Archive for the ‘Medications’ Category
Our Amgen Medical Liaison met with us this week. Her job is to supply information which has been published or presented at major meetings. She meets only with practitioners (MD, NP in our case) and cannot market any medications.
This is good. For the first time in 5 years, I missed ASBMR (American Society for Bone & Mineral Research). She was able to show us several studies presented at that meeting that were most helpful.
NP Katie and I, like most practitioners, always approach scientific papers with a critical eye. The studies answered several questions. They also raised further questions. Perhaps those answers will come next year.
Legislators pass rules and regs to keep medical practitioners away from information supplied by persons employed by Pharma. They fail to understand the value of critcally evaluating new scientific data. Detailed information about each available medication is needed if we are to find the best osteoporosis medication for each patient each time.
No single osteoporosis medication is right for everyone all the time. Every osteoporosis medication is the best choice for someone at some time. There are times when no medication is the best choice.
The more information Katie and I have about medications, the smarter we are when helping to choose what is best for each individual. No one can go to all meetings or read all published studies. A Pharma Medical Liaison helps gather relevant information.
YOU too can gather information before and after you visit your doc. Use the left column to find blogs about topics that interest you. You can Take Control.
Jay Ginther, MD
Forteo is a daily shot. That is a nuicence, but a small price to pay for the only Anabolic, the only osteoporosis medication which will increase bone mass in spongy (cancellous) bone. Diabetics give themselves a daily shot for the rest of their lives. Forteo is for only 2 years and uses a tiny insulin needle.
People worry about the warning that lab rats got Osteosarcoma after being given very high doses of Teriparatide for the equivalent of 70 human years. We have not seen this in humans, or chimps, or monkeys, or dogs. Rats have bones that grow all their lives. We do not give Forteo to growing humans, pregnant women, nursing women, persons with Paget’s Disease or unexplained elevated Alkaline Phosphatase, or persons who have had radiation to their bones.
Remember that you must take adequate Calcium, with food, spread out over 3 meals. You must take enough Vitamin D3 to be able to absorb Calcium. You must eat enough Protein for your OsteoBlasts to make new bone matrix.
Forteo (Teriparatide) increases the thickness of the struts making up spongy (cancellous) bone. Forteo is the only osteoporosis medication to do that. It also makes the hard outer shell (cortical bone) thicker. How? Forteo stimulates OsteoBlasts. They make bone matrix, the collagen protein that is more than 80% of bone.
Forteo also stimulates bone turnover. Healthy bone is constantly being resorbed and replaced. This allows bone to eliminate the micro-cracks that gradually accumulate with activity. Bone is strongest when it is a mixture of older more calcified (stiffer) material mixed thoroughly with younger less calcified (somewhat bendable) material. Cracks cannot enlarge. Strength is better. More force is required to fracture the bone.
Anabolic medication for osteoporosis actually increases bone thickness and strength! Antiresorptive medications for osteoporosis (Fosamax, Alendronate, Actonel, Atelvia, Boniva, Evista, Reclast, Prolia) only preserve bone.
We have talked about all of the Antiresorptive medications over the last 2 months. They are excellent treatment if slowing down the OsteoClasts (cells that eat away your bone) is sufficient. That is not always the case.
Now it is time to talk about something completely different. Anabolic medication stimulates the OsteoBlasts (cells that make new bone matrix). OsteoBlasts can rebuild your bones. If you have Fractures, your bones may need to be rebuilt.
Forteo (Teriparatide) is the only Anabolic medication for osteoporosis in the USA. Close cousins of Forteo are available in other countries.
You may need the Anabolic, Forteo, if you have a hip fracture, multiple other fractures, or if VFA testing reveals a Vertebral Compression Fracture. A DXA T-score well below -2.5 can be reason enough without fracture.
Glucocorticoid (Cortico-Steroid) medications (Prednisone, Steroid Inhalers) specifically supress OsteoBlasts (cells that make new bone). Stimulating the OsteoBlasts with the Anabolic, Forteo, can offset the bone loss from Steroid medications. Smoking also supresses OsteoBlasts, leading to bone loss. Stopping Smoking would be best, but Forteo can help.
Not everyone needs an Anabolic, but some individuals do. A Complete Bone Health Evaluation will tell you if an Anabolic is right for you.
More about Forteo (Teriparatide) next time.
Jay Ginther, MD