Archive for the ‘Bone Health’ Category
The American Society of Clinical Oncology received bad news about Breast Cancer Patients this week. A study of women with breast cancer, being treated with Aromatase Inhibitors (AI), was presented at the 2014 Breast Cancer Symposium. AI is a great treatment for breast cancer, however…
AI is known to decrease bone strength and to increase Fracture Risk. How many of these patients were evaluated for their bone health? Only 54%. How many got a repeat evaluation to check to be sure that their bone health was not deteriorating? Only 46%.
Of those tested, 43% had a DXA T-score in the “osteopenia” range. In this situation, FRAX is needed to calculate Fracture Risk. 41% of this group met guidelines for treatment with medication to prevent bone loss and Fractures. Of those who should have been treated, only 23% were.
Running your butt off several days weekly, as a child, is good for your bones. And the benefits last a lifetime!
We already knew that vigorous running sports can produce a peak bone mass and bone size at least 50% better than couch potatoes’. Now a study, in the Scandinavian Journal of Medicine and Science in Sports, of elderly individuals has shown that these traits persist long after retirement from sports. Fracture rates and Fracture Risk are also lower in former athletes.
A delicate balance between bone formation and bone resorption is needed for Healthy Bone. This balance is naturally present until menopause in a woman or “Low T” in a man. The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). OsteoClasts are cells that resorb or take away bone (Resorptive). Both live on the surface of bone. OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. Women make Estradiol from Estrogen. Men make Estradiol from Testosterone. Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. Estrogen is back on board. Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. They both mimic the natural process, but in different ways. We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD
A patient had no idea why her doc sent her to me for a Complete Bone Health Evaluation. As a “baby-boomer”, she lives by the motto: “You are only as old as you choose to be.” And she chooses to remain young. If only it were possible…..
“I can’t have Osteoporosis. I used to drink milk. I am active and I plan to stay active!!! So I just can’t have Osteoporosis!” Unfortunately, she does have Osteoporosis by BMD on her DXA, by the multiple Vertebral Fractures on VFA, and by FRAX. Still, there are simple steps to rescue her Bone Health before she Fractures.