25-hydroxy Vitamin D level recommendations for patients were plentiful at the American Society for Bone and Mineral Research (ASBMR) 2012 meeting. Many opinions. Little agreement. Research presented was usually observational. It did not specifically look at daily activity levels in relation to falls. It often only studied the elderly and nursing home residents.
Dr Neil Binkley, of the University of Wisconsin, gave the clinical summary presentation about Vitamin D dosing. He cited studies of blood levels in people who get their Vitamin D naturally from the sun. That included surfers, farmers, construction workers, and traditional herdsman cultures in Africa. These groups have average blood levels in the 40-60 ng/ml range. I recommend levels above 40 for my patients.
Today I taught the Nurse Practitioner class at Allen College. Their Bone Health – Osteoporosis section included 3 hours of classroom lecture and discussion. We also spent an hour teaching the basics of DXA, VFA, and how to read them correctly. This is not a full ISCD course, but enough to get the students pointed in the right direction.
Teaching is stimulating. Trying to distill the 250+ hours of Continuing Medical Education I have taken in the last 5 years down to 3 hours is challenging. Students always have thought-provoking questions. They make me think, and when I think, I learn too.
People who are lactose intolerant develope digestive problems when they eat dairy products. Live culture yogurts or other “probiotics” may help in mild cases. Persons with more serious intolerance should avoid dairy entirely. Religion, personal ethics, or personal taste are non-medical reasons some people choose to avoid dairy.
Calcium Deficiency is common among persons avoiding dairy products. Good bone health requires enough calcium in your diet. Traditional cultures offer guidance about other foods high in calcium. Modern nutritional substitute foods also give us options.
Studies of combinations of osteoporosis medications expanded at the American Society for Bone and Mineral Research (ASBMR) 2012. Previous meetings featured alternating the anabolic, Teriparatide (Forteo) with a Bisphosphonate Antiresorptive, usually Alendronate (generic Fosamax), and, more recently, simultaneous Alendronate and Forteo. This time we heard about the first study of Denosumab (Prolia) combined with Forteo. [Disclosure: I am on the Orthopedic Advisory Board for Prolia, and Speakers Bureau for Forteo]
The Bone Mineral Density (BMD) increase at one year was much better for the combination than for either drug alone. This is the same effect we have seen with previous combinations, but higher BMD numbers. This study had small numbers of patients (<200), and a short period of time (<2 years). It is not clear, whether the greater BMD of this combination is of any significance, and how well it will hold up over time. Also, BMD is not the whole story.