Posts Tagged ‘anabolic’
A delicate balance between bone formation and bone resorption is needed for Healthy Bone. This balance is naturally present until menopause in a woman or “Low T” in a man. The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). OsteoClasts are cells that resorb or take away bone (Resorptive). Both live on the surface of bone. OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. Women make Estradiol from Estrogen. Men make Estradiol from Testosterone. Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. Estrogen is back on board. Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. They both mimic the natural process, but in different ways. We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD
Are your bones still good enough and just need to be maintained? Or have you fractured several times and need to rebuild your bones? Are Steroid Inhalers supressing your Osteoblasts – the cells that build new bone? (not good) Or have your Osteoclasts – the cells that eat away bone – gone wild (even worse) now that you are post-menopausal or an older guy?
Different problems require different classes of medication. Bisphosphonates, Hormone Replacement Therapy, Synthetic Estrogen Receptor Modifier – Evista, and RANK-Ligand Antibody – Prolia, are all Antiresorptives, which act in different ways. They slow down the Osteoclasts that have gone wild and are eating up the bone. The Anabolic, Forteo, stimulates the Osteoblasts that make new bone matrix. Antiresorptive and Anabolic are radically diferent actions.
Patients who have already fractured may need osteoporosis medications. Adding fractures to a low BMD or T-score on DXA makes the Clinical Osteoporosis more severe and increases Fracture Risk. This is true of vertebral fractures detected on VFA, as well as clinically obvious fractures, like hip or wrist or shoulder.
Fracture Risk is the big deal. Fractures are what we want to avoid. Having suffered one fracture makes a Second Fracture 3 to 5 times as likely as the first. Bummer. Calcium, Vitamin D, Protein, Multivits and Exercise alone often cannot overcome those odds. Real bummer. Adding a medication often can avoid the Second Fracture.
Aunt Henrietta looked like half a raccoon with her entire left eye blackened. She dismissed her looks as not a problem saying, “I fall all the time, but I don’t break anything.” This is a change on both counts. Five years ago, falls were infrequent. Even so, she broke one wrist, then the other wrist, then her shoulder.
Two wrists, one shoulder, and half a dozen vertebral fragility fractures indicated Very Severe Osteoporosis. That was before she took the Anabolic, Forteo, for 2 years. She was the ideal patient for serious measures to stop her fractures. And it has worked!!