Friday, October 30, 2009


One of the things I did last year was complete a project on Osteoporosis for a Master of Public Health degree. In the process I learned quite a bit. The statistics are sobering:

1 in 2 women will have a fracture after the age of 50
1 in 4 men will have a fracture after age 50.
Each year there are 300,000 hip fractures and 700,000 spine fractures from osteoporosis.

That's a lot of people! That's a lot of fractures!
It's also a lot of pain and a lot of people ending up in nursing homes from hip fractures.

In any case, you would think that this is a big deal among patients and physicians but it continues to be a very silent epidemic.

For example, most women get a mammogram at least every 2 years (over 65%). Most women never get a bone density scan (DXA scan) more than once (less than 35% get a DXA scan more than once). Yet women are much more likely to get a fracture than breast cancer.

Even after a hip fracture, most patients never get put on calcium and vitamin D (only 35% do) and most patients never even get a prescription for a osteoporosis medication (less than 15%).

About half of people who are prescribed an osteoporosis medication stop in within the year and of the half who continue it, on average they take half their medication.

In other words, the take home message is that Osteoporosis is severely underdetected and undertreated. Probably no more than 5% of people in the United States with osteoporosis are taking their medication regularly to maximally prevent a fracture.

So what can you do?
1. Ask for a DXA scan to be detected
2. Read this website to calculate your own fracture risk.
3. Take calcium and vitamin D every day if you are older than 13.
4. Take a bisphosphonate like Actonel, Fosamax or Reclast.
5. Exercise and don't smoke.

On the 4th point, I actually do not care a whole lot which Bisphosphonate a person takes. People often ask me what medication is better than another and what type of calcium is ideal. I hope I've convinced you that that does not matter. It's better to take anything than nothing. I would take whatever is cheapest myself and what is covered on insurance. And for sure, I would take the generic over the brand because like I said I'm cheap. For those who are forgetful, Reclast which is a once yearly bisphosphonate is wonderful. I'd recommend it.

That's my 2 cents on Osteoporosis!

Wednesday, October 7, 2009

H1N1 and the regular Influenza virus

I've gotten my flu vaccination, have you?

This year is a little confusing because there are two flu vaccines to get. The first one is the regular influenza vaccine that everyone older than 6 months should get yearly. Kids 6 months to 8 years old who are getting their first vaccine need two. The high risk targeted groups for this vaccine are 1. children 6 months to 4 years old
2. children 4-19 with chronic illness
3. all adults older than 50
4. pregnant women
5. nursing home residents
6. adults with chronic illnesses/compromised immune systems
7. adults who are in close contact with kids listed above
8. Health care workers.

The H1N1 vaccine recommendations are different. The CDC lists it in order of importance.
1. Kids 6 months to 24 months
2. Pregnant women
3. People who care for kids birth to 24 months
4. health care workers and emergency personnel
5. Anyone 6 months to 24 years old
6. Anyone 25-64 who are at increased risk for complications due to chronic illness.

The big differences between the two vaccines is that the H1N1 vaccine targets young people, not geriatric patients. If you have grand kids, should you get vaccinated? If you provide a significant amount of child care then yes, you should get both.

How effective are these vaccines? I'm not sure about the H1N1 vaccine, but for the flu virus it depends on the year. Sometimes the vaccine correctly predicts the version of the flu and sometimes it doesn't. Each year anywhere between 25-75% of the population gets the flu of varying severity. The flu vaccine can prevent the flu (when it is effective) about half the time. So you would need to vaccinate anywhere from 4-15 people approximately to prevent 1 case of the flu.

I do wonder if this means yearly vaccines with two flu vaccines. Maybe they can combine it one year. We'll see!