Posts Tagged ‘Osteoporosis medication’
True in the 1960’s – even more true today. We expect to live into our 80’ and 90’s. We expect to enjoy those extra years. We can, with a little planning and action NOW.
If YOU don’t take care of your body, where ARE you going to live? That is the real question. Women start to rapidly lose bone at Menopause. This is totally natural and used to be unavoidable. Without action on your part, you could develop Clinical Osteoporosis and Fractures and wind up in a nursing home. You can avoid these complications of natural aging.
Cedar Valley Bone Health Institute of Iowa offers a Complete Bone Health Evaluation. DXA, VFA, specific blood tests not usually done in annual check-ups, full history, an examination and full consultation usually take 30 minutes focused on bone health alone. We can Prevent Osteoporosis if we start early enough. Prevention is far better than treatment, and ideally should start decades before menopause.
You must be prepared to Take Control of those issues you can control: Calcium, Vitamin D, Protein, Vitamins & Minerals, and Exercises for Balance, Strengthening and Posture. Everyone should do these Natural measures for best results, whether taking Osteoporosis Medications or not. For younger persons and for some individuals over 50, they are enough all by themselves.
More next time about how YOU can Take Control of your future.
Jay Ginther, MD
Recent studies have shown that the order in which we use osteoporosis medications matters. Traditionally most docs have used Antirsorptives first to preserve bone. All osteoporosis medications except one are Antiresorptives. Only when that failed, would they consider the Anabolic medication, Forteo, to build new bone.
As a practicing orthopedic surgeon, I started treating osteoporosis in the worst of my fracture patients. It was obvious that they needed to build bone first since there was very little bone to preserve. Therefore, I usually started with the Anabolic, Forteo. Once I had built up the bone, I preserved that improved bone with an Antiresorptive osteoporosis medication.
As the National and International Osteoporosis Foundations, (NOF and IOF) are now focusing on preventing second fractures, many more practioners are treating patients with one or more fractures. They are facing the dillema of how to prevent fractures in bone that is not good enough. None of the Antiresorptives work as well in patients with multiple fractures as they do in patients who have not yet fractured.
This year studies have shown that using Forteo after an Antiresorptive usually results in Forteo taking several months to overcome the previous slowing of bone turnover, Therefore, 2 years of Forteo results in less improvement when used AFTER the Antiresorptives tested, than we normally see in a patient who uses Forteo first.
At NOF and IOF this year speakers suggested that we change our approach. They suggested using an Anabolic first, and an Antiresorptive second should be the standard sequence for best results.
Would you rather only trying to preserve your bones after they have proven insufficient in multiple fractures? Or would you want to improve your bone first, and then prserve that improved bone matrix and improving BMD?
Do everything you can to improve and preserve your Bone Health.
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