Archive for October, 2012
Today I taught the Nurse Practitioner class at Allen College. ¬†Their Bone Health – Osteoporosis section included 3 hours of classroom lecture and discussion. ¬†We also spent an hour teaching the basics of DXA, VFA, and how to read them correctly. ¬†This is not a full ISCD course, but enough to get the students pointed in the right direction.
Teaching is stimulating. ¬†Trying to distill the 250+ hours of Continuing Medical Education I have taken in the last 5 years down to 3 hours is challenging. ¬†Students always have thought-provoking questions. ¬†They make me think, and when I think, I learn too.
People¬†who are¬†lactose intolerant develope digestive problems when they eat dairy products. ¬†Live culture yogurts or other “probiotics” may help in mild cases. ¬†Persons with more serious intolerance should avoid dairy entirely. ¬†Religion, personal ethics, or personal taste are non-medical reasons some people choose to avoid dairy.
Calcium Deficiency is common among persons avoiding dairy products. ¬†Good bone health requires enough calcium in your diet. ¬†Traditional cultures offer guidance about other foods high in calcium. ¬†Modern nutritional substitute foods also give us options.
Studies of combinations of¬†osteoporosis medications expanded at the American Society for Bone and Mineral Research (ASBMR) 2012.¬† Previous meetings featured alternating the anabolic, Teriparatide (Forteo) with a Bisphosphonate Antiresorptive, usually Alendronate (generic Fosamax), and,¬†more recently,¬†simultaneous Alendronate and Forteo.¬† This time we heard about the first study of Denosumab (Prolia) combined with Forteo.¬† [Disclosure: I am on the Orthopedic Advisory Board for Prolia, and Speakers Bureau for Forteo]
The Bone Mineral Density (BMD) increase at one year was much better for the combination than for either drug alone.¬† This is the same effect we have seen with previous combinations, but higher BMD numbers.¬† This study had small numbers of patients (<200), and a short period of time (<2 years). ¬†It is not clear, whether the greater BMD of this combination is of any significance, and how well it will hold up over time.¬† Also, BMD is not the whole story.
Vitamin D was the topic of a symposium attended by hundreds of clinicians at the American Society for Bone and Mineral Research (ASBMR) 2012 meeting.¬† Vitamin D3, D2, 25-hydroxy, 1-25-dihydroxy, 24-25-dihydroxy, and differnt assays. ¬†All the variations lead to confusing research results as we try to understand Vitamin D and how it works.
Dr Neil Binkley, of the University of Wisconsin, gave the summary presentation about Vitamin D dosing and measurement of blood levels. ¬†He gave a plea for everyone to switch to Vitamin D3, now that it is cheaper than D2, and available in prescription level doses.
I have made Vitamin D3 in 50,000 unit capsules available to my patients for the last 3 years, dispensed by my office. ¬†Finally some pharmacies are carrying it as well.