Entries from June 2008 ↓
Osteoporosis is a bone disease that is very common in our society today. Osteoporosis is defined as “porous bone” or the weakening of the bone. Bones become so weak and fragile that it puts one at risk for fractures, especially in the spine and in the hip. Screening for this disease is important because it can be prevented or improved with adequate intake of calcium, vitamin D, exercise and bisphosphonates, if they are needed. Bisphosphonate is a medication class that include medications like Fosamax, Actonel, and Boniva.
Usually this disease affects women of post menopausal ages and those who have had a total hysterectomy. This occurs because a decrease in estrogen increases bone loss. Increased age is also a contributing factor. As one gets older, bones become weaker and individuals who do not have an adequate intake of calcium, vitamin D or who may not have had adequate intake during the ages of 25-35 are more prone to osteoporosis.
Being white and of southasian decent increases the risk for getting this bone disease. Other races are at significant risk also. Very few men are affected, but they are also at risk for this disease if they are age 75 or older and/or if they have low testosterone levels.
Family history of osteoporosis puts individuals at risk for developing osteoporosis. Others at risk include smokers, long-term steroid users, those who have elevated thyroid hormone levels, decreased exposure to estrogen i.e late menstruation, early menopause, irregular periods; and those who succumb to eating disorders such as anorexia nervosa and bulimia.
It is recommended that screening for osteoporosis be done every two years. This screening assesses your bone density and can be done a number of ways. Screening options include ultrasound of the heel, quantitative computed tomograpy (QCT) of the spine, many other techniques that measure the bone density of the hand, wrist and ankle, and MRI.
By far the most common bone density screening test is the Dual Energy X-ray Absorptiometry or DEXA scan. The DEXA scan is a simple test which requires a low exposure to radiation (1/10 of the exposure of a chest X-ray) that takes about 5 -1 0 minutes to complete. No special preparation is needed for this test. This involves lying on a platform while a mechanical arm passes over your body examining your spine and hips.
The results of this test can be given as a T-score or a Z-score. Z- scores compare how your value deviates from individuals in your age group, who are the same sex, weight and race as you are. Healthcare professional appear to use the T-score more often. Simply put, the T-score tells how much your bone density value falls below the average value for a young adult.
The World Health Organization (WHO) has put together categories that your healthcare professional uses to arrive at a diagnosis of osteoporosis. T-scores better than -1, mean normal bone density. If the T-score falls between -1 and -2.5 then it is consistent with osteopenia. Osteopenia means thinning of the bone and puts an individual at an increased risk for developing osteoporosis. Your healthcare professional may recommend at this point, that you increase your calcium intake to 1500mg daily and Vitamin D to 800 International Units (IU) daily. Weight-bearing exercise may also be recommended–activities such as walking, jogging, climbing stairs, running, jumping rope and strength training may be suggested. Depending on how close a T-score falls to -2.5, medications like Fosamax, Actonel (taken once a week), or Boniva (taken once a month) may be prescribed.
If your T-score is less than -2.5, it is consistent with a diagnosis of osteoporosis. At this point you may be placed on medication, advised to take calcium and vitamin D and to exercise. Great caution should be taken because, at this point, the bones are very brittle and are at increased risk for a fracture. Discussion of your T-score and your treatment options should be taken up with your healthcare professional. At that point if bisphosphonates are not ideal for you, other medication options will be pursued.
A WORD ABOUT OSTEONECROSIS OF THE JAW
A recent concern has been heralded about possible osteonecrosis of the jaw being associated with medications used to treat osteoporosis. Osteonecrosis means “death of a bone”; more specifically, death of the bones of the jaw. Symptoms include jaw pain, swelling of the gums, loosening of teeth, exposure of the bone under the teeth; most symptoms seem to occur after a dental procedure.
In 2003, it was observed that some cancer patients who received chemotherapy and who were using intravenous bisphonophates (Aredia or Zometa) developed osteonecrosis of the jaw. Few individuals taking oral bisphonophates like Fosamax , have reportedly developed jaw osteonecrosis. These patients had a recent dental procedure or some sort of dental condition. Because of this, dentists have been recommending that patients on Fosamax, Actonel, or Boniva contact their physicians for further recommendations before having dental work done.
Recent recommendations pertaining to the prevention of jaw osteonecrosis include a 2 month drug holiday from the bisphosphonate before dental procedures involving teeth extraction or any type of dental surgery, as well as another 2 months drug holiday after the procedure. The reasons behind the development of jaw osteonecrosis in these patients are still not fully understood and more research is needed.
Any concerns and/or recommendations should be discussed with your healthcare professional as well as your dentist.
Information with regard to treatment options and screening specific to you should be discussed with your healthcare professional. Generalized information about issues discussed in this article can be found at the sites listed below:
National Osteoporosis Foundation (NOF)
Bone Densiometry Tutorial
Answers to questions on Jaw Osteonecrosis
With the recent death of Tim Russert on June 13, 2008, a lot of us are thinking about our own mortality. Are we eating the right foods, are we exercising enough and if we aren’t, are we at risk for a heart attack or even more devastating, are we at risk for sudden cardiac death (SCD).
Mr. Russert had a history of coronary artery disease and was, according to his doctor, being treated with the “right medications”. Despite taking “right medications”, his HDL (good cholesterol) was low and he was battling obesity. His autopsy results revealed extensive coronary artery disease in the left anterior descending artery of the heart, a blood clot in that artery, and an enlarged heart.
Coronary Artery Disease (CAD) is the build up of fatty deposits in an artery of the heart. Arteries of the heart are called coronary arteries and the fatty deposits are called plaque. When there is a build up of plaque, it causes the artery to harden, a process called arterosclerosis and this can cause significant arterial narrowing. This narrowing can cause the blood supply to the heart to be cutoff resulting in significant damage to the heart muscle as well as disturbances in the electrical activity of the heart.
Another more serious result of CAD can occur when a plaque in the coronary artery ruptures. This rupture causes the natural clotting process to begin and clots can form at that area of rupture. This will almost instanteously cut of blood supply to the heart and can cause the heart to go into a lethal rhythm called ventricular fibrillation. This rhythm causes the bottom portion of the heart-the ventricle- to quiver and not pump effectively, depriving the vital organs of the body of oxygen. If the heart is not defibrillated in time, sudden cardiac death occurs. This is what is believed to have contributed to Tim Russert’s death.
The majority of cases of CAD occur because of lifestyle issues. Heredity can also play a role. Approximately 310,000-325,000 people die of a heart attack each year without being hospitalized, 16,000,000 are diagnosed with CAD and about 1.2 million will be new to CAD or have a recurrence of a heart attack.
People who are at risk include those with the following conditions:
Elevated blood pressure
Elevated cholesterol levels
Age (older than 55 for men and older than 65 for women)
Family history of CAD (male family member younger than 55 years old with CAD and female family member younger than 65 years old with CAD )
Individuals with more than one risk factors are at greater risk for developing CAD and falling prey to sudden cardiac death.
Being proactive with your health is necessary to guard against developing CAD and making sure risk factors are controlled. It is important to have a physical exam at least once a year. If the above risk factors exist, following up with your healthcare professional more often is warranted to ensure that the risk factors that can be controlled are done so adequately.
Just like Tim Russert, doing the best you can does not always guarantee that you will not be affected by this disease. However, frequent visits to your healthcare professional, following his/her recommendations especially those dealing with regular exercise and diet control, and taking medications as prescribed will, I believe, afford greater control of coronary artery disease, and decrease heart attacks and sudden cardiac deaths.
Further information can be obtained from your healthcare professional and from the following websites:
American Heart Association
AHA Sudden Cardiac Death
Salmonella “Saintpaul” and Tomatoes
An outbreak of Salmonellosis is currently affecting at least 16 states. This began in mid-April. Salmonellosis is an infection with the Salmonella bacteria. The particular serotype involved is the Salmonella “Saintpaul”. This outbreak is linked to raw red plum, raw red Roma and raw round red tomatoes. So far the cherry and grape tomatoes are not affected. Tomatoes attached to the vine and home grown tomatoes are deemed safe to eat for now.
Symptoms of Salmonellosis include diarrhea, fever, and abdominal cramping about 12-72 hours after exposure to the bacteria. These symptoms can last 4-7 days. Healthy individuals will likely handle this infection without serious setbacks, however the elderly, children and individuals who are immuno-compromised can require hospitalization.
Usually no treatment is necessary but if the bacteria enters the bloodstream, an antibiotic is needed and if dehydration occurs fluid replacement is necessary. Identification of the salmonella bacteria is done by examining stool samples microscopically.
The salmonella bacteria can be found in the feces of humans and animals. Exposure occurs when we eat foods contaminated with feces. Foods most vulnerable to this bacteria include: beef, poultry, eggs, milk and vegetables. If these are cooked thoroughly, the likelihood of getting salmonellosis greatly diminishes.
To prevent infection with the salmonella bacteria cook food thoroughly and wash hands frequently. Some restaurants demand that infected employees not work until a stool sample proves that they no longer have the bacteria.
A full blown investigation is underway to discover the cause and source of this outbreak. In an effort to curtail the spread of this bacteria, restaurant chains such as McDonalds, Burger King, Taco Bell and Chipotle Mexican Grills and others have stopped serving food items that contain tomatoes. Winn Dixie and Albertsons have stopped selling the tomatoes cited by the CDC and FDA until a cause for this outbreak is discovered.
WHERE AND WHO:
States where this outbreak is reported so far include:
“Since mid-April, 228 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 23 states:
Arizona (12 persons), California (1), Colorado (1), Connecticut (1), Idaho (2), Illinois (17), Indiana (1), Kansas (3), New Mexico (39), Oklahoma (3), Oregon (2), Texas (56 persons), Utah (1), Virginia (2), Washington (1), and Wisconsin (3).
Patients range in age from 1 to 82 years; 49% are female.
At least 23 persons were hospitalized.
A 67 year old male in Houston, Texas has been reported to have died as a result of this recent outbreak.
As of Thursday, June 12, 2008 salmonella outbreak have been reported in 7 more states: Florida, Georgia, Vermont, Tennessee, Michigan, Missouri, and New York.
The CDC and FDA are investigating the cause of this outbreak. The websites listed will provide important information and updates: FDA, CDC.
Please check the above websites for current information regarding this issue.