5. FRAX

It's all about fractures.  Osteoporsis means increased risk of broken bones.  A niece recently broke her arm when her ATV rolled.  I supposed if I had been there instead of her, I might have had several, more serious fractures.  But who's to say?

Well, FRAX says something.  FRAX is the Fracture Risk Assessment tool developed by WHO and British researchers in 2008, using large populations, linking known fractures with demographic and clinical data.  

I went to the FRAX website, entered the requested information, and came up with a prediction that within the next 10 years I have a  27% risk of a major osteoporotic fracture and 16% risk of a hip fracture.  

Not bad, that means this year I have a 1 out of 37 chance of a major fracture. Returning to the tool and plugging in a normal bone density result, I would have only a 1 out of 167 risk of a major fracture.  To be dramatic, my osteoporosis means almost a 500% increase in risk of a major fracture this year. 

But frankly, it's not so much the major fracture I'm worried about, but rather the insidious microfractures that I'll talk about in my next post.

4. Non-Compliance and Faith

A couple of headlines from the past few days:
     "NASCAR will not penalize teams with noncompliant roof flaps"
      and "Forty percent of miners' technical reports are non-compliant"

More than just not following recommendations, "non-compliance" suggests a serious breaking of rules or laws.

Doctors use non-compliance to describe patients who don't take their meds, or don't quit smoking or don't exercise or don't have lab tests done.  For some, the law-breaking insinuation of the term is distasteful and "nonadherent" has been suggested instead, but nonadherent has its own problems.

You can read that some 50% of patients do not take prescribed medications, not unexpected in the 70 year old on 5-10 meds, each with different schedule (morning or night; before or after meals, etc.).  But I just have a once weekly self-injection for arthritis, and a couple of daily supplements (calcium, vitamin D, omega-3 pill) and now the weekly alendronate.  

No big deal if I forget the supplements a couple times a week, but I forgot alendronate dose 2, taking it couple days late, and this morning forgot dose 3; we'll see if I take it tomorrow. No wonder that 30% of osteos on alendronate stop taking it within several months.  I don't and won't feel better taking it--same goes for blood pressure or cholesterol lowering meds, among others--I just take it on faith.

3. Primary Osteo

Many factors disrupt the active bone remodeling described in the previous post.  

Muscles attach to bones.  Pull the muscle hard enough and the bone also gets pulled. Specialized nerve receptor cells in the bones recognize these pulls and respond by stimulating osteoclast activity.  Ergo, bones become stronger (more dense) with weight-bearing exercise.  I don't have an answer why inactivity has the reverse effect (loss of bone density) but it does.

Steroids such as prednisone used by asthmatics, or recipients of organ transplants.  These steroids may keep calcium from reaching bones or may disrupt the osteoclast/osteoblast balance.  The body can overproduce it's own steroids, yielding the same results

Excessive alcohol use and smoking are associated with osteoporosis; alcohol because it inhibits calcium and vitamin D absorption and may directly kill osteoblasts; the smoking link is unclear, perhaps just because smokers are more likely to abuse alcohol and to have poor nutrition.

Too much parathyroid hormone, not enough thyroid hormone, any eating disorder (including the simple deficiency of calcium), and certain cancers and renal disease also increase the risk of osteoporosis. Decreased bone density attributed to one or more of these factors is labelled "Secondary Osteoporosis."

I tested negative for all known risk factors, so I have "Primary Osteoporosis," which means an as yet undiscovered factor, or an acceleration of the inevitable bone loss that occurs with aging, has led to my bone loss.