New Rules on Bone Testing

Don't miss any of HealthyWoman from Bottom Line. Add our address, HealthyWomanfromBottomLine@news.bottomlinepublishing.com, to your Address Book or Safe List. Learn how here. July 21, 2011  New Rules on Bone Testing Tumors Dried Up and Gone in 2 Months Better Birth Control for Bigger Women Secret to Reversing Arthritis Pain Drink Tea to Guard Against Stroke   New Rules on Bone Testing "I would practically need a PhD to understand those new rules on osteoporosis screening," my 58-year-old friend grumbled. She was referring to the revised guidelines from the US Preventive Services Task Force (USPSTF), recommending bone density testing for women age 65 and older as well as for "younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors." Confusing? Let me explain... Women are at significantly higher risk than men for osteoporosis, the disease that weakens bones and leads to fractures. Risk increases with age. The old USPSTF guidelines, set in 2002, recommended bone density testing to screen all women age 65 and older (that part has not changed), plus women ages 60 to 64 who were at increased risk for osteoporotic fractures. Those guidelines were recently revised to more specifically define the level of risk that merits bone density testing for the 60-to-64 age group and to address the needs of younger women by utilizing a new online fracture risk assessment tool called FRAX. I spoke with Bruce Ettinger, MD, an emeritus clinical professor of medicine at the University of California Medical Center, San Francisco, and osteoporosis expert whose input helped set the new guidelines. He explained that FRAX prompts you to input your status with regard to various risk factors. These include age... height and weight... ethnicity (since genetic influences put Caucasians at higher risk than Asians, Blacks or Hispanics)... alcohol and tobacco use... diseases or drugs that can affect bones... and personal and family history of fractures. Then the Web-based program instantly calculates your 10-year probability of experiencing a fracture due to osteoporosis. To use FRAX: Visit www.shef.ac.uk/FRAX/index.jsp, enter the pertinent information and answer simple yes/no questions. The FRAX calculator gives you two percentages. The main number to consider is your risk of having a fracture at any of the four major osteoporotic fracture sites—hip, spine, wrist or upper arm/shoulder—within the next 10 years. Once this risk reaches 9.3%, which is the risk level of a healthy 65-year-old white woman, bone density screening is recommended. (The other percentage given is your 10-year risk of fracturing a hip specifically. Hip fractures are singled out because they are the most serious of the osteoporotic fractures—but since these are rare before age 70 to 75, for younger women it is more useful to consider the combined risk at all four major sites.) A fair number of women in their 50s do have a FRAX score higher than that of the hypothetical 65-year-old. Dr. Ettinger explained, "If you are 55 and you smoke, are thin and have a parent who had a hip fracture, then you’re more like a typical 65-year-old in terms of osteoporosis risk." Bottom line: If your major fracture site FRAX score is... Below 9.3%—continue to follow your doctor’s recommendations on diet, exercise and lifestyle habits that protect bones... and complete the FRAX questionnaire again in three to five years. Fracture risk typically doubles every seven to eight years, Dr. Ettinger said, so you can estimate when in the future your score might cross the threshold for bone density testing. 9.3% or higher—the recommendation is for your doctor to order a dual-energy X-ray absorptiometry (DEXA) test to measure your bone density. Those results can be entered into the FRAX calculator to further refine your risk level. If your bone density is right at the expected level for your age, your FRAX score won’t change much. But if your bone density is much lower than expected, this new factor could easily double your risk, Dr. Ettinger said. Your doctor will take this into account in determining the next appropriate step in your care. Source: Bruce Ettinger, MD, is an emeritus clinical professor of medicine at the University of California Medical Center, San Francisco, and an adjunct investigator in the Division of Research at Kaiser Permanente Medical Care Program for Northern California. Dr. Ettinger practiced endocrinology and internal medicine for 33 years and has authored or coauthored more than 200 journal articles, primarily on osteoporosis. Tumors Dried Up and Gone in 2 Months "Within two months, every tumor had shrunk, dried up and fallen off," said Tom to Dr. Gary Null about the miraculous disappearance of his rapidly spreading cancer. Tom had already gone through surgery once for skin cancer on his forehead. Unfortunately, his skin cancer was melanoma. Just 10 days after the operation, the cancer was back with a vengeance. It reappeared on his forehead, and quickly spread to his arm, upper body and chest. Four doctors all agreed: There was nothing they could do to cure this cancer. They all still wanted to operate. But Tom wanted to live—not just get sliced up. Read on... Better Birth Control for Bigger Women In May, after I reported that birth control pills are less effective for overweight women, a reader e-mailed me, basically saying, "OK, I’m obese. But do I really have to switch from the pill to something else? If so, what would work better?" I called ob/gyn Julie Laifer, MD, an attending physician at Bridgeport Hospital–Yale New Haven Health and a member of the HealthyWoman from Bottom Line advisory board, to discuss the matter. Dr. Laifer told me that this reader and other women in the same situation should indeed consider another form of birth control, given that about 2% to 4% of obese women on the pill end up pregnant in a year’s time, compared with just 1% of normal-weight women. Why the discrepancy? The pill contains hormones that halt ovulation—but extra fat tissue causes these hormones to be metabolized faster, so they don’t stay in a heavy woman’s system as long as they should... and heavier women have more blood volume, so the hormones get diluted slightly. The same problems with efficacy apply to the contraceptive skin patch, another type of hormonal birth control. An added concern is that both the pill and patch may cause weight gain—an undesirable side effect for most women, of course, but particularly for those who are already overweight. Plus, obesity increases the risk for blood clots—and the estrogen in the pill further augments this risk. Why not boost the effectiveness of hormonal contraceptives by giving heavy women a larger dose? Because as dosage rises, so do the risks. Better bets for obese women who want temporary birth control... Consider the ParaGard brand of intrauterine device (IUD), which contains no hormones (the other brand available in the US, Mirena, does contain hormones). ParaGard is a small, T-shaped device made of copper and plastic that a doctor inserts into the uterus via the vagina. It prevents pregnancy by interfering with sperm movement, and its success rate of 99.4% is not compromised by body weight. Downsides: An IUD can cause heavier, longer periods... and carries a small risk for uterine perforation. (While diaphragms, spermicidal jellies and condoms also are unaffected by weight and have minimal risks, Dr. Laifer cautioned that they are far less effective at preventing pregnancy.) Permanent contraception options... Tubal ligation, in which the Fallopian tubes are surgically cut or blocked, is very effective. However, it is not perfect—it has a failure rate of 0.5% during the first year and 1.5% to 2% after 10 years because occasionally the area heals improperly or other problems develop that impair effectiveness. Tubal ligation carries the same risks as any major surgery, and the procedure is more difficult and takes longer in obese patients. Less invasive are two new options, the products Essure and Adiana, which require no incisions and can be done in a doctor’s office using local anesthesia. The gynecologist inserts a scope through the vagina and into the uterus. Then a small device—a metal spring about an inch long for Essure, or a soft piece of silicone the size of a grain of rice for Adiana—is placed into each Fallopian tube. Over the next three months, scar tissue forms and permanently blocks the tubes so sperm and eggs cannot get through. These methods have a failure rate of 0.3% to 1.6%, which is better than the failure rate of the pill for obese women. Because these procedures are relatively new, there is limited data on their long-term effects—so be sure to discuss their benefits and risks with your doctor. Source: Julie Laifer, MD, is an attending physician in the department of obstetrics/gynecology at Bridgeport Hospital–Yale New Haven Health in Bridgeport, Connecticut, a private practitioner in Trumbull, Connecticut, and a member of the HealthyWoman from Bottom Line advisory board. Secret to Reversing Arthritis Pain Joseph couldn’t walk a step without limping when Mark Stengler, NMD, first saw him. For years, his osteoarthritis had been steadily getting worse. Now his painkillers were giving him ulcers, the agony was unbearable, and he envisioned a knee replacement in the near future. But Dr. Stengler did not give him steroids or even an aspirin tablet! Instead, he told Joe about a natural compound so harmless, even pregnant women can take it safely. Just two days later, his pain had already faded dramatically... Read on... Drink Tea to Guard Against Stroke Do you love a cozy cup of tea? If not, there is a good reason to develop a taste for it. Researchers from the University of California, Los Angeles, analyzed data from nine studies involving a total of nearly 195,000 people. Findings: Compared with people who drank less than one cup of tea daily, those who drank at least three cups daily of green or black tea (both of which come from the Camillia sinensis plant) had a 21% lower risk for stroke... risk dropped 42% for those who drank six or more cups of green or black tea daily. It is the flavonoid epigallocatechin gallate and the amino acid theanine, both of which are found in green and black teas, that might reduce stroke risk, researchers say. Note: Though not included in the study, oolong tea and white tea (but not herbal teas) also come from the Camillia sinensis plant and therefore may have similar stroke-preventing benefits. There was not enough data on decaffeinated tea to include it in the study. Source: Lenore Arab, PhD, is a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and lead author of a review of studies published in Stroke.    Tamara Eberlein, the editor of HealthyWoman from Bottom Line, has been a health journalist for nearly three decades. An award-winning author or coauthor of four books, she is committed to helping other women in midlife and beyond live healthy, fulfilling lives. Her latest book is the updated, third edition of When You’re Expecting Twins, Triplets, or Quads (HarperCollins). She is also the "chief health adviser" to her husband of 26 years and three college-age children.    BOTTOMLINESECRETS.COM Terms & Conditions Privacy Policy About Us Contact US Bottom Line Publications | 281 Tresser Boulevard, 8th Floor | Stamford, CT 06901 You received this free E-letter because you have requested it. You are on the mailing list as healthwellness82@gmail.com. Or... a friend forwarded it to you. 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