Pink Prescriptions - November 2022
Get in the Bone Zone: Put Bone Health on Your Prevention Radar
November 2022 Issue — Pink Prescriptions
Get in the Bone Zone: Put Bone Health on Your Prevention Radar
Maintaining good health for your bones is recommended at every age. Moderate exercise and vitamin-rich nutrition can help keep your skeleton in tip-top condition. However, aging bones can weaken and, in severe cases, become brittle. Bone health is usually not thought about until there’s a problem. That’s why it’s time to put your bones on your prevention radar to help reduce your risk of breaking a bone, maintaining good posture and reducing aches and pains. We asked our doctors to get us started on taking care of our bones and share his knowledge about bone health with us. Read on to learn more.
Dr. Eve Ashby
Beaufort Memorial Lowcountry Medical Group
Is hormone replacement therapy safe for preventing osteoporosis? What other treatment options are available that prevent bone loss?
Hormone replacement therapy containing estrogen can definitely help treat and prevent osteoporosis as it helps bone remodeling, especially after menopause. It is, however, not to be used as the first choice to treat brittle bones.
Because of the increased risks associated with postmenopausal hormone use, thankfully there are other options for treatment, as well as prevention of bone fractures. The class of medications called bisphosphonates (for instance, alendronate) has replaced HRT in the last 20 years as both treatment for osteoporosis, as well as “pre-osteoporosis” or osteopenia. These medications have been used extensively as an alternative to estrogen, but also carry risks, especially in the GI system.
About the same time the bisphosphonates became available, another option called raloxifene (brand name Evista) was developed that worked similarly to estrogen but without some of the risks. This category of medication, called SERM (Selective Estrogen Receptor Modulator) worked like an estrogen at the bone, but had an opposite effect at the breast, thus making it ideal for osteoporosis prevention and treatment. Side effects such as hot flashes and leg cramps might occur, but it is generally well accepted that this is a safer option than using estrogens for osteoporosis treatment if a bisphosphonate is not tolerated.
Weight bearing exercise, as well as a diet high in calcium/vitamin D, should still be first option to helping prevent postmenopausal fractures. And be careful on the pickleball court!
Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist with Beaufort Memorial Lowcountry Medical Group in Beaufort and Okatie. Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine.
James F. Gigante, MD
Is calcium and vitamin D important for bone health?
Osteoporosis is just what it sounds like: Osteo meaning relating to the bones, and for the porosis part, think of porous. As you get older, your bones start to become more and more porous, which causes them to become brittle and break. Because bones are living tissue that is in a constant state of break down and renewal, you can make proactive moves to help the process swing in a positive direction. Calcium and Vitamin D are a great start. Vitamin D helps your intestines absorb the calcium that your body needs to keep bones healthy. While your body gets calcium through the food that you eat, Vitamin D is made by your body when you are out in sunlight. The amount your skin absorbs is dependent on how light or dark your skin is.
How much exercise do I need to boost bone strength and which exercises do you recommend?
Here in the Lowcountry you can get much of the Vitamin D your body needs from being outside. Going for a walk around the neighborhood with your dog, or playing pickleball with friends, does two things: 1. You will be outside and absorbing Vitamin D; and 2. Your body will be getting exercise that helps to boost bone strength. Weight-bearing exercises are also great because they stimulate bone growth—you can get recommendations from your physician, or speak with a physical therapist or your trainer. You can also get Vitamin D through foods like fatty fish and egg yolks, or dark green leafy vegetables, etc. There is also fortified milk that gives you both Vitamin D and Calcium! If you are not getting enough from sunlight and the food you eat, you could take a vitamin supplement, but always discuss that with your doctor before you start, getting too much Vitamin D can be harmful.
What are some other lifestyle changes I should make now to keep my bones strong?
People with low bone mass should also avoid smoking and drinking alcohol because they decrease bone density and increase the risk of fractures. There are also new and ever-improving medications that your physician can prescribe, speak with your doctor about your bone health!
James F. Gigante, MD is a Board Certified doctor of Internal Medicine and a fellow with the American College of Physicians. He has been practicing medicine for 25 years, the last 17 here in the Lowcountry. 843-681-2222; 35 Bill Fries Drive, Bldg H, HHI.
Vandit Sardana, M.D., FACOS
Beaufort Memorial Orthopedic Specialists
Can medications taken for other illnesses cause bone loss?
Yes, medications being consumed for other conditions can cause or accelerate bone loss.
Commonly used medications that can result in bone loss include:
• Loop diuretics (water pill), such as furosemide, excrete calcium and
can lower bone mass.
• Vitamin A, if taken in excess can cause bone loss.
• Anticoagulants, such as heparin, low molecular weight heparin, warfarin, etc.
can lead to bone loss if taken over an extended period of time.
• Proton pump inhibitors such as omeprazole, pantoprazole, etc.
• Antiseizure medications such as phenobarbital, phenytoin and carbamazepine.
• Chemotherapy drugs such as methotrexate, ifosfamide and imatinib.
• Antidepressants, both TCA (tricyclic antidepressants) and SSRI (selective serotonin reuptake inhibitors).
• Antiretroviral therapy.
• Thiazolidinediones such as pioglitazone used in the treatment of diabetes.
Most of these medications can cause bone loss if used over an extended period of time.
If you are on any of the above listed medications, do not stop taking them for fear of bone loss. Instead, I recommend consulting with your physician and weigh the benefits and detriments of the medications before making any changes.
Dr. Vandit Sardana is a board-certified, fellowship-trained orthopedic surgeon with Beaufort Memorial Orthopedic Specialists in Okatie and Port Royal.