Wednesday Bubble: bisphosphonates…enough to make your jaw drop
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Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?
Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003. At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.
As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year. However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.
Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.
What you need to know
Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.
The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:
- pain, swelling
- gum or jaw infection
- gums that don’t heal
- loose teeth
- jaw heaviness or numbness
- impaired range of motion
- exposed bone
Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of hip fractures in a very small amount of women taking these drugs for five years or more.
Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.
Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.
Read MoreDazed and Confused – Revisited
Two years ago i wrote a post about the confusion surrounding therapies, effectiveness, and discerning right from wrong when it comes to clinical trials. Herbal and integrative therapies are perfect examples of the grey areas; many trials have not incorporated some of the most important tenets supporting the use of these strategies, most important of which is individualization. Hence, I wanted to share the post with you again, and hopefully, spark some dialogue that might lead to improvements in how we study and write about the therapies that are offered to patients.
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A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.
Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article a few years ago about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:
“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”
So what do you do? A few key points:
- Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
- Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
- Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
- Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.
No wonder we all feel so dazed and confused!
I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.
The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.
Read MoreNo bones about it: the best things in life are sea
Did you know that eating fish that live in the sea might help boost bone health and density? Although most of the attention on the link between osteoporosis and diet has focused on calcium, milk and soy, a few studies suggest that other nutrients, such as polyunsaturated fatty acids and omega-3s, may also play a role.
According to novel research published in the journal Osteoporosis International, a greater intake of sea fish, but not shellfish or freshwater fish, is linked to as much as almost a 7% increase in bone-mineral density and an almost 10% increase in bone mass in general and in the hip areas in particular. On average, the women studied, all of whom were menopausal, were eating about .8 ounces of sea fish a day — about 16% of their total daily protein intake, and about 2 ounces daily of sea fish and shellfish combined. Factors like body weight, smoking, and alcohol did not appear to influence the association between fish from the sea and bone benefits. (Note – the study did not specifically address the exact types of fish that they women were eating other than to say, it wasn’t freshwater or shellfish.)
Interestingly, prior studies have found similar links between higher bone mineral density and a high consumption of seafood among menopausal women. Researchers say that a higher intake of fish versus animal protein or low quality foods may account, at least in part, for the higher bone mass.And while they are unable to offer any reasonable explanation for why sea fish, especially the oily types like salmon or mackerel or tuna benefit bone health while freshwater fish does not, they say that it might be due to the high level of vitamin D , which has long been associated with favorable bone mass. Omega-3 fatty acids are also thought to play important roles.
The take-away on this is to eat more fish from the sea. Clearly, environmental concerns, like overfishing and high level of mercury, may influence your seafood selection, however, Seafood Watch offers some great resources how to make safe and careful choices. What I love about this information is that it not only serves to encourage healthier eating, which can help keep those pounds away (My friend Danielle Omar wrote a great guest post about sea veggies and weight about a month ago), but also provides another strategy for keeping bones healthy as we age. Yup, the best things in life are sea.
Read MoreWednesday Bubble: rhubarb rules the day
Today’s Bubble is straight from the research files and it’s not burstable. In fact, I’m pretty excited about this.
Researchers say that a phytoestrogen extract from Siberian rhubarb (rhapontic rhubarb), better known in studies as “ERr 731,’ is an effective alternative to HRT for alleviating menopausal symptoms.
Evidently Siberian rhubarb has been used for decades to treat menopausal symptoms, both in Germany, where it is readily and commercially available, and in Chinese medicine. Clinical studies suggest that ERr works very similar to estrogen in the body and in fact, has been shown to have properties that are equivalent to SERMS – selective estrogen receptor modulators – which are synthetic compounds that mimic the action of estrogen in the body without necessarily causing some of its harmful effects.
When I delved further into ERr 731, I found numerous, well-designed studies that demonstrate its benefits in perimenopausal women including:
- A significant decline in the number and severity of hot flashes over the short-term (i.e. 3 months) by as much as 50%, with further improvements through the long-term (i.e. 6 months).
- Improvements in other menopausal symptoms such as sleep disruption, mood and vaginal dryness.
- Improvements in self-reported quality of life.
- Minimal if any side effects and no changes in uterine or vaginal tissues among women taking the extract, suggesting that it may be safe in terms of breast or uterine cancer.
In the U.S., ERr 731 is marketed as a supplement called Estrovera. Although it appears to be safe, like any drug, you should speak to your practitioner before trying it.
I’m heartened to see that an herb that been in use for decades in both Western and Eastern cultures in finally available to US women. I’ll continue to monitor for additional studies but in the interim, I’d love to hear from you if you are taking Estrovera.
Read MoreDesigner muffs: cosmetic surgery below the belt – Guest Post by Jesse Mendes
A few months ago, I stirred the pot a bit by writing about genital cosmetic colorants and vaginal rejuvenation. The post was mostly well-received, although I did manage to anger one reader who accused me of ridiculing women who actually needed labiaplasty due to vaginal prolapse or stress incontinence issues. Then I met a writing colleague via Twitter who had similarly written labia amputation, clitoral hood removal and distortion of sexual aesthetics.
I am happy to continue the dialogue with this terrific post – Designer Vaginas. Please show writer and journalist Jesse Mendes some love (and a huge thanks for allowing me to repost this piece).
The push toward cosmetic surgery to “mask” the effects of aging is not news, and as the likes of Heidi Montag will attest, its practice is growing at an alarming rate with young women as well. What is talked about a lot less, though, is cosmetic surgery below the belt or, put another way and a lot more specifically, “designer vaginas” – a moniker granted it in a 2005 Globe and Mail article.
Both men and women today have wildly distorted impressions of so-called “normal” genitalia. Research repeatedly shows that women in particular are widely unfamiliar with real genital diversity, so they tend to rely on marketing and images provided by doctors and other professionals with ridiculously narrow aesthetic and sexual ideals. The reality is that the size, shape and form of a woman’s genitalia vary greatly, and change over time – we are as diverse “down there” as we are in our faces or our fingerprints.
That’s what I learned from the New View Campaign when I interviewed them several years ago. A grassroots organization formed in New York about 10 years ago, its purpose is, among other things, to challenge distorted messages about sexuality, and to expose aggressive marketing tactics that normalize women’s dissatisfaction with their bodies.
We’re talking women as young as 15 years old, going in for procedures such as drastic labia amputation or clitoral unhooding, with poor research on the consequences.
My question is this – how did we get here? How did we get to the point where we are so fucked up about our bodies, women of all ages are lopping off bits and pieces of their private parts in order to feel desirable?
The pressure to conform to a commonly agreed upon norm can be a highly oppressive force. We see and allow for diversity in nature much more easily than we do in our bodies, or for that matter, our sexual experiences. We’re always thinking about whether we measure up. Biologist and sex researcher Alfred Kinsey dedicated most of his life to educating people in this realm in the 1940s and 50s, yet we’re still dealing with a lot of the same (recycled) attitudes today.
Why are we so afraid of being different? As we age, and develop a more intimate relationship with our own bodies and our selves, this question might be more relevant than we think.
About Jesse…
Jesse Mendes is a freelance writer based in Toronto who is deeply committed to helping to change how older women are perceived in North America, and to dispeling the stigma around aging. Her blog, SeptemberMay, is dedicated to that. She came up with the concept of a dating site that celebrates the inherent eroticism, beauty and intelligence of the older woman. SeptemberMay will be launching later this year.
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