Posts Tagged ‘Fracture Risk’

You have started taking Osteoporosis Medication.  You think you have entirely eliminated your Fracture Risk.  Then, WHAM – you have a Fracture!  What went wrong?

It is time to re-evaluate.  There are many possible reasons for your fracture.

First, all osteoporosis medications gradually become effective over months.  Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.

By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3.  That is very good, but not perfect.

Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day.  You need to have a high enough Vitamin D level to absorb the Calcium.  You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough.  You also need Protein (1gram per kg of body weight).  If you had Secondary HyperParathyroidism, it must be resolved.

Third, Bisphosphonate pills are sometimes not absorbed adequately.  When they work, we actually absorb less than 1% of the drug taken.  If this is a problem, Reclast or Prolia can get around the absorption issue.  Of course, skipped doses do not work at all.

Fourth, there may be other issues causing fragility.  A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc.  These need to be fixed too.

Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives.  Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.

Fracture while on medication?  Time to re-evaluate.  Then modify your program if needed.

Jay Ginther, MD

Diabetes + High BMD = Brittle Bone

August 11, 2015 @ 8:50 pm
posted by Dr Ginther

Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD).  This is good?  WRONG !!

High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen.  This means that glucose (sugar) molecules are incorporated into the collagen protein chains.  This distorts and stiffens the Bone Matrix.

Normally, stiffer is better,  Calcium stiffens the bone matrix, which strengthens the bone.  But too much of a good thing is bad.  Too stiff becomes brittle.  Brittle bones break more easily than “stiff enough” bones.

Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics.  Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.

We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves.  Now we know that high blood sugars in diabetics are bad for bones too.

Take Control of Your Future.  If you have diabetes, work with your primary doc to get your blood sugars under control.

Jay Ginther, MD

Any Fracture => Bone Health Evaluation

June 23, 2015 @ 7:56 pm
posted by Dr Ginther

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


Keep Your Dad Fracture Free For Fathers’ Day

June 19, 2015 @ 10:04 pm
posted by Dr Ginther

Do better than another shirt or tie for Fathers’ Day.  Make sure your Dad stays Fracture Free!  What?  Men don’t have Osteoporosis or Fractures.  But they do!

25% of all Osteoporosis patients are Men.  Each year 80,000 men have hip fractures.  Over 30% of those men die of complications of their hip fractures.

1/4 of all Men over 50 will Break a Bone due to Poor Bone Health (Osteoporosis).  More Men over 50 will Break a Bone than will have Prostate Cancer.

Many diseases and some medications increase fracture risk.  So do many modern lifestyle errors.  The good news is that simple measures can Decrease Fracture Risk.

Enough Absorbable Calcium spread out through the day.  Enough Vitamin D3 to achieve a 25-hydroxy Vitamin D level of at least 40.  1 gram of Protein for every kilogram of body weight daily.  Multiple Vitamins & Minerals.  Balance and Weight-bearing exercises daily.

Go to the National Osteoporosis Foundation website ( or click the link at your right.  Read The Man’s Guide to Osteoporosis.

Get a Complete Bone Health Evaluation.  Fix potential problems.

Take Control.  You can Avoid Fractures.

Jay Ginther, MD