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EAGLE COUNTY - What a great last day at Vail the Sunday before last. It was a perfect Colorado morning for the last chance to ski, ride or snowshoe the mountain.
As my two sons led the way, I enjoyed the heat of the sun snowshoeing up from Eagle's Nest with my wife and a great friend. It was then I ran into my quandary.
The sun, I thought, would be great for our bones. When our skin is exposed to sunlight we make vitamin D, which is of course essential for calcium metabolism. On the other hand, I knew, as my wife pulled out the sun block, that skin cancer is a very real thing.
But I convinced myself, recalling my father had osteoporosis, that I need vitamin D. Then again, knowing melanoma is on the rise, it would be crazy not to cover up. What is a person to do?
Dear Doc: I just turned 50, and my mother broke her hip last year after a fall. Should I get a bone density test?
- Taking Calcium in Edwards
Dear Taking Calcium: We have already talked about the importance of taking Vitamin D with calcium. That advice used to be important only in colder climates, where dressing warmly or just staying inside limited sun exposure and thus our natural production of vitamin D.
Today, however, the same advice that helps minimize skin cancer risks also prevents our skin from producing vitamin D. Yes, even sun block inhibits that natural process. So, be safe in the sun and take vitamin D. Beyond prevention, however, osteoporosis can be successfully treated with several medications currently available and more on the way.
Unlike structures in our world, that are unchanging, our bones are constantly being remodeled. That means they are broken down and rebuilt every day. This is in response to stress put on them (thus the benefits of weight-bearing exercise). Medicines act by either increasing the building of bones or slowing their breakdown. These medications come in two basic flavors. They include:
-- Antiresorptive drugs. These medicines slow bone loss by decreasing the rate they are broken down.
-- Bone-building agents. These drugs help to increase the rate we rebuild our bones.
Of course, non-pharmacological interventions such as vitamin D and calcium remain essential even when taking prescription medicines.
The most important group of medications physicians use to treat osteoporosis are the biphosphonates. These drugs include Fosamax and Actonel. They belong to the antiresorptive drug class. Their most common side effect is gastroesophageal reflux (GERD, resulting in injury to the lower esophagus. This can be avoided by taking them on an empty stomach with a full glass of water and remaining upright for 30 minutes. Newer once-a-week forms of Fosamax and Actonel help ease taking them. Newer biphosphonates are coming that may further reduce side effects and increase their effectiveness.
Another class of antiresorptive drugs is the estrogen analogs. Known as selective estrogen receptor modulators (SERMS) they mimic the beneficial effect of estrogens on bones while avoiding their adverse side effects.
Although less potent than the biphosphonates, they remain a good choice for some. Currently, the only marketed SERM is Evista. Adverse side effects may include hot flashes, although beneficial side effects such as improving memory and reducing the risk of breast cancer are being investigated.
The last of the antiresorptive drugs is calcitonin. This is available as Miacalcin, a once-a-day nose spray. It is also less potent than the others but helps strengthen bones by improving their matrix or structure.
No matter which medication you might take, do not expect a measurable change in your bone density for two years.
The second class of drugs is the bone-building agents. Currently there is only one drug available in this class, although others are coming, as well.
Forteo is a form of human parathyroid hormone, which works to regulate calcium metabolism. It can be very effective in building bones even when the other medications are not. The treatment is given in daily injections for up to two years. The side effect includes an increased risk for osteosarcoma, a rare form of bone cancer. Because of that, it is best used in women at high risk when other treatments fail or cannot be tolerated.
That is a lot of information to digest! To put it simply, exercise regularly. Take calcium and vitamin D. Follow your doctor's advice on the best time to have your bone density screened. If it is too low, talk about the best treatment options for you.
Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him by e-mail to editor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, 81658.
Vail, Colorado
As my two sons led the way, I enjoyed the heat of the sun snowshoeing up from Eagle's Nest with my wife and a great friend. It was then I ran into my quandary.
The sun, I thought, would be great for our bones. When our skin is exposed to sunlight we make vitamin D, which is of course essential for calcium metabolism. On the other hand, I knew, as my wife pulled out the sun block, that skin cancer is a very real thing.
But I convinced myself, recalling my father had osteoporosis, that I need vitamin D. Then again, knowing melanoma is on the rise, it would be crazy not to cover up. What is a person to do?
Dear Doc: I just turned 50, and my mother broke her hip last year after a fall. Should I get a bone density test?
- Taking Calcium in Edwards
Dear Taking Calcium: We have already talked about the importance of taking Vitamin D with calcium. That advice used to be important only in colder climates, where dressing warmly or just staying inside limited sun exposure and thus our natural production of vitamin D.
Today, however, the same advice that helps minimize skin cancer risks also prevents our skin from producing vitamin D. Yes, even sun block inhibits that natural process. So, be safe in the sun and take vitamin D. Beyond prevention, however, osteoporosis can be successfully treated with several medications currently available and more on the way.
Unlike structures in our world, that are unchanging, our bones are constantly being remodeled. That means they are broken down and rebuilt every day. This is in response to stress put on them (thus the benefits of weight-bearing exercise). Medicines act by either increasing the building of bones or slowing their breakdown. These medications come in two basic flavors. They include:
-- Antiresorptive drugs. These medicines slow bone loss by decreasing the rate they are broken down.
-- Bone-building agents. These drugs help to increase the rate we rebuild our bones.
Of course, non-pharmacological interventions such as vitamin D and calcium remain essential even when taking prescription medicines.
The most important group of medications physicians use to treat osteoporosis are the biphosphonates. These drugs include Fosamax and Actonel. They belong to the antiresorptive drug class. Their most common side effect is gastroesophageal reflux (GERD, resulting in injury to the lower esophagus. This can be avoided by taking them on an empty stomach with a full glass of water and remaining upright for 30 minutes. Newer once-a-week forms of Fosamax and Actonel help ease taking them. Newer biphosphonates are coming that may further reduce side effects and increase their effectiveness.
Another class of antiresorptive drugs is the estrogen analogs. Known as selective estrogen receptor modulators (SERMS) they mimic the beneficial effect of estrogens on bones while avoiding their adverse side effects.
Although less potent than the biphosphonates, they remain a good choice for some. Currently, the only marketed SERM is Evista. Adverse side effects may include hot flashes, although beneficial side effects such as improving memory and reducing the risk of breast cancer are being investigated.
The last of the antiresorptive drugs is calcitonin. This is available as Miacalcin, a once-a-day nose spray. It is also less potent than the others but helps strengthen bones by improving their matrix or structure.
No matter which medication you might take, do not expect a measurable change in your bone density for two years.
The second class of drugs is the bone-building agents. Currently there is only one drug available in this class, although others are coming, as well.
Forteo is a form of human parathyroid hormone, which works to regulate calcium metabolism. It can be very effective in building bones even when the other medications are not. The treatment is given in daily injections for up to two years. The side effect includes an increased risk for osteosarcoma, a rare form of bone cancer. Because of that, it is best used in women at high risk when other treatments fail or cannot be tolerated.
That is a lot of information to digest! To put it simply, exercise regularly. Take calcium and vitamin D. Follow your doctor's advice on the best time to have your bone density screened. If it is too low, talk about the best treatment options for you.
Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him by e-mail to editor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, 81658.
Vail, Colorado
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