Frac­ture wake-up call: It may be os­teo­poro­sis

Record Observer - - SENIOR SATELLITE - By CHRISTINA MORGANTI, M.D.

For some peo­ple, hav­ing a heart at­tack can be life chang­ing, spurring them on to health­ier life choices, like reg­u­larly ex­er­cis­ing, start­ing a hearthealthy diet, and tak­ing med­i­ca­tion.

A bone frac­ture is not un­like a heart at­tack — they are both a sign that some­thing is wrong. In the case of a frac­ture, it could mean you have os­teo­poro­sis or a weaker form of bone loss called os­teope­nia.

Bones shouldn’t break with lowen­ergy falls such as from stand­ing height or less. When they do, your doc­tor may want to run blood and bone den­sity tests to de­ter­mine if you have os­teo­poro­sis. If di­ag­nosed, you should learn about weight-bear­ing ex­er­cise, fall preven­tion, and nu­tri­tion for healthy bones. In ad­di­tion, you may be a can­di­date for an os­teo­poro­sis med­i­ca­tion.

There are sev­eral med­i­ca­tions avail­able to treat os­teo­poro­sis:

• Bis­pho­s­pho­nates make up the largest class of drugs. This in­cludes Fosamax (Alen­dronate), Ac­tonel (Risendronate), Boniva (Iban­dronic acid), and Atelvia, which are pill form, and Zometa and Re­clast (Zole­dronic acid), which are once-yearly in­jec­tions. Th­ese drugs have been stud­ied in large clin­i­cal tri­als for up to 10 years, and com­pli­ca­tions are rare. We typ­i­cally rec­om­mend pa­tients cy­cle on and off bis­pho­s­pho­nates in three- to five-year cy­cles. You can take a “drug hol­i­day” with care­ful fol­low up and strict at­ten­tion to weight­bear­ing ex­er­cise and good cal­cium and vi­ta­min D in­take.

• Pro­lia (Deno­sumab) is a newer treat­ment op­tion ad­min­is­tered through a shot ev­ery six months. It is very ef­fec­tive in pro­tect­ing bone mass and is well tol­er­ated by pa­tients. There is a slight risk for pa­tients who are prone to in­fec­tion or who are on im­muno­sup­pres­sive ther­apy, since it is an an­ti­body ther­apy. It acts on the same cells as bis­pho­s­pho­nates, so it could have sim­i­lar risks.

• Hor­mone re­place­ment ther­apy for women af­ter menopause may help pro­tect bones. Evista (Ralox­ifene), a pill taken daily, af­fects the es­tro­gen re­cep­tors on breast and bone tis­sue and helps pro­tect against both breast can­cer and os­teo­poro­sis.

• For­teo (Teri­paratide) is the only medicine cur­rently avail­able that builds bone. It is an in­jec­tion self­ad­min­is­tered daily. It is lim­ited to two years of use. Once the two years of ther­apy are com­plete, you switch to one of the other medicines to main­tain the gains you made with For­teo.

• Most of the med­i­ca­tions re­duce the risk of hav­ing a new frac­ture by about 50 per­cent. If you’ve had a frac­ture from a low-en­ergy in­jury and you have os­teope­nia, you’re also a can­di­date for one of th­ese med­i­ca­tions.

Os­teo­poro­sis is one of the most un­der­treated dis­eases of modern times, de­spite the abun­dance of good treat­ments. Frac­tures from os­teo­poro­sis lessen your qual­ity of life with each new frac­ture.

We must treat frac­tures as a lifeal­ter­ing event trig­ger­ing treat­ment of os­teo­poro­sis, just like a heart at­tack trig­gers treat­ment of car­diac dis­ease.

Christina Morganti, MD, is an ortho­pe­dic sur­geon at Anne Arun­del Med­i­cal Cen­ter. She re­cently opened a ded­i­cated Os­teo­poro­sis pro­gram at her prac­tice, Anne Arun­del Med­i­cal Group Ortho­pe­dic and Sports Medicine Spe­cial­ists. To reach her of­fice, call 410-268-8862.

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