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Re: dual osteo tx From: DJK (djkrell@ix.netcom.com) Mon Oct 14 00:16:15 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Danny Tucker: "MTX therapy - delay to subsequent conception" Previous message: Charlie Chambers: "Re: Short Cervix" In reply to: Charlie Chambers: "Re: dual osteo tx" Charlie. Thanks for the details. The National Osteoporosis Foundation recommends that patients be tested with BMD determinations after 2 years of osteoporosis therapy. The reason is that a percentage of patients will continue to lose BMD in the early phases of treatment, no matter what the therapy. In the MORE trial there were about 12% of patients who were considered non-responders losing 2% of BMD or more. But this concept of response rate is based entirely on BMD change over time and is not correlated to the efficacy of reducing fracture rates. Fracture risk reduction on the other hand has components other than BMD. BMD accounts for no more than 30% of fracture risk reduction. BMD is a good predictor of risk of osteoporosis; however it is not a good efficacy assessment tool in therapy. Your patient who has continued to lose small amounts of BMD may still be experiencing some significant fracture risk reduction due to improvements in bone microarchitecture and positive shifts in Calcium balance. In this case, urinary markers for Calcium excretion might be measured in order to reassure the patient that bone loss is diminishing. Ultimately adding a bisphosphonate to Raloxifene might be a good therapeutic maneuver if urinary Calcium excretion is remaining high or continued loss of BMD occurs after 3 years of therapy. Douglas J. Krell MD Obstetrics and Gynecology -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Charlie Chambers Sent: Saturday, October 12, 2002 2:54 PM To: Multiple recipients of list OB-GYN-L Subject: Re: dual osteo tx Yes. As to more specifics, this patient is 54. She had previously been on HRT till about 2 years ago. Later placed on Evista. DEXA scans about 1 year apart went from -2.4 to -2.9. My suggestion to a colleague is to continue with current therapy. However, the colleague placed the patient on Evista and Fosamax. On Friday, October 11, 2002, at 08:02 PM, Len2976@aol.com wrote: <?fontfamily><?param Arial><?smaller>By dual therapy--do you mean fosimax and evista? L. McCall, CNM<?/smaller><?/fontfamily> **************************************************************************** ** Charlie Chambers -- Hood River, OR USA cchamber@alumni.rice.edu "All good things...come by grace, and grace comes by art, and art does not come easy." Norman Maclean **************************************************************************** *** Next message: Danny Tucker: "MTX therapy - delay to subsequent conception" Previous message: Charlie Chambers: "Re: Short Cervix" In reply to: Charlie Chambers: "Re: dual osteo tx"

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