Newsletters

Winter 2006

News Flash: Osteoporosis is Not Always What it Seems to Be

One of the great challenges of modern medicine is deciphering the huge amounts of data that rapidly accumulates to discover what is important and what is not. There is a bit of Sherlock Holmes in all of us, and physicians get a special joy in solving mysteries in order to help their patients.

Osteoporosis is a disease that can be diagnosed in two ways. One is called a “clinical diagnosis.” This is done after a bone breaks under circumstances where this should not have happened, as when a bone in the spine breaks (fractures) after lifting a bag of groceries. A better way is to make a “densitometric diagnosis.” That can be done before the first fracture occurs when a bone mineral density (BMD) test shows a “Tscore” that is –2.5 or less. This suggests that the bones are fragile and susceptible to fracture, and medication may help to strengthen the bones and reduce the risk of
fracture.

So where is the mystery? There is no challenge to this, you say. Here is the rub: Some patients with a T-score of –2.5 or less do not have osteoporosis, and some patients with better T-scores do have osteoporosis. It sometimes requires some extra effort to unravel all of this and find the treatment that is going to work the best.

Want some examples? The T-score may look like osteoporosis when there is really a localized bone disease, such as a bone cyst, bone cancer, or bone infection that needs to be treated very differently. Osteomalacia is a disease where low BMD is usually due to severe vitamin D deficiency. Treatments for osteoporosis in this situation may actually be dangerous if the vitamin D deficiency is not corrected first. On the flip side of the coin, many patients with a T-score better than –2.5 may be at high risk for fracture and need to be treated with osteoporosis medications.

For better or for worse, modern medicine cannot be practiced just by the “numbers.” A good medical detective will select the right information from all that is available, and use this to make the best possible decisions to improve your health and prevent future problems.