More On the Incredible Shrinking Woman!

Was the Wicked Witch really melting because of what Dorothy did, or if we waited long enough would the Witch of the West just shrunk away anyhow from ostoeporosis? For many women the loss of height is the first sign of bone loss and a reason your gyno may want to evaluate you more carefully than just looking at your spine. To my physical exam, the Wicked Witch was well on the way to advanced osteoporosis, she was  hunched backed dowager, and how about you? Are you 65, are you white, then I'll wager about 50/50 you've shrunk more than 2 inches and have at least 1 osteoporotic spinal compression fractures you don't know about as you've not been properly tested And osteoporosis can cause more than posture and fracture problems. Are you over 65, did you have gas at least more than a few times you wish you wouldn't have this past week? I'll wager 50/50 you've got a spinal compression fracture some where between the lowest thoracic vertebra and the top few lumbar vertebra. Why? Because these compression fractures take a toll on our posture poof out the back part of your spine and lead to the shrinking waist, and that poofy ab you though was just lack of sit ups or just a bit of extra winter pie eating, nope, it's more likely the sway backed, muscular, and disordered gastrointestinal system aggravated by osteoporosis. Did you smoke ever or ever hang a lot with smokers? Ah ha! Smoking is another risk factor for earlier menopause and less bone mass! And a women who thinks she doesn't have osteoprosis because her wrist or heel tested fine at some point, you may have to rethink waht you have been told. Bone loss is not even throughout your body, another myth.  Menopause alone leaches 50% of trabecular bone! Never to be returned! Can we have healthy bones in menopause without estrogen. Probably many of us can. But did you realize that estrogen actually increases the number of vitamin D receptors in the bone. If the bone weakens then wedge fractures can occur like in this picture.


If bone loss in menopause gets severe enough we say the patient has osteoporosis and it is a preventable disease. What we really are trying to prevent is a fracture.
BMD is related to fracture and for each SD there is 2-3 fold risk of fracture. Absolute fracture risk needs to be assessed for each individual taking clinical risk factors into considerations. Prior fracture increases risk of second 4x at spine and 2x for the hip.
Elderly patients have errors in their spine assessments because of degenerative changes, vertebral compression fractures and/or aortic calcifications all of which increase with age.

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