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Bone Mineral Density is Calcium in Bone

January 11, 2020 @ 11:20 am
posted by Dr Ginther

Why do some patients, who are already on good osteoporosis preventing or treating medications, still have a falling Bone Mineral Density?  Are the medications not working?  Not as well as they should!  Why?  Even the best medications cannot work without enough CALCIUM intake and absorption.

If you want to improve your bones you must ABSORB enough calcium.  This can be a bit tricky.  You need the right kind of calcium, taken in food or with food, and spread out over 3 meals or snacks.  “Calcium” is Calcium Carbonate which requires lots of acid to dissolve.  This often is a problem if you take antacids, have heartburn or GERD, have digestive issues like lactose sensitivity, celiac or IBS, or are just “too old”, which begins at 50.

Calcium in foods is easy to absorb.  Calcium Citrate tablets or Tricalcium Phosphate Gummies require 2 tablets or gummies to total the 400 or 500 or 600 mg on the label.  Adora Chocolates are 500 mg each.  We recommend taking in 1200-1500 mg calcium daily.  That means 400-500mg at each of 3 meals.

DXA does not show bones.  DXA shows calcium.  Calcium stiffens and strengthens bones.  You cannot have good BMD or good bones without enough calcium!  Take control of your bone health with adequate calcium in diet and supplements.

Next time a listing of Calcium in Foods

Jay Ginther, MD

Blue Zones Christmas! and New Year!

December 27, 2019 @ 12:34 pm
posted by Dr Ginther

Are you in a Blue Zone?  Don’t know what a Blue Zone is? Read “The Blue Zones” and “Thrive” by Dan Buettner.  Blue Zones are where life is good.

We are visiting our grandkids in California for the Christmas and New Year holidays.  We have 2 north of Sacramento and 2 northwest of LA.  Grandkids are even more fun than your own kids were.

Family is one of the key elements to living in a Blue Zone.

Jay Ginther, MD

 

Improve Bone First – Preserve Bone Second

December 8, 2019 @ 8:19 pm
posted by Dr Ginther

National Bone Health treatment goals are changing for those patients with high fracture risk.  Simply preserving bones already at a too high fracture risk never made much sense to this former orthopedic surgeon.  Now the national leadership is stressing the need to lower fracture risk first, then preserve bones at a lower level of fracture risk.

We now have 3 anabolic medications which substantially lower fracture risk by increasing the thickness and strength of bone structure: Teriparatide (Forteo), Abaloparitide (Tymlos), and Romosozumab (Evenity).  They all decrease fracture risk substantially more than the antiresorptive (preserving) medications alone.  The difference in fracture risk grows for up to 5 years.  After that the difference in fracture risk between anabolic meds followed by preserving meds vs. preserving meds alone remains the same.

Calcium can take up to 3 additional years to collect in newly formed bone matrix.  DXA shows calcium in bone (Bone Mineral Density).   Much of the increased BMD can only be seen on DXA after the anabolic med is completed and the antiresorptive med is started.

All of the anabolic medications must be followed by antiresorptive medication to preserve the gains made by the anabolic.  No medication to grow or preserve bone can work without adequate nutrition in the form of absorbable calcium, vitamin D3, protein and other vitamins and minerals.

Jay Ginther, MD

Recently I wrote about our participation in a clinical trial offering the anabolic Tymlos (Abaloparatide) to men.  Now we have been approved for participation in another Tymlos (Abaloparatide) trial – this one for women.  Currently Tymlos is available to women as a daily shot.  The new delivery system is a patch applied to the skin for 5 minutes daily.  That is far more convenient than a shot.

The FDA compliant trial is being run by the Northeast Iowa Family Practice Center.  They have years of experience with clinical trials.  Clinical trials always have strict inclusion and exclusion criteria requiring extensive screening, interviews and multiple testings.  All screening is free to the participant.  If you are accepted into the trial, all treatment is also at no charge.

All participants will receive the FDA approved anabolic (increases bone matrix) medication Tymlos (Abaloparatide).  Participants are randomized to the standard injection or the new patch.

Our participation in the study is that Bone Health will be doing all screening and quarterly study DXAs and ADI (Advanced Diagnostic Imaging of Iowa) will be doing the spine x-rays.  We are also screening our own patients for potential to be study participants.

Remember that anabolic medications Forteo (Teriparatide), Tymlos (Abaloparatide), and Evenity (Romosozumab), primarily stimulate new bone formation.  Antiresorptives Fosamax (Alendronate), Actonel/Atelvia (Risendronate), Boniva (Ibandronate), Reclast (Zolendronate), Evista (Raloxifene), and Prolia (Denosumab), primarily preserve bone.

Of course, all medications require proper nutrition to work well.

Jay Ginther, MD