Re: why endocrinologist

Sammy,

If you have osteoporosis or osteopenia, I can tell you with hesitation that an orthopedist is the WRONG type of doctor to see.

For a broken bone or a bad back or hip ... sure ... an orthopedist is the right doctor. But those types of problems are LOCALIZED problems with joints or bones. The orthopedist is really not a specialist in DISEASES. He/she is a specialist in conditions of the bones and joints.

Once it becomes clear that the condition is being caused by a systemic disease, one should look elsewhere. For example, one has a problem with their foot or toe and discovers that it is caused by diabetes. The orthopedist no longer should be the only one consulted ... an endocrinologist is really the expert in diabetes. Another example, one has a problem with a painful joint and discovers that the cause is rheumatoid arthritis. The orthopedist no longer becomes the ideal specialist to treat the DISEASE. Rheumatologists are usually the experts in RA.

The body has a very complex system to maintain calcium balance, consisting of the pituitary gland, the thyroid gland, testosterone, bone, the liver/kidneys, etc. A thorough and complete osteoporotic/osteopenic workup should include tests to determine to what degree each of these play a factor in the cause of the osteoporosis and also at what rate the bone is "breaking down" ... so as to determine the best treatment and dosage ... which may or may not be bisphosphonates, calcium supplementation, vitamin D supplementation, Forteo, etc. In fact, for some patients, it is possible that too much calcium or vitamin D may do harm.

The only specialist that has a full and detailed understanding of the body's biochemical balance and metabolism is an endocrinologist.

In my experience, there are GPs, internists, and orthopedists that don't even know what some of this is all about. For example, there is a urinary test called NTx (N-Telopeptides) that is used to tell the endocrinlogist the rate at which your bone is breaking down (it measures the collagens in the urine that are byproducts of bone breakdown). I have mentioned this test to some of my other doctors and they look at me with glazed eyes.

So that is my long-winded explanation of why an endocrinologist. Basically, it is necessary in order to fully understand the cause of your disease, the extent of it, and to get a complete and adequate treatment plan that is right for you.

See also

http://www.cory.com/drstaub/osteoporosis.htm
http://www.ahealthyme.com/article/gale/100083797
http://www.obgyn.net/osteo/ate_1200.htm

Hope this helps.

Larry E.

Sammy wrote:
I don't think that the Dexa people are doing a good job with me, and tomorrow I see my internist for my yearly physical. I have a question as to the manner in which the scan may have been read and the interpretation of the results.

I have read here Larry? that you suggest seeking an endocrinologist. Why would that specialty be preferred over an orthopedic doctor who is a back or lower back (my case) specialist?

I would like to go to my doctor with some information before I ask for a referral. I am thinking that the best doctor would be an orthopedic doctor, and they could get more information from an MRI or a repeat of the Dexa, with possibly another reading.

Sammy 


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