|A reader writes: “I am 74 female in general good health. I have taken Fosamax and it’s generic for 13 years and have -4 in spine and advancing ostopenia in hip. My specialist in osteoporosis is recommending Prolia and doing tests first. I’ve never been off Fosamax and wonder if I start Prolia, should I be off Fosamax for a while?”
This raises lots of issues to discuss in GENERAL terms.
I learned many new details about Osteoporosis prevention and treatment last week at the American Society for Bone & Mineral Research annual conference. I was also one of the teachers.
Osteoclasts are the cells that eat away bone. Osteoclasts are normally kept under control by Estrogen in women and Testosterone in men. Women lose Estrogen suddenly at Menopause. Men lose Testosterone gradually over time.
Osteoclasts are much like teenagers. They behave only as long as controls are in place. Once control is lost, it is “Osteoclasts Gone Wild”.
When treating osteoporosis, I am all about preventing fractures. I rely heavily on the body’s natural processes as the basis of any treatment. I use pharmaceuticals when necessary to supplement the body’s natural abilities. Times are changing. More and more pharmaceuticals are natural substances, missing from the person being treated. I am going to”school” to learn about them.
On the plane from Minneapolis to San Diego today, I talked with a basic scientist from Mayo Clinic. We are working on the same problems, but at opposite ends of the spectrum. I treat patients now. He is working at the beginning of a process which will take a decade or more beyond the decade he has already invested. Tomorrow we join thousands, all working together toward the same goals.
The American Society for Bone and Mineral Research 2011 Annual Meeting begins tomorrow. Thousands of researchers in the basic science of bone biology share discoveries. Others turn those discoveries into potential treatments. Still others test for safety and effectiveness. Many years later in the process, physicians like myself will have another option in helping patients. I am here to learn more about the basic science behind current and future “medications”.
The researcher I talked to is working on breast cancer that spreads to bone. Some women lack the ability to make a specific enzyme which is a natural defense against breast cancer spreading to bone. In these women the breast cancer cells hijack bone cells to help the cancer spread and grow. Years from now we may be able to replace that missing natural enzyme with a “medication” that is the enzyme itself.
This will not be unusual. Already 3 of the “pharmaceuticals” I use for osteoporosis are copies of missing natural hormones and enzymes.
Jay Ginther, MD