Monday, October 27, 2008

Do Young People Get Osteoporosis?

Osteoporosis is typically thought of as a disease of aging or senescence. In my practice, the typical patients that I see are females over 65 years of age and men who are 72 and older. Unfortunately, however, this terrible disease is becoming more common among even younger patients. \

As an example, in the last 6 months, I have treated three young men, between the ages of 35 and 42 years old. Although that's not the type of person we usually associated with osteoporosis, all three of these men had fragility fractures.

Why would they get this at their age? The answer might surprise you. All three men had vitamin D deficiency. That's right--osteomalacia, the same disorder that is known as rickets in children. A recent study reported at the American Society of Bone Mineral Research showed that 90% Canadian children had rickets.

What's more, most every patient with a fragility fracture that I treat also has vitamin D deficiency. These findings suggest that this disease is being seen in epidemic proportions.

Monday, October 20, 2008

Question: If I'm taking Fosamax, why is my bone density decreasing?

We commonly see patients with low bone density that continued to decrease although they were on medical therapy such as bisphosphonates.

While we want to think that these medications increase our bone density, it's very common for the bone density tests to stay the same on bisphosphonates like Actonel and Fosamax. However, when they stay the same or decrease on medical therapy, a search for underlying causes should be done. For people on medicine for osteoporosis, the most common cause of continued bone loss is vitamin D deficiency.

The National Osteoporosis Foundation recently increased their recommended daily intake of Vitamin D to 800-1,000 IU for all patients 50 and over. A study in 1997 documented that doses up to 2,000 IU are safe for adults.

Unfortunately, if you have vitamin D deficiency (also known as ricketts), taking the recommended 800-1,000 IU vitamin D is not enough to overcome it in a timely manner. Commonly, patients with ricketts be treated with a 50,000 IU pill daily for 30 days and recheck the blood level. It's important that your physician checks your vitamin D level before and during treatment. Although most labs use 30 ng/ml as the minimum normal level, it really should be 40 ng/ml or more.

About 90 percent of the patients we see (most who have fractures) have ricketts. Also, if you have continued decrease on your Dexa despite religiously taking your meds, you should have a comprehensive metabolic workup for secondary causes--that is, something else is usually going on and several blood and urine tests are usually needed to find out why.

Always consult your physician. I recommend finding a qualified physician who has an interest in osteoporosis. Preferably they will be involved with the NOF or at least aware of its recommendations. You need the best team on your side to beat this disease.

Tuesday, October 7, 2008

Why do calcium pills have Vitamin D?

This is a common question I receive. Vitamin D is commonly used in combination with calcium supplements because the body requires vitamin D in order to use calcium.

To understand why this is important, we need to talk about how amazing the bones that make up the skeletal system are. When we think of bones, we often associate them with long dead animals, like dinosaur bones in a museum. So, we tend to think that they don't change once we become adults.

In truth, however, our bones are actually living organs, just as vital to our survival as the heart or liver. Our bodies are constantly taking up old bone and laying down new bone in it's place.

Every cell in the human body requires calcium to function. From the beating heart to our muscles and nerves, if there isn't enough calcium, they cease to function. If the calcium levels in our blood get to low, the body takes calcium out of the bones to keep those levels high enough. When there is plenty of calcium in the blood, that is one of the factors that allows the body to lay down new bone using calcium.

Unfortunately, the average American diet has too little calcium. Vitamin D is also required for the body to absorb calcium from the gut (ie, from pills). If the body has too little vitamin D (also known as vitamin D deficiency or osteomalacia) the body can't absorb adequate calcium and--as a result--cannot lay down new bone.

Even if you took an entire bottle of calcium pills every day--which could kill you--if you don't have enough vitamin D in your body, you won't be able to use the calcium.

So how much vitamin D is needed? We'll talk about that on my next post, because there is a lot of controversy about that.

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