Racism and Discrimination in Health Care The highly influential New England Journal of Medicine published a series of perspectives on racial bias in health care. Dr. Mary Bassett, New York City's health commissioner, suggested that the medical community should not only do more to improve …Read more. When Is an Older Driver a Danger on the Road? Telling an older person he should no longer drive is difficult. This can be a devastating blow to the patient, who may resist the suggestion vigorously. No longer being able to drive takes away one's independence and increases isolation, depression, …Read more. Priorities in Lowering the Risk of Heart Disease Heart disease is the leading cause of death in the developed world. Although occurring at a later age, heart disease is just as common in women as in men. Despite this fact, fewer than 1 in 5 women believe that heart disease is a significant health …Read more. Being Your Parent's Parent Is Difficult But Potentially Rewarding I truly miss my mother, who died 18 months ago, at age 90. She was the quintessential Jewish mother and an expert at guilt. When I phoned her in South Africa, I didn't just say hello; I also said I'm sorry. I had almost always done something wrong. …Read more.more articles
Osteoporosis Drug Has Problematic Side Effects
For millions of women, and more recently men, the use of medications to treat osteoporosis has led to fewer fractures and less disability with advancing age. The most commonly employed medications are bisphosphonates, which have been shown to be highly effective in building bone mass and strength. Unfortunately, bisphosphonates have been associated with some very serious side effects.
To understand how bisphosphonates work, we must first understand normal bone metabolism. Adult bones are similar to a large tree — tough, sturdy and seemingly inactive. But look past the exterior, and you will find that bones are vibrant, living, ever-changing parts of the human body. Throughout life, bone is continually being remodeled. Broken down by cells called osteoclasts, bones are simultaneously being rebuilt by cells called osteoblasts.
This combined production and destruction determines the strength and resilience of our bones. If there is either decreased production or increased destruction of bone, osteoporosis or conditions like it will develop. In the most common form of osteoporosis — found in post-menopausal women and in men over the age of 70 — the major cause is decreased production caused by declines in hormones, inadequate calcium or vitamin D, and inadequate exercise.
Osteoporosis can be diagnosed clinically by the development of a fracture or through screening with a bone density or DEXA scan. When bone loss is minimal, further decrease can be prevented by diet and exercise. But if severe, treatment is warranted and bisphosphonates are the drugs of choice. These drugs build bone strength by inhibiting osteoclasts that cause the breakdown of bone, thus altering the delicate balance of bone destruction and production. With increased production comes greater bone strength.
Recently, thousands of patients have spontaneously stopped taking bisphosphonates due to reports of scary side effects. The most frequent side effect is indigestion, heartburn and damage to the esophagus. To prevent this from happening, the drug must be taken on an empty stomach with a full glass of water, and the patient should not lie down or eat for 30 to 60 minutes. More rarely, abdominal pain and diarrhea have been reported. The drug occasionally cannot be tolerated because of fatigue or muscle and joint pain.
Perhaps, the most serious side effect of bisphosphonates is a condition called osteonecrosis of the jaw.
These side effects occur because the bone built after treatment with any bisphosphonate is not totally normal. For this reason, experts recommend ceasing the drug for a year after bisphosphonates have been taken for five to seven years.
In a study released by the New England Journal of Medicine, researchers indicate that there is hope for treating or preventing osteonecrosis of the jaw. Teriparatide (Forteo) — a drug used to treat osteoporosis — aided bone recovery in patients undergoing surgery for periodontal disease. Furthermore, researchers reported complete healing in a patient with severe osteonecrosis of the jaw after treatment with Forteo, which is given as a subcutaneous injection daily for two years. In contrast to the bisphosphonates, Forteo stimulates bone production rather than inhibiting bone destruction.
Despite the side effects of bisphosphonates, these medications still remain the treatment of choice for osteoporosis. The cheapest generic form should be used first, and intravenous injections should be given only to those unable to tolerate newer therapies. Other medications, such as Forteo, should only be considered if the bisphosphonates are not tolerated or contraindicated.
A new medication (Prolia) is given as a subcutaneous injection twice a year. While more convenient than the daily shots of Forteo, it is a new, untested, expensive treatment with a similar mechanism of action to the bisphosphonates, hence the same side effects.
The long-term suffering and disability caused by osteoporosis is very profound. Despite some adverse effects, when used appropriately, treatment with medications is well worth it.
Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.
COPYRIGHT 2010 CREATORS.COM