Posts Tagged ‘Fracture Risk’

Breast Cancer

August 14, 2014 @ 8:39 pm
posted by Dr Ginther

Breast cancer is the most common cancer in women.  Some women have a family history of breast cancer.  They are at especially increased risk.  Unfortunately, most women who develop breast cancer do not have a family history.  Therefore, all women must be considered to be at risk for breast cancer.

Some breast cancers are stimulated by estrogen.  Women with a family history of breast cancer should generally avoid taking estrogen.  Exposure to estrogen beyond age 70 is associated with increased breast cancer risk.

Hormone Replacement Therapy does carry an increased risk of breast cancer, especially in women over 70.   Most physicians advise stopping HRT before age 70 for this reason.

There are 2 estrogen-like medications which actually decrease breast cancer risk.  They do this by competing with a woman’s natural estrogen for the estrogen receptors in breast tissue.  Raloxifene (Evista) and Tamoxifen both can occupy the estrogen receptors in breast tissue and block their activation by the woman’s own estrogen.  This protects the woman from developing estrogen dependent breast cancer by about 70%.

Tamoxifen is approved for both prevention and treatment of breast cancer.  Tamoxifen does not harm bone.  The more aggressive modern breast cancer treatments (Aromatase Inhibiters) do  harm bone.  Unfortunately, Tamoxifen has not been shown to preserve bone either.

Evista preserves bone and decreases Fracture Risk.  More about preventing breast cancer and decreasing fracture risk next time.

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!

Androgen Deprivation Therapy – ADT

August 1, 2014 @ 5:16 pm
posted by Dr Ginther

Androgen Deprivation Therapy is used to treat Prostate Cancer.  ADT is usually effective against Prostate Cancer, adding years to a man’s life.  However, ADT can cause Osteoporosis and Fractures, UNLESS we treat to Prevent Fractures.

The good news is that we can decrease Fracture Risk by more than half.  Plus, the medication which preserves bone can help treat the cancer!  We can usually delay, and sometimes prevent, metastases to bone.  Occasionally we can shrink the original prostate cancer tumor.  Amazing!  You can Take Control.

Acute Phase Reaction

July 26, 2014 @ 6:12 am
posted by Dr Ginther

An Acute Phase Reaction can occur the first time a person is exposed to a new class of medication.  With each subsequent dose, half as many people have the reaction.  The symptoms are like mild flu for 3 to 5 days.  The treatment is lots of fluids, and Tylenol (Acetaminophen) if needed.

Persons who have never taken any bisphosphonate before, can experience an acute phase reaction the first time they take Reclast (Zolendronate in osteoporosis dose).  This happens in about one-third of persons who have not taken Fosamax (Alendronate), Boniva (Ibandronate), Actonel (Risedronate), or Atelvia (enteric coated Risedronate) before their first dose of Reclast.  This happens in about one-sixth of persons after their second dose.  Third dose is down to one-twelfth.

Acute phase reaction is a significant nuisance.  However, a Fracture is a significant problem.  Reclast will reduce Fracture Risk by more than half compared to no osteoporosis medication at all.  See the visuals for fracture risk in women and men without osteoporosis medication.  Remember to check for good enough kidney funtion (GFR at least 45) before each dose.

It’s all about avoiding Fractures.

Jay Ginther, MD