Diabetes + High BMD = Brittle Bone

August 11, 2015 @ 8:50 pm
posted by Dr Ginther

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

Grandsons are Blue Zones

August 9, 2015 @ 6:12 pm
posted by Dr Ginther

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

Iowa Irish Fest

August 5, 2015 @ 10:15 pm
posted by Dr Ginther

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

Prevent and Treat ONJ with Forteo

July 31, 2015 @ 7:54 am
posted by Dr Ginther

Dentists and Oral Surgeons are sometimes wary of their patients being on ANY Osteoporosis Medications when they undergo tooth extractions or other dental proceedures.  One osteoporosis medication is different from all the others.  Forteo is the only Anabolic medication currently available in the USA.  Forteo does not cause dental and jaw problems.  Forteo can be used to treat ONJ and other bone problems of the jaw.

OsteoNecrosis of the Jaw (ONJ) is a rare complication of tooth extraction.  If you have cancer, are on chemotherapy, have uncontrolled diabetes, or are on the higher doses of Antiresorptive Osteoporosis Medications used in Cancer Patients with Metastases, ONJ is less rare.

ONJ is the result of too slow bone repair by the OsteoBlasts (the cells that make new bone matrix).  Antiresorptive medications slow down both OsteoClasts (the cells that resorb bone) and OsteoBlasts.

Forteo cannot cause ONJ.  Forteo (Teriparatide) stimulates OsteoBlasts.  That increases new bone matrix formation.  Therefore, Forteo can prevent and treat ONJ.

Forteo has been shown to improve bone healing in dental surgery, including implant osseointegration and healing alveolar defects.  Ref:  Batshutski JD, Eber RM, Kinney JS, et al.  Teriparatide and osseous regeneration in the oral cavity.  N Engl J Med. 2010, 363:2396-2405.  Ref:  Kuchler U, Luvizuto ER, Tangl S, et al.  Short-term Teriparatide delivery and osseointegration: a clinical feasibility study.  J Dent R. 2011:90(8):1001-1006.

As a former orthopedic surgeon, I have discussed these issues with several of our local oral surgeons and dentists.

If you are facing oral surgery or tooth extraction, discuss your osteoporosis medications with your dental surgeon.  Most osteoporosis medications should be held for your surgery.  Forteo is the exception.  Forteo actually helps your jaw heal after dental surgery.

Jay Ginther, MD