Latest News - Prolia

We are now offering Prolia injections at our Tulsa office in continuing our tradition of bringing the latest, FDA approved treatment options to our patients with osteoporosis.

Prolia (denosumab) is the first drug approved by the FDA in an entirely new class of osteoporosis-fighting medications known as RANKL, or RANK ligand inhibitors. These medications work decrease bone loss in a way that is different from other osteoporosis medications (such as Fosamax, Boniva, etc.)

Our patients who have chosen Prolia so far have done so mostly because it is better tolerated than some oral medications such as Fosamax. In addition, convenience can play a role as Prolia is typically given every 6 months, rather than every day.

Compared to other injectable therapies done by intravenous (IV) infusion, Prolia can be injected in office under the skin, much like a flu shot. This typically takes about 15 minutes, including observation afterwards.

If you are interested in Prolia, or for more information, call our office at (918) 260-9322.

The newly approved drug, denosumab (Prolia), is an injectable medication derived from a synthetic antibody. It is approved by the FDA for treating postmenopausal women with osteoporosis and other patients who have failed or couldn't tolerate other medications.

National Osteoporosis Foundation Tulsa Support Group

The National Osteoporosis Foundation Tulsa Support Group is open to anyone affected by, or interested in learning more about, osteoporosis. Our first meeting will be an educational and support group meeting at 6:00 pm on Tuesday, May 26th at Panera Bread located at 6981 South Lewis Ave., Tulsa.

Anyone interested is welcome to attend. This support group is affiliated with the National Osteoporosis Foundation, but is fully independent and not allied with any particular physician or healthcare organization.

During our first meeting, we will discuss the support group and plans for the future. Our guest speaker for this meeting is Dr. James Webb, who will present on who gets osteoporosis and the factors that put individuals at risk. There will be time for discussion and a question and answer session along with informational handouts. Upcoming topics of interest include diagnosis and treatments for osteoporosis.

The meeting is free and open to the public. For more information, contact Lisa @ 260-9322. Please join us!

What: Tulsa Osteoporosis Support Group

Who: Anyone affected by or interested in osteoporosis

When: Tuesday, May 26th at 6:00 pm

Where: Panera Bread located at 6981 South Lewis Ave., Tulsa

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.

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.

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.

Why Do My Bones Hurt?

Bone pain generally results in aching as well as pain and muscle spasm. For instance, in the case of arthritis, sensory fibers of the joint may respond to sympathetic activity due to inflammation. Most people know someone with arthritis. Sometimes the pain of arthritis is due to joint inflammation, but even this inflammatory response can cause bone pain.

Most body tissues, including bones, produce a number of chemicals and hormones that cause pain. Some examples are substance P, histamine and one class chemicals called prostaglandins. These are all associated with pain. Prostaglandins also play an important role in pain caused by bone metastases.

One of the most common reasons for bone pain is fracture due to trauma or osteoporosis. When normal bones are subjected to abnormal mechanical forces, a fracture can occur. Unfortunately in patients with osteoporosis, even normal mechanical stress can cause a fracture. This can result in disruption of the cortical bone and stimulation of the nociceptive (pain) nerve endings.

Although most people think of bone as a hard, unchanging tissue (like skeletons), our bones are living, active, changing organisms just like other organs. One reason fracture and other causes of bone pain hurt so much it of the exquisite nerve supply. Most of the nerves that cause pain appear to serve the periosteum.

The periosteum is the living, outer lining of bone that serves as a type of covering as well as a a type of anchor site for tendons and ligaments to attach to bone. When you pull a muscle or strain a ligament, much of the pain is associated with the stress on the periosteum and stimulation of the pain fibers there. This also is a factor in many forms of arthritis and the periosteum lines the bone up to the level of the joint.

As such, inflammation, fracture and even other pathological processes to which bone is subjected can result pressure changes which, in turn, results in bone pain. For example, during a bone marrow biopsy, a needle is placed into the marrow cavity and a sample obtained. This causes negative pressure (vacuum) that stimulates the pain fibers. In fact, this procedure is one of the most painful 'routine' medical procedures that we do. It's no surprise, therefore, that people with metastatic cancer or other bone pathology have so much pain.