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Preventing and Treating Osteoporosis

Osteoporosis is a disease marked by reduced bone strength due to bone mass and bone quality. It is often called a “silent disease” because it usually progresses without any symptoms until a bone fracture occurs or one or more vertebrae collapses.

Osteoporosis is the major underlying cause of fractures in postmenopausal women and the elderly. Fractures occur most often in bones of the hip, spine, and wrist, but any bone can be affected. Some fractures can be permanently disabling, especially when they occur in the hip. Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of minor bumps, falls, or normal stresses and strains such as bending, lifting, or even coughing.

Collapsed vertebrae may first be felt or seen when a person develops severe back pain, loss of height, or spine malformations such as a stooped or hunched posture.

In the United States today, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass. Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. In general, osteoporosis is more common in women, and they often develop it at a younger age.

Many people think that osteoporosis is a natural and unavoidable part of aging. However, medical experts now believe that osteoporosis is largely preventable. People who already have osteoporosis can take steps to prevent or slow further progress of the disease and reduce their risk of future fractures. Although osteoporosis was once viewed mainly as a disease of old age, it is now recognized as a disease that can stem from less than optimal bone growth during childhood and adolescence, as well as from bone loss later in life.

In addition to a healthy diet, a healthy lifestyle is important for optimizing bone health. You should avoid smoking and, if you drink alcohol, do so in moderation (no more than one drink per day is a good general guideline). It is also important to recognize that some prescription medications can cause bone loss or increase your risk of falling and breaking a bone. Talk to your doctor if you have concerns about any medications you are taking.

What are some of the causes of osteoporosis?

A major contributor to bone loss in women during later life is the reduction in estrogen production that occurs with menopause. Estrogen is a sex hormone that plays a critical role in building and maintaining bone. Decreased estrogen, whether due to natural menopause, surgical removal of the ovaries, or chemotherapy or radiation treatments for cancer, can lead to bone loss and eventually osteoporosis. After menopause, the rate of bone loss speeds up as the amount of estrogen produced by a woman’s ovaries drops dramatically. Bone loss is most rapid in the first few years after menopause but continues into the postmenopausal years.

In men, sex hormone levels also decline after middle age, but the decline is more gradual. These declines probably also contribute to bone loss in men after around age 50.

Osteoporosis can also result from bone loss that may accompany a wide range of disease conditions, eating disorders, and certain medications and medical treatments. For instance, osteoporosis may be caused by long-term use of some antiseizure medications (anticonvulsants) and glucocorticoid medications such as prednisone and cortisone. Glucocorticoids are anti-inflammatory drugs used to treat many diseases, including rheumatoid arthritis, lupus, asthma, and Crohn’s disease. Other causes of osteoporosis include alcoholism, anorexia nervosa, abnormally low levels of sex hormones, hyperthyroidism, kidney disease, and certain gastrointestinal disorders. Sometimes osteoporosis results from a combination of causes.

When should you talk to your doctor about osteoporosis?

  • You are a man or woman over age 50 or a postmenopausal woman and you break a bone.
  • You are a woman age 65 or older.
  • You are a woman younger than age 65 and at high risk for fractures.
  • You are a man age 65 or older and at high risk for fractures.
  • You have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause.
  • You have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss.
  • You have a chronic illness or are taking a medication that is known to cause bone loss.
  • You have anorexia nervosa or a history of this eating disorder.
  • You are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.
  • What are some types of medications for the treatment of osteoporosis?

Bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss.

Parathyroid hormone: A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended.

RANK ligand (RANKL) inhibitor  is approved for postmenopausal women with osteoporosis and men who are at high risk for fracture.

Estrogen agonists/antagonists (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues.

Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism.

Estrogen and hormone therapy are approved for the prevention of postmenopausal osteoporosis as well as the treatment of moderate to severe hot flashes and vaginal dryness that may accompany menopause. Estrogen without an added progestin is recommended only for women who have had a hysterectomy because estrogen increases the risk of developing cancer of the uterine lining and progestin reduces that risk.

The Food and Drug Administration has recommended that women use hormone therapy at the lowest dose and for the shortest time, and carefully consider and discuss with their doctor other approved osteoporosis treatments.

Weight Loss Resolution

Thanksgiving is a few days away. Christmas is a few weeks away. It’s getting darker earlier. It’s getting colder outside.

These are all things that are potential excuses as to why you aren’t watching what you eat and exercising on a regular basis.

This time of year people start thinking about their New Year’s resolution. They may have the mindset of “I’ll start working out and dieting next year,” and the gym is packed on January 2nd with everyone else who made the same resolution. Did you know that 80% of all people who join a gym in January give up in the first five months? Perhaps it’s because the gym is packed with people who are also committed to the idea of exercising, but will also drop out in the coming weeks months.

However, you don’t have to join a gym to get in shape. You can:

  • Walk or run around your neighborhood.
  • Get a good treadmill or other workout equipment. In the long run, these are less expensive than a gym membership (if you use them).
  • Use your stairs as a stair climber.
  • Do sit-ups and push-ups, they are easy to do just about anywhere.
  • Do lunges down the hallway.
  • Do squats while watching TV.
  • Get a set of free weights. Even 10, 20, or 30 pound weights will help maintain muscle tone.

If you get a minimum of twenty to thirty minutes a day, or about a hour of exercise three times per week, you can improve both your physical and mental health. Hard to stay motivated? Find a friend who will help keep you accountable or who will work out with you. Check out YouTube for online videos showing you workouts that you can do around the house. You can also join a virtual gym which turns your living room into an aerobic studio!

Exercising and eating healthy should be a way of life, not a diet. So many diseases and health issues (including heart disease, diabetes, and stroke to name a few) are preventable. All it takes is a commitment to taking care of yourself. It can save you thousands of dollars in doctor visits, medications, and time off of work. While it can be a good plan to work with a doctor to develop a weight loss plan that’s right for you, it’s important to know there is no magic pill and it may time some time to see the results. How do you know how much to lose, you ask?

Working with your doctor to determine your body mass index (BMI) is a good way to start. This is measured by calculating your height and weight. For example, if you are 5’10” tall and weigh 225 pounds, your BMI is 32.3 which is considered obese. Depending on your situation, your doctor may recommend a very specific diet such as high protein and low carb. Whatever the plan is, it’s important to set up reasonable expectations so you don’t set yourself up for failure.

Crash diets should be avoided. When you limit your eating, your metabolism actually slows down. Then once you’ve lost the 10 pounds you wanted to lose, your body burns calories slower and you end up gaining more weight.

Ready to get started? Talk to your doctor to make sure you are healthy enough for exercise and discuss your various options for dieting to find a combination of both that is right for you.

It’s never too late to start, but you don’t need to wait until January!

New FDA Approvals

New medications have recently been approved by the FDA for cardiovascular patients, diabetes, muscular dystrophy, and seizures — to name a few.

Yospral from Aralez Pharmaceuticals is a combination of aspirin, an anti-platelet agent, and omeprazole, a proton pump inhibitor (PPI), for patients who require aspirin for secondary prevention of cardiovascular and cerebrovascular events and who are at risk of developing aspirin associated gastric ulcers.

Zinplava from Merck is indicated to reduce recurrent Clostridium Difficile Infection (CDI) in patients receiving antibacterial treatment for CDI. Zinplava is not an antibiotic and is not indicated for treatment of CDI. It should only be used in conjunction with antibacterial drug treatment of CDI.

Adlyxin from Sanofi Aventis will help adults with type II diabetes by increasing glucose-dependent insulin release, and decreasing glucagon secretion. It will also slow gastric emptying. Adlyxin is to be used in conjunction with a healthy diet and exercise.

For patients with AIDS who also suffer from anorexia, Syndos from Insys Therapeutics is now available. Syndos is also approved for nausea and vomiting associated with chemotherapy in cancer patients who have failed to respond well to other anti-nausea treatments.

Another new drug was approved for the prevention of chemotherapy-induced nausea and vomiting. Sustol from Heron Therapeutics is an extended release injection specifically indicated for use in combination with other anti-nausea treatments in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide (AC) combination chemotherapy regimens.

Patients with a Duchenne muscular dystrophy with mutated DMD gene amenable to exon 51 skipping may have a new option in Exondys 51 from Sarepta. This new medication was granted accelerated approval based on an observed increase in dystrophin in skeletal muscle in some patients. A clinical trial of this new medication has not been established and continued approval may be contingent of a confirmed clinical benefit in a trial.

Carnexiv from Lundbeck is a replacement therapy for oral carbamazepine when oral administration is not feasible, in adults with seizures. Carnevix is supplied as an injection for intravenous administration.

Troxyca ER from Pfizer is new on the market for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment. Troyxca ER is an extended release capsule formulation of oxycodone combined with naltrexone. Oxycodone is a full opioid agonist and naltrexone is an opioid antagonist.

Two new drugs are now available for the treatment of certain cancers.

Keytruda from Merck has been approved for the treatment of head and neck squamous cell cancer. Keytruda is a programmed death receptor-1 (PD-1)-blocking antibody specifically indicated for the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum-containing chemotherapy.

Lartruvo from Eli Lilly has been approved for the treatment of soft tissue sarcoma. Lartruvo is specifically indicated for use in combination with doxorubicin, for the treatment of adult patients with soft tissue sarcoma (STS) with a histologic subtype for which an anthracycline-containing regimen is appropriate and which is not amenable to curative treatment with radiotherapy or surgery.

Talk to your doctor about your specific condition and if any of these medications are right for you. Like most medications, all come with a list of potential side-effects.

Sources: FDA and Centerwatch

Is Your Child Depressed?

Is your teenager or younger child depressed? Perhaps they are sad, hostile, withdrawn, doing poorly in school, or have changes in eating or sleeping habits. Sound familiar?

Traditionally, if a parent is concerned about their child’s mental health, they would take the child to the doctor for a screening test for depression, anxiety, or other concerns. However, in a recent article published in Contemporary Clinic, the findings from researchers at McGill University suggest that traditional screening tools often misdiagnosed depression in kids and teens.

“There was not a single tool with even moderate evidence of sufficient accuracy to effectively identify depressed children and adolescents without also incorrectly picking up many non-depressed children and adolescents,” said lead author Michelle Roseman, PhD.

“Our study shows that if depression screening were carried out using existing screening tools, many nondepressed children and adolescents would be mistakenly identified as depressed,” stated senior author Brett Thombs, PhD, in a press release. “This could lead to the unnecessary prescription of potentially harmful psychiatric medications and negative messages about the mental health of some children who do not have mental health disorders.”

Psychotherapy often is tried as an initial treatment for mild depression. Psychotherapy may help to determine the severity and persistence of the depression and whether antidepressant medications may be warranted. Types of psychotherapies include “cognitive behavioral therapy,” which helps people learn new ways of thinking and behaving, and “interpersonal therapy,” which helps people understand and work through troubled personal relationships.

What’s a parent to do? Perhaps we need to look at other factors and determine potential causes of the change in behavior. Any mental health problem begins when physical or emotional stress triggers chemical changes in the brain. Coping skills are methods a person uses to deal with stressful situations. Coping skills can be good or bad, so it’s important to train youth on how to positively cope for good mental health, so that the negative coping skills don’t become a way of life on into adulthood.

Positive life-long coping skills include:

Meditation and relaxation – practicing deep breathing techniques can help reduce stress and induce relaxation.

Physical activity – getting the heart rate up causes the body to release endorphins which provides some stress relief.

Reading – picking up a good book to escape reality for awhile is a positive way to de-stress and take their mind off of what is stressing them out.

Friendship – Having friends who listen and support through the good and the bad times is essential.

Laugh – Adding humor to a stressful situation can help lighten the mood.

Hobbies – Listening to music, working in the garden, and coloring in a coloring book (even for adults) or drawing are great ways to reduce stress in kids.

Spirituality – Recent studies have found that people who believe in a higher power and pray have better mental health than those who do not.

Pets – Taking care of a pet brings a calming influence in people and can help distract the mind from stressful thoughts.

Volunteer – being involved in the community is a good way to take the mind off of a person’s own problems and help someone who may have bigger problems to deal with.

Sleep – Everyone needs a good night’s sleep to give the body the chance to rest and repair after a stressful day. However, sleeping too much without the other activities can be a negative.

Eating well – Healthy nutrition will not only improve physical health, but it plays a huge role in mental health, too.

There is direct correlation between kids who are hungry with poor performance in school. Grades suffer and behavior problems are evident and these kids are often diagnosed with mental conditions that are not really the issue.

If you have tried these positive coping skills and the signs of depression are consistent, seek the help of a therapist who can help diagnose or provide other methods of treatment. If medication is needed, it’s important to continue working with your doctor and therapist for signs of suicide. Many antidepressants are black-labeled, meaning they have a suicide risk-factor. It’s also important to immediately stop taking prescription medications without consulting your doctor, as this may also produce negative side-effects.