Hip fractures kill and cripple far too many elderly women and men. Every year roughly 350,000 people in the U.S. shatter their hips and end up in the hospital, where more than 14,000 of them die. Another 24 percent die within a year of the injury; half lose their ability to walk. Most of these fractures, which cost about $17 billion in medical care annually, result from a withering of the skeleton known as osteoporosis.
Physicians have long used x-rays to estimate the density of bone minerals—a rough indicator of bone strength. In 2011 the influential U.S. Preventive Services Task Force, which sets testing standards that Medicare and other health insurers tend to follow, began urging all women to get an enhanced x-ray—known as a DXA (dual-energy x-ray absorptiometry) scan—of the hip or lower spine to check for small fractures or worn spots at age 65. The National Osteoporosis Foundation suggests that all men have the same screening scan by age 70.
Although everyone benefits from such baseline bone scans, most healthy people do not need screens every two years. “Repeat bone density testing has been oversold as a screening tool,” says Steven R. Cummings, a bone researcher at the University of California, San Francisco. Evidence shows many doctors focus too narrowly on reduced bone density, particularly in younger women, confusing one sign of osteoporosis risk with the disease itself. A better measure of skeletal health, Cummings suggests, puts bone density in a broader context, taking into account smoking status, drug interactions and history of prior fractures. Together these factors more accurately predict the risk of serious bone breaks, offering a better a guide to who should start taking fracture-preventing drugs and who should not.
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Add Comment... "in a group of people with the same bone mineral density, some got fractures and others didn't"
Reply | Report Abuse | Link to thisAny ideas as to the actual causal mechanism for fracturing? Could there be some sort of micro-crack development due to abnormal osteoclast/osteoblast functions, thus allowing the creation of stress concentrations? Stress concentrations are geometrical anomalies, such as sharp corners, cracks, etc. which can cause a multiplication, or increase, of the otherwise normal stress levels within a structural member.
Evidence is conflicting regarding the Calcium supplements as a preventive measure for Osteoporosis, some point to increased cardiovascular events with Ca, recent work indicates that this would be negligible, benefits clearly overcoming any risk, but for sure it has been shown that as more hours you're standing, and also exercising, the higher the increases in your hip's bone density and the bigger the decreases of your chances of suffering a hip fracture is, hip fractures that are probably more dangerous than the vertebral fractures that usually induce only pain. Vitamin D supplements have also beneficial effects in other health issues, and as a matter of curiosity, there's even work pointing that the only intervention, at least in the elderly, that will improve overall health would be weekly Vitamin D supplements, every day dosing being less efficacious, and dosing with a longer time span from one to the other, specially once a year dosing, would be even detrimental.
Reply | Report Abuse | Link to thisIs wrist DXA the best approach for checking Bone Mineral Density or not?
Reply | Report Abuse | Link to thisI am a 60-year old male. I have osteoporosis, but I have never had a fracture.
Reply | Report Abuse | Link to thisI could tell that something was wrong, so I asked two different primary care physicians if I could have a DXA scan. They both said, "No. You have no risk factors". Finally a third physician agreed with me and ordered the test. The results showed osteoporosis of the lumbar spine and osteopenia of the hip and femoral neck. I was 58 at that time.
In my opinion, everyone (both male and female) should have a baseline DXA scan at age 50 (the same as is recommended for a colonoscopy). The first sign of osteoporosis should never be a fragility fracture.