Often one is told they have decreased bone mineralization (osteoporosis or osteopenia) on their bone density (DXA) and are told to come into the office to discuss the results. Here are some important points to go through with your physician to make sure to get the most out of your visit.
• The first thing that your doctor must do is to confirm the results. It is very important for your doctor to see the actual bone density study to make sure they agree with the reading. This is similar to reviewing the x-ray report and then personally viewing the films. Unfortunately, like other images, the results are often open to various interpretations, depending upon who observes the actual images. One must be careful that the person who reads the scan has adequate training and certification to ensure the interpretation is accurate.
• If the scan was performed at a site outside your physician’s office, it is very important to get a copy of the original pictures from the DXA to bring to your visit. These should be colored copies or originals. Most scans should not be copied or faxed, as the image quality is significantly degraded.
After confirmation of your diagnosis, it is important to see if there is a secondary cause behind your disease. This entails a complete history of your possible risk factors and secondary conditions.
• The primary risk factors include, gender, increased age, estrogen deficiency, white race, low weight and body mass index (BMI), family history of osteoporosis, smoking, and history of prior fracture.
• It is important for one to bring a list of all their current medications with them as well as a history of previous medications because they may be a cause of disease. These include, steroids, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, depo-medrol, anti-neoplastic agents, or cyclosporin,
• There are many secondary disease states responsible for osteoporosis. These include:
1. Endocrine disorders: Cushing's syndrome, thyrotoxicosis, hyperparathyroidism, hyperadrenocorticism and diabetes mellitus
2. Nutritional disorders: vitamin C deficiency, calcium or vitamin D deficiency
3. Genetic disorders: Osteogenesis Imperfecta, Marfan's syndrome, Ehlers-Danlose syndrome and Cystic fibrosis
4. Hypogonadal states: androgen insensitivity, anorexia nervosa/bulimia nervosa, female athlete triad, hyperprolactinemia, panhypopituitarism, and premature menopause
5. Inflammatory diseases: inflammatory bowel disease, ankylosing spondylitis and rheumatoid arthritis
6. Miscellaneous conditions: alcoholism, congestive heart failure, emphysema, end-stage renal disease, HIV/AIDS, immobility, multiple sclerosis and sarcoidosis.
One should obtain recent lab testing to bring to the visit to assist in the work up of these secondary causes.
If one has or has had any of these conditions, it is important for one’s physician to know this in order to better customize therapy for this potentially disabling disease.
• Finally, it is important to know what brand and dose of calcium one takes as well as a clear history of previous drug therapy for osteoporosis.
Published On: December 21, 2006