You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
Jay Ginther, MD
Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD). This is good? WRONG !!
High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen. This means that glucose (sugar) molecules are incorporated into the collagen protein chains. This distorts and stiffens the Bone Matrix.
Normally, stiffer is better, Calcium stiffens the bone matrix, which strengthens the bone. But too much of a good thing is bad. Too stiff becomes brittle. Brittle bones break more easily than “stiff enough” bones.
Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics. Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.
We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves. Now we know that high blood sugars in diabetics are bad for bones too.
Take Control of Your Future. If you have diabetes, work with your primary doc to get your blood sugars under control.
Jay Ginther, MD
Cedar Valley Bone Health Institute of Iowa staff gained 2 grandsons this weekend.
Yesterday evening Shari, our receptionist/office lead, welcomed her first. He was born in Waterloo and she was there to hold him within the first hour.
This afternoon, Grammy and I welcomed our third grandchild, and first from our older boy. He is in California and we will see him in a week when we go to visit. For now we have to settle for a video.
Family is a Blue Zone.
Jay Ginther, MD
Waterloo hosted the Iowa Irish Fest for the 9th year this past weekend. It has gradually grown to include the Celtic heritages of Ireland and Scottland. With activities for children as well, it is a family Blue Zone.
We enjoyed the Shepherds Pie, Bangers & Mash, Irish Stew, Soda Bread along with Stout or Ale or Crispin (Hard) Cider over the 3 days of the event. Most interesting to me was the Haggis – in regular sausage casing rather than a sheep’s stomach.
The entertainment was outstanding. The Trinity Irish Dancers are girls from Chicago, Milwaulkee and Madison. This year they became the first team from this side of “the pond” to win the international championship.
Gaelic Storm was the band featured in the movie Titanic. They are great. The Screaming Orphans are an outstanding band that happens to be all female. Lots of other very good mixed bands – most with fiddles and a variety of drums, some with bagpipes.
We watched some of the Celtic Games – feats of strength requiring much practice to do safely and well.
Blue Zone weekend.
Jay Ginther, MD