risk for osteoporosis and bone fractures should:
--Take Vitamin D (and Calcium) Daily: Aim for serum vitamin D levels of 50 ng/ml. For most patients that means 1,000-2,000 IU per day.
--Engage in Regular Weight-Bearing Exercise: Not only does it strengthen bone and muscle, it also improves coordination and balance. Exercise need not be strenuous or intensive, just frequent and enjoyable.
--Get Involved in a Fall Prevention Program: It is not osteoporosis itself that disables someone, it is the falls and fractures. Patients and their families need to learn how to minimize fall risk.
--Avoid Alcohol & Tobacco: Smoking accelerates bone loss, to say nothing of its other health compromising effects. Heavy alcohol intake can impair balance, coordination and reflex speed, increasing risk of falls.
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/
Subscribe to:
Posts (Atom)
