Pharmaceutical Industry Websites

The following sites are sponsored by the manufacturers of these pharmaceutical agents:

Treat to Target # 2 – Fragility Fracture

January 31, 2018 @ 8:23 pm
posted by Dr Ginther

Treat to Target means aiming for NO NEW FRACTURES.  As discussed last time, the original target was to maintain Bone Mineral Density (BMD) at the level first tested.  25 years ago that was amended to be a T-score of -2.4 or higher, since “osteoporosis the test result” was set at -2.5.

But what if you already have fractured?  Clinical Osteoporosis the diagnosis is a T-score of -1.5 plus a “Fragility Fracture” acquired in any fall from standing height, even on ice.  That is because for the first year after a fracture your risk is 5 times normal. Your risk decreases to 2 times normal after 5 years, but always is higher after a fragility fracture.

If your Fragility Fracture was a Hip Fracture, you have Clinical Osteoporosis regardless of DXA BMD and T-score.  You are at high risk of future fracture, especially of the other hip.  You should start treatment to prevent a new fracture.  At the very least you need to optimize calcium, vitamin D3, protein, and multiple vitamins & minerals intake.

If you also need a pharmaceutical, it should be one which can raise your T-score above -2.5 if you have no fractures, and above -1.5 if you already have a fracture.  That usually means considering an anabolic.  Your goal is NO NEW FRACTURES.

FRAX next time.

Jay Ginther, MD

Calcium and Vitamin D3 Can Help !!

January 21, 2018 @ 9:43 pm
posted by Dr Ginther

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

MLK’s Unfulfilled Dream

January 15, 2018 @ 6:59 am
posted by Dr Ginther

Dr Martin Luther King, Jr preached at evening chapel at Wesleyan University (CT) too few weeks before he was killed.  He spoke and prayed briefly with those of us in the chapel choir before the service.  Not a tall man, he was none-the-less a giant among us.  Then, he preached his dream to a packed house.

He dreamed of a day when all persons could mingle and live together free of the superficial factors of race, ethnicity, economic class, religious denomination, or political affiliation. He dreamed of a day of peaceful cooperation among all peoples.

Unfortunately we remain too much human and too little humane.  All of us.  On this day let us all remember that we are each part of the problem.  Let us all strive to be part of the solution as well.  A unified society which must include us all.  Let us fulfill the dream.

Jay Ginther, MD

Puffball Birds

January 13, 2018 @ 8:52 pm
posted by Dr Ginther

Our birdfeeders have been mobbed by birds looking like puffballs.  With temps below zero F, everyone has their feathers fluffed out as far as possible, but especially the house finches.  Chickadees, juncos, cardinals, blue jays, goldfinches, downey woodpecker and the occasional house sparrow are all bundled up for cold too.  Great news – haven’t seen or heard crows in weeks.

Take time to step into the Blue Zones of the natural world.  All life is wonderful.

Jay Ginther, MD