Recent studies have shown that the order in which we use osteoporosis medications matters. Traditionally most docs have used Antirsorptives first to preserve bone. All osteoporosis medications except one are Antiresorptives. Only when that failed, would they consider the Anabolic medication, Forteo, to build new bone.
As a practicing orthopedic surgeon, I started treating osteoporosis in the worst of my fracture patients. It was obvious that they needed to build bone first since there was very little bone to preserve. Therefore, I usually started with the Anabolic, Forteo. Once I had built up the bone, I preserved that improved bone with an Antiresorptive osteoporosis medication.
As the National and International Osteoporosis Foundations, (NOF and IOF) are now focusing on preventing second fractures, many more practioners are treating patients with one or more fractures. They are facing the dillema of how to prevent fractures in bone that is not good enough. None of the Antiresorptives work as well in patients with multiple fractures as they do in patients who have not yet fractured.
This year studies have shown that using Forteo after an Antiresorptive usually results in Forteo taking several months to overcome the previous slowing of bone turnover, Therefore, 2 years of Forteo results in less improvement when used AFTER the Antiresorptives tested, than we normally see in a patient who uses Forteo first.
At NOF and IOF this year speakers suggested that we change our approach. They suggested using an Anabolic first, and an Antiresorptive second should be the standard sequence for best results.
Would you rather only trying to preserve your bones after they have proven insufficient in multiple fractures? Or would you want to improve your bone first, and then prserve that improved bone matrix and improving BMD?
Do everything you can to improve and preserve your Bone Health.
Jay Ginther, MD
This week I had a patient who has decided that she does not need to treat her Osteoporosis because she does not yet have symptoms. This could be a problem for her. The first symptom of Osteoporosis usually is a Fracture. Ouch!
Actually she has had symptoms. She has 5 Vertebral Compression Fracture Deformities in her thoracic spine. As is usually the case, she had aching, but not sharp pains, from these “crumble-type” fractures. Therefore she doesn’t really believe that they are “real” fractures.
Vertebral Fractures generally occur about a decade before Hip Fractures. They are the early warning that much more obvious, and much more inconvenient, fractures may be coming. You ignore that warning at your peril.
Clinical Osteoporosis is a Silent Disease until the first major Fracture (Bone Attack). Heart disease may be silent until the first Heart Attack. High Blood Pressure may be silent until the first stroke (Brain Attack). Each of these can change your whole life.
Osteoporosis with Fracture is far easier to prevent than to treat – for the patient as well as the doc. Why wait for a fracture? Why not start treatment before ruining your life for a few weeks – or forever.
Take Control of Your Life.
Jay Ginther, MD
We are taking time for the most important things in our lives. This most basic Blue Zones concept too often gets lost in modern life.
Family is important, especially children and grandchildren. We are finishing 2 weeks on the west coast with our grown children and our (now 3) grandchildren. It has been wonderful – most of the time.
Our newest grandchild is indeed a wonder. The others, and our own children doubtless were too. This is the first time I have been able to take the time to simply marvel at the wonder of a newborn. And I don’t even have to change a diaper!
At not quite 3 weeks old, he still is mostly on a cycle of eat-sleep-poop. But now there are periods of wakefulness as he begins to look at the world around him. The wonder of a new little person!
Take time to enjoy the wonders of life.
Jay Ginther, MD
Patients, Primary Care Docs, and Orthopedic Surgeons all worry about bone surgery while on Osteoporosis Medications. They also worry about Atypical Fractures of the Femur (AFF). There is one medication that actually helps bone healing and is routinely used to treat AFF. That is the Anabolic, Forteo.
Atypical Fracture of the Femur is quite rare. AFF has become less rare since we started treating osteoporosis with Antiresorptive Osteoporosis Medications. Typical Femur Fractures are still about 100 times as common – and we can prevent over half of those with Antiresorptive Osteoporosis Medications.
AFF is a Stress Fracture, usually just below the hip, that starts on the lateral side of the Femur. It is a small crack, which can gradually spread across the bone.
The best treatment for a stress fracture is stimulating the cells that make new bone (OsteoBlasts) and also stimulating the cells that gobble up bone (OsteoClasts). This increases bone turnover, which is needed for healing a fracture, especially a stress fracture.
Forteo is the only Anabolic we currently have in the USA. Forteo is routinely used to treat AFF before, as well as after, the fracture. It is also used to treat other stress fractures such as metatarsals in the feet and “shin splints” in the proximal shaft of tibia.
Forteo is also commonly used to enhance healing in osteoporotic patients in spine fusions and in total joint replacement.
Jay Ginther, MD