Osteoporosis is a common age-related metabolic bone disorder characterized by bone mineral loss and reduced bone strength, leading to an increased risk of bone fractures. It is a major public health threat for an estimated 44 million Americans.
In the U.S., nearly one of every two Caucasian or Asian women over age 50 will experience a broken bone due to osteoporosis. Men and women of other ethnic groups have a slightly lower, but still substantial fracture risk.1 It is also the cause of many disastrous consequences in terms of physical, psychological, social, and economic loss.
Overlooked and Undertreated
Even though there is a high general awareness of osteoporosis among patients and health care providers, it is overlooked and undertreated because there are no clinical symptoms until the initial fracture. There is a large gap between what is being spent on the management and treatment of osteoporotic fractures compared to diagnosis and prevention. It is crucial to diagnose osteoporosis early for timely prevention and treatment.
Considering a high percentage of chiropractic patients are older and suffering from various chronic disorders associated with bone loss (diabetes, hyperthyroidism, celiac disease, lupus and rheumatoid arthritis) and taking various medications, osteoporosis should be ruled out.
A majority of patients go to chiropractors for musculoskeletal issues.2 We are the experts for conservative management of bone and joint problems. We may be missing the opportunity to prevent and treat patients before that initial fracture.
Not every patient is aware they have osteoporosis, especially men; and not every postmenopausal woman gets a DEXA scan. The issue of medications causing bone loss is also often overlooked. Some patients have been taking medications for years that are contributing to their bone loss. How many of our patients are taking blood pressure medication, along with at least one other drug that can cause bone loss?
Drugs Associated With Bone Loss
The Limitations of Bone Mineral Density Screening: The DEXA Scan
Dual-energy X-ray absorptiometry (DEXA) has been the gold standard for bone mineral density since the World Health Organization established the criteria for osteopenia and osteoporosis in 1994. However, the DEXA scan isn't always the best choice:
Quantitative CT (QCT) calculates volumetric BMD (measured as milligrams per cubic centimeters) by using specialized software and a specialized BMD calibration phantom. QCT gives a more precise estimation of cancellous bone mineral density and is currently the clinical standard for volumetric BMD assessment.
Statistical studies suggest DEXA can miss 26-60 percent of patients with osteoporosis; and 11-18 percent of clinically osteoporotic patients can be categorized as normal.3 The DEXA scan is just a screening modality; however, QCT examinations are more expensive and result in higher radiation dose to patients.
Editor's Note: Complete references supporting the in-text citations accompany part 2 of this article, which discusses a simple screening solution for the issues discussed in pt. 1.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
