Posts Tagged ‘Smoking’
Fractures are NOT FUN. Not something you want to repeat. Any fracture is a Bone Attack. It is a warning that you probably have Bone Health issues that can be improved. Get a Complete Bone Health Evaluation and work to prevent a second fracture. Most people can succeed in preventing that second fracture.
I see many individuals who have had a first fracture. Often the DXA, BMD, and T-score are not that bad. I even see many who have good DXA test scores. But they still fractured with relatively minor trauma. They proved that they have increased Fracture Risk. Why?
Anabolic medication for osteoporosis actually increases bone thickness and strength! Antiresorptive medications for osteoporosis (Fosamax, Alendronate, Actonel, Atelvia, Boniva, Evista, Reclast, Prolia) only preserve bone.
We have talked about all of the Antiresorptive medications over the last 2 months. They are excellent treatment if slowing down the OsteoClasts (cells that eat away your bone) is sufficient. That is not always the case.
Now it is time to talk about something completely different. Anabolic medication stimulates the OsteoBlasts (cells that make new bone matrix). OsteoBlasts can rebuild your bones. If you have Fractures, your bones may need to be rebuilt.
Forteo (Teriparatide) is the only Anabolic medication for osteoporosis in the USA. Close cousins of Forteo are available in other countries.
You may need the Anabolic, Forteo, if you have a hip fracture, multiple other fractures, or if VFA testing reveals a Vertebral Compression Fracture. A DXA T-score well below -2.5 can be reason enough without fracture.
Glucocorticoid (Cortico-Steroid) medications (Prednisone, Steroid Inhalers) specifically supress OsteoBlasts (cells that make new bone). Stimulating the OsteoBlasts with the Anabolic, Forteo, can offset the bone loss from Steroid medications. Smoking also supresses OsteoBlasts, leading to bone loss. Stopping Smoking would be best, but Forteo can help.
Not everyone needs an Anabolic, but some individuals do. A Complete Bone Health Evaluation will tell you if an Anabolic is right for you.
More about Forteo (Teriparatide) next time.
Jay Ginther, MD
Patients who have already fractured may need osteoporosis medications. Adding fractures to a low BMD or T-score on DXA makes the Clinical Osteoporosis more severe and increases Fracture Risk. This is true of vertebral fractures detected on VFA, as well as clinically obvious fractures, like hip or wrist or shoulder.
Fracture Risk is the big deal. Fractures are what we want to avoid. Having suffered one fracture makes a Second Fracture 3 to 5 times as likely as the first. Bummer. Calcium, Vitamin D, Protein, Multivits and Exercise alone often cannot overcome those odds. Real bummer. Adding a medication often can avoid the Second Fracture.
Fracture Risk is the elephant in the room. Fractures can keep you from doing what you want for weeks or months. Fractures can put you in a Nursing Home, sometimes forever. Complications of fractures can kill you. Fractures are what you want to avoid if at all possible.
Increased Fracture Risk was defined as Clinical Osteoporosis by NIH in 2000. We may still think of Osteoporosis as a T-score of -2.5 on DXA. This is inaccurate. Fracture Risk increases with age and other factors at any given T-score. Over 80% of the persons who fracture have a T-score better than -2.5 !!! Accurately calculating your true Fracture Risk requires a Complete Bone Health Evaluation.