Posts Tagged ‘Fracture’
This week I had a patient who has decided that she does not need to treat her Osteoporosis because she does not yet have symptoms. This could be a problem for her. The first symptom of Osteoporosis usually is a Fracture. Ouch!
Actually she has had symptoms. She has 5 Vertebral Compression Fracture Deformities in her thoracic spine. As is usually the case, she had aching, but not sharp pains, from these “crumble-type” fractures. Therefore she doesn’t really believe that they are “real” fractures.
Vertebral Fractures generally occur about a decade before Hip Fractures. They are the early warning that much more obvious, and much more inconvenient, fractures may be coming. You ignore that warning at your peril.
Clinical Osteoporosis is a Silent Disease until the first major Fracture (Bone Attack). Heart disease may be silent until the first Heart Attack. High Blood Pressure may be silent until the first stroke (Brain Attack). Each of these can change your whole life.
Osteoporosis with Fracture is far easier to prevent than to treat – for the patient as well as the doc. Why wait for a fracture? Why not start treatment before ruining your life for a few weeks – or forever.
Take Control of Your Life.
Jay Ginther, MD
Patients, Primary Care Docs, and Orthopedic Surgeons all worry about bone surgery while on Osteoporosis Medications. They also worry about Atypical Fractures of the Femur (AFF). There is one medication that actually helps bone healing and is routinely used to treat AFF. That is the Anabolic, Forteo.
Atypical Fracture of the Femur is quite rare. AFF has become less rare since we started treating osteoporosis with Antiresorptive Osteoporosis Medications. Typical Femur Fractures are still about 100 times as common – and we can prevent over half of those with Antiresorptive Osteoporosis Medications.
AFF is a Stress Fracture, usually just below the hip, that starts on the lateral side of the Femur. It is a small crack, which can gradually spread across the bone.
The best treatment for a stress fracture is stimulating the cells that make new bone (OsteoBlasts) and also stimulating the cells that gobble up bone (OsteoClasts). This increases bone turnover, which is needed for healing a fracture, especially a stress fracture.
Forteo is the only Anabolic we currently have in the USA. Forteo is routinely used to treat AFF before, as well as after, the fracture. It is also used to treat other stress fractures such as metatarsals in the feet and “shin splints” in the proximal shaft of tibia.
Forteo is also commonly used to enhance healing in osteoporotic patients in spine fusions and in total joint replacement.
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
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