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Osteoporosis Deserves a Work-up

January 28, 2002

When patterns of bone density are understood as a record of each individual unique physiology and metabolism, and a means to evaluate the individual has been developed, it becomes quite clear that osteoporosis deserves a work up. There is a trend within health care to over rely on screening tests as a means to evaluate risk. Bone density is one such risk factor, and treatments have been established to reduce fractures when studied at the population level. Here the use of DEXA scanning for bone density has been established as a risk factor for fracture, and there has been some question as to whether any thing more needs to be known.

Here’s the rub: the treatments used are not equally effective for each person. If each person is to receive the maximum benefit possible for them, it is imperative to know why their bone has been produced in the pattern measured by the DXA (dual energy x-ray densitometry). This then allows for an individually tailored plan of treatment. When it is realized that the bone density pattern is also a reflection of other aspects of health, not just fracture risk, the need to appreciate its meaning is even more apparent. When we have to choose between a screen and treat approach as opposed to a metabolic work-up to more fully define the significance of individualized application of treatments, it seems clear that for the individual - osteoporosis deserves a work-up.

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