Osteoporosis
Osteoporosis is a skeletal disorder that is characterized by compromised bone strength predisposing a person to increased risk of fracture. Women naturally begin to lose bone beginning at about age 25. And after the age of 50, about 50% of women will experience a fracture. After a hip fracture, half of women will not regain independence and 20% will die within the year.

Contributing factors to osteoporosis include family history, smoking, low body weight (under 125 lb), steroid use, thyroid disorders, alcoholism, excessive soft drink intake, history of eating disorders and lack of exercise. Women who never reach their peak bone density in their 20's are also at risk, since any bone loss for them can leave them with devastating results.

Assessing for osteoporosis is most frequently done by bone densitometry. Fracture risk, and comparison to other women the same age, is given by this painless x-ray test that can easily be scheduled in our office. Depending upon the results of such a test, non-pharmacologic or pharmacologic approaches may be recommended.

Careful review of calcium and vitamin D intake is most important. Without calcium, bone cannot be manufactured by the body. There are multiple effective forms of calcium supplementation available. Finding a method that works for each individual is not difficult and 1200 mg a day is recommended. Vitamin D is necessary for the intestinal absorption of calcium and somewhere between 400-800 IU a day is recommended. Vitamin D supplements are available if the diet is not providing a sufficient amount. Vitamin D is also well provided by direct sunlight. The amount of sun exposure is difficult to determine however, and it must be off-set by the increasing the risk of skin cancer from the sun. A light-colored skin person in the summer, gets a sufficient amount of sunlight from being in the sun for about 5 minutes.

Exercise is also crucial for the protection of bones. Weight-bearing exercise puts stress on the bones that causes them to strengthen. Even exercise that is not directly weight-bearing will improve muscle strength and coordination to the point that fracture will be less likely if a fall were to occur.

Medical management of osteoporosis falls into several categories. The most frequently used ones are the biphosphonates (brand names-Fosamax. Actonel, Boniva) and the multiple varieties of hormone replacement therapy. The pros and cons of any of these treatments should be considered prior to instituting them.

"Natural methods, " that is diet, supplements and exercise should be optimized before medications, with their known side-effects, are implemented.

Bone density should be followed at least every two years in women at risk.

Suggested reading:
www.FORE.org
Foundation for Osteoporosis Research and Education
www.womenshealth.org
www.nlm.nim.gov/medlineplus/osteoporosis
www.rheumatology.org

Human Papilloma Virus and the Vaccine
In June 2006, the FDA approved the first human vaccine to prevent cancer. It is the Human Papilloma Virus (HPV) vaccine. HPV causes 99.7% of cervical cancers and cervical cancer is the second leading cause of women's cancer death worldwide. With the advent of the Pap smear however, cervical cancer deaths have decreased remarkably in the United States.

50%- 75% of people who have had sex will have HPV at some point in their lives. Currently the vaccine, called Gardasil, is being recommended to girls between the ages of 9 and 26. The hope is to vaccinate girls before there is a chance that they are sexually active. The vaccine cannot treat HPV or cancer once viral exposure has occurred.

Gardasil is almost 100% effective against HPV types 6,11,16 and 18. These strains of HPV cause 70% of all cervical cancer cases. The also cause about 90% of genital warts. It is not possible to "catch" HPV from the vaccine, it does not contain live or dead HPV virus.

Gardasil is given in a series of 3 injections. Side effects include pain (84%), redness (25%), swelling (25%), and itching (3%). The first injection is given at any time. The second injection is given at least two months after the first, and the third injection is given at least 6 months after the first. In our office you will be asked to pay each injection as you receive it (although you may pay for the series all at once, some may want the flexibility of receiving subsequent injections at a college campus health center). Most health insurance plans are at least reimbursing for a portion, if not all, of the series.

The following links have further information regarding HPV, the vaccine, and pap
smear screening:
www.acog.org
www.fda.gov/womens/getthefacts
www.youngwomenshealth.org
www.cervicalcancercampaign.org
www.gardasil.com