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Archive for the ‘Medications’ Category

If you fracture, your risk of a second fracture within a year is 3 to 5 times as great!  If that first or second fracture is a hip, you have a 25% chance of dying and a 25% chance of spending the rest of your life in a nursing home.  Scary.

Sometimes nutrition and lifestyle changes are enough.  Often medications are needed to effect real improvement.  The anabolic medications Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity) not only prevent further fractures by increasing bone mass, but also speed healing.  The antiresorptive medications decrease fracture risk by preventing bone loss.

The NOF video at https://vimeo.com/267839997 discusses the likelihood of benefit in relation to the very small risk of harm from antiresorptive medications.

Understand the relative risks of taking a medication compared to the relative risks involved in not taking a medication.

Jay Ginther, MD

Diet and exercise are not always enough to prevent fractures.  Medications are needed if you are fracturing or BMD is falling despite your best efforts. We have many posts about when medications should be considered and the differences among medications.

Traditionally DXA and BMD had been the main determinant of bone health.  Relying solely on BMD often lead us astray.  FRAX helps correct for factors other than BMD.  VFA, looking at the lateral spine, often finds patients with unrecognized crumbling of the spine.  TBS can be added to DXA to identify bone quality issues missed by DXA and BMD alone.

NOF has 16 pages of information at https://cdn.nof.org/wp-content/uploads/Bone-Basics_Osteoporosis-Medicines-FINAL-6.12.19.pdf

Picking the best medication for you personally requires a complete bone health evaluation and consultation with your healthcare professional.

Jay Ginther, MD

Fear of Covid-19 Can Kill

April 19, 2020 @ 6:20 pm
posted by Dr Ginther

We have discussed who is at the highest risk of death from Covid-19 or other diseases or injuries.  The usual suspects.  Those with serious chronic diseases:  Elderly, especially male; Diabetes, especially poorly controlled; Heart disease and blood pressure problems; Lung diseases like COPD, Asthma, Emphysema, especially those dependent on oxygen or inhalers.

None of these can be cured, but all can be controlled or made less severe.  That requires careful management.  Labs, other tests, discussion with the managing healthcare provider often need to be done every month or 2 or 3.  Medications need to be adjusted.  Careful management of chronic disease is not “elective”.  It is “essential”.

Fear of Covid-19 is keeping many with unstable chronic diseases from their usual testing and management.  Others delay going to hospital for worsening symptoms.  Waiting until your problems are severe makes even ICU care less likely to succeed.

Telemedicine can be an answer, but talk only is not as good as being able to see the patient.  Many older persons do not have a computer or smart phone which would make them visible to their healthcare provider.  Drawing blood tests by phone does not work either.

Most hospitals and many doctor’s offices are mostly empty making social distancing feasible.  Call your healthcare provider to arrange for needed management of your disease.  Adjustments can be made such as Drive-Thru Care.

Do not let fear of Covid-19 put you at greater risk of complications of your pre-existing chronic disease.

Jay Ginther, MD

Covid-19 is quite contagious.  Patients coming into a clinic or hospital could put themselves at risk from other patients.  Patients who are not yet symptomatic can put other patients and health-care workers at risk.  How can we get essential medications, yet limit risk?  Drive-Thru.

I am on several medications which cannot be stopped because I am controlling chronic diseases (that cannot be cured).  I no longer enter my pharmacy.  Drive-Thru window.

Osteoporosis is a chronic disease we cannot cure, but can control.  We now call every Prolia and Evenity patient offering the option of being met in the parking lot.

Roll down the car window.  Roll up your sleeve and put your arm out the window.  Get your shot.  Roll up your sleeve and window.  Done with minimal exposure to another person.

Remember that skipping a Prolia shot is a very bad idea.  Recently evidence has surfaced that missing a Prolia shot by more than 2 months can increase the risk of vertebral fracture to higher than it was before starting treatment.

Most of the time we can delay the DXA/VFA or lab tests by a month or 2 or even 6.  Prolia and Evenity should not be delayed.  Forteo and Tymlos usually arrive by mail for self injection.  Changing to a different medication could be another option.  Call your doc.

Jay Ginther, MD