Re: Osteoporosis/Menostar
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Thu Feb 10 19:49:02 2005
Ron:
Impressively thorough. I would refer to an internist/endocrinologist.
Somebody pointed out that this value, while low, could represent an
improvement.
I agree that she MIGHT be an estrogen candidate, with informed consent.
**Is anyone using Menostart, the low dose patch for prevention and
treatment of osteoporosis?** If so, are you using progestin, and, if so,
how?
Garry
At Thu, 10 Feb 2005, ainsron wrote:
>
>Has she been on steroids, or any signs of Cushings Syndrome? You need to
>look for other causes - check serum Calcium to exclude hyperparathyroidism,
>TSH to exclude hyperthyroidism, 25-hydroxyvitamin D to exclude vitamin D
>deficiency and 24 hr urinary calcium to assess malabsorption and renal
>abnormalities. Be sure she is taking 1200-1500 mg Ca and Vit D
>supplementation, 800 IU/d and weight bearing exercise. F/U BMD in 2 years.
>If she is truly taking her Fosamax, she may be a nonresponder, you could
>check a biochemical marker of bone resorption, if it is elevated
>significantly that could prove useful information. There is heterogeneity
>and markers often do not provide a clear-cut answer, but it may give you a
>reason to try another bisphosphonate, i.e. residronate. Teriparatide (human
>recombinant PTH) can be used in women who have failed or are intolerant to
>previous osteoporosis therapy, but it is quite expensive. You could
>consider Evista, clinical trials show decreased incidence of breast CA on
>women on it for 3 years.
>
>Ronald E. Ainsworth
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod
>Darryl G MAJ 48 MDOS/SGOBO
>Sent: Thursday, February 10, 2005 6:35 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Osteoporosis
>
>I haven't seen many postmenopausal women in the last 4 years, so I'm asking
>for some advice.
>
>I have a 58 yo G3P3 with history of breast cancer and endometrial cancer
>that has been taking fosamax 70mg/wk for her 'prevention of osteoporosis.'
>She has had a mastectomy and TVH/BSO in the past.
>
>This was the first I had seen her, so I ordered a bone density scan since
>she hadn't had one in several years. Her T score was -2.6.
>
>Obviously, she is not a candidate for estrogen therapy.
>
>Now that she is clearly osteoporotic, what other options do I have in her
>treatment?
>
>Thanks,
>
>Glen
>
>D. Glen Elrod, Maj USAF, MC
>
>Obstetrician/Gynecologist
>
>Maternal Child Flight
>
>48 MDOS/SGOBO
>
>UNIT 5210 Box 23
>
>APO, AE 09464
>
>DSN (314) 226-8334
>
>Comm 01638-52-8334
>
>Notice of Confidentiality
>Under the Privacy Act of 1974, you must safeguard all information reflected
>on this Email and, if applicable, all attachments. Disclosure of
>information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI
>33-219, and PL 93-579"
>This document may contain information covered under the Privacy Act, 5 USC
>552(a), and/or the Health Insurance Portability and Accountability Act (PL
>104-191) and its various implementing regulations and must be protected in
>accordance with those provisions. Healthcare information is personal and
>sensitive and must be treated accordingly. See
><https://sg.usafe.af.mil/HIPAADisclosure.cfm> for full details.
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
