Archive for July, 2012

TANSTAAFL

July 31, 2012 @ 9:28 pm
posted by Dr. Ginther

There Ain’t No Such Thing As A Free Lunch.  As true now as when Robert Heinlein shortened it to TANSTAAFL.

Every medication has benefits and risks.  Every decision to not take medication has increased risks as well as the avoidance of those risks medications may carry.  The trick is to put the benefits and risks into a proper balance based on your individual pre-existing risks.

The NIH definition of Osteoporosis is an Increased Risk of Fracture.  Genetics, age, smoking status, steroid medications, low calcium intake, low Vitamin D levels all contribute to Fracture Risk.  Some of these are addressed in FRAX.  A full bone health evaluation can determine the magnitude of your fracture risk.

Perhaps you can Take Control Naturally with the right amount of Calcium, Vitamin D3, exercise, avoiding smoking, etc.  These measures are often sufficient when fracture risk is low.  They are necessary in all cases.

The benefit of every osteoporosis medication is to Decrease Fracture Risk when the risk is high.  Your risk for each medication is determined by the details of your medical conditions.  The FDA warnings cover many risks which are extremely rare, as well as some more common.  A full discussion with your doctor or PA or NP will help you determine which risks apply to you.

Every action and inaction carries risks.  Take control by getting a full evaluation and full consultation.

Jay Ginther, MD

Finished Forteo – Now What?

July 23, 2012 @ 9:19 pm
posted by Dr. Ginther

Aunt Henrietta finished her 2 years of the Anabolic, Forteo.  It worked.  Just to prove it, she fell all the way down the stairs and didn’t break anything.  What osteoporosis medication should she take next?

The FDA specifically does not allow persons marketing Forteo to recommend any other medication to follow Forteo because no prospective, blinded, randomized trial involving at least hundreds of individuals switching to one specific medication has been done.  A separate trial would be needed for each Antiresorptive medication.

Forteo must be followed by an Antiresorptive medication in order to preserve the gains achieved by increased bone matrix formation.  Determining the best medication for each individual requires a full osteoporosis evaluation.

Different Doses – Different Names

July 13, 2012 @ 6:03 am
posted by Dr. Ginther

We have talked about Reclast and Prolia, two meds for osteoporosis.  We have not talked about Zometa and Xgeva, two meds for prevention and treatment of cancer spreading to bone (metastases).  We should.

Reclast and Zometa are the same drug (Zolendronate) given in different doses for different diseases.  Prolia and Xgeva  are the same drug (Denosumab) given in different doses for different diseases. 

Vitamin D Prevents Fractures – Only If You Take Enough!

July 10, 2012 @ 5:00 am
posted by Dr. Ginther

Last week NEJM published a study that looked at actual total Vitamin D intake by individuals (65 and older) in the study.  No previous study had divided individuals by their total Vitamin D intake (their assigned supplement + what they were already taking) and also asked how often they actually took their meds.

Those taking total 800 IU Vit D or more daily showed a 30% decrease in hip fractures.  This is highly significant.  This is also the first time persons taking 800 IU daily were studied.  When all individuals assigned to (400 IU) Vit D were combined (including those rarely taking their assigned dose) the 10% decrease in hip fractures was not statistically significant.