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Posts Tagged ‘Smoking’

Who is at High Risk of Dying from Covid-19?

April 13, 2020 @ 6:06 pm
posted by Dr Ginther

Although most persons infected with Covid-19 recover, some do not.  Some groups of people are more at risk of dying from Covid-19 complications than others.  This should not surprise us.  The same people are at higher risk with all diseases and injuries.  Those with pre-existing chronic diseases.

Who are the usual suspects?  The elderly, especially male. Diabetics, especially those poorly controlled or obese.  Those with heart diseases and high blood pressure.  People with lung problems like COPD, asthma, or emphysema, especially those already requiring oxygen and/or inhalers.  Smokers and vapers.

These are the same individuals who disproportionately die each year from influenza – a distant cousin of corona-viruses.  And even from the common corona-viruses, the common cold.  The difference is that Covid-19 is a strain which is completely new to humans and very contagious.  Nobody was immune from a previous year.

We do not yet have a vaccine for Covid-19, although progress is much faster than in the past.  With luck we may have something by fall.  Normally a vaccine is a  1-2 years project.

Having a vaccine will be great, but taking it will be crucial even though vaccines are not perfect.  Nearly every year the majority of people who die of influenza complications are high risk individuals who did not get the vaccine, for whatever reason.

Get your pre-existing chronic medical conditions under control.  Being as healthy as possible could save your life.

Jay Ginther, MD

Treat to Target #3 – FRAX

February 9, 2018 @ 5:04 pm
posted by Dr Ginther

Our Target is NO NEW FRACTURES.  The original goal by DXA was a  T-score of -2.4 or better.  But age is a huge factor in actual fracture risk.  The fracture risk of a T-score of -2.5 at age 60 is the same as a T-score of -3.1 at age 50, is the same as a T-score of -1.3 at age 80.

FRAX was developed by WHO and the International Osteoporosis Foundation to take age and other factors into account.  The big 5 risk factors are age, previous fracture, parental hip fracture, smoking, and oral or inhaled corticosteroids.  Rheumatoid arthritis (or diabetes), over 3 doses of alcohol daily, and BMI < 19 or > 35 also count.  Male and Female are different.  Femoral Neck of the hip BMD by DXA is only 30% of the calculation when available.

Treat to Target by FRAX is a “Major Osteoporotic” (wrist, shoulder, hip or clinically noticed spine) Fracture Risk of < 20%.  Alternately a Hip Fracture Risk of < 3.0 is the target.  FRAX identifies a more individualized fracture risk than DXA with or without fragility fracture.

Look up the FRAX tool at http://www.sheffield.ac.uk/FRAX/

FRAX gives different targets than DXA because it takes additional risk factors into account.  And there have been some refinements added.

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

Smoking is a major risk factor for fractures.  Smoking suppresses the osteoblasts (the cells that make new bone).  The osteoclasts (cells that eat away bone) then can easily outdo the osteoblasts, and you lose bone mass.  Lower bone mass = more fractures.

Stopping smoking altogether is the best for your bone health.  That is really tough to do.  E-cigarettes have not proven less harmful to bone.  Nicotine patches help only if they eventually lead to less nicotine intake than with smoking.

The damage smoking does to your bones (and lungs, and heart) is dose related.  Therefore, cutting way down is almost as good as quitting, and often much easier to do.

Especially if you are trying to heal a fracture, stopping smoking, even for a few weeks, is really important.  1 ppd smokers are 5 to 10 times as likely to not heal a fracture.  The same is true for infection rate after surgery.

Steroid Inhalers also suppress osteoblasts and bone formation.  Unfortunately many cannot get off their steroid inhalers, even after they quit smoking.  Major bummer.

Take Control Naturally of your bone health.  Stop Smoking.  Or at least cut way back.

Jay Ginther, MD