Posts Tagged ‘Menopause’
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
Denosumab (Prolia) mimics the natural process that keeps OsteoClasts (the cells that gobble up bone) under control before menopause. OsteoCytes release Osteoprotegrin (OPG) when Estrogen (or Testosterone) is on board. OPG controls the formation and activation of OsteoClasts by blocking RANK-Ligand, which is necessary for OsteoClast formation and activation. This decreases fracture risk.
Prolia mimics OPG and blocks RANK-Ligand, thus blocking bone resorption by preventing OsteoClasts. It is a RANK-Ligand Antibody. It is like birth control for OsteoClasts. Prolia is given as a shot under the skin twice a year. Prolia is very effective at first, but begins to fade by 6 months. Without another injection , Prolia has totally lost effectiveness by 12 months after the last shot.
A delicate balance between bone formation and bone resorption is needed for Healthy Bone. This balance is naturally present until menopause in a woman or “Low T” in a man. The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). OsteoClasts are cells that resorb or take away bone (Resorptive). Both live on the surface of bone. OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. Women make Estradiol from Estrogen. Men make Estradiol from Testosterone. Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. Estrogen is back on board. Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. They both mimic the natural process, but in different ways. We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD
Several patients in the last month have decided not to take the “unnatural” risk of taking medication for their Postmenopausal Osteoporosis. They have been scared by the media emphasis on rare possible risks and side effects of taking osteoporosis medication. They are not aware of the much greater Natural Fracture Risk of being a Post-menopausal Woman.
One patient specifically cited the risk of OsteoNecrosis of the Jaw (ONJ) as her reason. Her risk of ONJ if she takes an Antiresorptive is less than 1 /10,000 per year. Her FRAX calculation shows a total fracture risk of 1/10 per year and hip fracture of 1/35 per year if she does not take medication. She is 1000 times more likely to fracture without medication as she is to have ONJ with medication. Natural Risk can be a Bummer!