Archive for the ‘Bone Health’ Category
Copy for BTrue Magazine July 2014 Issue
Top 10 reasons to check your Bone Health
10. It’s all downhill after age 30. You reach your maximum bone mass by about age 30. Then you start to lose bone mass every year. After Menopause it is 1 to 2 percent bone loss every year. That adds up fast.
9. You are active and want to stay active. Weak bones can get stress fractures during sports or fun activities like dancing. Don’t get caught doing the wrong knd of break dancing. Strong bones require enough Calcium, Vitamin D, and Protein, as well as regular exercise. See our recommendations at www.BoneDocBlog.com.
8. Fractures “Suck”. A fracture is not fun. You could be in a cast or on crutches for months. That really sucks.
7. Most Iowans are low on Vitamin D. Unless you are taking extra Vitamin D all year long, you are probably too low to absorb calcium well. We can only get Vitamin D from the sun 5 months of the year and then only at mid-day. Find out how much extra you need by testing.
6. “Milk does your body good” Milk is optional. Calcium is not optional. You need about 1200 mg of calcium daily in divided doses with meals. In food is best. Supplements with food also work. Look up foods providing calcium on www.BoneDocBlog.com.
5. Babies steal from your bones. During pregnancy and nursing, your baby comes before your bones. You will steal calcium from your bones to build a healthy baby. Try running after a toddler with weak bones!
4. A fracture is a Bone Attack. It is a warning that you may have problems with bone density or bone quality. Someone with one fracture is 2 to 5 times as likely to have a second fracture. Bummer. A complete bone health evaluation can identify opportunities for improvement. Avoid that second fracture by fixing the problems.
3. A bone density exam (DXA) involves less radiation than a flight to LA and back. DXA is safe and much more comfortable than a mammogram, pelvic or prostate exam. Our machine rotates, so you don’t have to.
2. Osteoporosis is much easier to prevent than treat. Starting to build or preserve your bones while young is relatively easy and does not require medication. Trying to salvage serious osteoporosis after a major fracture is harder for you, and usually requires medication.
1. 60 minutes for a DXA/VFA and Complete Bone Health Evaluation can save you years of misery. Start early to prevent that hip fracture at 70. Or that wrist fracture at 50. Or that foot fracture at 30. They can really cramp your style.
A Complete Bone health Evaluation includes DXA, VFA, FRAX, CBC, CNP, TSH, PTH, 25-hydroxy Vit D level, and a consultation solely focussed on bone health. In seven years I have never seen a patient who did not have at least one bone health issue which could be improved.
Once again we have been treated to statisticians mushing together multiple disparate previous studies to “prove” that calcium alone, or vitamin D alone, or both together in one of many different combinations will not prevent fractures. All mushed together in a carefully selected meta-analysis, you can prove anything depending on which studies are included.
More important, asking if adding a specific dose of calcium, or vitamin D, or both, will prevent fractures, misses the entire point. Most studies did not properly account for the nutrients in each day’s diet in individual test subjects – or in individual control subjects, many of whom also consumed the nutrients being studied.
And how can you ethically ask a patient to limit their diet in a way you believe will put them at risk for fractures? You have to settle for encouraging patients who are inadvertently short on some nutrients to improve their diet. But then they do not fracture and you cannot prove that they would have if only you had withheld the information!
We help individuals improve their bone health. One size does not fit all. We do a Complete Bone Health Evaluation. Then we adjust nutrition and lifestyle as needed for that individual. In about half of women and three-quarters of men, this is enough.
Jay Ginther, MD
Iowa Bone Club met for the third time this past Friday, 20 October. Ritu Munjal, MD was the program chair and hosted the meeting at PCI in Cedar Rapids.
Great program for those attending. Guest CME topic was hypophosphatasia, which can be a cause of poor bone and increased fracture risk. Low alkaline phosphatase and elevated B6 are the key labs. The condition can be made worse by bisphosphonates, and probably other antiresorptives.
Spring 2018 meeting will be Friday 1 June in Spirit Lake.
Jay Ginther, MD
Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades. These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure them.
Bone health joins the Treat to Target club in 2017. Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.
What is our target? Traditionally it has been maintaining the T-score found at the first assessment. This does not necessarily make sense, especially if there already are fractures. The target should be NO NEW FRACTURES. This is a game changer.
This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured. How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.
This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles. (I did that a few years back.)
THE TARGET IS NO NEW FRACTURES.
Jay Ginther, MD