Posts Tagged ‘Multiple Vitamins & Minerals’
National Bone Health treatment goals are changing for those patients with high fracture risk. Simply preserving bones already at a too high fracture risk never made much sense to this former orthopedic surgeon. Now the national leadership is stressing the need to lower fracture risk first, then preserve bones at a lower level of fracture risk.
We now have 3 anabolic medications which substantially lower fracture risk by increasing the thickness and strength of bone structure: Teriparatide (Forteo), Abaloparitide (Tymlos), and Romosozumab (Evenity). They all decrease fracture risk substantially more than the antiresorptive (preserving) medications alone. The difference in fracture risk grows for up to 5 years. After that the difference in fracture risk between anabolic meds followed by preserving meds vs. preserving meds alone remains the same.
Calcium can take up to 3 additional years to collect in newly formed bone matrix. DXA shows calcium in bone (Bone Mineral Density). Much of the increased BMD can only be seen on DXA after the anabolic med is completed and the antiresorptive med is started.
All of the anabolic medications must be followed by antiresorptive medication to preserve the gains made by the anabolic. No medication to grow or preserve bone can work without adequate nutrition in the form of absorbable calcium, vitamin D3, protein and other vitamins and minerals.
Jay Ginther, MD
I was asked about treatments for Fibromyalgia. Pain clinics have injections and pharmaceuticals that often help, but not always enough. I approach from a different angle.
Fibromyalgia is a collection of many different maladies that are magnifying each other. They are very difficult to untangle. Treating all aspects of the pain is the key to success.
I have actually “cured” fibromyalgia only 4 times, but usually I can decrease the pain enough that other measures will work better than before.
The key is understanding that pain often is nerves misbehaving, magnifying the intensity of unpleasant stimuli. This is neuropathy or neuralgia. These conditions are made much worse by nutritional deficits.
B1, B6, B12 and Folate are key nutrients for nerve function. Controlling diabetes is also important. Low calcium, potassium or magnesium cause cramping and pain. These should ALL be checked.
Vitamin D is often overlooked as essential for nerve function. Low vitamin D will cause depression, malaise, nerve malfunction and increased pain. I aim for a vitamin D level of 70 ng/ml – higher than needed for bone health, but completely safe. If your level is very low you may need megadoses, well above 5000 IU daily.
Take Control Naturally with Vitamin D3, as well as B1, B6, B12, Folate, Calcium, Potassium and Magnesium.
Jay Ginther, MD
Treat to Target means aiming for NO NEW FRACTURES. As discussed last time, the original target was to maintain Bone Mineral Density (BMD) at the level first tested. 25 years ago that was amended to be a T-score of -2.4 or higher, since “osteoporosis the test result” was set at -2.5.
But what if you already have fractured? Clinical Osteoporosis the diagnosis is a T-score of -1.5 plus a “Fragility Fracture” acquired in any fall from standing height, even on ice. That is because for the first year after a fracture your risk is 5 times normal. Your risk decreases to 2 times normal after 5 years, but always is higher after a fragility fracture.
If your Fragility Fracture was a Hip Fracture, you have Clinical Osteoporosis regardless of DXA BMD and T-score. You are at high risk of future fracture, especially of the other hip. You should start treatment to prevent a new fracture. At the very least you need to optimize calcium, vitamin D3, protein, and multiple vitamins & minerals intake.
If you also need a pharmaceutical, it should be one which can raise your T-score above -2.5 if you have no fractures, and above -1.5 if you already have a fracture. That usually means considering an anabolic. Your goal is NO NEW FRACTURES.
FRAX next time.
Jay Ginther, MD
Choose your parents well. Their genetics mix to form your genetics. Your genetics play a large role in determining your potential strengths and weaknesses. However, what you do with your potential is up to you.
We all wish we could be something we are not, and never can be. That is completely natural, but not helpful. You have to play the hand you were dealt. You have to take control of your future, and you can.
If your parents had great bones, you probably will too – as long as you take care of them with Calcium, Vitamin D, Protein, Exercises, Balance, and Avoid Smoking.
If your parents crumbled into kyphosis (humpback) or broke a hip, due to osteoporosis, you better get working on what you can control as early as possible. You will probably need medications eventually, but starting on natural treatments early enough can delay that need for years.
If you Take Control Naturally of what you can control early enough, you can achieve many years of fracture free life. That’s as good as it gets.
Jay Ginther, MD