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Colleagues,
 | An Introduction to COLLAGE, The Art & Science of
Healthy Aging Wed., February 15,
1 to 2 PM, EST Click HERE to reserve your Webinar seat now |
An initial bone density test, also known as DXA or DEXA testing (dual X-ray absorptiometry or dual energy X-ray absorptiometry), is seriously underused, as reported in an article, Older Women and Bone Tests from The New Old Age, Caring and Coping Blog of The New York Times. The article, written by Paula Span, comments on a large-scale investigation that looked at how long it takes older women to reach a point of osteoporosis, which is associated with fractured hips, wrists and/or vertebrae. Several of the most critical excerpts from the blog article include:
- Medicare will cover DXA testing of the hip and spine every two years.
- For women whose first DXA results showed normal or nearly normal bone mass, it turns out, that process (how long it takes women to reach the point of osteoporosis) takes considerable time: up to 15 years, an argument for a long interval between scans.
- Despite the federal legislation, despite recommendations from the United States Preventive Services Task Force, the surgeon general and a range of other medical authorities, despite all those Sally Field ads, surprisingly few women over 65 get bone density tests at all.
- One reason that only a minority of older women get bone density testing is that osteoporosis is asymptomatic: People often don't know they're at risk until they break a bone. Also, primary care physicians have more to juggle than ever. And patients probably aren't asking for it.
- Bottom line: A DXA test might be something you need quite rarely...or pretty often. Without the first screening to assess your bone density, there's no way to tell. But if your first test brings happy results and you have no other risk factors, you can probably put off the second test for many years.
A few salient comments from readers of the blog article included:
- There are healthy ways to improve your bone density without resorting to drugs that may not even prevent fractures in the long run. A low acid diet, plenty of weight bearing exercise and maintaining a healthy weight....instead of passively waiting for disease, you can take charge of your health right now. Starting today you can stop smoking, lift weights, eat lots of fruits and vegetables, cut out soda pop and cut back on meat.
- Whenever possible, alternative methods should be used to treat osteoporosis, as bisphosphonate osteoporosis drugs (such as Fosamax) carry heavy risks and may lead to irregular femur breaks, stimulate an enzyme that causes jaw osteonecrosis, may initiate and/or perpetuate atrial fibrillation through altering intracellular calcium levels, and cause esophagitis and eventually esophageal cancer. (See S. Heckbert et al, "Use of alendronate and risk of incident atrial fibrillation in women," Archives of Internal Medicine, April 28, 2008: 826-31; see also, J. Green et al, "Oral bisphosphonates and risk of cancer of esophagus, stomach, and colorectum: case control analysis within a UK primary care cohort," British Medical Journal, 2010 (published online)).
- Alternatively, there are studies which claim no link between Fosamax and atrial fibrillation or esophageal cancer, but the purported links between bisphosphonates and a series of adverse effects (to put it mildly) is consistent....
- The article has several unspoken assumptions, which are not entirely valid. First, is the assumption that DXA is a highly accurate method of predicting fractures, which is not entirely true. Second is that our available meds are highly effective at preventing fractures -- not really true either....
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What is COLLAGE, The Art & Science of Healthy Aging?
COLLAGE is a consortium of aging services organizations working to advance healthy aging and improve outcomes of older adults living independently. Members of the consortium - continuing care communities, moderate-income and federally subsidized housing programs, and home care and community-based agencies - use an evidence-based assessment tool to improve quality of life and successful aging. As of December 2011, there were over 50 non-profit sites in 20 states participating in the membership consortium and using the COLLAGE Web-based software.
COLLAGE gives organizations the tools to partner with older people in their quest to age successfully. Through the COLLAGE assessment system, organizations have the opportunity to measure, track and improve healthy aging outcomes. Valid and reliable assessment data leads to: 1) the development of personalized healthy aging plans for individuals, and 2) a methodology to target the right programs and services to best match needs for a campus or community. This two-level approach enables individuals to take charge of their own healthy aging and allows organizations to focus aging support resources appropriately for their community.
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