Osteoporosis, another major cause of problems for women in the menopause, it is the major cause of morbidity in women, affecting millions of women, causing millions of fractures each year and costing billions of dollars to treat. It is estimated 25% of all Caucasian women will fracture their spines, 33 will fracture their hips sometime in their life time. These are very dramatic statistics, and we expect them to continue to increase based on the fact that the younger generation are not taking in the same quantities of calcium that most of us did when we were growing up. So we are anticipating these statistics to double or triple over the next 10 years. This is the most preventable type of morbidity that we as health care providers can actually intervene and make a big difference in a woman’s life. The peak age of bone mass is when a woman is 25 to 30. At that time, the bone resorption or bone loss processes, equilibrium to the bone formation process. By the time a woman is 40 and she starts to have some minor changes in her estrogen level, we start seeing that the bone resorption process begins to accelerate a little bit but it is usually not in excess of bone formation. Viagra professional online. By the time she is in the menopause, or primarily within the first five years of menopause, we see that bone resorption process accelerate 2 to 3 times that of the bone formation process. As a result, there is bone loss and often times osteopenia. If left untreated, that will progress to osteoporosis, hip fractures and once again a major source of morbidity for that woman. The bone on the right is a classic example of the deterioration in the micro architecture of the hip bone of a woman with osteoporosis. The two major bones that we look at when we are looking at osteoporosis in the postmenopausal woman, are the hip and the spine. You can see by this graft, over the age of 50, there is age rheumatic rise in the rate of fracture in women right up until the age of 85 and then it’s abruptly accelerated from there. Once again, there are things we cannot control such as race, ethnicity or body frame or family history, but there are some modifiable factors that we as health care providers can counsel patient’s about such as smoking cessation, alcohol, caffeine use, sedentary life style, and also optimizing medical conditions such as hypothyroidism, making sure that is under well control, if they are asthmatics on chronic steroid use or arthritis on chronic steroid use, probably adding agents to slow down the bone loss process because these are all conditions that would accelerate osteoporosis.
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There are lots of different ways to measure bone loss and if you find a woman in your practice that is at risk for bone loss, it would be useful to get at least a baseline measurement and our best way to do that would be through a DEXA scan, it is the most accurate and precise method that gives the least amount of radiation. It is performed with a woman in a supine position with elevation of her hips and lower extremities and various measurements are made through the right hip and through the spine, and then a score is calculated. It’s called a T sore, the T score is a measurement of peak bone mass as it is compared to a reference population, and that reference population is usually a group of women between the ages of 25 and 30 because that is the time that a woman’s peak bone mass is usually measured. A positive T score would obviously represent a bone mass density that is higher than the mean versus a negative which is lower, and when you have a negative T score of 1 to 2.5, that is considered osteopenia. When it is greater than 2.5 standard deviations and once again in the negative range, that is considered osteoporosis and then from there, there are various degrees of osteoporosis. We would like to intervene before it gets beyond osteopenia, and we can by just providing resources regarding diet, regarding supplements that can be given to slow down the bone loss process. Our treatment goal is to prevent fractures, but also it’s to stabilize and enhance bone mass density. If a woman has already had a fracture, it’s to try to relieve symptoms of the fracture and there are various medications useful for that, and to try to maximize physical function and deformity. Generic soma online 350 mg
There are various agents that can be used, by far the golden standard, if a woman can take it, would be estrogen, estrogen is not only useful in decreasing or preventing bone loss, but in treatment of bone loss. Fosamax is a very potent agent, an anti-resorptive agent that is useful in decreasing bone loss as well as treating bone fracture and further preventing bone fractures. Calcitonin is really reserved for more last resort treatment, however, just a word about calcitonin, it comes in a nasal spray now and it’s very useful in treating women who have already had a spinal compression fracture because there is an analgesic effect to it. The drawback with calcitonin is usually after two or three years, a woman will develop antibodies and there is very little change in bone mass density after that point. We are seeing limitations with the use of calcitonin so it is really reserved for last resort. Raloxifene we now know does decrease fracture rates, it is useful in enhancing bone mineral density, calcium alone is not useful for decreasing fractures, it is useful in slowing down bone loss, but it cannot be used alone in terms of decreasing fracture rate, and fluoride which is no longer available was one of the only bone formation agents that we had and it would build bone at the expense of the cortical bone. Sleepwell xanax without prescription. The bone that we were discussing today is trabecular bone or the weight bearing bone. The entire skeleton is made of cortical bone and how fluoride works, it will help take away from the cortical bone to build trabecular bone so it makes it very dense, the problem is, it is not very strong and one of the other effects is that it has severe gastrointestinal side effects. So it is no longer available, but over the next few years, along with the selective estrogen receptor modulators, we will be seeing new bone formation agents in terms of growth formation factor agents.