Kamis, 18 Mei 2017

infusion drug for osteoporosis

infusion drug for osteoporosis

[music plays][no dialogue] >>lori banks:in the u.s., more than 40 million people either have osteoporosis, or are at high risk.are you one of them? today on being well, physician assistant keithballinger from sarah bush lincoln will be here to talk about the silent disease, orosteoporosis. we'll learn more about who's at risk and whatyou can be doing right now to lessen your chances of developing it.that's all coming up next on being well, so don't go away.[music plays] production of being well is made possiblein part by:

sarah bush lincoln health system, supportinghealthy lifestyles. eating a heart healthy diet, staying active,managing stress, and regular checkups are ways of reducing your health risks.proper health is important to all at sarah bush lincoln health system.information available at sarahbush.org. dr. ruben boyajian, located at 904 medicalpark drive in effingham, specializing in breast care, surgical oncology, as well as generaland laparoscopic surgery. more information online, or at 347-2255.>>singing voices: rediscover paris.>>lori banks: our patient care and investments in medicaltechnology show our ongoing commitment to

the communities of east central illinois.paris community hospital family medical center. [no dialogue]welcome to this edition of being well. i'm your host, lori banks.and today, we're talking about osteoporosis. and keith ballinger, who's a physician assistantwith the toledo clinic of sarah bush, is joining us.thanks for coming over. >>keith ballinger:thanks for having me. >>lori banks:so, tell us a little bit about your practice and what you do down at the toledo clinic.>>keith ballinger: i've been a pa for 13 years.currently, i'm working at sarah bush in the

toledo clinic.i've been there for four years, practicing in family practice.over the last 13 years, i've had experience in family practice, as well as a seven-yearstint in urology. >>lori banks:okay, and what's interesting about keith is he was actually an accountant for severalyears. so, you joined medicine later in life.>>keith ballinger: yes, i did.>>lori banks: that's wonderful.so, when we were talking to you about topics, you said, "hey, i want to talk about osteoporosis."why was that an important thing for you to

educate the public about?>>keith ballinger: osteoporosis is a condition that is, has beenwidely overlooked for the most part, until it's a problem for the patient.i, approximately two years ago, dr. ranchero and dr. stevens and i got together and identifieda problem. we identified an area that we're lacking,as far as addressing women's issues, as far as osteoporosis.because patients simply don't typically come in asking to be screened for osteoporosis.>>lori banks: so, let's start with the obvious question.explain to us what is osteoporosis. >>keith ballinger:osteoporosis, basically if you take the word,

break it apart, it refers to bone, porous,and a condition. it's a condition of porous bone.it's a condition of bone loss. you lose bone strength, therefore it subjectsyou to increased risk of fractures. >>lori banks:so, who out there in our population is at higher risk for getting it or developing it?>>keith ballinger: typically, it impacts women more so than men.men are not excluded, however. post-menopausal women definitely need to bescreened. >>lori banks:so, why is it women are getting it, and why later in life?what's the connection?

>>keith ballinger:typically, it's the estrogen. once a woman goes through menopause, theylose that estrogen production. therefore, we see an increased osteoclasticactivity, which leads to additional bone loss. >>lori banks:so, when i was looking at osteoporosis for this show, i'd seen a term called osteopenia,and i'd never heard of that before. and i want you to explain the difference betweenthat and osteoporosis. >>keith ballinger:sure, osteopenia is literally a condition that's going to lead to osteoporosis.when you have a dexa scan done, it's resulted based upon standard deviations.it'll have a negative score.

and if it's negative, or zero to negativeone, you're at low risk for a fracture. negative one to negative two point is higherrisk, but still not severe osteoporosis. so, you have a little window of opportunityin there that we label as osteopenia, which means you're losing some bone, but you'renot to the osteoporotic stage yet. >>lori banks:mmhmm, we're talking about osteoporosis, osteopenia. it all has to do with bone density.and i want you to kind of talk about bone density, and when are we creating and buildingbone density through our lives. >>keith ballinger:you attain maximum bone density by the age of 30.so, as early as 30 and thereafter, you start

losing some bone density, unless you get proactiveand try to develop and adapt lifestyles that will promote good bone health.>>lori banks: okay, so what are some of those healthy thingsthat we should be doing, that maybe we're not?>>keith ballinger: well, eating right, exercise, calcium supplementation,making sure that you take in enough calcium and vitamin d on a daily basis to minimizeyour risk of chance of developing osteoporosis. >>lori banks:okay, so really, starting at age 30 is when we should really start thinking about thisand doing something about it. but it's a little more than just drinkinga cup of milk a day.

you need more than that.what are the recommended levels of calcium per day?>>keith ballinger: for post-menopausal women, i usually recommendat least 1,200 milligrams of calcium and vitamin d on a daily basis.and the nice thing is most of your over-the-counter calcium supplements are already developed,and they'll have 600 milligrams of calcium with 400 international units of vitamin d.take that twice a day, along with your other nutritional intake that you're consuming throughoutthe day in your meals, you've got your calcium level satisfied for the day.>>lori banks: and calcium comes in lots of, in food form.i mean, obviously we have our dairy, but it

also comes in other forms, such as...>>keith ballinger: oh, you can get calcium in certain vegetables.kale, yogurts, cheeses, dairy products. there's, calcium's... or calcium fortifiedcereal. >>lori banks:and breads, and things like that. can you take too much calcium?can you overdose on calcium and vitamin d? >>keith ballinger:you can, you can. you can actually ingest too much, and that'snot recommended or advisable either. >>lori banks:okay, so what happens if you're taking in too much?or what are some of the side effects of maybe

if you're-->>keith ballinger: for the most part, with calcium you're goingto have increased gi irritation. you can also have constipation as a result.vitamin d, it's a little harder with vitamin d to ingest too much, but you can.and it has a whole other set of issues and problems associated with it.>>lori banks: okay, so starting at about age 30 is whenwe need to start thinking about this. so, what if you're watching this show, andyou're my age, and you're 45 or 50, and you haven't started thinking about it?is it too late? >>keith ballinger:no, it's not too late.

main thing is get proactive.talk with your primary care provider. if you haven't had a dexa scan done, and youqualify for one, get it done so you know what your t-score is.>>lori banks: alright, that's what i was... you had saidyou would like for all post-menopausal women to be screened for their bone density.is that something that your primary care is going to look at your chart and go, "oh, it'stime for you to be screened"? >>keith ballinger:hopefully, yes. but unfortunately, we're all very busy.patients typically come in for other issues, complaints, concerns we're busy addressing,and so forth.

so, i try to encourage all my patients, andeven people that i speak with, talk to your primary care provider.you know, bring up osteoporosis. if you're post-menopausal and you've not hada dexa scan, you know, just give them a little reminder.>>lori banks: okay, so really, it's more on you as the patient.you're the one that should be more proactive in asking for that.>>keith ballinger: exactly, be more proactive.>>lori banks: so, how does, i've never had a dexa scan.i don't... how does it work? >>keith ballinger:a dexa scan is a simple radiographic study

done at the hospital.non-invasive. it's literally a glorified x-ray with verylow radiation exposure. >>lori banks:okay, so you don't have to drink a bunch of fluid or anything.let's get back, let's talk about osteoporosis. so, are there any symptoms?>>keith ballinger: unfortunately not.there's no, it's usually found by incidental finding.and what i mean by that is, typically a patient presents to er, to the office, or orthopedicsis involved because they've had a fracture. and that's when we identify, oh, there issome osteoporosis going on here.

>>lori banks:so, there's no outward symptoms of pain or anything like that?>>keith ballinger: it's always after the fact, unfortunately.>>lori banks: okay, so what if you, you know, we've probablyall seen elderly women that are kind of stooped over.is that a telltale sign of osteoporosis? >>keith ballinger:that's typically associated with compression fractures of the spine.and that, too, is indicative of some underlying osteoporosis.>>lori banks: so, can it be reversed?or how does it work?

so, if it's caught early, you take, you know,some kind of, we'll talk about medications in a little bit, can it be reversed?>>keith ballinger: we can make some significant improvements.to say it is completely reversible, getting you back to a t-score of zero, that's probablya little misleading. but with the medications that we have, absolutely,we can make some definite improvements in your bone mineral density just by calcium,vitamin d, and other medications that are designed to actually improve that bone loss.>>lori banks: is there a point at which it's too late, andyou can't quite get that back? >>keith ballinger:yeah, if you have severe osteoporosis, it's

more of a challenge for us to get you treatedadequately and get that bone mineral density back even close to even an osteopenic level.but nonetheless, we don't want to ignore it either, because it is going to continue toprogress and get worse. so really, i mean if you have osteoporosis,your biggest risk factor are fractures, easy breaks and fractures.are there any other risk factors or other things that come along for women who haveosteoporosis? >>keith ballinger:risk factors that lead to osteoporosis? >>lori banks:or if you have osteoporosis, other things that happen as a result of it.or is it just fractures?

>>keith ballinger:basically, it's bone fragility. you're at high risk for fractures, you'rehigh risk for falls. you know, we discussed earlier, you know,which one kind of came first. was it the hip fracture causing the fall,was it the fall that caused the hip fracture? nonetheless, with osteoporosis that risk offractures due to falls is significant, sometimes can be quite disabling for some of these patients.>>lori banks: so, that's something we need to keep trackof, just like we keep track of our blood pressure, our, you know, diabetes and things like that.let's talk a little bit about activities that help build our bone density.>>keith ballinger:

mmhmm, for the most part if people will stayactive. walking, riding a bike, dancing, stair step.any type of physical activity that requires some weight bearing activities is going tobe beneficial to maintaining good, strong bones.i like to send a lot of my patients over to physical therapy, just to work with them acouple times to help them develop a nice home exercise program that they can complete athome to actually increase and maximize what activities they're doing, just to increasethat bone strength, as well. >>lori banks:but clearly, if you have more mid- to advanced stage osteoporosis, and you never exercise,you probably don't want to go out.

and you need to be a little mindful of theactivities you do. >>keith ballinger:right, and you really need to talk to your primary care provider, and get their input,as well. >>lori banks:we talked about some of the people who are more at risk, obviously, are women.and why are women of thin or smaller stature, low weight, at risk?>>keith ballinger: one of the articles i recently read taggedwomen who were 127 pounds or lighter are at higher risk for developing osteoporosis.and i think it goes back to the fact that their bone mass is less than men, and withtheir being such a small frame, light weight,

their weight bearing activities is going tobe significantly less of a demand on the body than someone who's heavier or stockier build.>>lori banks: what about, you know, that smoking leads tolots of other things. what impact does smoking have on osteoporosis?>>keith ballinger: smoking impacts many organ symptoms.and the bone is a healthy tissue, it's a living tissue, as well.so, smoking is going to impair the proper bone remodeling to occur within that bone.and it's just going to worsen the bone health overall.>>lori banks: mmhmm, so let's get into a little bit of treatmentoptions.

at what stage does someone, does a doctorrecommend a medication, a prescription kind of option for osteoporosis?>>keith ballinger: well, calcium and vitamin d is going to bethe first mainstay. i mean, most everyone by the time they're30 and beyond can start that on their own accord.if you have a dexa scan and it comes back showing osteopenia, the sooner you can interveneand treat that condition, the better your outcome's going to be.so, the better our chances of getting you back to a normal bone density is going tobe definitely to your benefit. >>lori banks:so, you really do step in fairly early and

start treating?>>keith ballinger: the sooner, the better.>>lori banks: okay, so what's... we don't need to get intoall the actual names, but the medication can take several forms.i've seen pills and injections. how do you know which one is the best one?>>keith ballinger: it's basically, i evaluate each patient individuallyto see how significant their osteoporosis is.if they've had fractures, any previous fractures. and i always kind of assess the patient andlook to even beyond. okay, what's the likelihood of this patientfracturing in the next 12 months, two years,

whatever.and i kind of evaluate the patient and decide which treatment modality would best fit theirneed at this point in time. the medications come in all sorts of forms.there's oral medications, there's injectables, there's iv infusion.part of deciding which one to choose is which one i can get the patient to cooperate withand take. >>lori banks:okay, so one isn't for more severe cases than the other.>>keith ballinger: one, we have one medication that is anabolic.it does actually rebuild bone. but it is an injectable medication.some people cringe because they do have to

do that every morning or every day themselves.but still, there, certain medications we do, i do lean toward with my more serious cases.>>lori banks: okay, let's kind of go backwards a littlebit. what role does our early nutrition play inour future bone health? so, if we had a poor diet growing up as akid, is that going to impact our chances for osteoporosis later in life?>>keith ballinger: it can contribute to it, it sure can.we're seeing more and more research showing that young females who engage in fad diets,who lose weight repeatedly and frequently, are predisposing themselves to osteoporosisat an earlier age.

basically, through the first 30 years of yourlife is when you're building up the maximum bone density.if that's affected in any way by poor dietary intake, fad diets so to speak, that couldvery well predispose you to developing early onset of osteoporosis later in life.>>lori banks: okay, so it's important as a kid to, and asa young adult to eat healthy, and that up and down weight loss, which is problematicfor young women who want that thin, ideal build, which is obviously, as we know fromtalking to you, is a risk factor later in life.what other conditions are risk factors for developing osteoporosis?>>keith ballinger:

other medical conditions that contribute toosteoporosis, such as diabetes, thyroid disease, parathyroid disease, chronic steroid use forlike asthma, autoimmune disorders. we also use steroids oftentimes with certainautoimmune disorders, as well. so, all those conditions are risk factorsto, toward the development of osteoporosis. >>lori banks:so, those are things that you need to be aware of.when you brought up thyroid disease, that's also something that a lot of women deal with.>>keith ballinger: correct, very common.>>lori banks: so, what is the connection with the thyroidand calcium?

>>keith ballinger:the thyroid is actually very, very crucial in our entire body's metabolism.the parathyroid glands reside there amongst the thyroid gland.and those parathyroid glands are instrumental in the calcium regulation within the bonesand within the bloodstream. >>lori banks:so, if you have your parathyroid glands removed, you're going to have a hard time...is it absorbing calcium, or...? >>keith ballinger:basically, parathyroid glands are going to work to control and regulate the calcium.>>lori banks: i wanted you to... we talked about this earlier.can you explain the role that, you know, like

our hormones play, or estrogen plays with...and i'll have you, you did a better job explaining it, so there's this kind of little pac manthing. i want you to kind of explain that.it's a really good analogy on the role that hormones play with osteoporosis.>>keith ballinger: okay, basically our normal bone remodelingoccurs under osteoclastic activity and osteoblastic activity.the osteoclasts are cells, and i use the analogy of referring to them as the old pac man game,they chomp away at the old bone. the osteoblast, or the builders, they comealong and they make those repairs. when you have a healthy woman who has notgone through menopause, the estrogen actually

helps to suppress some of that osteoclasticactivity. so, you have a longer time frame or a longerperiod where the bones remain healthier because of the suppression of the osteoclastic activity.once they pass through menopause and they lose a lot of that estrogen production, thatthen up-regulates the osteoclastic activity. and therefore, you get the osteoclasts chompingaway like the little pac man, and removing bone at a faster rate than your osteoblastscan keep up in repairing it. >>lori banks:so, if a woman had a hysterectomy in her 30s and has been on hormone replacement therapy,is that doing the same, is the hrt doing the same thing as normal estrogen would do?>>keith ballinger:

yes, if a woman goes through a hysterectomyor a bilateral oopherectomy, which is where they take out the ovaries, they're placedon hormones. that hormone replacement therapy is supplementingthe body exogenously, and will actually help prevent osteoporosis from developing.>>lori banks: okay, but we know, as you said, hrt bringsa whole other, that's a whole other show. >>keith ballinger:that's a whole other segment. >>lori banks:i want to, as we're kind of wrapping up here, i think what's interesting about, and kindof scary, about osteoporosis is that it is this kind of silent syndrome that could begoing on, and we don't know about it.

>>keith ballinger:right, it's also sometimes referred to as the "silent thief," because you have no warningsigns, no outward symptoms until, unfortunately, it's recognized with a fracture, fall, break.sometimes we can pick it up on plain film x-rays, as well.>>lori banks: mmhmm, so what should, this is your platformnow, tell us what women should be doing and at what age to stave off this "silent thief.">>keith ballinger: i would recommend that women starting in,even in their 30s, develop that habit of supplementing your diet with calcium and vitamin d.when women become post-menopausal, talk with your primary care provider.become proactive.

get that dexa scan done so you know what yourbone health is. it needs to come just as routine as havingyour mammograms done, your annual pap and pelvics done, and so forth.>>lori banks: so, it's really, it's a simple thing, butit's one more thing we should add to our, as you said, our list of preventative health.and it can be, to a certain extent, if caught early, reversed, which a lot of our otherchronic diseases can't be reversed. like diabetes cannot be.but this is one that-- >>keith ballinger:we can treat it, and we can make some amazing improvement in your overall bone health.>>lori banks:

alright, well keith, thank you so much forcoming on being well. this is the first time we've covered osteoporosison the show. and i know my eyes are wide open, and i'llbe going out to the store and getting myself some calcium supplements today.>>keith ballinger: very good.thanks for having me. >>lori banks:thank you. [music plays]

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