BMD, fracture, Krege, Nature, prediction

numbers, numbers….and the mysteries of the invisibility of spinal fractures

The last post looked at the scores on the scans.  These show how my bones compare to other women’s bones, both young and fit, and the same age and fit.  If everyone had great bones and never got osteoporosis, someone would still be the worst.  They don’t tell you anything about what the risk of fracture is by themselves.  I’d like to know if my spine already has the small wedge fractures that lead to dowager’s hump, but I can’t tell that from anything in the current data.

The hip figures are used in an easy to use calculator called FRAX, which you can use at this link site  You do need to have your hip bone mineral density to work this out.  Based on my score I have a very low risk of fracture in the next ten years, even if I add in the chronic malabsorption caused by my problems with gluten (family history of coeliac disease, don’t know if I have it or one of the other gluten sensitivities).    Action for me would be some general lifestyle advice about eating well, reducing risk of falls by tidying the house, changing style of shoes etc.   With that as the sole bit of data I’d probably stop skiing (which I hardly do anymore) and try to be a bit less chaotic around the house. I already wear very sensible lace-up shoes and never wander around in my socks.

Malabsorption problems like coeliac disease are important in considering bone health.  If you don’t absorb nutrients properly, eating well and exercising properly in the bone building years to thirty will not be as effective in giving you long lasting strong bones.  I had a quick look at some current trials on osteoporosis drugs currently recruiting in the UK, and they all  excluded subjects with malabsorption issues.

So, if the spinal figures are so much worse for me, how likely am I to have a future spinal fracture?  Hard to say…the simple figure says high risk, and that is why I am taking the drugs and trying to learn to move in a way which protects my spine.  One thing that even a small amount of reading tells me is that these spinal fractures are strange and odd things.  I’ll write about what happens shortly, but for the moment a piece of research on the importance of spine imaging for identifying vertebral fracture and for identifying people at high risk for fracture makes an interesting point.

” Among 947 subjects with morphometric vertebral fracture, 66 reported a history of vertebral fracture by questionnaire and 881 did not. Thus, 93% of subjects with a morphometric vertebral fracture were unaware of the fracture. Additionally, among a total of 84 subjects with a history of clinical vertebral fracture by questionnaire, 66 (79%) were found to have a vertebral fracture by morphometric analysis of radiographs, whereas 18 (21%) were found not to have a vertebral fracture.”

Fracture risk prediction: importance of age, BMD and spine fracture status

John H Krege, Xiaohai Wan, Brian C Lentle, Claudie Berger, Lisa Langsetmo, Jonathan D Adachi, Jerilynn C Prior, Alan Tenenhouse, Jacques P Brown, Nancy Kreiger, Wojciech P Olszynski, Robert G Josse, David Goltzman & on behalf of the CaMos Research Group)

What this shows is that people often don’t know if they have any spinal fractures.  That seems odd, but the individual bones in the spine are held in place by the other vertebrae, the ribs, other bits of tissue, and you can have a lot of fractures and still wander around getting on with life.  If you have ever seen those people, usually elderly women, who are out doing their shopping but walking along with a very bent back so they can only see the ground, they probably have spinal fractures that are visibly disabling but don’t prevent them from getting about.

I would like to know if I had spinal fractures already.  I’ve had years of back problems caused by my extremely pronating feet (flat feet) which I didn’t start correcting until my thirties, and I have used a programme of new prescription orthotics every year since then, combined with very controlling shoes (I found Ariat riding boots excellent, as the stiffness in place for the stirrups held my heel on the orthotics very well) and chiropractors and massage therapists helping to keep me aligned.  For the last six years or so it hasn’t mattered what podiatrist I have been to, I still can’t get rid of the neck pain, and the last two massage therapists I saw left me in pain for weeks.  Something has clearly changed.

It’s not a simple matter to know what state your spine is in.  You need access to complex imaging equipment, expert assessment of the images, and someone in the health system who decides you need to know.  It’s not like deciding to have a dental check up.  It is, of course, completely unnecessary to know if any of my spinal vertebrae are already showing compression fractures, but I’d like to see how the treatment and lifestyle choices I make now affect my spine over the next few decades.  A baseline measure would be good.


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