Diplomate, Board Certification of Emergency Medicine
I was asked to speak about osteoporosis. This disease
generally affects the bones of females, and males when the
influence of the gender hormones decreases, such as in
females after menopause and males with hormone problems.
These hormones cause the bones to solidify and stop growing,
one of the reasons why people stop growing at maturity. Older
women get brittle bones as a result of the lower level of
hormones in the blood and are prone to back and hip
fractures, as well as hunchback deformities.
The obvious answer may be to give those hormones when the
level falls, in a patch or pills. But recent studies have
shown this may cause more danger then good, as these hormones
can also cause a higher risk of cancer and heart disease.
Calcium and Vitamin D -- the main components of bone -- would
be a good idea and indeed it does seem to help. In the USA,
they have started to fortify orange juice with calcium.
Calcitonin -- which is found in salmon -- causes bone to
uptake calcium in the body, but the use of this hormone
(given as a nasal spray) only helps a little. So what does
help?
The other hormone in the body controlling calcium is
parathyroid hormone and injections of this do help. There is
a new class of drugs that are called biphosphonates that
reduce the natural remodeling of bone and stabilize bone.
Some of these can be expensive -- but when compared to hip
fractures they may be cheaper. Hip protectors and reducing
dangerous falls in the home through avoiding obstacles, will
help. Many men fracture their hips due to not wearing
footwear when they go to mikveh. Exercise definitely
helps. The source article for my remarks, and a good
resource, is the BMJ 16 Aug. 03.
Hip fractures all require surgery and, while the surgery
isn't hard to perform and doesn't even need general
anesthesia, the recovery period is long and the chance of
clots in the legs is high.
Do women who take more antibiotics have a higher rate of
cancer? This rumor spread like wild fire through the media.
However there was a serious flaw in the research: the women
involved may have impaired immune systems, which might
account for more infections as well as cancer.
I do not use antibiotics haphazardly, but when needed they
are very helpful. Knowing when to use them requires a
physician to be up on the latest literature. There is another
resource: a small book produced yearly called Sanford
which lists the antibiotic of choice for every disease.
Write me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. I saw a case of Zoster today, a painful rash that
is a reactivation of chicken pox. Valtrex is the answer if
started early.
