Tag Archives: osteoporosis

EXPERT ADVICE FROM AN OUTSTANDING ENDOCRINOLOGIST

Baum Howard B-70838Dr. Howard Baum is a close friend of mine and an outstanding endocrinologist who is on the faculty of Vanderbilt University Medical Center.   During a recent visit I was able to ‘pick his brain’ on three topics of importance and interest to many patients who see me.  Check out his podcasts on:

Hypothyroidism

Diabetes

Osteoporosis

You will learn practical information that will guide you in understanding these conditions, and you will be able to manage your own disease better.

MY VITAMIN RECOMMENDATIONS FOR SPECIFIC CONDITIONS

balloonsAs most of you know, I am not a huge proponent of vitamins, based on concerns about the potential negatives they can cause,  as well as the lack of evidence for their general effectiveness.

That said, there are situations in which vitamins can be considered and here is a list of my current recommendations, with particular brands mentioned (that are known to be of high quality.  Other brands may be fine, but these are the ones I am comfortable with.)

Bones (documented osteoporosis with added Vitamin D required.)

Natural Factors Vitamin D3 (1000, 2000, 5000 unit capsules)

Calcium Citrate…..Citrical Brand (all varieties)

 

Memory Loss (ALZHEIMER’S DISEASE):

Nature Made Vitamin E 1000 unit capsules, 2 daily

B Vitamins (folic acid & B-12) in the form of Xymogen Methyl Protect, 1 daily (we have this at our office)

 

Fatty Liver (ALSO CALLED NASH…NON-ALCOHOLIC STEATOHEPATITIS):

Nature Made Vitamin E 400 units capsules, 2 daily

 

Hair Loss (Alopecia)

Nature Made Biotin 2500mcg

Natural Factors Easy Iron, 20mg tablets, 1-2 daily

 

Iron Deficiency Anemia:

Natural Factors Easy Iron, 20mg tablets, 1-4 daily (easiest on the digestion)

Ferro Sequels (Ferrous Fumarate), slow release iron, 1-4 per day

Iron Sulfate 325mg, 1-3 per day

A PATIENT WONDERS: WHAT ABOUT THE DANGERS OF CALCIUM? ….. HERE’S MY ANSWER

citrical


 Dear Dr. Lakin,
In this morning’s NY Times (Science section), there was an article reporting  the results of “… a Swedish study that followed 61,433 women born between 1914 and 1948 for an average of 19 years.  After controlling for physical activity, education, smoking, alcohol and other dietary factors, they found that women who consumed 1,400 mgs. or more of calcium a day had more than double the risk of death from heart disease, compared with those with intakes between 600 and 1,000 mgs.  These women also had a 49 percent higher rate of death from cardiovascular disease, and a 40 percent higher risk of death from any cause. ”   The authors noted that calcium can increase blood levels of a protein associated with higher risk for cardiovascu  lar disease.I now take 1760 mgs. of calcium a day.  (Citracal – 1260 mg + Multi-vitamin – 500 mg.)  My last bone scan (April 2012) showed a 13% lower reading than the previous scan 3 years earlier.  Should I be concerned about the findings in the Swedish study?  Should I make any changes to mydaily calcium intake?Thank you in advance for your advice.

Mary Anne

Mary Anne;
 
Such epidemiological studies are always interesting and often curious, but they are difficult for any decision-making in a particular patients situation.
 
The risk of death is 100% of course…..eventually!  For all of us (but I’m working on this one!)
 
Seriously.  If your risk is 1% in your 60’s.  Perhaps 2% in your 70’s….from heart disease…..and 4 % in your 80’s……then you will increase to 1.5, 3 and 6% respectively.  I don’t think that is much in ‘absolute’ terms……so I would not let such indendiary comments lead to too much teeth gnashing.
 
I think this entire issue is uncertain as there is data, quite as compelling, just as contradictory and touting the benefits of calcium.
So…..I would:
1.  Do the most you can with natural forms of calcium.
2.  Continue to supplement…although you might diminish that a bit (I suppose) in deference to these findings.
 
 
DR LAKIN
 
 
PS…..I drove to work today…….1000% more dangerous than taking calcium!

 

 

 

TREATMENT FOR BONES IS GOOD FOR MEN, BUT QUESTIONS REMAIN

Reclast is an IV form of bone-builder that we use in women for osteoporosis.  It has been proven effective and safe and is particularly good for patients who cannot tolerate Fosamax or Boniva pills, due to GI distress.

This latest study shows benefits at one year, in men with documented osteoporosis, with a substantial reduction in bone fractures.  That said, there was a statistical increase in heart attacks.  Although this has never been seen before with this medication, and is of uncertain significance, I am still a bit wary of this finding and I think until it is clarified, I would hold on treating men with this IV form of medication unless there is very strong indications.

Although the article minimizes the heart issue, based on the lack of previous concern in study, I think it prudent to be more cautious.  Like Groucho Marx  once famously said…..”Who are you going to believe ….me…or your lying eyes?”

 

http://www.nejm.org/doi/full/10.1056/NEJMoa1204061

 

CALCIUM CITRATE IS MY CALCIUM OF CHOICE

Calcium Citrate (Brand CITRICAL) is my choice for calcium supplementation in those who need additional calcium for their bones.

The reasons I like this brand are:
1.  The various forms that are available, from once-daily to smaller pills for those with difficulty swallowing

2.  Calcium Citrate is better absorbed that Calcium Carbonate and is generally easier on digestion.  Calcium can cause constipation and the better absorbed products will limit this side effect

Here is information on bone healthy……

https://dl.dropbox.com/u/61406543/DoctorDougsNewDesk/Minfo—Bone%20Health.doc

and here for information on calcium to be found in the diet…..

https://dl.dropbox.com/u/61406543/DoctorDougsNewDesk/Diet—Calcium%20Info.doc

LET’S CHECK YOUR BONES LESS OFTEN

In a new study from the NEJM (New England Journal of Medicine), women over 65 with normal bones on DEXA (bone mineral scanning), or those with only mild bone loss, can take up to 15 years to get their 2nd bone scan.
Great news!
We have been doing scanning at 2 year intervals and although the radiation involved is very minimal, it is a costly procedure. Doing it less often will not miss many women at risk of developing osteoporosis.
I’ve been increasing the interval between bone scans for such woman, but now it’s good to have data to support that. That said, not sure we will wait 15 years…but rather 5-10 to do our second scan.
As always, it’s important to discuss this directly with the doctor, to understand the pro’s and con’s of monitoring, but it’s nice to get such reassuring information on woman at ‘low risk’.