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hi all,
i'm currently reading the myth of osteoporosis and gaining a lot of insight into the medical establishment as a whole. apparently, bone quality is an important indicator for bone fracture...maybe even more important than quantity (density as measure by dexa). does anyone know of any test or measure to assess bone quality???? thanks linda
Linda,
I've read the book too, and think it's good you're asking to see if any new testing has been developed. I recall the book was dated around 2002. I'm planning to see a specialist next month and may bring that little book along. Have highlighted some of the info about the bisphosphonates. I've been on alendronate for a year and the book has made me nervous about side effects and long term residual effects on bone regeneration.
Tom
As far as I've read, there is no widely-available, non-invasive test for bone quality. Bone density is responsible for 60-80% of bone strength and is therefore still important. The only test for bone quality would be a bone biopsy and I would doubt that you could get it covered by insurance and I'm not sure how much information you would get anyway. Your doctor could tell you more about bone biopsy.
Just last week, I was told by a nurse practitioner that the only way to determine the bone quality is to actually take a look at the bone (she didn't mention a biopsy.) The idea of letting someone actually dissect one of my bones is not attractive, needless to say. This topic really interests me, though, because as I've indicated in other postings, due to side effects of drugs prescribed for one reason or another, I've had several incidents of completely losing my balance and suffering bad falls -- out of bed, down stairs, plunging out of a hotel shower (and landing at my astonished husband's feet), and collapsing on concrete on my way into a store. (Needless to say, I don't take any of those drugs any more!) Despite these mishaps, I've yet to suffer a single fracture. Maybe my bones are made of rubber?
There is a new non-invasive test to determine bone quality currently being tested out in 4 centers around the country. As such, it is not available for general use yet. With the current health environment in our country--increasing need with declining re-imbursement--I don't know if it will ever be widely available. Until then, we really don't know what is going on inside our bones.
There are people with severe osteoporosis who don't fracture and people with osteopenia who do. This is where bone quality, not just bone density, makes the difference.
Practicing back strengthening exercises, balance, and good body mechanics, along with other interventions, should help prevent falls and fractures.
There is also a 3D bone scan (DEXA is 2D) but it isn't widely available and exposes you to much mroe radiation than a DEXA. I can look up what the name of that was if you need it but I don't recall it off-hand.
If you are falling frequently, you must check out why. Do not presume that your OP meds are responsible.
Many other reasons, especially inactivity, can be the cause. Meds other than OP meds can be problematic.
A physical therapist can assess your falling and teach you techniques to improve this problem. Reducing the risk of falls is key to reducing the risk of fracture.
Lucy Buckley PT aka Mother Goose
Hi! linnyd531 and everybody, I am also very interested in diagnostic tests for bone quality to supplement the DEXA scan for bone density. Heel-bone quantitative ultrasound (QUS) can be used to screen for bone density, and the way in which the ultrasound wave is altered as it passes through the heel bone describes the elasticity and structure of the bone. These two properties are combined into the term Stiffness Index, which is related to bone density.
hi bone lady, i've never heard of the heel-bone quantitative us. that sounds pretty interesting. do you know if this is regularly done? it sounds like the stiffnes index is more related to bone density rather than bone quality. i'm going to see if i can find any research data on this test.
11 years ago a piece of my bone was sent to John Hopkins. The results I got back said I had low bone turnover. I really didn't find out any more than this. Do they give you any more info on biopsies today?
linnyd531, I am still researching QUS myself, but from what I have learned so far, ultrasound is routinely used as an inexpensive osteoporosis screen for people not previously diagnosed with osteopenia/osteoporosis.
According to one source, QUS measures bone quality; it tells us about the structure, elasticity and strength of the bones. These factors are strongly correlated to bone density and help predict fracture risk. The source of that info, although I read similar descriptions at other sites, is http://www.womenshealthmatters.ca/Centres/osteo/diagnosis/QUS.html.
As a result of these postings, I decided to go on Pubmed and look for studies and information on bone quality. So far, what I have found is that no-one really knows what bone quality is or how to measure it. There are some interesting papers being presented on this subject--some with languaging I'm not familiar with but, so far, no real definitions. I'm continuing to explore.
One interesting presentation did relate bone quality to hydration so, drink your water ladies and gentlemen.
I guess, for now at least, we really don't know what it is. Bone density remains the only non-invasive test that gives us information on the internal structure of bone. Again, practicing good body mechanics and doing site-specific exercises are good ideas along with avoiding movements that are known to cause fracture.
hi bone lady,
thanks for the link on QUS. i'll let you know if i find any data/studies on the subject........linda
http://www.medscape.com/viewarticle/463098
the above link discusses the issue of bone quality.
linnyd531, Great link on bone quality!
You must sign in to view the article on medscape but it only takes a minute and is well worth the time. Basically, the NIH Consensus Panel definition cited four potentially important contributors to bone quality: architecture, turnover, damage accumulation (not addressed in this article), and mineralization. Other factors also discussed include percent collagen content of bone and levels of homocysteine. Studies showed increased circulating homocysteine levels equaled decreased broadband ultrasound attentuation at the heel, increased bone turnover markers, and increased fracture risk. The bone turnover marker that most consistently predicted both vertebral and nonvertebral fracture was the urinary pyridinoline/creatinine ratio.
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