Posts Tagged ‘Exercise’
Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades. These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure them.
Bone health joins the Treat to Target club in 2017. Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication. We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.
What is our target? Traditionally it has been maintaining the T-score found at the first assessment. This does not necessarily make sense, especially if there already are fractures. The target should be NO NEW FRACTURES. This is a game changer.
This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured. How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.
This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles. (I did that a few years back.)
THE TARGET IS NO NEW FRACTURES.
Jay Ginther, MD
Clinical Osteoporosis 2017, NOF and ISCD joint meeting had a different emphasis this year. Fracture Risk, rather than Bone Mineral Density (BMD) is now the key metric. Several speakers emphasizd the importance of VFA in making the diagnosis of Clinical Osteoporosis. This is something I have presented in poster exhibits 2015, 2016 and 2017. I am now mainstream!
“Treat to Target” was the big new message this year. We should set a target of decreased Fracture Risk for each patient and alter treatment until we reach it. This has been routine for years in diabetes, hypertension, cholesterol, etc. This is recognition that Osteoporosis is a chronic disease that we can control, but never cure, just like many others.
Take Control Naturally is the necessary first step, as I have outlined over the last few months. This is often sufficient for prevention and in mild disease.
Advanced Osteoporosis, especially after fragility fractures, or vertebral compression fractures seen on VFA, is usually beyond nutrition and exercise only. This will usually require medications to significantly reduce fracture risk.
The huge change is the recommendation to use an Anabolic medication first, to markedly reduce fracture risk, when BMD is very low or multiple fractures have already occured. Then follow up with an Antiresorptive to maintain a low fracture risk. Traditionally Medicare and other insurances have demanded we try Antiresorptives first to maintain bone as it is, even when multiple fractures have proven the bone to NOT be good enough at curent BMD.
We are entering a new age of Fracture Prevention!!
Jay Ginther, MD
Choose your parents well. Their genetics mix to form your genetics. Your genetics play a large role in determining your potential strengths and weaknesses. However, what you do with your potential is up to you.
We all wish we could be something we are not, and never can be. That is completely natural, but not helpful. You have to play the hand you were dealt. You have to take control of your future, and you can.
If your parents had great bones, you probably will too – as long as you take care of them with Calcium, Vitamin D, Protein, Exercises, Balance, and Avoid Smoking.
If your parents crumbled into kyphosis (humpback) or broke a hip, due to osteoporosis, you better get working on what you can control as early as possible. You will probably need medications eventually, but starting on natural treatments early enough can delay that need for years.
If you Take Control Naturally of what you can control early enough, you can achieve many years of fracture free life. That’s as good as it gets.
Jay Ginther, MD
The purpose of good bone health is to prevent fractures. Most fractures happen as a result of a fall. If you do not fall, you decrease your fracture risk. How do you prevent falls?
Regular exercise will strengthen your muscles. Strong muscles are part of the solution. But you also need good balance. Good balance requires exercises to strengthen the muscles required for balance.
Balance exercises have been used for centuries to keep people limber and free from falling, and thereby, free from fractures. They are often taught in group sessions, but can be performed alone on any flat surface.
Tai Chi and Yoga are the best known ancient balance exercises. Daily, or at least 3 times weekly, sessions of 20-30 minutes will gradually improve your balance and prevent falls.
Less interesting, but easier to do anywhere, is simply walking on your toes for several minutes. More challenging is walking on your heels, like a penguin. If you can do that for 2 minutes straight, you have great muscles, strong ankles, and are unlikely to stumble, even on uneven ground.
Take Control Naturally by working on your Balance. Remember that proper nutrition is necessary for strong muscles and bones.
Jay Ginther, MD