Posts Tagged ‘Fracture Risk’

“I want to treat my bone health entirely naturally – without any “artificial” medications.”  That might be possible if you are among the less than half of all women not destined to suffer one or more fragility fractures without medication.  Your odds are certainly better if you take all the measures outlined over the past weeks.

Years ago Osteoporosis was rarely a problem.  100 years ago most people died before age 65.  200 years ago most people died before age 40.  We live too long to avoid the natural decline in bone health.  (I would rather live long and deal with medications).

When I was in medical school (45 years ago) we lived entirely naturally in terms of bone health.  Most woman, and some men, became stooped forward with “humpback” kyphosis until they fell, broke a hip and either died or were shipped to a nursing home forever.  There was nothing we could do to prevent that.

Now we know a bunch of natural things we can do to postpone that scenario, but we cannot prevent it entirely in many people without adding medication.  Adding medication may be “cheating”, but I would rather stay active and enjoy life.

Take Control Naturally as long as you can, but evaluate your bone health periodically and add osteoporosis medication when your fracture risk rises.

Jay Ginther, MD

So how do you find out what aspects of your bone health are pretty good already, what will be easy to fix, and what will take some real work?  Start with a Complete Bone Health Evaluation.

DXA is about 1/3 of the story and should include both hips and spine.  When you are as old as I am, the spine probably is too arthritic to be really accurate, but helps complete the picture.  If you have had a total hip replacement, you should use the non-dominant forearm.

VFA will pick up many persons at increased fracture risk who are missed by DXA alone.  You should ask for VFA, especially if you or a parent have kyphosis (humpback) or have lost height.

The FRAX calculation picks up different individuals at high fracture risk.

Blood tests should include CBC, CMP, TSH, PTH, and 25-hydroxy Vitamin D as a start.  Further testing may be needed.

A medical history and examination focused on bone issues is a critical part of the full consultation.  We allot a minimum of 30 minutes for discussion.  Often a follow-up visit is needed to be sure both we and our patients are clear on the whole picture.

DXA alone misses over half of the individuals who need to improve their bone health.  Get a Complete Bone Health Evaluation.

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

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