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PREVENTION OF OSTEOPOROSIS

The current epidemic of osteoporosis in women aged 60 and above reflects the fact those ten years ago; there wasn't an accurate test to discover the very early stages of this disease. These women came to medical attention only when they had developed humping of the spine or bone fractures and, unfortunately, at this advanced stage, it is difficult to put back the calcium that has been leached out. The good news is that we can prevent calcium from being lost from the bones if treatment is begun in the early stages, at the time of the menopause — and not ten years later.

WHAT IS THE NORMAL SIZE FOR A PENIS?

How severe is the condition

Finding the cause

METHODS OF PREVENTION

1. Hormone Replacement Therapy
HRT is the most effective method of prevention, ideally beginning when deficiency of the female hormones first becomes apparent usually at the time of the menopause and in some women in the pre-menopausal years. Many studies have shown HRT to be the most effective treatment for the maintenance of bone size and strength and the prevention of bone fractures and HRT is far better than any other therapy available for preventing osteoporosis.
Women who have oestrogen therapy have about 10% more bone after three years' treatment than those not on HRT. Diagram 6 shows the effect of oestrogen therapy in slowing down the rate of bone loss.
One in three women can be classified as fast bone losers. In such cases, oestrogen replacement is able to slow the rate of bone loss so that the fracture threshold is never crossed.
HRT is the greatest insurance policy a woman has against osteoporosis because it not only reduces the loss of minerals from the bone but slows down loss of collagen from the skeleton as well. It also slows down the loss of collagen from the deeper layers of the skin and it is thought that this effect slows the rate of ageing of the skin. It seems that HRT is not only good for your inner layer but also for your outer layer! HRT and Fractures
The bony vertebrae of the spine may become weak and spongy and their once rectangular solid forms are crushed into triangular wedges. These are called compression fractures. This causes a loss of height, protruding abdomen, curved posture, with compression of the spinal nerves causing sharp shooting pains in the spine and limbs. Currently in Australia, one in four women over the age of 65 years have one or more such spinal compression fractures.
Loss of bone mass also commonly occurs in the hips and there are over 14,000 hip fractures in Australia every year. Without HRT, 50% of postmenopausal women will be at risk of an eventual fracture by the age of 75 years. Replacement with oestrogen for fifteen years after the menopause extends the age of fracture to 90 years. Currently, the average life span for Australian women is 80 to 85 years and so HRT enables the majority of women to escape fractures. As women continue to live longer, we will need to give HRT for longer periods; the ideal solution would be to reprogram the ovaries to pump out oestrogen indefinitely.
Some progestogens have worthwhile ability in reducing bone loss and this provides another reason for combining oestrogens and progestogens in HRT prescriptions.

2.         Calcium Supplementation
Calcium plays a role in building up your peak bone mass and reducing bone loss associated with age and menopause. Fracture rates in the elderly are reduced if adequate calcium intake is maintained. Professor Chris Nor-din from Adelaide University is a brilliant authority on calcium metabolism and recommends 500mg of calcium daily if you use dairy products regularly, and l, 000mg daily if you do not. Don't forget to use the calcium content of foods in Appendix 1 to make sure that your diet and calcium supplements provide you with at least l, 00mg of calcium daily.
Your calcium supplement is best taken last thing at night on retiring as it is during sleep and when your stomach is empty that blood calcium levels fall causing parathyroid hormone to dissolve precious calcium from your bones.
I recommend a book called Allan Borushek's "Pocket Calorie (Jounter," for those women wanting a useful and excellent guide on cholesterol, calorie and calcium values of foods.
3,         Male Hormones (anabolic steroids)
These are well known for their infamous role in competitive sports, yet few know that they are often used to help women with established osteoporosis. The rationale for their use is that menopausal women with high blood levels of testosterone have a slower loss of bone. The role that male hormones play is not clear, but they have been shown to help prevent bone loss and possibly produce some degree of bone gain in established osteoporosis. These injections may be extremely useful for women who are unable to take oestrogen.
Be aware that they may induce an increase in facial hair, greasy skin, piples, voice deepening and increasing libido so that some women refuse to continue with them. On the other hand, some women find that they reduce musculoskeletal pains, improve skin texture and greatly increase vitality and choose to continue with them.

 

EXCITING NEW TREATMENTS

1.         Etidronate
This drug is most useful for women with severe osteoporosis or those unable to take oestrogen. It can increase the strength of dematerialized bone and reduces the frequency of spinal fractures2. Currently, Etidronate is not generally available, but, if you want to know if it can help you, ask your local doctor for a referral to a bone physician or a hospital clinic for bone diseases.

2.         Calcitonin
Another natural hormone that may be used more generally in the future is Calcitonin which is extracted from salmon or eels. Calcitonin, used as a nasal spray, delays bone loss both during the menopause and in older women with established osteoporosis. At present, Calcitonin is expensive and needs to be given by daily injection making it unavailable for general use. Hopefully, it will soon be available in the form of a nasal spray and it could become a very useful alternative for the prevention and treatment of osteoporosis, especially for many women unable to take oestrogen replacement therapy.
All these developments are encouraging but the fact is that modern medicine still does not have the ability to reverse severe established osteoporosis. What doctors can do extremely well is to prevent osteoporosis by the use of treatment in pre-menopausal, menopausal and post-menopausal years. Do not be lulled into a false sense of security; start taking precautions in your pre-menopausal years and you won't be robbed by the silent thief.

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News

EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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