Osteoporosis: what’s the 411?
Osteoporosis and low bone mineral density are well-known issues for menopausal women. As women enter the early stages of menopause, their bones lose their ability to retain their mass and manufacture new bone tissue, resulting in bone loss and increasing the risk for osteoporosis and its deleterious effects. 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. Besides the discomfort, hip fractures in women lead to a loss of mobility, a need for long-term care and even death. No bones about it; osteoporosis is no laughing matter.
Risk factors that contribute to a loss of bone mineral density are varied and include age, genetics, low calcium/vitamin D intake, body weight and menopause status. However, osteoporosis is a mixed bag and there are several underlying conditions that can also contribute to its severity:
- Medications (e.g. heparin, anticonvulsants, progesterone, chemotherapy agents)
- Parathyroid hormone (which regulates how calcium is used in the body – released in urine, absorbed in diet and stored in bones)
- Calcium imbalance due to excessive calcium excretion, aka “hypercalciuria,” Vitamin D deficiencies
Before I move into the land of boredom, there is a reason why I’m sharing some of the facts about osteoporosis, which BTW are readily available on the National Osteoporosis Foundation website (if you’ve not perused the site, I strongly encourage you to do so!): there is an indication that your practitioner might not be looking for these important secondary causes! Moreover, sometimes they are not even readily apparent.
Writing in the journal Menopause, researchers studying 204 menopausal women say that they’ve discovered that among the various factors that influence a woman’s risk for low bone density, several impact severity:
- Low vitamin D levels (82% of women in this study had below optimal levels)
- Elevated parathyroid hormone levels (35% of women in the study) — (leads to too much calcium in the blood and a loss of calcium from bones)
- Unusually high calcium excretion (20% of women in the study)
- High bone turnover rates (41% of women in the study) — (high bone turnover refers to an increase in the breakdown, or resorption of bone without a compensation for the repair of bone, leading to compromised strength, thinning, brittleness and fractures)
There are a number of dietary and lifestyle strategies to prevent osteoporosis, including incorporating Vitamin D and calcium supplementation, omega-3 and omega-6 fatty acids into the diet, and increasing physical activity. More recent findings suggest that beer, onions and even flaxseed may be effective (although more research is needed). Meanwhile, if you’ve recently learnt that your bone mineral density is low (or that you’ve actually developed osteoporosis) you need to speak to your practitioner about some of these other markers. Knowledge is power and the more you know, the greater the likelihood that you can start incorporating treatment now to prevent further bone deterioration.
That’s the 411. No bones about it!
Read MoreWednesday Bubble: Another nail in the coffin for HRT
Still hearing that HRT can’t hurt your heart? Findings from yet another study, this time published in the February 16 edition of Annals of Internal Medicine, confirm the dangers that HRT poses to your heart, especially in the short-term.
In this latest analysis, researchers evaluated data derived from 16,608 postmenopausal women enrolled in the Women’s Health Initiative trial who still had their uterus. The findings?
Compared to women who had never used hormone replacement therapy, those who had used it continuously over 10 years had more than twice the risk of developing heart disease over the first 2 years, and more than 1.5 times the risk over the subsequent 8 years. For women who started hormone therapy after 10 years of entering menopause, there was also a trend towards developing heart disease over the first 2 years. Of note, researchers did observe a possible protective effect after 6 years in the women who started therapy closer to menopause as risk did start to level off at this time.
The upshot is that the first two years of taking HRT can be a dangerous time for women regardless of whether they start hormones closer to menopause.
Another nail? Yes, I’d say so.
But don’t take my word for it. Knowledge is power. Educate yourselves. And if you’d like to learn more about heart disease and menopause, I’ve written about it numerous times on this blog. I also encourage you to visit the American Heart Association website. Finally, I’d love for you to take a stand. Don’t you think it’s time for the FDA to start paying attention? These drugs are dangerous for women. Yet, they remain on the market and are prescribed daily. Whose nail, whose coffin?
Read MoreWest meets East…Guest post: Jonathan Black, MD/MPH student
I spend a lot of time on Flashfree writing about complementary or Integrative Medicine. This refers to the meeting of the Western versus Eastern minds, combining the best of both worlds, if you will. Hence, I was excited to read my Twitter friend @jonathanblack’s positive experiences with his integrative medicine courses, so much so, that I asked him to write a guest post. I was curious to learn how and if medical schools were starting to slowly incorporate Eastern/Integrative health into their curriculum and even more so, how students felt about it. It seems that there is a huge divide between doctors who are up and coming in the field today and those who have been practicing for awhile. Although it is possible to encounter a physician who embraces integrative medicine, it is probably easier to find those who characterize it as “quackery,” refusing to give credence to the evidence-based studies that exist or consider that perhaps, the way that studies are conducted in Western medicine do not consider the intricacies of Eastern practice. Regardless, because I feel so strongly about integrative strategies and their role in our healthcare as women, I think that it’s imperative that we understand where the bridges and gaps are. Without that understanding, we can never entirely play an active role in our own healthcare. Or become a strong voice for a broader imcorporation of these practices into Western, or allopathic medicine.
Please welcome Jon and show him some love with some great comments!
The exposure that medical students receive to Integrative Medicine varies between medical institutions. It depends on a number of factors, including whether or not the institution has a center for Integrative Health, how progressive the medical administration is at the medical school, and the relationship between practitioners and physicians within the geographical area. Regardless, most of the time, the degree that medical students are exposed to Integrative Medicine is insufficient.
To that end, my medical school dedicates one afternoon during the second year to Integrative Medicine. For students who opt out of an an additional four-week elective, that one afternoon is the only exposure that they will receive throughout their entire education. Considering that over 40% of patients use some form of Integrative Medicine, whether it is Yoga, vitamins, or something else, this is problematic. If you don’t have a solid understanding about Integrative Medicine, it is difficult to talk to patients about it. Understanding this concept, I chose to take the additional four-week elective.
During these four weeks, I shadowed and worked with massage therapists, herbologists, yogis, reiki masters, music therapists, chiropractors, and qigong instructors. Ultimately, I found this experience to be tremendously useful, as it provided me with a new perspective from which I can discuss Integrative Medicine with my patients and it allowed me the opportunity to connect with practitioners who I otherwise wouldn’t have had access to. As someone going into Obstetrics and Gynecology, it also peaked my interest regarding how these forms of therapies might be integrated into women’s healthcare.
The more I’ve looked into the blossoming relationship between women’s health and Integrative Medicine, the more I have realized that I am like a small fish lost in open water. From conferences to complete guides on the subject, the materials and opportunities available in this field are endless. There is also a lot that is unknown on the matter and an abundance of research continues to evolve. That being said, I have come to the conclusion that while I will always be able to competently care for women from an allopathic standpoint, this won’t always be the case from an Integrative Medicine standpoint, regardless of how much time I put into learning different modalities. So, on a professional level, it will be important for me to develop solid relationships with Integrative practitioners within the community I am working in, and hopefully, integrate them and their work into my own practice. Collaborative medicine is the wave of the future and I want to be on the forefront and I think that this approach will allow me to be there.
About Jonathan…
Jonathan D. Black is a 4th year MD/MPH student at the University of Rochester School of Medicine and Dentistry in Rochester, New York. He is going into the field of Obstetrics and Gynecology.
Read MoreUnchain my lungs…estrogen and asthma
As the evidence continues to accrue against the use of combined hormone replacement therapy (HRT), attention must be turned to estrogen-only hormone replacement therapy. However, is it safer?
In the Women’s Health Initiative, which was halted last decade, taking estrogen alone was associated with an increased risk of blood clots, stroke, impaired cognitive function and dementia. In the latest bit of information to hit the news, estrogen-only therapy may also increase the risk for developing asthma.
Results of a 12-year study among almost 58,000 women who were not suffering from asthma at the start of menopause showed that they were 21% more likely to develop asthma symptoms. This risk was significant among women who had been taking estrogen only compared to women who had never used hormones, had a 54% greater risk of developing asthma. The risk was even greater among women who had never smoked, although a small proportion of study participants had allergies prior to developing asthma.
Once again, Reuters has done an excellent job of reporting on this study and has some great quotes from the researchers as well.
Meanwhile, what should you do if you’ve been taking estrogen to combat the symptoms of menopause? As always, you have a choice and only you and your practitioner can determine if you are at risk for developing any of the conditions that are associated with hormonal therapy. The good news? Breathe easy. Yet another reason to lose the hormones…for good.
Read MoreWednesday Bubble: Just melt that fat away
What if someone told you that you zap that tired around your middle that’s suddenly appeared? Or melt away the flab on your thighs? According to manufacturers of Zerona™, low-level laser can be applied to the areas of fat deposits lying right below the skin to literally reshape and recontour the body. In fact, you can reportedly lose up to two sizes with only two weeks of treatment. What happens to the fat? It seeps into the body’s lymphatic system and then is used as energy.
Why does this sound too good to be true?
According to an in-depth piece in the New York Times, Zerona is readily available nationwide at a pricetag of $1700 to $3800 for six sessions. Experts say that results depend on the individual, including whether or not they are obese, have had prior surgery on the area that they want re-treated, and if they eat healthy and exercise. However, some experts say that it’s unclear how the body rids itself of fat and remain unconvinced that fat can be eliminated in a non-invasive way. On the other hand, data presented at the American Society of Dermatologic Surgery suggest as much as a 22% reduction of the fat layer in some people.
What do you think? Bubble or not? It might be too early to tell. Although the company has reportedly submitted clinical information to the Food & Drug Administration in hopes of approval, so far, it’s just an experimental dermatologic treatment that can put a major dent in your bank account.
Zerona. “Reveal your true self.” Hmmmmm.
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