Dr. Eck received a Bachelor of Science degree from the Catholic University of America in Biomedical Engineering, followed by a Master of Science degree in Biomedical Engineering from Marquette University. Following this he worked as a research engineer conducting spine biomechanics research. He then attended medical school at University of Health Sciences. He is board eligible in orthopaedic surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
How often should DEXA scans be repeated to monitor treatment?
Monitoring osteoporosis treatment using DEXA scans is highly controversial.
Some doctors recommend DEXA scanning at one- to two-year intervals to monitor changes
in bone density during treatment. But recent scientific evidence questions the
usefulness of such interval monitoring. Reasons why repeating bone density scans
is extremely tricky include:
Bone density changes so slowly that the changes may
be smaller than the measurement error of the machine. In other words, repeat
DEXA scans cannot distinguish between a "real" increase in bone density or a
mere variation in measurement from the machine itself. Typically, BMD changes
1% per year, which is less than the error of a DEXA machine (usually in the range of
3%). Changes of less than 2%-4% in the vertebrae and 3%-6% at the hip from
test to test can be due to the precision error of the method.
Whereas the real purpose of prescription osteoporosis treatment is to
decrease future bone fractures, there is no good correlation between increases
in bone density as measured by DEXA with decreases in fracture risks with
treatment. There are multiple examples of this in recent clinical studies. For
example, the improvement in BMD only accounted for 4% of the reduction in spine
fracture risk with raloxifene, 16% of the reduction in
spine fracture risk with alendronate, and 18% of
the reduction in spine fracture risk with risedronate. Thus, improvement in BMD does not indicate the
amount of the anti-fracture benefit of osteoporosis medication. Prescription
medication may decrease a person's risk of fracture even when there is no
apparent increase in BMD. Physicians and
non-physicians alike are often surprised to learn this information.
Even if the DEXA scan shows continued deterioration in
bone density during treatment, no research data exists demonstrating that
changing a medication, combining medications, or increasing medication doses
will be safe and helpful in decreasing the future risk of fractures compared
to just continuing the same medication.
Even if a person's bone density deteriorates during
treatment, it is quite likely that the person would have lost even more bone
density without treatment.
Recent research has
shown that women who lose bone density after the first year of menopausal
hormone therapy will gain bone density in the next two years, whereas women who
gain in the first year will tend to lose density in the next two years of
therapy. Therefore, bone density during treatment naturally fluctuates and may
not be indicative of the fracture protection of the medication.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Paget's disease is a chronic bone disorder due to irregular breakdown and formation of bone tissue. Symptoms of Paget's disease include bone pain, headaches and hearing loss, pressure on nerves, increased head size, hip pain, and damage to cartilage of joints.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Turf toe is a sprain to the ligaments around the big toe joint. Symptoms and signs include pain, swelling, a popping sound, and limited range of motion. Treatment may involve taking ibuprofen, immobilizing with tape, cast, or a walking boot.
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