Posts Tagged ‘Prolia’
This weekend is Aunt Henrietta’s 90th birthday. I have just the right gift for her, Adora Premium Chocolates. My Aunt Henrietta has been our posterchild since the beginning of Cedar Valley Bone Health Institute of Iowa. Her adventures are well chronicled.
First, she broke one wrist when she was thrown down by a throw rug. Then she broke the other wrist when her bifocals did her in. Then she broke her shoulder when she thought all the ice had melted. I had to tell her Endocrinologist about the Anabolic, Forteo. She agreed to give herself a daily shot. Then she proved that treatment had worked by falling down the stairs and not breaking anything. Finally she locked in the gains of Forteo by starting the Antiresorptive that gets along with her severe GERD and aging kidneys, Prolia.
She can live alone in her own home because she Took Control of her bone health, with Calcium, Vitamin D3, Protein, Multiple Vitamins and Minerals, and Osteoporosis Medications. They are all necessary.
Happy Birthday Aunt Henrietta!
Jay Ginther, MD
Aromatase Inhibitors (AI) do a great job treating Breast Cancers which are Estrogen dependent. The AI wipe out all Estrogen thereby depriving the breast cancer of a needed stimulus.
Unfortunately, Aromatase Inhibitor treatment will also do considerable damage to your bones unless you take medication to protect your bones. The good news is that we have medication which can completely offset the harm AI treatment could do to your bones. But, you have to take it, and the sooner you start, the better.
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.
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