Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Estrogen hormone therapy after menopause (previously referred to as hormone replacement therapy or HRT) has been shown to prevent bone loss, increase bone density, and prevent bone fractures. It is useful in preventing osteoporosis in postmenopausal women. Estrogen is available orally (Premarin, Estrace, Estratest, and others) or as a skin patch (Estraderm, Vivelle, and others).
Estrogen also is available in combination with progesterone as pills and patches. Progesterone is routinely given along with estrogen to prevent uterine cancer that might result from estrogen use alone. Women who have had a hysterectomy (surgical removal of the uterus) may take estrogen alone since they no longer have a uterus to become cancerous. Nasally delivered estrogen and lower-dose combination pills of estrogen and progesterone are also being studied. However, due to adverse effects of HRT, such as increased risks of heart attack, stroke, blood clots in the veins, and breast cancer; HRT
is no longer recommended for long-term use in the therapy of osteoporosis. Rather, HRT is used short term to relieve menopausal hot flashes.
Every woman needs to have an individualized discussion regarding HRT with her
doctor because each woman will place different weight on the risks and benefits
of the treatment.
Medications that prevent bone loss and breakdown
Currently, the most effective medications for osteoporosis that are approved by the FDA are antiresorptive agents, which decrease the removal of calcium from bones. The bone is a living dynamic structure; it is constantly being built and removed (resorbed). This process is an essential part of maintaining the normal calcium level in the blood and serves to repair tiny cracks in the bones that occur with normal daily activity and to remodel bone based on the physical stresses placed on the bone. Osteoporosis results when the rate of bone resorption exceeds the rate of bone rebuilding. Antiresorptive medications inhibit removal of bone (resorption), thus tipping the balance in favor of bone rebuilding and increasing bone density. HRT is one example of an antiresorptive agent. Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia).
Bisphosphates
Bisphosphonates decrease the risk of hip fracture, wrist fracture, and spine fracture in people with osteoporosis. Alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronate (Reclast) are bisphosphonates.
To reduce side effects and to enhance absorption of the medicine, all bisphosphonates taken by mouth (orally) should be taken in the morning, on an empty stomach,
30 minutes before breakfast, and with at least 8 ounces (240 ml) of water (not juice). This improves the absorption of the biphosphonate. Taking the pill sitting or standing (as well as drinking adequate amounts of liquids) minimizes the chances of the pill being lodged in the esophagus, where it can cause ulceration and scarring. Patients should also remain upright for at least 30 minutes after taking the pill to avoid reflux of the pill into the esophagus. Newer intravenous bisphosphonates, such as ibandronate (Boniva) and zoledronate (Reclast), bypass the potential esophagus and stomach problems.
Food, calcium, iron supplements, vitamins with minerals, or antacids containing calcium, magnesium,
or aluminum can reduce the absorption of oral bisphosphonates, thereby resulting in
loss of effectiveness. Therefore, oral bisphosphonates should be taken with plain
water only in the morning before breakfast. Also, no food or drink should be
taken for at least 30 minutes afterward.
Alendronate (Fosamax)
Alendronate (Fosamax) is a biphosphonate
antiresorptive medication. Alendronate is approved for the prevention and
treatment of postmenopausal osteoporosis as well as for osteoporosis that is
caused by cortisone-related medications (glucocorticoid-induced osteoporosis).
Alendronate has been shown to increase bone density and reduce fractures in
the spine, hips, and arms. Fosamax is taken by mouth once a week to
prevent and treat postmenopausal osteoporosis. Alendronate is the first
osteoporosis medication also approved for increasing bone density in men with
osteoporosis, either in a daily or a weekly dosing schedule.
Fosamax generally is well tolerated with few side
effects. One side effect of alendronate is irritation of the esophagus (the
food pipe connecting the mouth to the
stomach). Inflammation of the esophagus (esophagitis)
and ulcers of the esophagus have been reported infrequently with alendronate
use.
Risedronate (Actonel)
Risedronate
(Actonel) is another bisphosphonate
antiresorptive medication. Like alendronate, this drug is approved for the
prevention and treatment of postmenopausal osteoporosis as well as for
osteoporosis that is caused by cortisone-related medications
(glucocorticoid-induced osteoporosis). Risedronate is chemically different
from alendronate and has less likelihood of causing esophageal irritation.
Risedronate also is more potent in preventing the resorption of bone
than alendronate.
Ibandronate (Boniva)
Ibandronate (Boniva) is a bisphosphonate for prevention and treatment
of postmenopausal osteoporosis. It is available in formulations for both
daily and monthly oral use as well as for intravenous use every three
months.
Zoledronate (Reclast)
Zoledronate (Reclast) is a unique intravenous bisphosphonate antiresorptive medication that is given once every year. This formulation seems to have very good ability to strengthen bones and prevent fractures of both spinal and
non-spinal bones. The convenience of once-a-year dosing is obvious. As with all bisphosphonates, patients taking Reclast must be taking adequate calcium and vitamin D prior to and after infusion of the medication for optimal results. Generally, patients are given acetaminophen (Tylenol) the day of the infusion and for several days afterward to prevent occasional minor muscle and joint aches. The infusion lasts approximately 20-30 minutes. Reclast is used to treat and prevent osteoporosis in postmenopausal women and increases bone mass in men with osteoporosis. Reclast is also used to treat and prevent steroid-induced osteoporosis (glucocorticoid-induced osteoporosis). Reclast reduces risk of fractures after a low-trauma hip fracture. Reclast should not be used during or prior to pregnancy.
Selective estrogen receptor modulators (SERMs)
Raloxifene (Evista)
Raloxifene (Evista) belongs to a class of drugs called selective
estrogen receptor modulators (SERMs). SERMs work like estrogen in some tissues
but as an antiestrogen in other tissues. The SERMs were developed to reap the
benefits of estrogen while avoiding the potential side effects of estrogen.
Thus, raloxifene can act like estrogen on bone but as an antiestrogen on the
lining of the uterus where the effects of estrogen can promote cancer.
The first SERM to reach the market was tamoxifen (Nolvadex), which
blocks the stimulative effect of estrogen on breast tissue. Tamoxifen has
proven valuable in women who have had
cancer in one breast for preventing
cancer in the second breast. Raloxifene is the second SERM to be approved by
the FDA. Evista has been approved for the prevention and treatment of
osteoporosis in postmenopausal women. In a three-year study involving some 600
postmenopausal women, raloxifene was found to increase bone density (and lower
LDL cholesterol)
while having no detrimental effect on the uterine lining (which means that it is
unlikely to cause uterine cancer).
Because of its antiestrogen effects, the most common side effects with Evista are hot flashes Conversely, because of its estrogenic effects,
Evista increases the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (blood clots in the lung). The greatest increase in risk occurs during the first
four months of use. Patients taking raloxifene should avoid prolonged periods of immobility during travel, when blood clots are more prone to occur. The risk of deep vein thrombosis with raloxifene is probably comparable to that of estrogen, about
two to three times higher than the usual low rate of occurrence. Evista
decreases the risk of spinal fractures in postmenopausal women with
osteoporosis, but it is not known if there is a similar benefit in decreasing
the risk of hip fracture. (The only agents that are definitely proven to
decrease the risk of hip fracture are bisphosphonates and denosumab.)
Calcitonin (Calcimar, Miacalcin)
Calcitonin (Calcimar,
Miacalcin) is a hormone that has been approved by the FDA in the U.S.
for treating osteoporosis. Calcitonins come from several animal species, but
salmon calcitonin is the one most widely used. Calcitonin can be administered as
a shot under the skin (subcutaneously), into the muscle (intramuscularly), or
inhaled nasally (intranasally). Intranasal calcitonin is the most convenient of
the three methods of administration.
Calcitonin has been shown to prevent bone loss in
postmenopausal women. In women with established osteoporosis, calcitonin has
been shown to increase bone density and strength in the spine only.
Calcitonin is a weaker antiresorptive medication than bisphosphonates. Calcitonin is not as effective in increasing bone density and strengthening bone as estrogen and the other antiresorptive agents, particularly bisphosphonates. In addition, it is not as effective as bisphosphonates in reducing the risk of spinal fractures and has not been proven effective in reducing hip fracture risk. Therefore, calcitonin is not the first choice of treatment in women with established osteoporosis. Nevertheless, calcitonin is a helpful alternative treatment for patients who cannot tolerate other medications.
Common side effects of either injected or nasal spray
calcitonin are nausea and flushing. Patients using Miacalcin Nasal Spray can
develop nasal irritation, a runny nose, or nosebleeds. Injectable calcitonin
can cause local skin redness at the site of injection, skin rash,
and flushing.
Teriparatide (Forteo)
Teriparatide (Forteo) is a synthetic version of the human hormone, parathyroid hormone, which helps to regulate calcium metabolism. Unlike other medications for osteoporosis which reduce the resorption of bone, teriparatide promotes the growth of new bone.
Forteo is self-injected into the skin. Because long-term safety
is not yet established, it is only FDA-approved for 24 months of use. It reduces
spinal fractures in women with known osteoporosis, but it is not known if there
is a similar reduction in the risk for hip fracture.
Denosumab (Prolia)
The latest treatment approved for osteoporosis is denosumab (Prolia), an intravenous, infusible antibody that blocks a chemical messenger that plays a role in promoting bone thinning by the bone cells that are responsible for bone resorption. Prolia strengthens bone by increasing its density and reduces fractures. Prolia is administered by twice yearly injections under the skin. Denosumab
is used for the treatment of postmenopausal women with osteoporosis at high risk
for fracture, defined as a history of osteoporotic fracture, or multiple risk
factors for fracture; or patients who have failed or are intolerant to other
available osteoporosis therapy. Denosumab can cause increased risk of infections
and low blood calcium levels (hypocalcemia).
Osteoporosis - Symptoms at Onset of DiseaseQuestion: The symptoms of osteoporosis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
There are several bones in the foot, and these bones can be broken (fractured) in a variety of ways. Falling from heights, dropping heavy objects on the foot, or stress fractures from running or walking. Treatment of a broken foot depends on what bone in the foot is broken.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Hyperparathyroidism is a disorder of the parathyroid glands. There are two types of hyperparathyroidism, primary and secondary. When the parathyroid glands produce too much hormone, hyperparathyroidism is the resulting condition. Most cases of hyperparathyroidism have no evident cause. Symptoms include fatigue, weakness, depression, loss of appetite, nausea, vomiting, constipation, or confusion. Increased calcium and phosphorous excretion may cause kidney stones. The main treatment of hyperparathyroidism is parathyroidectomy.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Kyphosis is outward curvature of the thoracic spine (upper back). Abnormal kyphosis results in the appearance of a hunchback, which is accompanied by back pain, stiffness, and muscle fatigue in the back. There are three types of abnormal kyphosis: postural, Scheuermann's, and congenital kyphosis. Postural kyphosis is caused by poor posture and a weakening of the back's muscles and ligaments. Scheuermann's kyphosis is caused by a structural deformity of the vertebrae. Congenital kyphosis is caused by an abnormal development of the vertebrae prior to birth. Treatment of kyphosis depends upon the type of kyphosis the patient has.
Premature ovarian failure (POS) is the cessation of normal functioning of the ovaries in women under the age of 40. Premature ovarian failure may be caused by follicle depletion or dysfunction. The most common symptom of premature ovarian failure are irregular periods. There is no "treatment" that will restore the ovarian function, but there are treatments that my relieve symptoms.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Loeys-Dietz syndrome is a syndrome is an inherited genetic syndrome characterized by aortic aneurysms in children. Children with Loeys-Dietz syndrome are at a greater risk of dying from the aortic aneurysms, because the aneurysms are prone to rupture at a smaller size than other aneurysms. Physical characteristics of the syndrome include early fusion of the skull bones, widely spaced eyes, and split uvula or cleft palate. Treatment includes surgical repair fo the aneurysms.
Enjoying a healthy diet helps to prevent diseases. A good diet also helps to control celiac disease, diabetes, and high blood pressure and maintain health by preventing loss of bone mass, muscle strength, and vitamin deficiencies.
Severe acute respiratory syndrome (SARS) is a respiratory disease caused by the coronavirus SARS-CoV. Symptoms include fever and shortness of breath. Patients with SARS often require oxygen and severe cases require mechanical ventilation.
Osteoporosis may be linked to bone loss in the jaw, which in turn, leads to tooth loss. Low bone density may result in ill-fitting dentures, tooth loss, and gum disease. Dental X-rays may be able to distinguish people with osteoporosis from those with normal bone density.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Setting a good example for your children when it comes to diet and exercise will help them to make healthy decisions about nutrition and fitness. Eating calcium-rich foods and performing weight-bearing exercise will help your children prevent osteoporosis and fractures later in life.
Womens Health RSS
Healthy Living Tips
This site complies with the