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Archive for August, 2019

We have a new DXA Machine with a great new feature.  We can do body composition with BodyLogic (by Hologic).

Traditional body composition is a skin-fold pinch or BMI.  Both are often highly misleading.  (Most professional athletes are “obese” or “morbidly obese” by BMI because they have too much muscle.)  Newer systems like bio-impedance or immersion can give fairly accurate measures of total lean and total fat.  These were a big step forward, but BodyLogic goes way beyond that.

BodyLogic separates lean into bone and muscle.  It can even give a good estimate of the volume of each muscle group.  This has made it useful in assessing athletes as they train for specific sports.  Professional teams, and a growing number of Division I NCAA teams now track their players’ progress routinely.

BodyLogic body composition is also useful to recreational athletes and members of the fitness community who want to track their muscle development and fat loss.  The biggest advantage is that it can measure metabolic health by differentiating healthy fat and unhealthy fat.

“Love handles” are sub-cutaneous white fat which is actually healthy fat when present in moderation.  We dislike them because we can see them, but they do little harm.  What we cannot see is what can really hurt us.

Visceral Adipose Tissue is unhealthy yellow fat inside the abdomen and chest.  Too much of this can lead to diabetes, hypertension, atherosclerosis and metabolic syndrome.  More about VAT and how to change it next time.

Jay Ginther, MD

 

Evenity is a Really Different Anabolic

August 8, 2019 @ 6:42 pm
posted by Dr Ginther

We now have a third anabolic medication to build new bone.  Evenity is really different from the other anabolics, Forteo (teriparatide) and Tymlos (abaloparatide).  Forteo and Tymlos are daily shots based on the human hormones PTH and PTHrP.  Evenity is an antibody to the human hormone sclerostin.

Sclerostin controls bone formation by telling osteoblasts to stop making new bone, and telling osteoclasts to gobble up old bone.  This results in  stable bone turnover remodeling (until menopause decreases control over the osteoclasts and they go wild).  Evenity suppresses sclerostin.

Evenity markedly increases new bone matrix formation within the first month.However, the ability of Evenity to increase new bone formation diminishes month by month until it is mostly gone by one year.  Therefore, it has been approved for use for only one year at a time.  Like Forteo and Tymlos, Evenity must be followed by an antiresorptive to preserve the increase in bone.

Evenity also suppresses bone resorption by the second month.  This is a less dramatic action, but it continues at the same level to the end of the year.  The net result is a significant increase in bone matrix by the end of the year, in the same general order of magnitude as Forteo and Tymlos.

Evenity is a monthly shot into the subcutaneous fat on the back of both arms by a healthcare professional.

There is a possibility that Evenity may increase cardiac events in persons who have had a recent stroke or heart attack.  This was found in only one of the 3 clinical trials of Evenity.

Preauthorization is required for insurance to cover Evenity.  Most insurances will probably cover it within the first 3-12 months.  More next time.

Jay Ginther, MD