Thought Leaders Rank Existing and New Drugs for Rheumatology and Multiple Sclerosis in two New Reports from MedPredict
(PRWEB) October 18, 2011
MedPredict Market Research, a global provider of pharmaceutical competitive intelligence and market research, has published two new “Thought Leader Insight & Analysis” reports on Rheumatology and Multiple Sclerosis. Rheumatology Report Highlights:
The MedPredict Rheumatology report summarizes a thought exercise conducted with eight North American (n=5) and European (n=3) rheumatologists in September 2011. “We cover a broad range of rheumatologic conditions,” said report author Jeff Berk, “with each panelist having specific areas of specialization: rheumatoid arthritis, psoriatic arthritis, lupus, osteoporosis, gout, osteoarthritis. In this report we share each panelist’s “Fantasy Formulary”, and the strengths, weaknesses and product news for each pharmacotherapy that is mentioned.” The result of this exercise: panelists identify their “must have” branded and generic drugs for their real-world practice in the year 2016.
The MedPredict Multiple Sclerosis report highlights a series of interviews (n=7) conducted with our neurology experts in September, 2011. “Again, for this report we asked panelists to compile their ‘Fantasy Formulary’ in MS,” according to Berk. “This comprises the top seven therapeutics in the development pipeline they want to see available for use in the prevention/treatment of multiple sclerosis. We allowed Panelists to choose the class of drug, a specific drug (if they had a preference), the unmet needs to be addressed and the benefits that they expected their choices to deliver. The panel’s responses are just as enlightening regarding what they would NOT put on their fantasy formularies.”
The reports may be purchased by contacting MedPredict.
About MedPredict
MedPredict (http://www.medpredict.com) maintains a proprietary database of over 1,000 global physician thought leaders. MedPredict publishes periodic therapeutic area reports to keep clients up-to-date on emerging trends and competitive activity. The reports include thought leader reactions to recent publications and presentations, as well as clinical, regulatory and marketing activity.
Nutri-Med Logic Responds to the International Journal of Rheumatic Disease (8-11) and States: Supplementation of Nutrients, Such as Omega-3, is as Important, if Not More
Miami, FL (PRWEB) August 08, 2011
Nutri-Med Logic Corp.: Calcium or Omega-3? Is one more important than the other for Osteoporosis?
The August issue of International Journal of Rheumatic Disease only emphasizes on the need for supplementation of Calcium in Osteoporosis (doi: 10.1111/j.1756-185X.2011.01628.x. Epub 2011 Jul 8). Nutri-Med Logic believes that knowledge of anti-inflammatory foods, such as, Omega-3 would take precedent, at least in the case of menopause Osteoporosis.
Having the same general diet before, during or right after menopause, the reason that some or most women fall victims to Osteoporosis has less to do with lack of calcium in their diet, rather the lack of anti-inflammatory foods.
Women enjoy a natural anti-inflammatory hormone (estrogen), which its levels begin to fall right before menopause.
Hormone replacement therapy or Osteoporosis medication attempt to introduce anti-inflammatory to moderate chronic inflammation / lower the activity of the cells that remove old tissues from the bone.
The bone removing cells (Osteoclasts) go to work via inflammatory signals, an immune mechanism and a normal biological process. However, when the body loses its homeostasis, or in another word the inflammation becomes dysregulated, then things go out of control.
In bone remodeling (removing and making new bone tissues) the bone removing cells (Osteoclasts) can only work if they are given the signal (inflammatory signals). Before menopause, estrogen, an anti-inflammatory hormone keeps Osteoclasts in-check.
However, right before menopause, the levels of estrogen (the anti-inflammatory) begin to fall and thus the body’s homeostasis changes in favor of inflammation (inflammatory signals), increasing the activities of the Osteoclasts. If the activities of Osteoclasts is not moderated (what estrogen does) more tissue is removed, than normal, bones lose their density and if that continue, then, bones will ultimately fracture easily.
Be it hormone replacement therapy (estrogen) or any and all of the Osteoporosis medications, the target is to moderate the activity of Osteoclasts, which can only work through inflammatory signals.
If the activities of Osteoclasts is more than normal, then it would not make any difference how much of calcium is supplemented, the bones will continue losing their density.
At least in the case of menopause Osteoporosis, anti-inflammatory diet takes precedent to calcium diet. Both are important but, in our opinion, anti-inflammatory is more important.
Osteoclasts (Bone removing cells) function with inflammation and the key and principal reason for their over-activity , at least in the case of menopause Osteoporosis, is the lack of the anti-inflammatory estrogen.
Omega-3 is a potent anti-inflammatory food. A good portion of the cellular membrane (what surround the cells) must be Omega-3, this is by design.
Our body was designed to have Omega-3 in every cellular membrane. However, the body cannot produce it due to lack of enzymes (ability). Omega-3 must be obtained from diet. Anti-inflammatory foods, like Omega-3, help in moderating inflammation, as does the estrogen, but ,obviously, estrogen has much more strength.
Without a doubt, a diet rich in Omega-3 is most beneficial in the cases of Osteoporosis. However, nutrients cannot and should not be a substitute for medications. At the same time, it is not a secret that proper nutrients improve the overall health and thus confer valuable benefits.
It is also very important to note that one should not relate the cause of Osteoporosis to lack of anti-inflammatory diet.
Lack of anti-inflammatory diet contributes to a disease state such as Osteoporosis but it cannot and should not be made as mean to diagnose. Additionally, taking anti-inflammatory food, such as Omega-3 cannot be considered as a prevention or a cure.
But, anew, and without a doubt, a diet rich in Omega-3 is very beneficial for Osteoporosis, be it menopausal or otherwise.
In conclusion, Nutri-Med Logic Corp.,is not being contrary to the Publication of International Journal of Rheumatic Disease, but believes that education for anti-inflammatory diet would have to take precedent or have equal importance to Calcium supplementation, at least in the cases of menopause Osteoporosis.
The most desirable Omega-3 would be a concentrated Omega-3 and a molecularly distilled Omega-3.
Nutri-Med Logic Corp is a producer of dietary supplements that would be Essential in countering stress, inflammation, redox imbalance and hypomethylation “The Four Factors”; all of which affect the homeostasis of the body.
Nutri-Med Logic’s products are Formulated Based on Nutritional Logic, made from the highest quality raw materials that are manufactured in pharmaceutical facilities, encapsulated in pharmaceutical facilities and, also, packaged in pharmaceutical facilities.
Osteoporosis and interventions for vertebral fracture
World osteoporosis month Osteoporosis: Interventions to manage vertebral fractures
Dr (Maj) Pankaj N Surange MBBS, MD, FIP Interventional pain and spine specialist Some important facts about osteoporosis • Osteoporosis is a systemic skeletal disorder characterized by low bone mass, disruption of the microarchitecture of bone tissue, and compromised bone strength which leads to an increased risk for fracture. • Bone strength is a product of both bone density and bone quality. Bone density is expressed as grams of mineral per area or volume; bone quality refers to factors such as architecture, turnover, damage accumulation (e.g., microfractures), and mineralization • Osteoporosis is common among menopausal women but is often clinically silent until a fragility fracture occurs. Osteoporosis is also being recognized with increasing frequency in older men. • After peak bone mass is reached, the bone remodeling process is in a state of equilibrium until menopause. Cessation of estrogen production leads to rapid bone loss of approximately 2% to 3% per year in the spine for up to 6 to 8 years, which accounts for 50% of the total spinal bone loss among normal women .This is then followed by a slower rate of bone loss (0.5%/year), which is attributed to aging. • Even among men, it is now known that estrogen deficiency plays a big role in bone loss, perhaps an even bigger role than played by testosterone . Studies among osteoporotic males have shown a closer correlation between estradiol levels and bone mineral density (BMD) than testosterone and BMD. A finding that men with osteoporosis may have low estradiol yet normal testosterone levels further supported this correlation. • Clinically, osteoporosis is diagnosed when bone mineral density (BMD) is reduced or when fragility fractures (ie, fractures after little or no trauma) occur.
Dual-energy x-ray absorptiometry (DXA) is by far the best standardized technique and is preferred for diagnosing osteoporosis and monitoring responses to therapy. BMD assessment by DXA has been used by the World Health Organization to define osteopenia and osteoporosis
Normal BMD T-score –1
Low bone mass (osteopenia) BMD T-score < –1 and > –2.5 Osteoporosis BMD T-score –2.5
Severe osteoporosis BMD T-score –2.5 with one or more fragility fractures
• The most common misuse of the WHO criteria is applying it to nonwhite postmenopausal populations. The fracture risk/T-score relationship used for these criteria was derived solely from a database of white, postmenopausal women. Thus, the criteria cannot be taken to mean or suggest the same fracture risk when the individual being measured is male, premenopausal, or nonwhite. • The T-scores obtained from peripheral sites do not have the same fracture implication as those obtained with central machines. • Degenerative changes in the spine are exceedingly common among the elderly. These are seen as sclerotic changes in the facets and discs as well as osteophyte formation. They elevate BMD and may lead to falsely normal BMD and T-scores in the spine. • Vertebrae with compression fractures are denser than normal vertebrae and would have higher T-scores. It would be a big mistake to withhold therapy for a patient who appears to have normal T-scores due to compression fractures.
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The most common osteoporosis-related fractures involve the thoracic and lumbar spine, the hip, and the distal radius.
Biochemical evaluation Successful management of osteoporosis requires a careful choice of biochemical tests to determine the presence of secondary causes of osteoporosis. At a minimum, laboratory evaluation should include a complete blood cell count, serum chemistry panel, liver function tests, and serum thyroid-stimulating hormone and calcium determinations. Complete Blood Count
Complete blood count (CBC) tests can detect anemia, which can be seen in many secondary causes of osteoporosis; these include celiac sprue and other malabsorptive states, chronic liver disease, chronic kidney failure, metastatic bone disease, and multiple myeloma. KFT Renal insufficiency often leads to a deficiency in 1–25 OH vitamin D deficiency and secondary hyperparathyroidism, which must be addressed prior to initiation of osteoporosis therapy. Bisphosphonates are contraindicated when GFR falls below 30 mg/24 hours Liver Function Tests
An alanine aminotransferase (ALT) test is the most cost-effective way to screen for liver disease among osteoporotic patients. Elevated ALT levels suggest liver dysfunction, which, regardless of the cause, increases the risk of vitamin D deficiency.
Serum calcium
Postmenopausal women as a group are commonly affected by primary hyperparathyroidism .A serum calcium determination adequately screens for this disorder
Treatment of osteoporosis
The essentials of management for most forms of osteoporosis include the following: • Lifestyle modifications. • Nutritional interventions. • Pharmacologic therapies. • Interventional procedures for vertebral fractures Lifestyle Modifications Safety of the patient’s immediate environment to prevent falls and fractures, eliminating habits that are deleterious to skeletal integrity and that can contribute to falls
Discontinue smoking and alcohol consumption.
Weight-bearing exercise program
In patients with inflammatory diseases who are receiving long-term glucocorticoid therapy and are at risk for osteoporosis, an exercise and physical therapy program is imperative
Nutritional Interventions
Nutritional interventions for osteoporosis should assure that the diet plus supplements provide at least 1200 mg of elemental calcium per day and up to 1500 mg in high-risk patients over the age of 70 with established disease or with steroid-induced osteoporosis. Pharmacologic Therapy Drugs for osteoporosis can be divided into two major classes: antiresorptive and anabolic agents. Antiresorptive agents inhibit bone resorption, mainly through their action on osteoclasts, whereas anabolic agents stimulate osteoblastic differentiation and activity.
Antiresorptive Therapy
Bisphosphonates
These pyrophosphate analogues bind to hydroxyapatite crystals in the bone, are taken up by osteoclasts in the bone, and exert their action by inhibiting the mevalonate pathway, subsequently leading to inhibition of osteoclast function and increase in rates of apoptosis. Oral bioavailability is generally low, only 1% to 3%, and is greatly inhibited by food, calcium, iron supplements, and drinks. Patients must be advised to take this medication in the morning, to withhold food and drinks to ensure good absorption, and to remain upright for at least 30 minutes. • • Bisphosphonates Alendronate 5 mg/d or 35 mg/wk for prevention of osteoporosis; 10 mg/d or 70 mg/wk for treatment of postmenopausal, male, and glucocorticoid-induced osteoporosis
Risedronate 5 mg/d or 35 mg/wk for prevention and treatment of postmenopausal and glucocorticoid-induced osteoporosis Ibandronate:2.5 mg /d or 150 mg/month .or 3mg iv 03 monthly
Raloxifene Raloxifene is a selective estrogen receptor modulator, with agonistic effects on bone. The major efficacy trial for raloxifene was the Multiple Outcomes of Raloxifene Evaluation (MORE) Trial. The LS BMD increase over the 3-year study period was 2% to 3%, and vertebral fracture reduction rates in women with and without preexisting fractures were 50% and 30%, respectively. Calcitonin Because of its modest effect on BMD, and small fracture risk reduction, calcitonin is rarely used as first-line therapy; rather, owing to its mild analgesic effects, this drug is more commonly used now as an adjunctive therapy after an acute vertebral fracture, usually combined with a stronger antiresorptive.
Hormone Replacement Therapy Hormone replacement therapy (HRT) was the original antiresorptive therapy used for osteoporosis. However, current controversies centered on increased breast cancer, and cardiovascular risks have resulted in a marked decline in use for osteoporosis indications.
Anabolic Therapy Teriparatide Synthetic human parathyroid hormone [PTH (1–34)], or teriparatide, is an anabolic agent that has been approved for postmenopausal and male sosteoporosis treatment
Combination Therapy Trials that have studied combination therapy for osteoporosis had BMD and not fracture risk reduction as the primary endpoint. Thus, although the effects appear to be additive, it is unknown whether there is indeed a greater reduction in fracture risk when two agents are combined.
Interventional procedures for vertebral fractures
Kyphophasty and Vertebroplasty
These two surgical modalities have been reported to successfully relieve pain from acute compression fractures and decrease kyphosis slightly .The procedures entail injection of polymethylmethacralate or bone cement directly into the fractured vertebra in vertebroplasty, and into a balloon within the vertebra, in kyphoplasty.
Vertebroplasty is a percutaneous procedure with a low complication rate that provides immediate and long-¬term pain relief to patients suffering from chronic ver¬tebral compression fracture pain. Vertebro¬plasty is a minimally invasive procedure that not only provides immediate relief but continued and prolonged relief that may increase the patient’s daily activity level, which in turn helps provide a better quality of life. In several studies it has been shown that in more than 90% cases it provide immediate pain relief. Some of the potential complications include leakage of the cement into the spine, surrounding structures, and vessels.
dr pankaj nsurange is an Interventional Anesthesiologist and practicing interventional pain management.
special interest in spine interventions and chronic pain management
The meaning of the term ‘Osteoporosis’ originates from ‘Osteo’ meaning bone, and ‘porosis’ implying thinning or becoming more porous. Hence, osteoporosis literally means ‘thinning of bone’. Medically, Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced which means one has a low bone mass and deteriorating bone tissue. In simple words the bones become thin, brittle and may be easily broken. Bone mass (bone density) is the amount of bone present in the skeletal structure. The higher the density the stronger are the bones. Bone density is strongly influenced by genetic factors, which in turn are sometimes modified by environmental factors and medications.
If Osteoporosis is not prevented in the early stages or if left untreated, osteoporosis can progress painlessly until the bone tends to break. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist. The fracture caused by osteoporosis can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine). Though thee spine, hips, and wrists are common areas of osteoporosis-related bone fractures almost any skeletal bone area is susceptible to osteoporosis-related fracture.
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Symptoms of Osteoporosis
Severe pain, humpback, actual loss of height, are the main symptoms. Spasms of the back muscles and backache, thinning of pelvic bones, loss in twisting and bending strength, aching of the long bones and frequent occurrence of fractures.
Causes of Osteoporosis
1. Prolonged deficiency of calcium and Vitamin D demineralizes the skeleton and shrinks it. The disease is more prevalent among women.
2. Chronic alcoholism and heavy smoking.
3. Excess consumption of meat.
4. Reduced physical activities with age.
5. Post menopausal hormonal imbalance and prolonged cortisone treatment are other factors.
How to Prevent Osteoporosis
As we grow older, our skeletal system degenerates making our bones weak and prone to fracture. However, if you start living a healthy lifestyle early in your life, you may be able to interrupt the development of this disease. Here are some ways to prevent your chances of developing osteoporosis:
1. Get regular weight-bearing exercise, such as walking, jogging, climbing stairs, dancing, or weight lifting. Weight-bearing exercise helps keep bones strong and decreases the risk of developing osteoporosis.
2. Eat a healthy diet that includes plenty of calcium and vitamin D. Both are needed for building healthy, strong bones. You can get a boost of Vitamin D by drinking fortified milk or by spending 10 to 15 minutes in the sun each day (if you have a dark skin, you will need more time in the sun). Take supplements of calcium and vitamin D if you are not getting enough in your diet.
3. Don’t smoke.
4. Limit your alcohol intake to 1 drink per day or less.
5. Cut down on caffeine. Caffeine increases calcium loss from your body and puts you at risk for osteoporosis.
6. There are medications, including estrogen, which can help prevent osteoporosis. Talk with your doctor about whether these are ideal for you.
Home Remedies for osteoporosis
1. Oats, rice, millet and barley, sour milk products and foods rich in lactic acid should be consumed in liberal quantities.
2. Fruits like blueberries, raspberries, strawberries; sunflower seeds and sesame seeds; carrots, cabbage and green vegetables rich in calcium, magnesium, potassium and silicon are particularly beneficial.
3. Avoid overeating and large meals. Chew food thoroughly.
4. Trace mineral boron prevents calcium loss and de-mineralization.
www.therenegadehealthshow.com – Discover the shocking side effects of bisphosphonate drugs, which are supposed to help prevent bone loss and osteoporosis. Video Rating: 5 / 5
Osteoporosis is a disease of the bones characterized by a decrease in bone mass and structural deterioration of bone tissue, leading to bone fragility and increased susceptibility to fractures of the hip, spine and wrist.
The word “osteoporosis” literally means “porous bones.” Osteoporosis (pronounced OSS-tee-o-puh-RO-sis) occurs when bones begin to lose some of their essential elements. The most important of these elements is calcium. Over time, bone mass decreases. As a result, bones lose their strength, become fragile, and break easily. In extreme cases, even a sneeze or a sudden movement may be enough to break a bone.
Causes of Osteoporosis
Causes of osteoporosis are heredity and lifestyle. Whites and Asians, tall and thin women and those with a history of osteoporosis are those at the highest risk of getting osteoporosis. The behavioral causes of increasing the risk of osteoporosis are smoking, alcohol abuse, prolonged inactivity and a diet low in calcium. There are also some diseases that are associated with aging that cause osteoporosis, which include kidney failure, liver disease, cancers, Paget´s disease, endocrine or glandular diseases, gonadal failure and rheumatoid arthritis. There are some medications like steroids, seizure drugs, thyroid hormone and blood thinners that are also found to cause osteoporosis.
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Symptoms and Treatment
Usually, osteoporosis does not cause any symptoms at first. Osteoporosis is often called the “silent” disease, because bone loss occurs without symptoms. People often don’t know they have the disease until a bone breaks, frequently in a minor fall that wouldn’t normally cause a fracture. Many people confuse osteoporosis with arthritis and believe they can wait for symptoms such as swelling and joint pain to occur before seeing a doctor. It should be stressed that the mechanisms
Risk Factor of Osteoporosis
1. A diet low in calcium, either as an adult or as a child, can increase your risk of developing osteoporosis.
2. Vitamin D helps the body absorb calcium. Lack of vitamin D is another risk factor for developing osteoporosis.
3. Smoking cigarettes interferes with the body’s ability to absorb calcium.
4. Excessive alcohol consumption also makes it difficult for calcium to be absorbed. Bones will be weaker without sufficient calcium.
Treatment of Osteoporosis
Although osteoporosis has no cure, several types of medications are available to reduce the rate of bone loss, increase bone density, and reduce the number of fractures. In general, they work in two main ways: they lessen bone break down (anti-resorptive agents) or they stimulate the formation of new bone (anabolic agents).
Hormone therapy
Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone.In addition, it is important to get enough vitamin D. A daily intake of 400 IU, but no more than 800 IU, each day is recommended. Obtaining adequate amounts of vitamin D from our food may be difficult. The main sources of dietary vitamin D are fortified milk (100 IU/cup), egg yolks (25 IU/yolk) and oily fish (vitamin D content varies).
Osteoporosis is a bone disease. It is virtually a disease on account of which the bones generally become fragile and weak. Osteoporosis if not taken proper care of lead may to the breakage of the bones thus leading to a fracture. Osteoporosis generally is found to be very much typical in certain parts of the body, say for instance in the hips, wrists, spinal cord and also in the vertebras. Osteoporosis is like a silent killer which attacks an individual without prior symptoms.
Osteoporosis is a silent condition which weakens bones and causes fractures which can result in severe disability. It is the third most common disease (after Hypertension and Diabetes) in the elderly population. Osteoporosis has been recognized as the third most common disease to be prevalent in India by WHO ( World Health Organization). One in three women, and the one in five men around the world who will be affected by osteoporosis.
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Causes of Osteoporosis
Causes of osteoporosis are heredity and lifestyle. Whites and Asians, tall and thin women and those with a history of osteoporosis are those at the highest risk of getting osteoporosis. The behavioral causes of increasing the risk of osteoporosis are smoking, alcohol abuse, prolonged inactivity and a diet low in calcium. There are also some diseases that are associated with aging that cause osteoporosis, which include kidney failure, liver disease, cancers, Paget´s disease, endocrine or glandular diseases, gonadal failure and rheumatoid arthritis. There are some medications like steroids, seizure drugs, thyroid hormone and blood thinners that are also found to cause osteoporosis.
Signs and Symptoms of Osteoporosis
During the preliminary stages of the bone disease, patients usually do not feel any symptoms. However as the bones become significantly weakened by the disease, the symptoms will start to appear. When osteoporosis is advanced, patients will likely notice symptoms of bone pain, back pain, height loss, neck pain, stooped posture, and bone fractures.
Since the symptoms are negligible during the early stages of osteoporosis, getting an early diagnosis can be inconvenient. Thus, Mayo Clinic recommends getting a bone density test if the patient is between 60 (female) to 70 (male) years old.
Treatment of Osteoporosis
Here is a list of methods of treatment of osteoporosis:
1. A balanced diet rich in calcium and vitamin D.
2. Exercise.
3. You may need strong pain killers (analgesics), for some time, for an osteoporotic fracture.
4. A healthy lifestyle.
Another treatment method for osteoporosis is using a method that is going to stop or eliminate bone loss. This is one of the reasons why patients are so prone to fractures. Due to the fact that they loose components of their bones over time, it is more likely for them to get bone fractures for any given reason.
An additional treatment goal for osteoporosis is to use a method whereby the bones are going to be strengthened. Typically, this is where the prescription medicine comes into play. Medicine is given that is going to strengthen the patient’s bone. This is something that can certainly prevent fractures.
Osteoporosis is an important factor in consequences and disease states. It can occur due to the lack of calcium intake, weight bearing activities, and estrogen deficiency. This disease affects over 25 million American women and causes about 250,000 hip fractures a year. It is called a silent disease, which causes bone density to slowly decrease and fractures to develop (Alexander, 2004 p. 267). After age 30, bone resorption speeds up faster than bone replacement can take place. When a woman reaches menopause she will experience approximately 20% of bone loss within a five to seven-year period. After age 50, one in two women will experience osteoporosis related fractures, which may lead to disability, chronic pain, and even death (Alexander, 2004 p. 399). The economic cost is overwhelming and significant for osteoporosis. This is why it is important to properly select the main focus point of long-term prevention or acute care of osteoporosis. It has been a complex decision, which has been a growing issue for women worldwide. Some issues that each program must over come in order to be an affective long-term prevention or acute care program are services reaching proper target audiences, maintaining ethics, effective budget spending, eligible health care services, increasing insurance coverage and personal knowledge.
In long-term prevention, preventive education of osteoporosis was a strategic tool to overcome this disease. Promotional education has been aimed at the premenopausal phase of women’s lifecycle. This phase represents promoting nutritional facts to help build stronger bones, which are aimed at children and adolescents as a general target audience. This is based on research of early lifestyle changes that promotes optimal adult peak bone mass. The specific target audience is low income and high-risk applicants who met categorical, residential, income, and nutritional risk requirements.
There are several Federal agencies as well as non-profitable organizations, which maintain ethics by providing strict guidelines. This allows participants to experience uncompromised services such as health education, specialized services, and sometime financial support (Food and Nutrition Service United States Department of Agriculture [FNS-USDA] n.d.). Some examples of these agencies are Women Infant Children (WIC), Expanded Food and Nutrition Education Program (EFNEP), U.S Department of Health and Human Services (DHHS), and National Dairy Council (NDC).
Another issue of concern is individual effective budget spending, which is measured through cost effective services. There are multitudes of diverse governmental and non-profit agencies that are operating jointly or individually in support of healthy lifestyles and stronger bones. The combination of overall promotional efforts is justified by a 50% decreased risk of osteoporosis, according to the Milk Pilot Study by the National Dairy Council (NDC, n.d.).
Other issues such as eligible health care services and increasing insurance coverage are intertwining problems. In 2001, 41.2 million U.S. citizens were uninsured. There were a million more that had limited insurance coverage, which were restrictive and prevented necessary health care services (Alexander, 2004 p. 18). There are a growing number of 44 million uninsured citizens, which is partially due to the increasing elderly population (Connolly, 2000). Affective long-term educational prevention should help decrease the massive amount of patients who are at need of medical assistance. This is due to reinforcing positive lifestyle changes to help prevent chronic illness. Defining and reducing additional risk factors to provide better prevention techniques such as avoiding high protein intake to avoid urinary calcium loss. Another prevention technique to reduce a risk factor is avoiding high fat intake to avoid reduced bone mineralization due to elevated needs of bisphosphonates for metabolic intermediates of cholesterol synthesis (Hegsted, 2001).
Personal knowledge of providing educational support allows us to overcome learning barriers that must be faced such as cultural differences and body image. Cultural background influences the ways adolescents think about things and interact with others. It is important to consider the cultural aspects in order to break down social barriers and provide adequate behavior modification tools. Especially when reviewing the many factors that contribute to an adolescent’s culture such as socioeconomic, educational, family, ethnic, and racial background (Conflict Research Consortium, n.d.). The other barrier is body image, where proper support of nutritional education and counseling becomes necessary for adolescents’ development. This becomes evident as self-perception traits become defined in the preteens. If they carry their negative association of dairy products into adulthood, their risk of osteoporosis will become great. Surveys indicate dairy products are considered to be calorie dense food items (Adolescent Health Committee & Canadian Pediatric Society, 2004). Negative self-perception contributes to low calcium intake, which in turn contributes to a decrease in adult peak bone mass (DHHS, n.d. & Teegarden, 1999).
I have learned in this class that today’s adolescent development could lead to tomorrows growing issues of chronic problematic illness such as osteoporosis. I question the overall effectiveness of long-term educational prevention of osteoporosis. According to the National Osteoporosis Foundation, more than 25 million Americans have osteoporosis (DHHS, n.d.). 50% of patients with hip fractures will be considering long-term disabled. 25% of those patients will require long term-nursing facilities (The Bone and Joint Decade [BJD], 2004). If National Osteoporosis Foundation was able to receive stronger Federal support to coordinate state agencies in joint, local, as well as national effort, the overall program will become effective. This is why it is important to properly select the main focus point towards long-term prevention.
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Addressing the issues of effective osteoporosis therapy in an acute care setting is an ongoing process. This type of health care service is always changing towards more efficient techniques. Currently doctors recommend healthy lifestyle of nutritional dense foods and weight bearing activities. They prescribe medication for bone resorption such as Fosamax and Calcitonin (Alexander, 2004 p. 403). They also prescribe hormone therapy such as Raloxifene, which reduces 50%-70% vertebral fractures (Alexander, 2004 p. 402).
Services reaching proper target audiences in the past were questionable. According to multinational study of orthopedic surgeons, 95% fracture patients were not properly screen for osteoporosis (BJD, 2004). Another target audience that has been over looked were patients who were experiencing celiac disease. It is common for these individuals to be lactose intolerant as well, which puts them at risk of osteoporosis (American Academy of Family Physicians [AAFP], 2005). Screening is an important tool to reach, as well as confirm, proper target audience. Currently, selecting patients for screening has drastically improved, making it possible to catch osteoporosis in the beginning stages. Individuals who are experiencing estrogen deficiency, vertebral abnormalities, long-term glucocorticoid therapy, or hyperparathyroidism can be properly screened (Albert Einstein Healthcare Network [AEHN], n.d.).
When maintaining ethics, there should be a clear path of treatment for patients.In the pastOrthopedists were not consistent in treatment or referrals. It was an experimental practice, which was vastly growing through trial and error. Medical decisions were made by doctors without long-term clinical research (BJD, 2004). Currently patients are being offered choices of preferred treatments. The diverse pharmacologic prevention consists of teriparatide, raloxifene, bisphosphonates, and salmon calcitonin. Bisphosphonates were recommended as the most effective pharmacologic prevention for osteoporosis (Wright, 2004).
Effective budget spending of related osteoporosis costs were from admirable. In 1995, the cost of treating osteoporosis acute and long-term care was 13.8 billion American dollars. Currently more high-risk patients are experiencing early detection and treatment through advanced screening and medical attention. This will have a plausible influence on budget spending. The increasing number of geriatric needs will always be a growing challenge for effective budget spending (DHHS, n.d.). Eligible health care services and increasing insurance coverage were a challenge for people when faced with chronic diseases such as osteoporosis. Individuals often struggle to pay for appropriate treatment for long-term illness. Most people were forced to turn to Medicaid as a public insurance program (Alexander, 2004 p. 398). Currently conditions have been improving for patients with osteoporosis. According to National Osteoporosis Foundation (NOF), Medicare will reimburse bone density tests such as DEXA scans. Due to the direct reimbursement of Medicare, insurance will be able to cover these types of testing, which allows for early detection of osteoporosis (AEHN, n.d.).
Personal knowledge of providing clinical research allows us to overcome barriers such as cultural differences and body image. Cultural differences could develop into issues for osteoporosis patients such as 54-year-old raw food vegetarians who are at high risk. This is due to alternative dietary lifestyles of high fiber, low vitamin D and calcium intake. Clinical research indicates lactovegetarians have decreased risk factors compared to raw food vegetarians. A transition from raw food vegetarianism to lactovegetarianism is smooth and advisable for individuals (Hitti, 2005). Another barrier is body image. In 1998 the Gallup poll found 59% of women ranging 35-49 years of age were on some kind of diet. These diets are known as yo-yo diets, which are hazardous to your health. This is due to overall decreased food intake, which affects macronutrients as well as micronutrients. This includes important needed items of the bone matrix such as calcium, phosphorus, magnesium, Vitamin K, and Vitamin D. Another growing concern dealing with body image is individuals who are currently seeking weight loss through Bariatric surgery. This procedure pertains to a partial bypass of the duodenum, which is an important part of the small intestines. This causes a deficiency of calcium due to chronic malabsorptionand puts the patient at risk for osteoporosis. Clinical research indicates progressive atrophy of the unused duodenum, which stresses the importance of corrective surgery to prevent significant chronic damage (Strong Health Bariatric Surgery [SHBS], n.d.).
I have learned in this class there could never be enough research in order to make a precise decision. This is why additional financial aid through governmental and non-profit agencies is greatly needed for proper clinical research. Completing additional research will make acute care for osteoporosis more affective.
In conclusion, acute osteoporosis therapy is dependent on long-term prevention success. This is due to promoting awareness and managing risk factors that are modifiable. These techniques have been proven to decrease a large demand on acute care. This directly causes a decrease in potential target audience for acute care. Maintaining effective budget, providing eligible health care services, and available insurance coverage is easier when there are less demands due to decreased needs of medical services. Both programs are necessary in order to provide optimum health care of women nationally.
Reference
Adolescent Health Committee & Canadian Pediatric Society. (2004). Dieting in
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