Posts Tagged ‘Vitamin D3’
National Bone Health treatment goals are changing for those patients with high fracture risk. Simply preserving bones already at a too high fracture risk never made much sense to this former orthopedic surgeon. Now the national leadership is stressing the need to lower fracture risk first, then preserve bones at a lower level of fracture risk.
We now have 3 anabolic medications which substantially lower fracture risk by increasing the thickness and strength of bone structure: Teriparatide (Forteo), Abaloparitide (Tymlos), and Romosozumab (Evenity). They all decrease fracture risk substantially more than the antiresorptive (preserving) medications alone. The difference in fracture risk grows for up to 5 years. After that the difference in fracture risk between anabolic meds followed by preserving meds vs. preserving meds alone remains the same.
Calcium can take up to 3 additional years to collect in newly formed bone matrix. DXA shows calcium in bone (Bone Mineral Density). Much of the increased BMD can only be seen on DXA after the anabolic med is completed and the antiresorptive med is started.
All of the anabolic medications must be followed by antiresorptive medication to preserve the gains made by the anabolic. No medication to grow or preserve bone can work without adequate nutrition in the form of absorbable calcium, vitamin D3, protein and other vitamins and minerals.
Jay Ginther, MD
I was asked about treatments for Fibromyalgia. Pain clinics have injections and pharmaceuticals that often help, but not always enough. I approach from a different angle.
Fibromyalgia is a collection of many different maladies that are magnifying each other. They are very difficult to untangle. Treating all aspects of the pain is the key to success.
I have actually “cured” fibromyalgia only 4 times, but usually I can decrease the pain enough that other measures will work better than before.
The key is understanding that pain often is nerves misbehaving, magnifying the intensity of unpleasant stimuli. This is neuropathy or neuralgia. These conditions are made much worse by nutritional deficits.
B1, B6, B12 and Folate are key nutrients for nerve function. Controlling diabetes is also important. Low calcium, potassium or magnesium cause cramping and pain. These should ALL be checked.
Vitamin D is often overlooked as essential for nerve function. Low vitamin D will cause depression, malaise, nerve malfunction and increased pain. I aim for a vitamin D level of 70 ng/ml – higher than needed for bone health, but completely safe. If your level is very low you may need megadoses, well above 5000 IU daily.
Take Control Naturally with Vitamin D3, as well as B1, B6, B12, Folate, Calcium, Potassium and Magnesium.
Jay Ginther, MD
Treat to Target means aiming for NO NEW FRACTURES. As discussed last time, the original target was to maintain Bone Mineral Density (BMD) at the level first tested. 25 years ago that was amended to be a T-score of -2.4 or higher, since “osteoporosis the test result” was set at -2.5.
But what if you already have fractured? Clinical Osteoporosis the diagnosis is a T-score of -1.5 plus a “Fragility Fracture” acquired in any fall from standing height, even on ice. That is because for the first year after a fracture your risk is 5 times normal. Your risk decreases to 2 times normal after 5 years, but always is higher after a fragility fracture.
If your Fragility Fracture was a Hip Fracture, you have Clinical Osteoporosis regardless of DXA BMD and T-score. You are at high risk of future fracture, especially of the other hip. You should start treatment to prevent a new fracture. At the very least you need to optimize calcium, vitamin D3, protein, and multiple vitamins & minerals intake.
If you also need a pharmaceutical, it should be one which can raise your T-score above -2.5 if you have no fractures, and above -1.5 if you already have a fracture. That usually means considering an anabolic. Your goal is NO NEW FRACTURES.
FRAX next time.
Jay Ginther, MD
Spring! The Sun is back for more than 12 hours daily! The sun crossed the equator at 0529 CDT. Vitamin D? Not so fast. This is Iowa and we are still too far north.
Your skin can make Vitamin D when exposed to strong enough sunlight. Strong enough sunlight happens when the sun is high enough in the sky that its UV rays are not blocked by the atmosphere. This happens at mid-day all year round in the tropics.
Iowa needs to wait another couple of weeks for our first moments of Vitamin D from the sun. Mid-day is around 1:10 to 1:25 pm CDT, depending on location. Southern Iowa will get enough sunlight several days before northern Iowa. Late June we will have 4-5 hours of opportunity.
Unfortunately, Vitamin D, Sunburn and Skin Cancer are often a package deal. You can encourage them all, or block them all with Sun-block.
Your safest move is to protect yourself from sunburn and skin cancer, and take your vitamin D3 tablets or gel-caps. A 25-hydroxy Vitamin D blood test will show if you have achieved the ideal range of 40-80 ng/ml.
You need to take control, but this is one area where naturally can have a significant downside.
Jay Ginther, MD