James Otten D.D.S.

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Women's Health
What You Need to Know about Osteoporosis and Treatment

As is the case with many medications, these medications called “bisphosphonates” have multiple uses with the exact mechanism of action sometimes unclear. Their use in cancer therapy and one of the side effects that shows up dentally gives us reason to be cautious. It seems that these drugs help maintain bone and calcium mass by decreasing the bone’s ability to rapidly form new blood vessels in bone. In cancer therapy this can retard the growth of a tumor also by slowing the breakdown of bone at the site of the cancer lesion but it also may have the negative effect of inhibiting healing particularly after surgery.

So you’re probably wondering what the connection is between the use of these drugs in cancer treatment and the use for osteoporosis? In cancer therapy, the dosages given for these medications are much higher than the individual oral dose for osteoporosis. At these higher doses roughly 15-20% of people develop significant bone infections of the upper and lower jaws, sometimes related to dental procedures or existing dental problems. These infections called osteonecrosis of the jaw or “ONJ” are often very difficult to treat creating complex oral health problems.

The frequency of these bone problems of the jaw with people taking the lower dosages for osteoporosis is much less — so far, but there still is reason for concern. The problem is in the fact that these drugs stay in your system for YEARS. Some estimates state that a significant amount of the drug taken today is still in your system range from 7-10 years from now. So conceivably you are accumulating very high doses of the medication in your system perhaps eventually approaching the amount the cancer patients receive.

If all of this sounds a little uncertain to you, that’s exactly the point. We really don’t know a lot about how these drugs work, how long they are truly in your system (all we know is a long time) and what the serious long-term side effects might be. And there is clear clinical evidence that they could have some harmful long-term effects. The good news is that some manufacturers are starting to realize this and are decreasing the recommended dosages. As is the case with many medications this seems to be more a problem of over prescription than a problem with the therapeutic benefit of the drug itself.

Here are some steps you can take to protect yourself. First, like all medications, don’t agree to take it unless you really need it. Do your homework. All medicines have side effects. Even some common medications like ibuprofen can have very serious long-term side effects that many people are not aware of (call of write us to learn more).

How do you decide if you really need a medication? It’s all about risk and reward, that is, determining if the risk of taking the medication (including the unknown) is worth the benefits you get.

Next, get tested, a bone scan can produce a BMD or bone mineral density test that can tell you how much risk you have for true osteoporosis (which is different than osteopenia, a lesser precursor condition) of the long bones like hip and back bones or vertebrae. In this instance a high risk of fracture with osteoporosis might indicate serious consideration for use of bisphosphonates to avoid debilitating injury. Any condition less than this should cause you to at least question the use of these medications and consider your alternatives.

What are your healthy alternatives? A with most health issues, prevention is the best medicine but you still can treat much of this problem even after it has formed with some simple steps.

Take Calcium and Vitamin D. A daily dose of soluble (dissolvable) calcium from a reliable quality supplement supplier is sufficient. Be sure it is soluble and time releasing, some less quality calcium supplements are like swallowing a whole clam shell and don’t dissolve in your system.

Do consistent weight bearing exercise. This may be one of the most underutilized and effective ways to prevent and treat the decalcification of bone.

Get off the soft drinks. This may be especially important in young people as the high amounts of phosphoric acid in soft drinks can significantly deplete calcium in developing bone.

Here’s what the National Osteoporosis Foundation says about testing, calcium, vitamin D and exercise:

You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone mineral density (BMD) test. A BMD test uses a special machine to measure bone density. Some people also call it a bone mass measurement test. This test lets you know the amount of bone mineral you have in a certain area of bone. Bone density testing can be done on different bones of your body, including your hip, spine, forearm (between the wrist and elbow), wrist, finger or heel. A BMD test is safe and painless, and it provides important information about your bone health. Your healthcare provider uses this information to make recommendations to help you protect your bones.

How Often to Repeat a BMD Test

 People taking an osteoporosis medication should repeat their BMD test by central DXA every two years, according to the National Osteoporosis Foundation (NOF). Some healthcare providers may have certain patients repeat their BMD test after one year.

Authors note: we think that given the unknown yearly re-testing is more appropriate in order to determine the best minimum dosage required for each individual.

Healthcare providers use the T-score to diagnose osteoporosis. If more than one bone is tested, they use the lowest T-score to make a diagnosis of osteoporosis. The World Health Organization (WHO) has defined the T-scores and what they mean.

What your T-score means:

The lower a person’s T-score, the lower the bone density. A T-score of -1.0 is lower than a T-score of 0.5; a T-score of -2.0 is lower than a T-score of -1.5; and a T-score of -3.5 is lower than a T-score of -3.0.

Calcium
According to NOF recommendations, adults under age 50 need 1,000 mg of calcium daily, and adults age 50 and over need 1,200 mg of calcium daily.

Vitamin D
According to NOF recommendations, adults under age 50 need 400-800 IU of vitamin D3 daily, and adults age 50 and older need 800 – 1,000 IU of vitamin D3 daily. Vitamin D3 is the form of vitamin D that best supports bone health. It is also called cholecalciferol. Vitamin D can also be obtained from fortified milk, egg yolks, saltwater fish, liver and supplements.

Role of Calcium

Getting the daily recommended amount of calcium, whether through diet, supplements, or combination, is essential to maintaining bone strength and can play a vital role in preventing osteoporosis-related fractures.

Role of Vitamin D

Vitamin D plays a major role in calcium absorption and bone health. Vitamin D3 is manufactured in the skin following direct exposure to sunlight; however, there are many different factors that affect a person’s ability to make adequate amounts of vitamin D.

Bone is living tissue that responds to exercise by becoming stronger.

You know that your muscles get bigger and stronger when you use them. Bones are similar; they get stronger and denser when you make them work. And “work” for bones means handling impact, the weight of your body, or more resistance. Currently, we know the most about two types of exercises that are important for building and maintaining bone density. These are:

Weight Bearing, Impact Excercises

These exercises include activities that make you move against gravity while staying upright. iWeight-bearing, High-Impact Exercises are best for building bones in people who do not have low bone mass, osteoporosis or are frail.

Resistance and Strengthening Excercises

These exercises include activities where you move your body, a weight or some other resistance against gravity.

Weight-bearing, Low-Impact Exercises can also help to build bones and are safer for people who cannot do high-impact exercises. 

Some of these exercises include:

Osteopenia and osteoporosis are common problems effecting mostly middle aged and older women. As with all disease, effective treatment regimens should be the result of informed choice after discussion and research with your health professionals.

At our office this has been our philosophy for many years and we hope this allows you to be more fully informed about the options available to you. Our belief is the same as the famous physician Albert Schweitzer who said: “every person carries their own best physician inside of them and our task is to help them discover it”

Yours in oral; health and wellness

Jim Otten