Insane medicine – Osteoporosis: Calcium and Vitamin D with medication choices for treatment.

Insane medicine - Osteoporosis
Insane medicine – Osteoporosis
  • Osteoporosis is diagnosed by bone density tests or fragility fractures. Bone densitometry is reported in the form of a T-score. A normal value is a value that is within a standard deviation (S.D) of a young adult mean bone density value. Anything that is 2.5 S.D.  or more below the mean is osteoporosis.
  • http://www.shef.ac.uk/FRAX/tool.aspx?country=9 <- A calculation tool, the FRAX model, can help predict a 10 year probability of hip or other osteoporotic fracture based on risk factors and known bone density at the femoral neck.
  • Reviews of postmenopausal women and older men (>70) who took vitamin D and calcium had fewer hip fractures and nonvertebral fractures.
  • Recommendations for calcium: 1000mg for all adults ages 19-50, including pregnant and lactating women, and 1200 mg of elemental calcium a day for women over 50 and men over 70 years old.
  • Vitamin D intake 600 IU a day for men and women up to 70 and 800 IU a day for women over 70.
  • http://www.ars.usda.gov/ba/bhnrc/ndl  < — this is a link to calcium content and Vitamin D content in food you eat.
  • Target serum 25-OH-D (25-hydroxy-vitamin D) level is 30-60 ng/ml. This is a measurement of how much vitamin D is in your system.
  • We obtain vitamin D from food sources (see link above) such as salmon, tuna, milk, and many other sources. Calcium is obtained in milk products and vegetables. See the link above for sources.
  • Calcium supplementation: There is no evidence that calcium supplements increase your heart attack risk up to 1000 mg a day when taken with 400IU of vitamin D, based on the women’s health initiative. The choice of calcium supplement would include Calcium citrate if you take anti-acid medications such as proton pump inhibitors or proton pump inhibitors. If your take calcium carbonate, it should be taken with food to increase absorption.
  • treat osteoporosis if you (1) get a hip or spine fractue (2) you have a T score of less than -2.5 at the spine, femoral neck, or total hip area, or (3) if your FRAX risk is > or = 3% for hip fracture and your T score is between -1.0 and -2.5.
  • Options for treatment include Biphosphonates, which are non-hormonal agents that inhibit osteoclasts, which break down bone. Examples are Alendronate (Fosomax), Risendronate, Ibandronate (Boniva), and Zoledronic acid (Reclast). each has various routes of administartion and frequency of administration. You have a choice of once a day, weekly, monthly, or even annual intake of some medications.
  • Side effects that are common with bisphosphonates include heartburn and esophagitis if you don’t drink enough water and stay upright for 30 minutes after taking the pill. Osteonecrosis of the jaw is rare, but more common in immunocompromised patients. If use occurs for longer than 5 years, there is an increased risk of atypical hip fractures.
  • Duration of treatment is not clear, but continuing bisphosphonates beyond 5 years does decrease the number of vertebral fractures, but not non vertebral fractures. Some doctors recommend stopping treatment for a while after 5 years of medication with Bisphosphonates.
  • Denosumab (Prolia) is a monoclonal antibody that inhibits osteoclasts and decreases bone breakdown. It is injected every 6 months and decreases vertebral, hip, and nonvertebral fractures as well as increasing bone density.
  • Estrogen antagonists such as Raloxifine is useful to prevent and treat postmenopausal osteoporosis. It reduces only vertebral fracture incidence, not non vertebral fracture rate. It can reduce the risk of invasive breast cancer.
  • Duavee, a combination of estrogen and Bazedoxifene ( a selective estrogen receptor modulator like Raloxifene), is useful in postmenopausal women with an intact uterus. It increased bone density. There was no increase in endometrial, ovarian, or breast cancer.
  • Contact your doctor to discuss the options right for you.
  • The rate of bone loss increases rapidly after menopause in women.
    The rate of bone loss increases rapidly after menopause in women.

    Osteoporosis and the spine
    Osteoporosis and the spine

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