The Curbsiders Internal Medicine Podcast #277 Bone Up on Osteoporosis in Primary Care with Dr. Carolyn Crandall
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May 31, 2021 Dr. Carolyn Crandall, an internist and osteoporosis researcher at UCLA, shares her expertise on osteoporosis and menopause. She highlights the importance of early screening to prevent fractures and offers patient-friendly explanations for complex concepts. The discussion covers treatment decisions, emphasizing the balance between fracture risk and medication side effects. Crandall also explores adherence strategies and the role of lifestyle changes in prevention, stressing that primary care physicians must prioritize high-risk patients and initial fractures.
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Explain DEXA And Diagnosis Clearly
- Explain DEXA results simply and tell patients their diagnosis is based on the lowest T-score.
- Emphasize fracture risk and discuss measures to reduce that risk rather than microarchitecture details.
Fracture Can Define Osteoporosis
- Osteoporosis can be diagnosed by T-score ≤ -2.5 or by a fragility fracture of hip or spine.
- A radiographic vertebral fracture counts as osteoporosis even if bone density is not low.
Which Sites Count As Major Fractures
- Use FRAX major osteoporotic fracture definition: distal forearm, hip, clinical spine, and upper arm.
- Consider these four sites when assessing prior fractures and future risk.