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Posts Tagged ‘Osteoporosis medication’

Treat to Target #1 – Which Target?

June 19, 2017 @ 6:30 pm
posted by Dr Ginther

Treat to Target has been standard for chronic diseases like high blood pressure and diabetes for decades.  These are chronic diseases, more common as we get older, that we can control with diet, exercise, and eventually medication.  We cannot cure them.

Bone health joins the Treat to Target club in 2017.  Increased Fracture Risk (Clinical Osteoporosis) is a chronic disease, more common as we get older, that we can control with diet, exercise, and eventually medication.  We cannot cure Increased Fracture Risk, so treatment of some sort is necessary “forever”.

What is our target?  Traditionally it has been maintaining the T-score found at the first assessment.   This does not necessarily make sense, especially if there already are fractures.  The target should be NO NEW FRACTURES.  This is a game changer.

This means that we are aiming for a Bone Mineral Density T-score higher than -2.5 in someone who has not yet fractured.  How we get there requires a new approach to medications, once we have reached the limits of Take Control Naturally detailed in previous posts.

This also means we need to check the VFA for previous Vertebral Compression Fractures, most of which go un-noticed, mistaken for pulled muscles.  (I did that a few years back.)

THE TARGET IS NO NEW FRACTURES.

Jay Ginther, MD

“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

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