October 21, 2022
4 minute read
Biography: Aldasouqi is a professor of medicine and head of the division of endocrinology at the Michigan State University College of Human Medicine in East Lansing.
Disclosures: Aldasouqi reports that he is a consultant for Abbott Diagnostics.
In an April article on my fight against osteoporosisI wrote about my own case of the disease, which was unique in many ways.
For one thing, my osteoporosis was much more severe than that of the vast majority of my osteoporosis patients. Also, osteoporosis is generally considered rare in men.
Related to the above – and disappointing for understanding my own case – the vast majority of the osteoporosis literature concerns osteoporosis in women, both before and after menopause. Very little literature on male osteoporosis has been published.
These last two realities are particularly painful, both for me as a doctor of male patients with osteoporosis and for myself as a male patient with osteoporosis.
Last week I attended our state’s annual endocrine symposium in the beautiful town of Traverse, Michigan, a beautiful resort town on Lake Michigan, famous for its endless beaches with glorious sand dunes for the summer and a ski resort for the freezing winter. During the Q&A break of a session on metabolic bones, I raised my hand and posed a question to one of the two speakers.
I started the question with this: “I want to ask a question both as a doctor for my osteoporosis patients and as a patient for my own osteoporosis…”
I asked, “What should I do now?”
I explained that my osteoporosis is still severe and took bisphosphonates, teriparatide (Forteo, Eli Lilly; Bonsity, Alvogen) and now denosumab (Prolia, Amgen). Should I switch to the newer and stronger drug, romosozumab (Evenity, Amgen)?
The responder replied that unfortunately there is no data on romosozumab for men, which did not surprise me. He added that even if you want to take it as an off-label treatment, insurance won’t approve it — and the drugs are very expensive.
Moreover, my own osteoporosis had a mysterious and elusive initial presentation. In the summer of 2014, I suffered unprecedented sudden, sharp and excruciating back pain that lasted for a few weeks, following a bike ride with my children around Mackinac Island in the Michigan. My first thought was a herniated disc.
When the MRI was finally done – due to persistent back pain refractory to painkillers, NSAIDs and physical therapy – it showed a Schmorl’s node or Schmorl’s phenomenon. No major herniated discs were found except for degenerative disc disease, which is not uncommon.
At the time, this strange “Schmorl” knot/phenomenon was described in the radiology literature as an asymptomatic and nonsignificant incidental radiological finding. But the back pain continuedand it became nightmarishas I wrote in previous posts.
Finally, I called my friend, the late Dr. Daniel Duick, in Scottsdale, Arizona.
Dan told me to do a DXA scan.
“Why?” I asked. “Why would I have osteoporosis? »
The DXA revealed that I had osteoporosis and my T-score was -3.9, which means severe osteoporosis.
This Schmorl’s knot turned out to be a form of vertebral compression fracture. The eleventh thoracic intervertebral disc had collapsed into the twelfth thoracic vertebral body. In my case, the Schmorl knot turned out to be a real thing, caused by the bumpy bike ride around Mackinac Island. In fact, recent literature suggests that Schmorl’s lymph nodes are common in older men, with a prevalence of 41% in one study, and in men of Middle Eastern descent, 88% were associated with osteoporosis or osteopenia. I am originally from the Middle East.
You can see that in every way my own case of osteoporosis is unique.
The diagnosis of osteoporosis is made by a relatively old x-ray imaging study, the DXA scan – dual energy x-ray absorptiometry – to determine bone mineral density.
It is intriguing and perhaps frustrating in some ways that DXA was the only diagnostic tool for osteoporosis. This technique was invented by John Cameron of the University of Wisconsin in the 1960s. In a fun introduction to a 2013 article on the Irish Health Pro website, Eimear Vise wrote: “‘There are now more than 50,000 bone densitometers worldwide. I doubt more than 50 radiologists in the world know who invented the instrument,” said the late John R. Cameron, a pioneering medical physicist from Wisconsin, USA, and the father of modern X-ray absorptiometry. dual energy – now the established standard for measuring bone mineral density. “I learned from Dr. Lester Paul, chair of radiology at the University of Wisconsin, that there was no method to detect osteoporosis early and that many women were dying each year from broken hips. I invented bone densitometry in the early 1960s. It was of little interest at first because there was no known cure. My invention was used to evaluate the different possible therapies”, he explained during an interview with Radiology Malaysia in 2004, a year before his death. “I have the satisfaction of knowing that I have done something useful for society. »
I have struggled tremendously with my own osteoporosis case, in many ways, including struggles with insurance to approve DXA scans more frequently than every 2 years; prior authorization of the most potent but most expensive drugs; and experience what it is like to be a patient.
But what saddened me the most about my own osteoporosis was the loss of height. I was a proud tall man over 6 feet tall, and now I’m barely 5’11”. I had to shorten all my pants.
Othman M, Menon V. Osteoporos Int. 2022;doi:10.1007/s00198-022-06316-y.
Vize E. Evolution of DXA scanning. 2013. Available at: https://www.irishhealthpro.com/content/articles/show/name/evolution-of-the-dxa-scan#:~:text=I%20doubt%20if%20more%20than,bone% 20mineral%20density%20(BMD). Accessed October 18, 2022.