Posts Tagged ‘BMD’

“Bisphosphonate Holiday” 2014

March 8, 2014 @ 8:56 pm
posted by Dr Ginther

“You are entering a Data-Free Zone”   That was unfortunately the messasge at the joint meeting of the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) last month.  We simply do not have data from a study involving tens of thousands of patients.  We do know some things that are helpful.

Bisphosphonates build up in bone over time.  After about 5 years of Bisphosphonate therapy, you should have enough medication in your bones to last for additional years.  How many years?  That depends.  Different individuals lose Bisphosphonates from their bones at different rates.  Different Bisphosphonates tend to stay in bone longer or shorter than others.  We call the time you are able to stop taking medication for a while (because you have enough in your bones already) ”Bisphosphonate Holiday”.

The International Society for Clinical Densitometry (ISCD) met last week.  Our society has been dedicated to properly evaluating DXA to determine Bone Mineral Density (BMD) and t-score.  Now ISCD is taking the next step.

The recurring theme at the 2014 ISCD joint meeting with the International Osteoporosis Foundation (IOF) was that DXA, BMD, and t-score are only tools to reach the real goal.  The real goal is Preventing Fractures.  DXA, BMD, and t-score alone do not get us to that goal.  As health care providers, we can best prevent fractures by evaluating the reasons for Fracture Risk, and correcting those issues. 

Natural Risk

February 13, 2014 @ 8:03 am
posted by Dr Ginther

Several patients in the last month have decided not to take the “unnatural” risk of taking medication for their Postmenopausal Osteoporosis.  They have been scared by the media emphasis on rare possible risks and side effects of taking osteoporosis medication.  They are not aware of the much greater Natural Fracture Risk of being a Post-menopausal Woman.

One patient specifically cited the risk of OsteoNecrosis of the Jaw (ONJ) as her reason.  Her risk of ONJ if she takes an Antiresorptive is less than 1 /10,000 per year.   Her FRAX calculation shows a total fracture risk of 1/10 per year and hip fracture of 1/35 per year if she does not take medication.   She is 1000 times more likely to fracture without medication as she is to have ONJ with medication.  Natural Risk can be a Bummer!

Enjoy A Nooner

January 23, 2014 @ 9:59 am
posted by Dr Ginther

Again we have a patient whose Spine BMD has dropped despite good osteoporosis medication.  She takes 500 mg Calcium at breakfast and at supper.  She remembers that you can only absorb 5-600 mg Calcium at a meal.  But what about lunch?  She needs at least 200 mg more calcium in her day.

She plans to eat a yogurt for lunch.  This would get her to her minimum of 1200 mg Calcium daily – if only she remembered more than once a week.  We need to entice her with a “nooner”.  We need her to crave her calcium.  Adora Premium Chocolates could do it.