Menopause and osteoporosis

[leonid_nn]

Good afternoon. At me a menopause, and recently at inspection have found out an osteoporosis. I would like to learn or find out, (as much as possible natural, it is possible or probable from replaceable hormonal teparii, not the alimentary additive) it is better to apply what preparation. Thanks in advance.

[Kristishka]

For treatment of an osteoporosis until recently use ZGT was considered as the gold standard. To number *quot; as much as possible ?aOOOa?y?UO*quot;, using your terminology, it is necessary to carry femoston and femoston 1\5.

But all problem not o*quot; maximal ?aOOOa?y??O?*quot;, and in TREATMENT of concrete disease at the concrete person.

Therefore YOUR doctor and you should weigh all pro and contra ZGT at YOU, instead of as a whole at mankind, to discuss preparation ZGT and its or his form t in optimum IMENO At YOU (lipids, age, libido. Other diseases, other displays menopauzalnogo a syndrome).

If ZGT it is counter-indicative, it is necessary to consider or examine other variants of treatment - bisfosfonaty, miakaltsik, in the extremity or end of-extremities SERM (this text already for YOUR doctor).

If you wish to receive volumetric enough information, it is desirable to think over an opportunity of consultation at speutstsialistov on treatment of an osteoporosis - in particular, the authoritative expert is d.m.n. L.JA ROzhinskaja - www .endocrincentr.ru

[Lera]

Also it would be quite good to fill up a ration with soya products, to increase daily consumption of a calcium up to 1,5 g, vitamin 3 800 ED and fluorides (25 mg of fluoride of sodium).

And also to refrain from abusing coffee, table salt. All references have preventive character.

[Ilona]

Dear doctor Vad!

Purpose or Appointment of FLUORIDES - very much and very uneasy situation, also it is necessary to think ten times before in absentia to give similar consultation.

Reception bisfosfonatov, miakaltsika and SERM is necessarily accompanied by purpose or appointment of preparations of a calcium and vitamin.

Without these preparations use actually preparaov a calcium and vitamin D, at all my love to them, concerns to sphere of prophylaxis of an osteoporosis, than to sphere of treatment more likely.

[Sila]

Quite with you it agree, Galina Afanasevna, what bifosfonaty and raloksifen is the best for the present moment in treatment menopauzalnogo an osteoporosis, but how much or as far as they on a pocket?

Fluorides though are not recommended to apply in treatment, but has been shown, that have the certain efficiency at conducting patients:

Arch Intern Med 2001 Oct 22; 161 (19):2325-33

Sustained-release sodium fluoride in the treatment of the elderly with established osteoporosis.

Rubin CD, Pak CY, Adams-Huet B, Genant HK, Li J, Rao DS.

Geriatrics Section, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8889, USA. Craig. Rubin@UTSouthwestern.edu

BACKGROUND: We ascertained the safety and efficacy of fluoride in augmenting spinal bone mass and reducing spinal fractures in older women with established osteoporosis. We compared a combination of sustained-release sodium fluoride, calcium citrate, and cholecalciferol (SR-NaF group) with calcium and cholecalciferol alone (control group). METHODS: Eighty-five ambulatory women aged 65 years or older with 1 or more nontraumatic vertebral compression fractures were enrolled in a 42-month randomized, double-blind, placebo-controlled trial. Primary outcome measures were vertebral fracture rate, bone mass, and safety. RESULTS: The vertebral fracture rate determined by means of computer assistance in the SR-NaF group was significantly lower than that in the control group (relative risk [RR], 0.32; 95 % confidence interval [CI], 0.14-0.73; P = .007). Results of visual adjudicated inspection also confirmed a significant reduction in fracture rate (RR, 0.40; 95 % CI, 0.17-0.95; P = .04). Bone mineral density in L2 through L4 increased significantly from baseline in the SR-NaF group by 5.4 % (95 % CI, 2.7 %-8.2 %; P*lt; .001), and by 3.2 % in the control group (95 % CI, 0.8 %-5.6 %; P = .01). The between-group differences in bone mineral density were not significant. The femoral neck and total hip bone mineral density remained stable in the SR-NaF group and was not significantly different from that of the control group. There were no significant differences in adverse effects between groups. CONCLUSION: The SR-NaF group significantly decreased the risk for vertebral fractures and increased spinal bone mass without reducing bone mass at the femoral neck and total hip.



Osteoporos Int 2003 Jan; 14 (1):2-12

A comprehensive review of treatments for postmenopausal osteoporosis.

Hauselmann HJ, Rizzoli R.

Center for Rheumatology and Bone Diseases, Klinik im Park, Zurich, Switzerland.

The aim of this review is to assess the efficacy of treatments for postmenopausal osteoporosis in women with low bone mass or with an existing vertebral fracture. We searched the literature for studies (randomized, double-masked, placebo-controlled and prospective) that reported on drugs registered in Europe or North America. We included 41 reports on 12 agents. To assess the consistency among the studies for each drug, we plotted the percent change in bone mineral density (BMD) for the control group against the percent change in BMD for the treated group for lumbar spine and femoral neck. We used methods of cluster analysis to determine consistency among the studies. For each agent we summarized the relative risk for vertebral fracture (patients with new fracture) and for hip fractures. The duration of the studies ranged from 1 to 4.3 years. The proportion of patients who discontinued treatment ranged from 4 % to 80 %. Most of the studies reported on change in BMD. Twenty-six studies (10 drugs) provided data on new vertebral fractures and 12 (6 drugs) on hip fractures. Apart from fluoride effects on spine BMD, increases in BMD with bisphosphonates were greater than those seen with the remaining treatments. Generally, for each agent the changes in BMD (relative to placebo) were consistent among the studies. The exceptions were calcitriol and calcitonin for changes in BMD of the spine and of the femoral neck. Alendronate, calcitonin, risedronate and raloxifene caused significant reductions in the risk of vertebral fractures. Alendronate, risedronate or the combination of calcium plus vitamin D had a significant effect on the risk of hip fracture. Most therapies are effective in increasing BMD; some decrease the risk of vertebral fracture. For hip fracture, alendronate and risedronate reduce the risk in women with osteoporosis, and calcium and vitamin D reduce the risk in institutionalized patients.

[pixtovka]

You personally are able to treat fluorides?

[anatoly]

Even in eyes preparations with fluorine did not see.

[The stamp]

THEN let's discuss, in what sense of our conversations from patients - even on an example of the given discussion.

The question of the patient was quite concrete - a menopause, the osteoporosis is diagnosed. A preparation of a choice from group ZGT (the demand of the patient - is maximal *quot; natural *quot;.

The answer of YOUR obedient servant (in full conformity with opinion of a lot of associations on a menopause + daily mine and my colleagues job) - Yes, ZGT - *quot; ??O*quot; the standard.

The same associations demand from us after end of researches WHI to acquaint patients, that, if the indication the only thing - an osteoporosis, that is alternatives (they are listed by YOUR obedient servant).

The calcium and vitamin D are not listed or transferred (it is additions to any of the listed methods of treatment of the OSTEOPOROSIS though have independent value or meaning;importance at osteopenii and at normal MPK as prophylaxis).

Fluorides are not INCLUDED into number of these alternatives - the matter is that preparations are whimsical, OBLIGATORY exception of an osteomalacia (far not always it simply) is required, and, increasing or enlarging MPK, THEY DO NOT REDUCE (randomizirovannye, prospektivnye) risk of fractures.

AS writes L.ROzhinskaja (cyte. On memory - enough profound knowledge of the doctor on a problem of an osteoporosis, and sufficient patience of the patient are required to choose it lechennie).

YOUR obedient servant never appointed or nominated fluorides, though all the others (including raloksifen) used.

T.e, choosing even the Internet - consultations, we should aspire to that our answers sotvestvovali both the international experience, and our experience, and hardly pertinently to advise what you never nobody treated (is what on it the reason).

[VL]

Once again thanks for a science, fluorides as well as the some people dr. Preparations at us a greater or big rarity (probably do not buy or purchase izza absence of demand), therefore and it was not possible them polzovat, on a duty or debt of service meet only onkoindutsirovannymi osteoporosises, therefore even bifosfonaty do not apply the first generation, and the subsequent to generation are accessible only to units, but I trouble, that patients cannot allow themselves of much... Probably, you should not be interested at advised, and that they can allow themselves from treatment, and here far from the center of a civilization at times it is necessary uhishchritsja to pick up any type of therapy adequate to a pocket.

[Valentine]

I am afraid, that I should be interested in all - but mainly that, we treat the person or for it or him we solve its or his material problems.

Give with YOU we shall be defined or determined - we in advance know, that money is not present, therefore we offer what noneffectively or demands supernatural diagnostic opportunities?

Or we suppose an idea, that the person who has left in and-is not present, wishes to receive consultation on a subject - what to do or make in a concrete situation, and that the answer is given, proceeding from an available universal experience. Increased by own activity - in the extremity or end of the-extremities, it is possible in fact to discuss and cheaper klimonorm (instead of to go on a line - that more naturally) and from bisfosfonatov ksidifon costs or stands copecks.