Posts Tagged ‘antiresorptive’

Aunt Henrietta’s Birthday

August 28, 2014 @ 9:11 pm
posted by Dr Ginther

This weekend is Aunt Henrietta’s 90th birthday.  I have just the right gift for her, Adora Premium Chocolates.  My Aunt Henrietta has been our posterchild since the beginning of Cedar Valley Bone Health Institute of Iowa.  Her adventures are well chronicled.

First, she broke one wrist when she was thrown down by a throw rug.  Then she broke the other wrist when her bifocals did her in.  Then she broke her shoulder when she thought all the ice had melted.  I had to tell her Endocrinologist about the Anabolic, Forteo.  She agreed to give herself a daily shot.  Then she proved that treatment had worked by falling down the stairs and not breaking anything.  Finally she locked in the gains of Forteo by starting the Antiresorptive that gets along with her severe GERD and aging kidneys, Prolia.

She can live alone in her own home because she Took Control of her bone health, with Calcium, Vitamin D3, Protein, Multiple Vitamins and Minerals, and Osteoporosis Medications.  They are all necessary.

Happy Birthday Aunt Henrietta!

Jay Ginther, MD

Modern Hormone Replacement Therapy (HRT)

August 7, 2014 @ 5:40 am
posted by Dr Ginther

Modern Hormone Replacement Therapy (HRT) is safe in most women through their 60′s.  20 years ago, when Progesterone was included in the formulation, HRT was associated with heart problems.  Estrogen alone in modern HRT avoids this issue, at least until age 70.  Recent studies have shown that modern HRT actually decreases heart disease deaths in women in their 50′s.

Modern HRT is most commonly used to treat menopausal symptoms.  However, human estrogen is what naturally preserves bone in a pre-menopausal woman.  Restoring human estrogen will also preserve bone in a post-menopausal women.  You can postpone Osteoclasts Gone Wild eating away your bones!

Bisphosphonates are the most commonly prescribed Antiresorptive medications used to prevent or treat Ostoeporosis.  We know them as Fosamax (Alendronate), Boniva (Ibandronate), Actonel (Risendronate), Atelvia (enteric coated Risendronate), and IV Reclast (Zolendronate).  All but the last are pills taken weekly or monthly.

If your bone is strong enough that preserving it is sufficient to prevent fractures, then Antiresorptive medication is what you need.  If you are able to follow the protocol of taking the pill on an empty stomach, followed by one or more full glasses of plain water, and eating or drinking nothing else for at least 30 minutes (60 for Boniva) while remaining upright, Oral Bisphosphonates are the medication for you.

Atypical Fracture of the Femur (AFF) and OsteoNecrosis of the Jaw (ONJ) are rare complications of Untreated Osteoporosis.  They also occcur rarely in patients treated with long term Antiresorptives including: Fosamax, Boniva, Actonel, Allendronate, Ibandronate, Atelvia, Reclast, and Prolia, at a higher, but still very low, rate.  Neither has been reported in Evista.  Forteo is commonly used as a treatment for AFF and ONJ.

AFF and ONJ are rare even in patients treated for Osteoporosis with Antiresorptive medications.  Rates are estimated at between 1 in 1,000 and 1 in 10,000.  Let’s label AFF (X),  ONJ (Z), and patients with neither (O).  Here is a graphic representation, if the worst case estimate is correct:

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOXOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOZOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

These are very rare problems, even in patients on Antiresorptive Osteoporosis Medications for over 5 years.  Fractures from Osteoporosis in patients Not taking Medications are much more common.  That Graphic next time.

Jay Ginther, MD