Archive for September, 2011
|A reader writes: ¬†“I am 74 female in general good health. ¬†I have taken Fosamax and it‚Äôs generic for 13 years and have -4 in spine and advancing ostopenia in hip. My specialist in osteoporosis is recommending Prolia and doing tests first. I‚Äôve never been off Fosamax and wonder if I start Prolia, should I be off Fosamax for a while?”
This raises lots of issues to discuss in GENERAL terms.
I learned many new details about Osteoporosis prevention and treatment last week at the American Society for Bone & Mineral Research annual conference. ¬†I was also one of the teachers.
Osteoclasts are the cells that eat away bone.¬† Osteoclasts are normally kept under control by Estrogen in women and Testosterone in men.¬† Women lose Estrogen suddenly¬†at Menopause.¬† Men lose Testosterone gradually¬†over time.
Osteoclasts are much like teenagers. They behave only as long as controls are in place. ¬†Once control is lost, it is ‚ÄúOsteoclasts Gone Wild‚ÄĚ.
When treating osteoporosis, I am all about preventing fractures.¬† I rely heavily on the body’s natural processes as the basis of any treatment.¬† I use pharmaceuticals when necessary to supplement the body’s natural abilities.¬† Times are changing.¬† More and more pharmaceuticals are natural substances, missing from the person being treated.¬† I am going to”school” to learn about them.
On the plane from Minneapolis to San Diego¬†today, I talked with a basic scientist from Mayo Clinic.¬† We are working on the same problems, but¬†at opposite ends of the spectrum.¬† I treat patients now.¬† He is working at the beginning of a process which will¬†take a decade or more beyond the decade he has already invested.¬† Tomorrow we join thousands, all working together toward the same goals.
The American Society for Bone and Mineral Research 2011 Annual Meeting begins tomorrow.¬† Thousands of researchers in the basic science of bone biology share discoveries.¬† Others turn those discoveries into potential treatments.¬† Still others test for safety and effectiveness.¬† Many years later in the process,¬†physicians like myself will have another option in helping patients.¬† I am here to learn more about the basic science behind current and future “medications”.
The researcher I talked to is working on breast cancer that spreads to bone.¬† Some women¬†lack the ability to make a specific enzyme which is a natural defense against breast cancer spreading to bone.¬† In these women the breast cancer cells hijack bone cells to help the cancer spread and grow.¬† Years from now we may be able to replace that missing natural enzyme with a “medication” that is the enzyme itself.
This will not be unusual.¬† Already 3 of the “pharmaceuticals” I use for osteoporosis are copies of missing natural hormones and enzymes.¬†
Jay Ginther, MD