Thursday, May 10, 2012

Post menopausal bone fractures - some adivce

Common things happen commonly and rare things happen ... rarely! People do get eaten by sharks, and it's terrifying and awful when it does happen, but shark attacks are sufficiently rare that they shouldn't stop people going for a dip in the sea. It's the same as riding a bike: we are actually encouraged to stop using our cars and take up cycling, but if you've ever fallen off your bike - which really isn't that un-common - then you might think twice about taking up cycling.

The reason I write about what might happen and what rarely happens is that I've just finished an article on Bisphosphinates. These are a group of medications that people, more commonly women, take in their later years to help prevent bone fractures. These medications have been around for 10 to 15 years now and were introduced to help reduce the fracture rate amongst post-menopausal women who are at greatest risk of breaking their bones. But obviously its far better to start a treatment before breaking a bone and the best way to do this is with Bone Densiometry, which is a tool used to literally measure how strong the bones are and to predict the relative risk for fractures. Each person is given a T score, and depending on that score, treatment might be offered.

Now here's the rub: Bisphosphinates do help those at highest risk in the first five years, but then the benefit seems to level off. Also, there are some rare - there's that word again - complications which aren't very nice: osteo-necrosis of the jaw bone - you don't want that - and "atypical" fractures in the femur - you don't want that either. But I emphasize that these are rare (think shark attacks) and overall Bisphosphinates do more good than harm - for those who genuinely need them.

Enter the FDA cautioning about long term usage of these class of drugs. So what does a good women do?

1. The long term ideal solution is prevention and this would take decades to have an impact. The ideal prevention is to strengthen bones from early adolescence and maintain that healthy bone with regular exercise, resistance training and good nutrition. If that were to be 100% successful, we would be in medical Nirvana!

2. For those at high risk - women with strong family histories of spinal and hip fractures; these ladies need to exercise appropriately and eat bone healthy meals. They also need to have bone densiometry to check their T score and if it's low then medication needs to be discussed and offered. Then they need to repeat their T scores from time to time to see if the treatment is actually effective for them: if not then they stop the medication!  

3. Those who have moderate or lower risk should also take regular, appropriate exercise and eat bone healthy food and get their T score checked as indicated by their monitoring physician.

4. This also applies to men with increased risk of bone fractures.

If your Doc suggests any treatment for any condition, probably the most important thing is to get a regular review and don't just carry on taking whatever it is without having some "review by date". Medicine is constantly changing and our level of knowledge and understanding of disease and treatments is also evolving, so what was a great idea 10 years ago might just be not quite so great now - or it might be even better than was realized before. But get a review and never be afraid to ask questions.
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