Recently, while I was touring around the country talking all things Acid Base (!), I spent a bit of time talking to practitioners about the limitations of our current protocols and assessment tools for detecting ‘Bad Bones’. I was surrounded by a sea of nodding heads and when I offered a solution in the form of additional bone health markers, I could see light bulbs going on all over the room
We all appreciate that osteoporosis develops over a lifetime not overnight, yet the current screening recommendation in most countries suggests that women at the ripe old age of > 65yrs and men >70yrs undergo their FIRST (!) BMD scan! The only exception to this rule is that they recommend an earlier scan in those individuals at high risk…ahem….does anyone here not have their hand up??
Trouble with this practice, and with all bony insights being left to the BMD DXA scan is that by the time this investigation is deemed to be worthwhile, the horse has usually long ago bolted and we are faced with a big red FAIL on our very first sitting of the test.
But if bone demineralisation starts decades before the BMD scan can detect & diagnose anything, surely there are more sensitive tools we could employ in younger patients to get an early warning, providing us with an opportunity for true preventative health care?? Well wouldn’t you know it…there are and some of these are already sitting there in your patients’ pathology results like ALP and phosphate..you just have to know how to read them!
ALP and phosphate are the least specific of these additional bone health markers, but they still fulfill a useful role by jumping up when something is wrong, with the effect of yelling, ‘Hey – look over here! You should take a closer look at this patient’s bone health!’. The collagen peptides (CTx and NTx) are much more specific, quantifying the amount of resorptive activity taking place in your bones right now.
Sounds so amazing that these must be new and expensive and hard to access tests right? Wrong! CTx and NTx testing is available through the major mainstream labs in Australia and can be subsidised under Medicare under certain circumstances. So why aren’t they being performed more often in our higher risk patients? The main issue seems to be the lack of familiarity GPs and other health professionals have with them.
Well, now at least you know ;)…pass it on!
Want to learn more about how to read these additional bone markers and uncover unhealthy bones earlier in your clients? You can download the most recent Update in Under 30 recording here
Rachel is on a mission to stop the late diagnosis of osteoporosis in patients and as part of this reminds us that this is a condition that develops over a lifetime not overnight – so waiting until women are 65yrs and men are 70yrs (which is the standard recommended age for BMD screening) seems a little remiss in terms of identifying our opportunity for preventative medicine. Are there earlier warning signs that we are ignoring or specific tests more sensitive and accessible than DXA scans that we could be ordering to better monitor patients who are at higher risk of bone demineralisation. The answers are of course, yes and yes! This Update in Under 30 outlines the clinical tools we should be using to uncover unhealthy bones earlier in our patients, how to implement them, their limitations and their strengths.