Take Time For The Important Things in Life

August 29, 2015 @ 12:38 pm
posted by Dr Ginther

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

Forteo Treats Atypical Fractures of the Femur

August 21, 2015 @ 9:09 pm
posted by Dr Ginther

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.

If you need increased bone turnover, increased bone matrix formation, or enhanced healing of osteoporotic bone, consider the Anabolic, Forteo.

Jay Ginther, MD

Visiting a New Grandson – Blue Zone

August 17, 2015 @ 10:22 pm
posted by Dr Ginther

We are visiting our new one week old grandson.  Grammy is enjoying herself fully.

Families are Blue Zones!

Jay Ginther, MD

You have started taking Osteoporosis Medication.  You think you have entirely eliminated your Fracture Risk.  Then, WHAM – you have a Fracture!  What went wrong?

It is time to re-evaluate.  There are many possible reasons for your fracture.

First, all osteoporosis medications gradually become effective over months.  Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.

By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3.  That is very good, but not perfect.

Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day.  You need to have a high enough Vitamin D level to absorb the Calcium.  You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough.  You also need Protein (1gram per kg of body weight).  If you had Secondary HyperParathyroidism, it must be resolved.

Third, Bisphosphonate pills are sometimes not absorbed adequately.  When they work, we actually absorb less than 1% of the drug taken.  If this is a problem, Reclast or Prolia can get around the absorption issue.  Of course, skipped doses do not work at all.

Fourth, there may be other issues causing fragility.  A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc.  These need to be fixed too.

Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives.  Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.

Fracture while on medication?  Time to re-evaluate.  Then modify your program if needed.

Jay Ginther, MD