Even if people are significantly shorter - five centimeters or more - then the chances are that there is osteoporosis. "
When you get diagnosed?
"There are two groups of patients in whom we diagnose osteoporosis They are the first people we we find a low bone density, a T-score of -2.5 or less of the bone density measurement The second group -.. And that's newish - are people with XRs.
This requires the development of new equipment. Often, the vertebral height with the same device can be determined as the bone density. If we find a slump, we also speak of osteoporosis. This measurement is known as Vertebral Fracture Assessment (VFA). Not all hospitals have the equipment.
A XRs may be associated with low bone density, but not necessarily. Patients with severe osteoporosis - especially from a XRs - can be quite a bit shorter. Sometimes as much as 5 to 15 centimeters. And that can, for example if you want to grab something from a kitchen cupboard, very annoying. "
What happens after such a measurement?
"If you treat is diagnosed with osteoporosis, we will start immediately. The standard treatment for osteoporosis consists of a drug and a calcium and vitamin D supplement and lasts five years. The effectiveness of osteoporosis drugs is clear especially studied for a period of five years . The efficacy after five years is less proven.
It's hard to swallow medications long five years. Most of the patients experienced very few side effects, but still a lot of research is apparent from that half of the patients has been stopped after one year. And if you do not take drugs, they do not work. "
How to keep patients motivated then?
"That's a big problem. That is why we now pay much more attention to 'follow up'. Osteoporosis nurse can play a role. In many hospitals are nurses who have additional time for the patient. In general you will find them too, but called the practice nurse.
Another way to motivate patients to repeat the bone-density after two years. Then, patients can see whether the amount of bone increases. But that's difficult, because in two years you build actually not so much bone. In addition, there is also always is the variation of the measurement. So this is a lot of discussion.
The third way - as we do here in the VU - you see more and more hospitals: we measure the rate of bone breakdown in the blood. This method can be seen already after three months, or someone on medication. My own experience as a doctor is about very positive. If you can show people the effects of the medicine is, they stay motivated. This is not well proven scientifically, but I really feel that it helps! "
His patients healed after five years?
"After five years we do a bone-density again. If the bone density than above -2.5 (T-score), then we stop the drugs. You must then, however, calcium and vitamin D continue to swallow. It is not you're healed.
The treatment is focused on the prevention of bone fractures. After five years of treatment, the risk is much lower then, so the treatment usually put (temporarily) stop is. Patients are often advised to come back again after three or four years for a bone-density measurement. Some are then immediately turn for treatment, while others only have to swallow drugs again after six or twelve years.
If after five years from the bone-density shows that osteoporosis is still severe, we go through with treatment for a while. "
Professor Willem Lems's rheumatologist at the VU University Medical Center and Reade, both in Amsterdam. His main line of research, osteoporosis in rheumatic diseases. He is a founding member of and working at the outpatient osteoporosis / fracture clinic at the VU University Medical Center. Lems was also chairman of the working group that revised the CBO guideline for osteoporosis in 2011.
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