Bone loss and osteoporosis develop so slowly in most women whose bones test normal at age 65 that many can safely wait as long as 15 years before having a second bone density test, researchers report in a new study.       

So, what does the National Osteoporosis Foundation– which promoted  bones scans while taking major donations from Merck,  other bisphosphonate makers and imaging companies — have to say?  Not much,

See our earlier report on this topic, w/ more below:

Is the new test for osteoporosis better than a bone density test?

Boston Globe – Boston, Mass., July 28, 2008

HEALTH ANSWERS

Some doctors believe the Fracture Risk Assessment Tool, or FRAX, will improve their ability to identify patients likely to suffer the worst consequence of osteoporosis – broken bones. The test will “simplify osteoporosis diagnosis for busy primary care physicians,” said Mary Bouxsein, who studies the biomechanics of bone strength at Beth Israel Deaconess Medical Center.

Others agree, but say the test won’t get at a major problem: Doctors are testing and treating the wrong people for bone loss.

Bone density is only one measure of bone strength. Many women with dense bones still fracture; many with thin bones don’t.

FRAX can predict fracture risk more precisely than bone density by considering factors such as age, race, weight, and smoking history, that doctors can enter into an online form. Rather than the bone scan’s abstract “T-Score” – which describes how far your bone density is from the ideal – the FRAX calculates a patient’s 10-year odds of breaking a bone.

“I think it is good to get away from this narrow focuses on bone density and something like FRAX could be useful if people get a little bit of common sense about when to use drugs,” said Cindy Pearson, director of the National Women’s Health Network, a Washington DC-based advocacy group. Serious side effects – including bone and joint pain – are now emerging in long term-users of common osteoporosis drugs.

But the FRAX doesn’t go far enough in presenting risk in a way that patients can understand, said Dr. Bruce Ettinger, a long-time osteoporosis researcher with Kaiser Permanente now with the University of California at San Francisco.

Ettinger prefers an approach that informs patients that they are at high, moderate, or low chance of breaking a bone.

Still, most agree that the calculator is an improvement over the bone scan alone. The FRAX is only a few months old, and for now, busy primary care doctors will have to find time to enter the data into a computer. But, researchers predict the next generation of bone scanners will come equipped with FRAX calculators.

Credit: TINKER READY. Boston Globe

From Case Western Reserve via Science News Daily

 ScienceDaily (Jan. 3, 2012) — Bingo, a popular activity in nursing homes, senior centers and assisted-living facilities, has benefits that extend well beyond socializing. Researchers found high-contrast, large bingo cards boost thinking and playing skills for people with cognitive difficulties and visual perception problems produced by Alzheimer’s disease (AD) and Parkinson’s disease (PD).

 Abstract:

External support may improve task performance regardless of an individual’s ability to compensate for cognitive deficits through internally generated mechanisms. We investigated if performance of a complex, familiar visual search task (the game of bingo) could be enhanced in groups with suboptimal vision by providing external support through manipulation of task stimuli. Participants were 19 younger adults, 14 individuals with probable Alzheimer’s disease (AD), 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson’s disease (PD), and 20 PD-matched healthy adults. We varied stimulus contrast, size, and visual complexity during game play. The externally supported performance interventions of increased stimulus size and decreased complexity resulted in improvements in performance by all groups. AD also obtained benefit from increasing contrast, presumably by compensating for their contrast sensitivity deficit. The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance

• Wide heart monitor use tied to missed alarms

The burgeoning use of heart monitors allows hospitals to care for sicker patients on regular floors – typically without hiring as many nurses as they do in intensive care units – and to admit patients faster, easing emergency room congestion. Many physicians routinely put patients on the monitors, knowing they can save lives by catching life-threatening abnormalities. And since monitoring is noninvasive, it seems harmless.

•  State reports detail 11 patient deaths linked to alarm fatigue in Massachusetts

http://seg.sharethis.com/getSegment.php?purl=http%3A%2F%2Fbostonboomer.wordpress.com%2Fwp-admin%2Fpost-new.php%3Fpost_type%3Dpost&jsref=&rnd=1325171836585

Seniors face additional challenges in preparing for and responding to issues like power and communication outages, icy surfaces and lack of heat. Experts recommend that they, and their adult children, neighbors or caregivers do some simple pre-planning to protect their safety during the winter.

“Seniors need to prepare for winter long before it arrives so they have safety and mobility plans in place,” says Andrea Cohen, CEO of HouseWorks, a Massachusetts home care company dedicated to helping seniors live independently. “Snow and ice, cold temperatures and heating devices are all potential safety hazards that result in a number of accidents every year. Minor additions or changes to a senior’s home can minimize the risk of an accident and create a dramatically safer environment.”

And, if all that has you burned out, check out this column from the NYTimes:

So why all of a sudden did I feel as if I didn’t love my mother, that I hated taking care of her?

“What you’re describing is really a matter of resentment,” said Barry J. Jacobs, psychologist and author of “The Emotional Survival Guide for Caregivers.” “Sometimes caregivers have a difficult time distinguishing between resenting the caregiving and resenting the person. It’s a clear sign of burnout.”

Caregiver burnout often manifests as resentment, anxiety, depression, sleep problems or waking up with a feeling of dread. Many caretakers, Dr. Jacobs added, don’t realize they are burning out until they are “very symptomatic.”

On Sunday, the Globe ran the last of a four-part, year-long series on a family coping losing their patriarch to early stage Alzheimer’s.

Bruce Vincent sits at a table in a stark room at Massachusetts General Hospital’s Charlestown research center, just a few minutes into what will be an hourlong test of his fading memory.

“Next, I will read you a list of words,’’ says research assistant Natacha Lorius, who sits across the table from him. “I need you to repeat the words back to me, in any order.

Suds, noose, spree, proxy, simile, nectar,’’ she says, reading slowly from a list of about 15 words.

When she finishes, Vincent, still raven haired and nearly wrinkle free at 49, stares at her for several seconds.

“I don’t remember any of them,’’ he says.

Alzheimer’s has recently quickened its devastating pace, snatching from Vincent more social skills and abilities than it had since his diagnosis three years earlier. He has a form of the disease that strikes at a young age.

Gone in the latest slide is the easy back and forth of conversation, the ability to sort and price products at the family’s Westminster grocery store that he once ran, and his recall of words, and sometimes entire conversations, from a few minutes earlier. Often he hovers, almost childlike, looking for direction in everyday tasks such as serving salad from a bowl to a dinner plate.

When Vincent shoveled his driveway after the snowstorm last month, he inexplicably walked dozens of yards to the backyard to empty each scoop, instead of simply tossing the snow to the side.

As the disease accelerates, Vincent’s family treasures all the more the bedrock pieces of his personality that remain — his optimism, his gentle nature, and especially his boyish humor.

“If I didn’t have Alzheimer’s,’’ Vincent confided after completing the memory-testing session, “that would have been a blast.’’

Rita Wilson — famous not for writing but for acting — introduces the page. (In case you are wondering, this writer is not available for upaid acting jobs. )

If you’re reading this without glasses consider yourself lucky. 

Many of you are looking to your future and creating a vision for the next few decades. Whether your future is Calgon clear or as grey as the hair you dye, life for Post50 Boomers is probably nothing like what your parents’ was.  I know there are those of you will argue the differences between Boomers and Jonesers.  We will have thousands of discussions about what defined our generation.  But for now, just go with the flow.

COSTS OF CARE PARTNERS with HEALTH LUMINARIES for 2011 ESSAY CONTEST

Costs of Care, a physician-run nonprofit based in Boston, has launched its second
annual national healthcare essay contest, with the goal of expanding the public
discourse on the role of doctors, nurses, and other care providers in
controlling healthcare costs.

BOSTON, MA (PRWEB) SEPTEMBER 12, 2011—Last year Costs of Care (www.CostsOfCare.org) launched an innovative essay contest that elucidated the importance of price transparency in everyday medicine by gathering more than 100personal stories  from patients, nurses, and doctors across the nation. This year, Costs of Care is looking for more stories, and will award prizes for anecdotes about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money
(lead).

As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to
discuss their own role in healthcare spending. However according to Neel Shah, M.D., Executive Director at Costs of Care, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will
successfully contain costs unless healthcare providers are invested in fixing the problem.”

To help mobilize healthcare providers to examine their own role in spending, Costs
of Care is launching an essay contest that will collect and widely
disseminate stories from the frontlines of medicine. Costs of Care will award
$4000 in prizes to top submissions. Two $1000 prizes will be reserved for
patients, and two $1000 prizes will be reserved for care providers. Preference
will be given to stories that best demonstrate the importance of cost-awareness
in medicine. Examples may include a time a patient tried to find out what a
test or treatment would cost but was unable to do so, a time that caring for a
patient generated an unexpectedly a high medical bill, or a time a patient and
care provider figured out a way to save money while still delivering high-value
care.

To help select the winning entries, Costs of Care has partnered with five health
luminaries who will serve as judges:

• Peter Orzsag, former Director of the White
  House Office of Management and Budget
• Dr. C. Everett Koop, former United States Surgeon
  General
• Hon. Jennifer Granholm, former Governor of Michigan
• Dr. Susan Love, women’s health and cancer
  research advocate
• Dr. Alan Garber, health economist and Harvard
  University Provost

Anyone looking to learn more about the successful entries from last year’s contest can
find our more at www.costsofcare.blogspot.com.

All submissions will be due on November 15^th, 2011. Finalists will be announced on
December 15^th, 2011 and the $1,000 prize winners will be announced on January 15^th, 2012. All qualifying submissions will be published biweekly at www.costsofcare.org
during the 2012 calendar year, and will be made available to the media.

The contest is sponsored in part by through the generosity of Blue Cross Blue
Shield of Massachusetts and Harvard Pilgrim Health Plan.

About Costs of Care

Costs of Care is a nonprofit organization that gives patients and healthcare workers the information they need to deflate medical bills, while expanding the national discourse on the
role of care providers in responsible resource stewardship. Costs of Care was
founded by a resident physician based at Harvard Medical School who noticed
that even the best physicians sometimes overlook something critical—the bill.

Full contest details are available at www.costsofcare.org/essay

From The Boston Globe

Specialists differ on the
value of tests for bone density

By Tinker Ready

Globe Correspondent

4//25/00

When Winchester gynecologist Robert Shirley does an ultrasound bone scan  of a patient’s heel, the news he delivers is often less than comforting.
Based on the heel scan, which measures bone density in the foot, Dr.
Shirley diagnoses 1 in 3 of his older patients with either osteoporosis or
osteopenia, the bone-thinning disease that is common in aging women and
also affects some older men.

“It’s a very helpful tool to make them realize that osteoporosis is
real, and they need to think about it,” said Shirley.

Certainly, few women will fail to take notice when they hear they have
a disease that may lead to brittle bones, a hunched back or “Dowager’s
hump,” and painful, disabling fractures. As frightening as the diagnosis
sounds, however, it does not always lead to serious fractures _ the most
severe of which is hip fracture _ and the bone scan itself cannot
accurately predict who will get hip fractures, or even fully measure bone strength.

Still, osteoporosis is now defined by bone density, even though
density only accounts for about 70 percent of bone strength. Other factors
_ such as the actual shape, structure and size of a bone, and the presence of
tiny cracks know as “microdamage” _ seem to factor in as well.

But these things are not measured by bone scans. And, when it comes
to hip fractures and the elderly, a person’s risk of falling seems to play as
much of a role in fracture risk as does bone density.

So, when a group of scientists convened by the National Institutes of
Health met for three days in late March to review the most current data on
the diagnosis and treatment of osteoporosis, they declined to endorse the
bone scan as a screening test for osteoporosis. In its March 29
consensus statement, the panel noted that the risks for osteoporosis _ as
reflected by low bone density _ and the risks for fracture, overlap but are not
identical.

In addition, the panel expressed concern that different bone scanning
devices and techniques produce conflicting results. A committee of scientists
is working on a plan to standardize the tests, but right now, an ultrasound bone
scan of the heel might indicate osteoporosis, while an x-ray scan of the spine may
not. And even though bone loss can accelerate at menopause, tests in women under the age
of 60 are particularly weak at predicting hip fractures.

“There are other things outside of bone density that we may want to
measure to better improve our prediction of fracture risk,” Mary Bouxsein,
an instructor in the Orthopedic Biomechanics Laboratory at Beth Israel
Deaconess Medical Center told the panel.

This is in stark contrast to what many doctors and advocacy groups
say about bone scans and osteoporosis. Many see the disease as a silent
epidemic that goes undiagnosed in millions of women. The National
Osteoporosis Foundation cites an alarming list of statistics to drive that
point home: 28 million people either have the disease or are at risk, and

half of all women will suffer a fracture of the spine, hip or wrist

during their lifetime. The group recommends bone scan screening for all women
over 65, has lobbied Medicare to cover the test, and is now pushing formandatory private insurance coverage.

Bone scans are not perfect, but they are the best tool available to identify women with the disease, said Conrad Johnston, director of the Bone Studies Laboratory at Indiana University, who is the current president of the National Osteoporosis Foundation. “Everybody who has high cholesterol doesn’t have a heart attack, and everyone who has low bone mass doesn’t have a fracture. But for many women, he said, “low bone density is the single best predictor of who will fracture.”

So should women just ignore this? The pharmaceutical industry certainly isn’t. The makers of bone building drugs are active in promoting bone scans. Merck, which makes Fosamax, recently ran ads in magazines like Good Housekeeping and Parade encouraging healthy women to seek testing. Warning that undiagnosed osteoporosis can lead to broken bones or the disfiguring Dowager’s hump, the ad equates the simple, painless bonedensity test with mammography to detect breast cancer.

Osteoporosis is serious business for many who have it. According to the National Osteoporosis Foundation, the disease causes 1.5 million fractures annually, about half of them in the spine. Spinal fractures cancause a range of symptoms; some people may feel nothing at all, others may have back pain, and yet others may develop the Dowager’s hump.

The scientific data on the incidence and severity of spinal fractures is incomplete. But, all agree that the hip fracture, which strikes about 300,000 people per year in their 70s and 80s, can be a devastating and sometimes deadly event. About 30 percent of older people who fall and break a hip end up in a nursing home.

Bone density contributes to hip fractures, but so does a long list of other factors including age, low body weight, smoking, mobility, exercise habits, and poor eyesight, which can make someone more vulnerable to falls,says Dr. Arminee Kazanjian, the director of the British Columbia Office of Health Technology Assessment.

After reviewing years of research into bone mass and fracture, her agency released on of the most scathing critiques on the use of bone scans. It concluded that as many as 70 percent of the women who eventually break ahip will not be diagnosed at menopause with osteoporosis, if that diagnosis is based on a bone scan alone. And, only half of the 30 percent of women identified as having osteoporosis or osteopenia will go on to have a fracture.

“The important health outcome is bone fracture,” said Kazanjian.“Bone mineral density is a minor factor. Any other combination of factorsis much more important.”

Rather than rely on the bone scans alone to diagnose osteoporosis, Kazanjiam and others suggest that doctors focuson the other factors that contribute to fracture risk.

For example, a woman with low bone density, but who doesn’t smoke(which contributes to thinning bones) and has good eyesight, may be less likely to break a hip than a woman with high bone density who uses a walker and has afamily history of fractures, she said.

Amy Allina of the National Women’s Health Network, a Washington,D.C.-based advocacy group, says that women who are told they don’t have osteoporosis based on a bone scan alone may not take steps to prevent the falls that cause hip fractures, even though they may be at risk. And those whose bone scans indicate that they have osteoporosis may spend years on medication, even though they may never have broken a bone.

That’s a problem, Allina said, because the treatments for osteoporosis themselves come with risks. Hormone replacement therapy, which millions of women take to both treat and prevent osteoporosis, can increase a woman’s odds of developing breast cancer. And Fosamax, a non-hormone drug that builds bone, irritates the throat and its long-term effects are unknown.

A 1993 decision by a World Health Organization panel set the stage for the bone scan to inadvertently become a routine diagnostic test for osteoporosis. The panel established a scale _ based on the average bone density of a
premenopausal woman _ that allows doctors to measure bone loss, diagnose osteoporosis, and establish fracture risk.

The average 55-year-old woman has a 15 percent chance of breaking her hip someday. If her bone density is 1 point below the WHO average, she is defined as having osteopenia, a level of bone thinning that increases the lifetime risk of hip fracture by 20 to 45 percent. Osteoporosis is diagnosed when bone density falls 2.5 points below the WHO average. This, by  some measures, raises the risk of hip fracture to greater than 45 percent.

Brigham and Women’s Hospital in Boston recently produced a detailed set of osteoporosis diagnosis and treatment guidelines for its patients and doctors. The guidelines don’t endorse bone scans to be used as screening tools alone, but they advise doctors to recommend bone scans to all women over the age of 65.

Dr. Robert Barbieri, chairman of the Department of Obstetrics and Gynecology at Brigham and Women’s, sees the bone scan as a useful tool but he emphasized that a diagnosis of osteoporosis should not be based on the testalone. He says he is confident that doctors are considering other factors when assessing a patient’s bone strength and risk of a fracture.

“They use history and physical exams and laboratory tests in an integrative  way and pull them all together,” he said.

But Mark Hefland, a researcher at the Oregon Health Sciences University, told  the NIH pane that doctors are relying too heavily on bone scans, even though  many of them admit that they don’t understand how bone scan scores relate to fracture risk.

“However we may like it, this is how diagnosis is occurring in everyday practice,” said Hefland, the director of the school’s Evidence-Based Practice Center.

Dr. Shirley of Winchester says he relies on bone scans to diagnose osteoporosis, but said that he also spends a lot of time with patients talking about fracture risk and alternatives to drug therapy like increasing weight-bearing exercise and boosting calcium intake.

But according to Diane Saparoff, who runs a monthly support group for women with osteoporosis at the Jenks Senior Center in Winchester, Dr. Shirley’s approach differs greatly from that of other doctors. “Many ofthe doctors order these tests but there is no follow up,” she said. The

doctors often don’t explain the test scores or help women come up with a  fracture prevention plan, she said. “They just throw Fosamax at them.”

Dr. Johnston of the National Osteoporosis Foundation acknowledges that some doctors may be relying too much on bone scans to diagnose osteoporosis.

“I think that’s probably happening but it shouldn’t be,” he said. “Thisis a reasonably new area. Bone mineral measurements have only been around for about 10 years. Its takes a while for people to get up speed.”

Sidebar

Report lists ways to avoid injuries

A recent report  from the National Institutes of Health offers advice on how to build and maintain strong bones:

*Get adequate calcium and vitamin D both early in life and throughout
adulthood.

* Engage in regular exercise; it contributes to the development of peak

bone mass and may reduce the risk of falls in older individuals.

*As needed, use drugs that enhance bone mass; medications have been been

shown to reduce the risk of osteoporotic fractures.

In addition to regular exercise, there are several steps seniors can

take to avoid falls, according to the National Center for Injury Prevention

and Control:

* Use non-slip rugs and bath mats. Put grab bars in the bathroom

and handrails on the stairs.

* Ask your doctor to review medicines that may cause drowsiness or

confusion when combined with others you may be taking.

*Stay current with eye exams.

–Tinker Ready

This story ran on
page D01 of the Boston Globe on 4/25/2000.

© Copyright 2000 Globe Newspaper Company.

William B. Kannel, an epidemiologist whose work for six decades on the landmark Framingham Heart Study helped revolutionize the way heart disease is treated, died Aug. 20 at a nursing center in Natick, Mass. He was 87 and had colon cancer, his daughter Patricia Hoffman said.

Any patient ever told by a doctor to eat better, exercise more, lose weight, quit smoking or take cholesterol medication to lower the risk of heart disease owes that life-saving advice in large part to Dr. Kannel.

From BU Today:

…A cardiovascular epidemiologist, Kannel began work with the Framingham Heart Study in 1951 and served as director from 1966 to 1979. The multigenerational epidemiological study, begun in 1948 by the National Heart, Lung, and Blood Institute of the National Institutes of Health and run by BU since 1971 under NIH contract, sought to identify causes of cardiovascular disease by following the health and lifestyles of 5,000 residents of Framingham, Mass. The study currently follows 14,000 people, almost all of them descendants of the original cohort. Between 1979 and 1987, Kannel was the University’s principal investigator with the study and later worked as senior investigator.

Here’s the lead:

Dr. Elizabeth Rafferty is trying not to lapse into rhapsodic cliches. “I don’t want to call it a magic bullet, because that
would oversell,” she says. “It’s not a panacea.” Then, five minutes later: “I don’t want to say it’s catching on like wildfire.” After a few minutes more, though, Rafferty can’t help herself. She lets her enthusiasm loose. “People have been waiting for it for a long time,” she says. “It’s a step, but it’s a step by a person who has a stride of 7 feet.” “It” is a 3-D mammography machine, the Selenia Dimensions system, one of which sits in the breast imagingclinic at Massachusetts General Hospital that Rafferty, a radiologist, runs. The machine, which is made by the Bedford company Hologic and developed partly at MGH under Rafferty’s supervision, produces images that are so vivid and clear they seem to speak out loud: “Hey, right here! This is a tumor!”

The benefit? In an FDA application, the company  “…reported a 7 percent improvement in their ability to distinguish cancerous from noncancerous cases when they used the new system.” In other words, seven percent fewer women will have to come in for a repeat mammogram or follow-up surgery.

But the company, and the rest of us, should be careful not to overhype 3-D mammography. As Rafferty says, it’s not a panacea. The technology does come with costs, financial and medical. A fully equipped 3-D machine runs on average $474,541, not including the annual service fee Hologic charges for maintenance, and even hospitals that already own an upgradeable 2-D system made by Hologic have to pay about $125,000 to get it adapted for 3-D use. There are also costs in the sense of risks: Women who get a combo 2-D and 3-D mammogram, the protocol that confers the most dramatic jump in benefits, are exposed to twice as much X-ray radiation as the norm (albeit still an amount that’s under the FDA’s permitted limit). And no one yet knows if the new technique will actually save lives.

The story goes on to quote MGH docs and Otis Brawly of the ACS dismissing the US Preventive Services Task Force recommendation to limit screening mammography to women over 50 – bad data they say.

No comments yet on the story, but with the question of screening at 40 v. 50 still the subject of a raging debate in some circles, we expect to see a few.

If you prefer the “Sex and the City” take on cancer, see the NYTimes story on Kris Carr, the woman behind the “Crazy Sexy Cancer” franchise. (She was treated at Dana-Farber.) We appreciate the diet/prevention/watch and wait approach; but we’ll skip the burning hot pink.

“I wanted to say this isn’t your grandma’s cancer,” she says. “And at the bookstore, all I could find was all this old, sad, pass-the-tissues Hallmark stuff.” So she developed a style that’s a mash-up of “Eat, Pray, Love” and the expletive-laced pro-vegan “Skinny Bitch” books, her voice frilled with easy intimacy and bedecked with hot-pink chick-to-chick flourishes. Carr’s cancer world is a place where prostheses are for “boobies,” medical binders are “bitchin’ ” and patients are encouraged to become “ ‘Prevention Is Hot’
cheerleaders.”

To each her own. We prefer our cancer news from the straight-talking-but-not- at-all-humourless Breast Cancer Action.