Posts Tagged ‘Calcium’
Determining the correct 25-hydroxy Vitamin D level is still a work in progress. In the 8 years I have been attending meetings, we have made considerable progress. NOF 2007 was the first time any society proposed an intake above 400 IU daily and a 25-hydroxy Vit D level of more than 20 ng/ml.
At the 2015 U. Wisconsin “Bare Bones Symposium” the latest recommendations were discussed. I have summarized them here.
Take Vitamin D3. D3 is Cholecalciferol (what we make in sunshine). Vitamin D2 is Ergocalciferol (what plants make and use). D3 works much better in people than D2 becuse it is the right stuff. It lasts 5 times longer and the assay is more accurate.
Test for 25-hydroxy Vitamin D level and aim for between 40 and 80 ng/ml. At 40 ng/ml over 98% of people can absorb and utilize Calcium fully. You want to have some margin of safety since lab test results vary by at least 20%. If you are seriously deficient, we give 50,000 IU of D3 every M, W, F based on your level and size, to correct the level quickly.
If you do not want to test your level, and you are the “average person” of 154# or 70 kg, you should take 3800 IU daily. This should achieve the 40 ng/ml level – eventually. If you are very deficient, this could take a year or more. If you are larger than the old average, or you have digestive issues, you will need more.
Finally, some cancer researchers believe that 70 ng/ml is better for preventing and treating cancers. If they are right, you should go for the higher level. If they are wrong, you have done no harm by going for the higher level.
Take Control of your Bone Health. Take enough D3.
Jay Ginther, MD
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
Protein is necessary for strong bone and muscle. Two patients complained that they were gaining weight when they added enough Protein for good bone health to their diets.
That was their problem. They ADDED Protein to a diet that already had enough Calories in Fats and Carbs. The key is to add Protein without adding Calories. This is harder than it sounds. You may have to reduce other foods to avoid a gain in Calories.
Proteins and Carbs are about equal in Calories. Fats are packed with twice as many Calories. Getting enough Protein as a Vegetarian or Vegan is challenging, but feasible.
Remember that the ideal weight for bone health is a BMI between 22 and 33. The ideal weight to AVOID Death From All Causes is a BMI between 25 and 30 if you are over 60 years of age. A BMI between 22 and 25 almost as good.
Many of our patients Take Control Naturally by getting enough absorbable Calcium in Foods, Vitamin D3, Protein in Foods, Multiple Vitamins & Minerals, and Exercises for Balance and Strength. This way they can often avoid medications for several years.
Take Control Naturally with enough Protein in a balanced diet.
Jay Ginther, MD
Any fracture, especially after age 50, in a woman or a man, requires a Complete Bone Health Evaluation. This was preached from the podium at the National Osteoporosis Foundation (NOF) meeting last month.
ANY Fracture must be taken seriously. Whether you “fell really hard” on concrete or ice, or fractured in sports, or even if you broke bones in a car crash, ALL Fractures indicate increased Future Fracture Risk.
Studies of injuries in car crashes, after matching passengers for seat positiion, closing speed of the collision, belted or not, tell the story. Those with the best Bone Health are least likely to break. Those with poor Bone Health are much more likely to break.
Age 50 approximates menopause in women, but menopause at any age is more significant than age alone. So are parental fractures, especially of hip or spine. And don’t forget men.
Fractures at any age indicate an increased Fracture Risk. After your first fracture, try to avoid your next fracture by improving your bone health.
Most of us can decrease our Fracture Risk before even considering medications. Enough Calcium, Vitamin D3, Protein, Balance and Strengthening Exercises, go a long way to improve your bone health. This is especially true if you start LONG BEFORE age 50.
Did you fracture? Take Control of your Future. Find what you need to change with a Complete Bone Health Evaluation.
Jay Ginther, MD