Guest guest Posted March 22, 2011 Report Share Posted March 22, 2011 Sharon--- The biggest loss in women is the first 5-7 yrs of menopause--how much varies greatly. I've had 70 yr old women with nl BMDs. Firstly with this woman, her T-scores reflect osteopenia in her hip only and and nl BMD in her spine so there is *no reason to treat her*. A no. of years ago, they recommended treating women with osteopenia if they had significant risk factors. They NO LONGER recommend treating osteopenia at all.This woman's BMD is minimally now at any rate. *Osteoporosis requires a T-score of -2.5. ** There are a no. of BMD machines and it's hard to compare results. *Because of that, a new method(a few yrs ago) of assessment called *FRAX* was developed. Google it. This method takes into account different machines and various risk factors(< 125 lb, smoker, FH, various drugs, etc) to calculate fracture risk, as we do with the Framingham scale for MI risk. You can have her old BMD compared to the new one but differences in machines makes it hard to assess loss. For any menopausal woman, you should check a Vit D level and make sure she is taking 1200 mg Ca and doing wt bearing exercise. Biphosphonates are reputed to stay in your bones for many yrs. Women taking them longer than 7 yrs have had odd femur fractures. After 2 yrs, It's good to take a " holiday " so bone metabolism returns to nl. Many now say to d/c rx altogether after 5 yrs. Still, they say biphosph's reduce fracture rate in the elderly. I " m not even sure what that means anymore. Some people don't put an elderly woman on the Rx until they fall and break a bone?!?(like my 89 yo with dementia who's had a nl BMD until recentty). I suspect there are other reasons for fractures that we aren't yet aware of/understand. There is no reason to treat this woman. Check her D and Ca po and re-do BMD in 2 yrs. Ellen > > For Graham and other's: > > > Now that bisphosphonates seem to be less beneficial than we maybe > thought, I'm confused about when to recommend them. How much bone > density does the average post-menopausal woman lose per year and when > should we offer something that can improve things? > > For example, yesterday I saw a 61 year old British woman who appears > to have thin bones (whatever that implies). Had a Dexa last year with > a T score of -1.2 left trochanter, -0.6 lumbar spine. Density at left > trochancer was 0.744 g/cm2. In 2002, it was 0.744 on a different > machine. I know you can't really compare, but of course, want to. > Looks like a 4.4% bone lose if I am figuring correctly. > > From my memory, women lose 1% density a year, is that correct? (I'm > having trouble finding data on that.) So, it seems this woman is doing > fine, even though the thought of a 4% bone loss in 8 years freaked her > out. She is doing well with exercise (walking), not so much upper > extremity, and working on getting enough calcium and Vitamin D. > > Any sense of how much bone density a woman loses if she does > everything right? (ie where can we get without pharmaceuticals?) > > > Thanks, > Sharon > > > Sharon McCoy MD > Renaissance Family Medicine > 10 McClintock Court; Irvine, CA 92617 > PH: (949)387-5504 <tel:%28949%29387-5504> Fax: (949)281-2197 > <tel:%28949%29281-2197> Toll free phone/fax: > <tel:> > www.SharonMD.com <http://www.SharonMD.com> > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2011 Report Share Posted March 22, 2011 Apart from VitD and Ca, there are a number of orthomolecular compounds (trace minerals and vitamins) that are emerging. Nothing with the evidentiary basis of D and Ca, but this is mostly stuff that's present in trace amounts in food anyway. Strontium salts (esp ranelate) are emerging as a useful strategy for slowing osteoporosis (Consult Pharm. 2008 Jul;23(7):531-7. PMID: 18764671, to cite just one review). Vit K is also being actively studied. No clarity yet on K1 vs. K2 (of course, avoid in warfarinized pts). (Health Technol Assess. 2009 Sep;13(45):iii-xi, 1-134. PMID: 19818211) Silicon, Boron, and Vit C are also under investigation. Doses haven't been clarified, and nothing's " ready for prime-time " per FDA approval. There are some expensive " osteo support " multivitamins on the market - a good multi often has adequate doses of some of the trace minerals, but not always. Weight-bearing exercises, of course, will help. There's emerging evidence on Tai Chi (useful for balance, too). Finally, watch for PPIs. Serious hypocalcemia or hypomagnesemia is rare, but reported (see last week's Medscape Gastroenterology). If so, it's likely that they may be inducing functional, low-level deficiencies. I've worked with a number of people that get relief from muscle cramps, spasms, etc when I add D/Cal/Mag to their regimen. Whether in ten years there will be a clinically significant change in osteoporosis, fracture rates, etc, I can't tell you. -- Be well, Bill Walter ND Golden Apple Healthcare, LLC billwalter@... www.goldenapplehealthcare.com For Graham and other's: Now that bisphosphonates seem to be less beneficial than we maybe thought, I'm confused about when to recommend them. How much bone density does the average post-menopausal woman lose per year and when should we offer something that can improve things? For example, yesterday I saw a 61 year old British woman who appears to have thin bones (whatever that implies). Had a Dexa last year with a T score of -1.2 left trochanter, -0.6 lumbar spine. Density at left trochancer was 0.744 g/cm2. In 2002, it was 0.744 on a different machine. I know you can't really compare, but of course, want to. Looks like a 4.4% bone lose if I am figuring correctly. From my memory, women lose 1% density a year, is that correct? (I'm having trouble finding data on that.) So, it seems this woman is doing fine, even though the thought of a 4% bone loss in 8 years freaked her out. She is doing well with exercise (walking), not so much upper extremity, and working on getting enough calcium and Vitamin D. Any sense of how much bone density a woman loses if she does everything right? (ie where can we get without pharmaceuticals?) Thanks, Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com -- Be well, Bill Walter ND Golden Apple Healthcare, LLC billwalter@... www.goldenapplehealthcare.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2011 Report Share Posted March 24, 2011 It's also quite curious to me how much is made about Vit D and Ca and wt bearing exercise and the fact that there are plenty of women with nl BMDs who don't do any of this. I have a woman with IPF--idiopathic pulm fibrosis--soon to go on the transplant list. And she has fantastic BMD at 58 and does limited exercise. She's not tiny but nor is she obese. I think genetics plays quite a big role. I saw another woman today who is 86 and travels all over inspite of her macular degeneration. She is small and has a great BMD too. We so want to impact issues with our science. And so we try. But there is so much we don't know. Ellen > > Thanks guys. > > > I do use FRAX, thanks for the reminder. > > Always seems crazy to me that you have to be over 20% chance of major > fracture for 10 years to be considered at risk (19% just isn't > enough). On the other hand, I don't think I see anywhere near 1/5 of > my postmenopausal woman having major fractures every 10 years, so > don't know what to make of it (of course some have OK bone density). > > I guess my lesson is that you can't really measure how well or poorly > someone is doing maintaining their bone mass via Dexa scans unless > they use the same machine and protocol repeatedly and the change is > huge, which I knew but needed to be reminded I guess. > > Prevention stuff is always good. Problem is all those fractures and > MI's and suicides we prevent just aren't noticed:) > > Sharon > > Sharon McCoy MD > Renaissance Family Medicine > 10 McClintock Court; Irvine, CA 92617 > PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: > www.SharonMD.com <http://www.SharonMD.com> > > > > On Tue, Mar 22, 2011 at 10:25 AM, T. , MD > <DonS@... > > wrote: > > Go to FRAX <http://www.shef.ac.uk/FRAX/> and calculate her 10-year > risk of fracture, using the data from the machine used most > recently (you need to input the type of machine to use the > calculator). You also need to input her weight, and other risk > factors. > > You cannot compare bone densities from different machines, so > don’t even try. Actually, you shouldn’t compare densities done on > the same machine by different technicians. > > Don > > Formerly ISCD certified clinical densitometrist. > > dts > > *From:* > <mailto: > > [mailto: > <mailto: >] *On Behalf Of > *Sharon McCoy > *Sent:* Tuesday, March 22, 2011 9:11 AM > *To:* > *Subject:* bone density question > > For Graham and other's: > > Now that bisphosphonates seem to be less beneficial than we maybe > thought, I'm confused about when to recommend them. How much bone > density does the average post-menopausal woman lose per year and > when should we offer something that can improve things? > > For example, yesterday I saw a 61 year old British woman who > appears to have thin bones (whatever that implies). Had a Dexa > last year with a T score of -1.2 left trochanter, -0.6 lumbar > spine. Density at left trochancer was 0.744 g/cm2. In 2002, it was > 0.744 on a different machine. I know you can't really compare, but > of course, want to. Looks like a 4.4% bone lose if I am figuring > correctly. > > >From my memory, women lose 1% density a year, is that correct? > (I'm having trouble finding data on that.) So, it seems this woman > is doing fine, even though the thought of a 4% bone loss in 8 > years freaked her out. She is doing well with exercise (walking), > not so much upper extremity, and working on getting enough calcium > and Vitamin D. > > Any sense of how much bone density a woman loses if she does > everything right? (ie where can we get without pharmaceuticals?) > > Thanks, > > Sharon > > > Sharon McCoy MD > Renaissance Family Medicine > 10 McClintock Court; Irvine, CA 92617 > PH: (949)387-5504 <tel:%28949%29387-5504> Fax: (949)281-2197 > <tel:%28949%29281-2197> Toll free phone/fax: > <tel:> > www.SharonMD.com <http://www.SharonMD.com> > > > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.