The Dexa Scan

The Dexa Scan or Dual Energy X-Ray Absorptiometry Scan is used to diagnose and to follow Osteoporosis. In theory, when 2 X-ray beams with different energy levels are aimed at the patient’s bones and soft tissue absorption is subtracted out, the Bone Mineral Density can be determined. But, Medicine is not a perfect science and, as with most tests, sometimes the numeric value or perhaps even the interpretation of the numeric value does not tell the whole story.

Bisphosphenates such as Alendronate and the others have been approved to treat Osteoporosis by the FDA, largely by showing improvement in Dexa Scan scores. Unfortunately, some investigators point out that bisphosphenates are industrial chemicals that mostly coat the bones so that when the scan is repeated, a higher number is reported. These drugs have largely not been shown to build bone matrix (bone structure).

And here’s another example why interpretation of the scan can be tricky. A patient of mine recently went to see an Endocrinologist who ordered a Dexa Scan and also ordered x-rays of the spine. The scan results did not meet the numerical criteria for either Osteopenia or Osteoporosis and the patient was told that “everything is fine” on the basis of the score. However, the x-rays were reported by the Radiologist as showing “Anterior Wedging” and “Exagerated Kyphosis”. “Anterior Wedging” means that the normally square shaped vertebra had assumed more of a triangular shape due to the front (anterior) part of the vertebra being squished down on itself. And, “Kyphosis” is the bent-over stance that is most evident in older patients who are losing height. You’ve seen them…little old people walking slowly who can’t keep their heads up because their spines are bent over forwardly. While this was not visually evident in this patient, the astute Radiologist could see it on x-ray and reported it as such.

Now imagine this. Let’s say vertebra is square shaped and it is not gonna collapse on itself and become triangular shaped unless there is loss of bone matrix and the structural integrity in the interior of the bone is weaker. So, if a bone is “thinned out” and it collapses on itself … then perhaps the Dexa Scan is gonna produce a “more dense” reading than it would have if it hadn’t collapsed on itself.

Therefore, my interpretation was that this patient is losing bone matrix and I would not have told this patient that “everything is fine”. I would have counseled this patient on nutrition and the building of bone and I would have had a discussion on management of his impending Osteoporosis, including Bio-Identical Hormone Replacement.

BTW, how many times have you gone to the Doctor and you have been told that “everything is fine” but you come away with a funny feeling inside that everything may not be?

In another post, I will comment on the “normal range” of lab tests and how they are not what you think they are. This is most true in the interpretation of Thyroid Function Tests.

Action to Take: search Osteopenia vs. Osteoporosis, 95% confidence level, standard deviation

The GI Tract and Tiny Nutrients

In the past, physicians, myself included, rarely ordered Bone Scans in Male Patients because Osteoporosis was largely considered a disease of Women after Menopause. So, generally, we ordered bone scans on women in the 55 – 60 years age range or we ordered them after minimal trauma fractured bones and we went looking for a reason.

Even today, this is standard procedure for most “providers” especially HMO providers working with Managed Care or Government Care (contracted) Patients possibly because a financial interest is involved. The Affordable Care Act promotes this practice of limiting services. How this works is a topic for another post, but suffice it to say the government contracts a “Provider Group” to care for X number of patients at $X per patient per month and if money is left over at the end of the month, guess who keeps it. The next time you see photos of a local Hospital Executive along with a local Provider Group Executive in the local newspaper smiling away because they just came to an agreement to care for Medicare Patients under the ACA, guess why they’re smiling….

Today, I order bone scans on most patients, both men and women, in the late 40s – 50 years age range because they tell me what is going on in the rest of the body and help me manage their care. If the bones are disintegrating, what do you think is happening to the heart, the brain, and all the other organs? And since he body is always working away on a microscopic level to make big things happen, the digestive system and nutrient absorption are linked not only to what happens to bone and the rest of your body, but also to itself because, if you can’t absorb nutrients, the gut breaks down making it even more difficult to absorb those same nutrients and keep itself working optimally. Patients with Inflammatory Bowel Disease get Osteoporosis.

It has been assumed by investigators, geriatricians, and most physicians that malabsorption of nutrients was common among elderly patients. However, we now know that this is not the case. Elderly patients, as well as younger patients, who malabsorb nutrients do so because of disease, not because of age.

If you do any gardening, you know that the soil must be prepared before you plant anything if you expect the garden to flourish. The body is this way too. You need to set the stage for macronutrients and micronutrients to be absorbed and distributed where they are needed. Tiny nutrients that help make this happen are Fructooligosaccharides such as Inulin and Oligofructose. These “fructans” function as “Prebiotics” to stimulate and feed the healthy bacteria in the digestive tract such as Bifidobacteria and Lactobacilli. These are essential “Probiotics” that increase the absorption of nutrients for the promotion of digestive health, overall health, and strong bones. Foods that are particularly high on these Fructans are onions, bananas, garlic, asparagus, and tomatoes.

 Russel, Robert M. “Factors in Aging that Effect [sic] the Bioavailability of Nutrients.” Journal of Nutrition. April 1, 2001. Vol. 131 no. 4 13595-13615. 
Coxam V. “Inulin-type fructans and bone health: state of the art and perspectives in the management of osteoporosis.” Br J Nutr. 2005;93: Suppl 1:S111–23.

Action to take: Search fructans, prebiotics, probiotics, lignan, flax seed

ANTI-AGING MEDICINE – THE CONCRETE BLOCK

THE FIRST DECADE OF LIFE:

Let’s say you go to Home Depot and you buy a bag of cement and you go home, mix it with water, pour it into a cubic container and you let it set. A week or so later you take the concrete block out of the container and you walk out in front of your house and drop it on the sidewalk. What happens? It might break or it might chip or crack. But at the very least it’s gonna be damaged cause mixing cement and water doesn’t produce a very strong concrete.

In the first 5 years of life, the child’s body is developing but it’s not strong yet. It can easily be damaged by trauma.

So, let’s say you go out to Home depot and you buy a bag of cement and a bag of sand and you go home, mix it with water and put it in a cubic container and let it set. A week later you take it out in front of your house and drop it on the sidewalk. It will probably hold up better than the concrete block without the sand, but it’s still likely to crack or be damaged.

Up until age 10 the child’s body is getting stronger, but the body is not at it’s strongest yet.

THE 2ND DECADE OF LIFE:

Here, the body continues to develop and get stronger. And, something happens when the age of 12 or 13 is reached. Puberty starts. The body is not a child’s body anymore. Hormones are produced which makes the body very strong. It’s like going to home depot and buying a bag of cement, a bag of sand, and this time you put rebar in it. And, around age 15 or so, you tie the rebar together with wire to produce a really strong concrete block.

So now you take the concrete block out in front of your house and drop it on the sidewalk. What happens? Well, if you did it correctly. Probably nothing is gonna happen. Twenty year old bodies are very strong. They’re the strongest they’re ever gonna be.

THE 3RD DECADE OF LIFE:

The years between 20 & 30 years old are the prime years of life. These are the years where bone & muscle strength are the strongest, physical function & athletic performance are at the highest level, and sexual function & brain function and overall vitality are undeniable.

BEYOND AGE 30:

After the age of 30 something starts to happen that is so unnoticeable most would deny it. The changes are so slow, most people wouldn’t give them a second thought. It’s like leaving that block of concrete outside exposed to the elements. It rains, the wind blows, and the sun beats down. The exposed concrete block alternates expanding and shrinking by absorbing moisture and drying out by absorbing moisture and drying out. Guess what happens if this is allowed to continue. The concrete block begins to break down. It cracks. Chips fall off and the rebar becomes exposed. In time the concrete block is no longer a concrete block. It falls apart & dies.

So, what is it that happens after age 30 or so? Can you guess? Hormones start to decline. This is where Anti-Aging Medicine comes in. Anti-Aging Medicine is designed to protect that concrete block and to preserve it’s function. We want to put a tarp over that concrete block or put it in the garage. Bio-identicle hormones such as estrogen, testosterone, and progesterone are used to bring the body back into balance and to preserve function. But nutrition, detox, and life style are also important because hormonal & biochemical reactions require the co-factors, vitamins, minerals, electrolytes, & enzymes that drive them.

Replacement of estrogen and testosterone are familiar but replacement of progesterone tends to be unfamiliar. In conventional medicine, most physicians never think of giving progesterone to men and they only think of giving it to women who are menopausal, still have a uterus, and are being placed on estrogen replacement to control menopausal symptoms. But progesterone is important for building bone, positively affecting blood glucose levels, decreasing the conversion of testosterone to estrogen, improving memory, and modulating mood & restfulness and improving sleep. It’s perhaps the first to begin to go in our mid-30′s and replacing it should be considered a good thing.

Videos:

All information contained in this blog and on this website are provided for informational and discussion purposes only and may not be construed as personal medical advice. No action should be taken based solely on the contents of this information. This information is provided with the understanding that the presenter does not enter into a physician-patient relationship with it’s audience. Always consult with your physician or health care provider regarding the information provided here. These statements have not been approved by the food and drug administration and are not intended to diagnose, treat, prevent or cure any disease.

Welcome!

I’d like to welcome you to the blog of The Austin Clinic website. The purpose of this blog is to present information and to augment the readers’ knowledge of medical issues, especially as they pertain to the health care we offer at The Austin Clinic … Personalized Adult Medicine.

I do not pretend to be an expert on all the subjects presented here, nor am I a medical guru or a researcher or investigator. I get information from many different sources and I work hard to have current & credible information that I get from those different sources. I want you to know that I do not believe everything I hear or read. My general way of screening information is to look for the same information, presented over & over from different credible sources, before I begin to consider it.

I am, of course, somewhat biased … I tend not to readily believe information presented by the Pharmaceutical Industry (Big Pharma, the Drug Cartel) or that from the Insurance Industry (the Insurance Cartel). And, I tend to be skeptical of some generally accepted information that somehow doesn’t make sense to me, and the obvious Myths that have been propagated over time. My reason for this is that I believe that traditional medical education is largely inefficient and inelastic and, basically, skewed to line the pockets of big money interests. Practically every medical seminar out there is “supported” by Big Pharma, the Drug Cartel, and most of the “educators” speaking at these seminars are the same “investigators” who are paid by the Drug Cartel to do their research. So, it’s a bit like the fox guarding the hen house. These are the “experts” that give lectures telling physicians what drugs work the best and what we are supposed to prescribe or not prescribe. And in my view, most information given is designed to support the status quo. I’ll give you a few important examples.

In the last year, Lipitor lost it’s patent and generics are now available. About the same time, we learned that Lipitor increases blood glucose levels and increases risk from diabetes. We’ve been prescribing this medicine for 20+ years and now they tell us this??? Additionally, statins have been shown to reduce heart attacks in patients who have had previous heart attacks, yet they have generally not been shown to prevent first heart attacks. Statistically, approximately 100 patients need to take statins for approximately 5 years to prevent 1 heart attack. And, half the patients who have heart attacks have normal cholesterol levels. Yet, the “standard of care” is that every patient with cholesterol levels over 200 need to be on a statin. Clearly, there are other factors involved. yet, the word “cholesterol” has become a household world with physicians & patients (both consumers) placing much emphasis on choletserol levels when, perhaps they should be concerned about other factors. Indeed, a small group of “experts” are now spreading the word that inflammation and glycation may be as important. More on these later.

Over the last 10 years or so, it’s been the standard of care to prescribe bisphosphanates, such as Fosamax and Boniva for osteoporosis. Yet, buried under layers of TV and magazine ads is information that questions whether these drugs build bone matrix. And, they are associated with abnormal fractures of the femur and avascular necrosis of jaw bones yet it’s relatively uncommon to hear about patients breaking their legs or losing their teeth .

In July, 2002, results from The Women’s Health Initiative hit the mainstream press suggesting that Estrogen increases Breast Cancer. Over night, patients quit their Hormone Replacement Therapy and Physicians quit prescribing them. Ten years later, even the researchers who presented the data initially, began to question the results. The problem was that the WHI did NOT study Estrogen and it did NOT study Progesterone. It studied “Prempro”, which is a combination of 2 synthetic hormones. These are “equine derived congugated estrogen”, aka. “Premarin”, which is a synthetic derived from pregnant horse urine, and “Provera”, aka. Medroxyprogesterone Acetate, which is also a synthetic that falls under the category of “Progestins”. Even today, many Physicians and writers of articles tend to group synthetic horse estrogens and Natural Estrogen as the same thing. And, they also tend to group synthetic Progestins and Natural Progesterone as the same thing. In my mind, this is not correct and it is a continuing problem that contributes to the controversy. I will write more on this subject in another blog article.

The next time someone suggests that Hormone Replacement Therapy causes Breast Cancer or Prostate Cancer, ask them … Why don’t 20 year old women and men get Breast Cancer and Prostate Cancer? These are the ages when our production of Natural Estrogen and Natural Testosterone are the highest they are ever going to be in our lifetimes. Yet, Breast Cancer and Prostate Cancer are diseases associated with aging and they are generally found in patients 50+ years old when levels of Natural Estrogen and Natural Testosterone are the lowest they have ever been. Why is that?

If we are going to be intellectually honest with ourselves and with our patients, we have to ask these questions and we have to seek answers.

As a usual disclaimer, I have to add that the information offered here is for informational purposes only. None of the information presented in this blog or on the website of The Austin Clinic has been approved by the Food and Drug Administration and none of the information presented here is intended to prevent, diagnose, treat, or cure any disease. Always seek the help & counsel of your own Physician or Health Care Provider before considering the health care strategies presented here.

Action to take:

Search: Women’s Health Initiative, equine derived congugated estrogens, progestins, Provera, Prempro, medroxyprogesterone,

Videos to watch:

Again, welcome to the Blog of The Austin Clinic website. I hope you will find the information presented here stimulating and usefull. Thank you for your attention.

George D. Martinez MD