osteoporosis

[jcmatthews]

Sorry to take awhile to respond, Alissa (and others). I've been hoping that the Troll would crawl back into his cave, which seems to have happened.

I downloaded the Jane Brody article, and it's excellent. There is conflicting evidence about the drawbacks of bisphosphonate therapy, but the important thing to remember is that these drugs have never been proven to decrease the incidence of fractures. The only medication proven (in a well-designed study) to decrease fractures is estrogen. That doesn't mean that Fosamax doesn't prevent fractures, just that it's not proven.

I know that estrogen replacement has gotten a pretty bad name since the WIH trial was terminated, but more recent analysis of the data has been coming out that shows fewer dangers than we thought at first. Specifically, they've found that the big concern about heart disease doesn't apply to younger women-- those who start estrogen within ten years after menopause. It may even be protective, which is in line with what has been believed for many years.

Calcium supplements and vitamin D are another area of controversy. Another study which came out of WIH was published recently (New England Journal of Medicine, Feb.16) and didn't show much benefit from taking calcium and vitamin D. There could be lots of reasons for this outcome, but a likely one is that half of the women were not on estrogen replacement. Estrogen helps the body use the available calcium. Another study recently came out (sorry I don't have the reference for this-- I'll try to find it) that showed much more benefit from 800 milligrams of vitamin D daily than from 400. The current recommendation is for just 400.

So what do I tell my patients? Take 1000 to 1200 mg of calcium daily, preferably with something acidic like OJ (helps with absorption). Take at least 400 mg daily of vitamin D. Do weight bearing exercise at least 4 days a week ( Rowing, though it's not technically weight-bearing, is great for spinal bone density.) If you're within 10 years of menopause and have no contraindications, consider using hormone replacement. (Talk to your doctor about your individual risk factors.) There's no clear-cut evidence either way about taking bisphosphonates for osteopenia, but I do recommend them for osteoporosis if estrogen isn't used.

Here are the best online sources of info I've found:
National Osteoporosis Foundation, www.nof.org
National Institutes of Health, www.osteo.org
Medline Plus, www.nlm.gov/medlineplus/osteoporosis.html

Hope this helps!

[johnlvs2run]

[johnlvs2run]

[johnlvs2run]

[Alissa]

Calcium supplements and vitamin D are another area of controversy. Another study which came out of WIH was published recently (New England Journal of Medicine, Feb.16) and didn't show much benefit from taking calcium and vitamin D.

Hi all.

Just to continue the discussion, apparently there's yet another study (an Australian one published in today's Archives of Internal Medicine, according to the WSJ). For those of you who can access the WSJ, Tara Parker-Pope's Health Journal column today, "Protecting Your Bones: New Evidence Helps Clarify The Benefits of Calcium" discusses both the new study and some re-interpretation of the WHI study discussed earlier. Their conclusion seems to be

"A new calcium study published today, along with new insights from the earlier research, are starting to clear up the confusion. The verdict: Calcium works, but only if you take it regularly."

It appears that this is another one of those "buying the [____] is not enough, you need to actually consume/use [____]." (fill in the blanks with just about any good-for-you thing you buy!)

So this is news?

One of the co-authors of the WHI calcium study seems to have come to the same conclusion as jcmathews:

"I heard women saying, 'That's it. This study says [calcium] isn't important and I should throw them out,'" says Andrea LaCroix, professor of epidemiology at the Fred Hutchinson Cancer Research Center and co-author of the WHI calcium study. "But that's the wrong take home message. I think there are so many things about this trial that support the guidelines to get at least 1,200 milligrams a day."

I'll be interested to hear more about this new study and reinterpretation of the old over the next couple of days/weeks.

But it looks as though I need to get with it and start keeping track of my calcium intake (and supplement as needed). I normally drink quite a lot of skim milk (about a gallon a week), so pick up a lot of calcium that way, I would think. Does it make sense to simply see what I am getting from diet each day and then supplementing any shortfall the next day?

Well there's never any shortage of things to think about; I'll be interested to hear the thoughts of the rest of you on this.

Alissa