Boland Osteoporosis Centre https://bolandosteoporosis.co.za Bone Density Paarl Tue, 27 May 2025 10:32:10 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.4 https://bolandosteoporosis.co.za/wp-content/uploads/2021/06/BOC_favicon-150x150.png Boland Osteoporosis Centre https://bolandosteoporosis.co.za 32 32 BOLAND OSTEOPOROSIS CENTRE UPGRADING OF SCAN FACILITY https://bolandosteoporosis.co.za/blog/boland-osteoporosis-centre-upgrading-of-scan-facility/ Fri, 24 Nov 2023 08:40:15 +0000 https://bolandosteoporosis.co.za/?p=2804 We are now able to perform and analyse WHOLE BODY SCANS and generate reports on fat mass, lean tissue mass, visceral fat, and regional analysis of fat distribution in your body. This information can be valuable in determining treatment strategies for patients with metabolic syndrome.

Metabolic syndrome is a cluster of conditions, including abdominal obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels, that collectively increase the risk of cardiovascular disease, type 2 diabetes, and other health issues.

Here’s how the information from body composition analysis can be utilized in the treatment of patients with metabolic syndrome:

Targeted Lifestyle Interventions:
• Fat Mass and Visceral Fat: Individuals with metabolic syndrome often have excess fat, particularly visceral fat around the abdomen. Targeting weight loss, especially reduction in visceral fat, through lifestyle interventions such as diet and exercise can be crucial. Visceral fat is metabolically active and is associated with insulin resistance and inflammation.
• Lean Tissue Mass: Preservation or enhancement of lean tissue mass is important. Resistance training and adequate protein intake can help preserve or build lean muscle mass, which is associated with improved metabolic health.

Nutritional Guidance:
• Regional Analysis of Fat Distribution: Understanding how fat is distributed in different regions of the body can guide nutritional recommendations. For example, targeting abdominal fat may involve dietary strategies that promote overall fat loss, reduce calorie intake, and improve the quality of the diet.

Cardiometabolic Risk Assessment:
• Fat Mass: Excessive fat mass is a risk factor for metabolic syndrome. Monitoring changes in fat mass over time can provide feedback on the effectiveness of interventions and help guide adjustments to treatment plans.
• Visceral Fat: Elevated visceral fat is particularly associated with insulin resistance and an increased risk of cardiovascular disease. Targeting visceral fat reduction can be a specific goal in the management of metabolic syndrome.

Physical Activity Recommendations:
• Lean Tissue Mass and Fat Mass: Physical activity is a key component of metabolic syndrome management. Exercise, particularly a combination of aerobic and resistance training, can help reduce fat mass, improve insulin sensitivity, and positively influence body composition.

Medication Management:
• Visceral Fat and Metabolic Parameters: In some cases, medications may be prescribed to manage specific components of metabolic syndrome, such as hypertension, dyslipidemia, or elevated blood sugar. The information from body composition analysis can aid in monitoring treatment effectiveness.

Individualized Treatment Plans:
• Regional Analysis: Recognizing that fat distribution can vary among individuals, tailoring treatment plans to the individual characteristics of each patient can enhance effectiveness. For instance, focusing on abdominal fat reduction for those with central obesity may be a priority.

In summary, body composition analysis provides valuable insights that can be used to develop personalized and targeted treatment plans for patients with metabolic syndrome. Lifestyle interventions, nutritional guidance, physical activity recommendations, and, when necessary, medication management can all be informed by a thorough understanding of the patient’s body composition profile. Additionally, ongoing monitoring of changes in body composition allows for adjustments to treatment strategies based on individual responses and progress. It’s important for healthcare providers to work closely with patients to develop sustainable and effective interventions that address the specific needs identified through body composition analysis.

Speak to your healthcare provider about the benefits on how a DXA whole body examination can be used to improve your health situation.

]]> Decision to treat osteoporosis with pharmaceuticals https://bolandosteoporosis.co.za/blog/decision-to-treat-osteoporosis-with-pharmaceuticals/ Fri, 10 Dec 2021 14:02:38 +0000 https://bolandosteoporosis.co.za/?p=2717 If bone density is low at 1 or more skeletal sites and it meets the world health organization (WHO) criteria for “low bone mass” (T-score between -1.0 and -2.5) the threshold where pharmacologic therapy is recommended by the National Osteoporosis Foundation (NOF) treatment should be contemplated. However all treatment decisions require clinical judgement and consideration of individual factors namely:

  • Patient Preferences
  • Comorbidities
  • Previous drug use
  • Risk Factors not captured in the FRAX model:
    • Frailty
    • Falls
    • Vitamin D deficiency
    • Increased bone turnover
    • Interval significant decline in bone density
  • Possible under/over estimation of fracture risk by FRAX

Patients should follow a healthful lifestyle regardless of type of Pharmacological intervention:

  • Good Nutrition with adequate calcium and Vitamin D
  • Appropriate weight-bearing exercise

Follow Up DEXA Measurements

If a patient is treated with pharmaceuticals consider repeating the DEXA study in 1 year to reassess the patients status/response on treatment.

]]> Non-pharmacological management of osteoporosis https://bolandosteoporosis.co.za/blog/non-pharmacological-management-of-osteoporosis/ Thu, 29 Jul 2021 14:29:07 +0000 https://wishbone.co.za/bos/?p=1922

Non -pharmacological management of osteoporosis largely involve nutritional measures, physical exercise, limiting alcohol consumption, stopping smoking and avoiding bone-toxic drugs and are essentially aimed at:

Improve bone strength to prevent fractures by:

  1. Following a healthy eating plan:
    Vitamin D, Calcium intake, high protein and phosphate intake. Vitamin C, B6 and K, trace elements, zinc, copper, boron and manganese

  2. Doing physical exercise:
    Specific resistance exercises have a beneficial effect in preserving bone density. Lower intensity training increases aerobic fitness, but do not have effect on bone mineral density. Exercise intervention can improve muscle strength and fitness. Excessive exercise, especially when coupled with severe caloric restriction and a poor calcium intake is well known to result in functional hypogonadism ( hypothalamic amenorrhoea) and osteoporosis, not infrequently associated with fractures.

  3. Limiting alcohol consumption and completely stop smoking.

  4. Avoid using bone-toxic  drugs
    A number of drugs, other than alcohol and smoking, predispose to fracture, either by reducing bone strength and /or by pre disposing to a fall. Note that drugs like anti-convulsants may cause not only osteoporosis, but osteomalacia.

The prevention of falls

A relatively small number of risk factors for falls emerge consistently:

  • Medication
  • Cognitive disfunction
  • Gate and balance disorder
  • Previous history of falls
  • Visual impairment
  • Mental impairment
  • Alcohol
  • Severe depression
  • Confusion
  • Previous stroke
]]> Treatment of the symptomatic patient https://bolandosteoporosis.co.za/blog/treatment-of-the-symptomatic-patient/ Thu, 22 Jul 2021 14:30:50 +0000 https://wishbone.co.za/bos/?p=1844

a. We recommend that the symptomatic acute vertebral fracture syndrome be treated with conventional analgesics and supplemented with heat pads and ice packs.

b. The utilisation of physiotherapy, hydrotherapy, gradual mobilisation and back rehabilitation.

c. Given the current state of our knowledge, the use of specific bone-active drugs, like calcitonin, for the treatment of the symptomatic vertebral fracture syndrome does not appear to be cost-effective, and cannot be recommended.

d. Based on current medical evidence and, in particular, the recently published randomised sham-operation controlled trials, the use of vertebroplasty cannot be recommended at present. Although firm evidence-based recommendations will have to await further studies, we suggest that balloon kyphoplasty be considered if severe back pain persists for six weeks following a vertebral fracture, particularly if the loss of vertebral height is no more than 50%, and a STIR-MRI reveals the presence of bone oedema suggesting a recent fracture. Earlier intervention may be considered where the loss of height is more than 50%,  whereas the absence of bone oedema on STIR MRI may require that a more conservative wait-and-see approach be considered.

Reference:
JEMDSA 153 2017; 22(1) (Supplement 1)

]]> Is dit nodig dat ek behandel moet word vir beenverlies? https://bolandosteoporosis.co.za/blog/is-dit-nodig-dat-ek-behandel-moet-word-vir-beenverlies/ Fri, 21 May 2021 10:48:18 +0000 https://wishbone.co.za/bos/?p=1231

Indien u T-telling binne die grense van opsteoporose is( -2.5 of laer) sal meeste geneeshere aanbeveel dat u behandeling ontvang. Indien u T-telling binne die opsteopenie grense is( -1.0 tot – 2.5 ) kan die gebruik van WHO FRAX instrument help om te besluit of u aktief  behandel moet word of nie. 

Die FRAX instrument is geskep om n geneesheer te help besluit of n pasient aktief behandel moet word. Inligting van 10 risiko faktore asook u beendigtheid uitslag word opgelaai na n aanlyn tuiste. n 10 jaar risiko vir n heup fraktuur of enige major beenfraktuur word dan bereken. U geneesheer kan hierdie inligting tesame met u gesondheids geskiedenis, fisiese ondersoek en laboratorium uitslae gebruik om te besluit indien en watter tipe medikasie gebruik kan word.

]]> Investigations for Secondary Osteoporosis https://bolandosteoporosis.co.za/blog/investigations-for-secondary-osteoporosis/ Fri, 21 May 2021 10:48:00 +0000 https://wishbone.co.za/bos/?p=1229

Standardized Protocol of Investigations for Suspected Undiagnosed Causes of Secondary Osteoporosis:

Investigations are done based on clinical, radiological and Dexa findings.

  1. Exclude primary hyperthyroidism and osteomalacia:
    Serum calcium,   Phosphate,  Albumin,  Serum 25OHD(vitamin D),  PTH and   ALP
  2. Biochemical tests to identify causes of osteoporosis should largely be dictated by clinical assessment, and few test should be performed routinely.  
  3. In patients with established disease the following tests should be done:
    Full blood count, ESR, serum protein, electrophoresis, sex hormone levels in males and females when the menupausal state is uncertain.
    Urine calcium level.
  4. Optional tests:
    Serum or urine bone turnover markers
    Liver transaminases
    Serum T4 and T3
    Bone biopsy
    Bone marrow aspiration
    Isotope bone scan
    Cancer markers

List of tests for osteoporosis:

  • Blood tests for 25-hydroxyvitamin D:
    institutionalised patients, housebound patients or patients having low sunlight exposure. Patients with increased skin pigmentation, obese, malnutrition malabsorption, liver disease or using drugs that interfere with vitamin D metabolism, like the anticonvulsants.
  • Alkaline Phosphatase: Bone turnover
  • Alanine aminotransferases: alcoholism
  • Bioavailable testosterone (men only)
  • Creatinine: Kidney function
  • Complete blood count: Indication of cronic disease
  • Calcium: Bone turnover
  • Serum electrolytes: Kidney functioon
  • Erythrocyte sedimentation rate: Inflamation
  • Free thyroxine (T4) / triodothyronine (T3): Thyriod function
  • Phosphorus: Bone turnover
  • Parathyroid hormone: Bone turnover
  • Protein electrophoresis: Myeloma
  • Thyroid-stimulating hormone: Thyroid function
  • Serum C-terminal telopeptide (a measure of bone resorption)
  • Tissue transglutaminase (tests for celiac disease)
  • Urinalysis 24-hour; calcium 24-hour creatinine: Excretion of calcium
  • Radiographs: Thoracic and lumbar spine (anteroposterior view, lateral view)
]]> Guidelines for the Pharmacotherapy of osteoporosis https://bolandosteoporosis.co.za/blog/guidelines-for-the-pharmacotherapy-of-osteoporosis/ Thu, 18 Mar 2021 09:04:11 +0000 http://wishbone.co.za/bos/?p=1

NOFSA (National Osteoporosis Federation of South Africa ) recommendations on the choice of a pharmacological agent in the treatment of osteoporosis:

a. We acknowledge the fact that, given the heterogeneity of the osteoporosis syndrome and the lack of significant head-to-head comparative studies, no ideal drug scenario for management can be recommended.

b. Drug therapy must be individualised, taking due cognisance of the disease profile (particularly the severity of bone loss and skeletal sites involved), the patient profile (age, general health, concomitant disease, clinical setting), and the available resources and personal preferences.

The Hows and Whys of Osteoporosis Medications

 
CLASS AND DRUG BRAND NAME FORM FREQUENCY GENDER

Antiresorptive Agents 

Bisphosphonates
Alendronate Fosamax®, Fosamax Plus D™ Oral (tablet, solution) Daily/Weekly Women & Men
Alendronate Binosto® Oral (effervescent tablet) Weekly Women & Men
Ibandronate Boniva® Oral (tablet) Monthly Women
Ibandronate Boniva® Intravenous (IV) injection Every 3 months Women
Risedronate Actonel® Oral (tablet) Daily/Weekly/Twice Monthly/Monthly Women & Men
Risedronate Atelvia™ Oral (tablet) Weekly Women
Zoledronic Acid Reclast® Intravenous (IV) infusion One Time per Year/Once every two years Women & Men

 

RANK ligand (RANKL) inhibitor

  
Denosumab Prolia™ Injection Every 6 Months Women & Men

 

Calcitonin
Calcitonin Fortical®, Miacalcin® Nasal spray Daily Women
Calcitonin Miacalcin® Injection Varies Women

 

Estrogen* (Hormone Therapy)
Estrogen Multiple Brands Oral (tablet) Daily Women
Estrogen Multiple Brands Transdermal (skin patch) Twice Weekly/Weekly Women

Estrogen Agonists/Antagonists
also called selective estrogen receptor modulators (SERMs)
Raloxifene Evista® Oral (tablet) Daily Women

 

Tissue Specific Estrogen Complex (TSEC)
Estrogen/Bazodoxifene Duavee® Oral (tablet) Daily Women

 

Anabolic Agents

Sclerostin Inhibitor
Romosozumab-aqqg Evenity Injection 2 injections once monthly for 12 months Women

Parathyroid Hormone (PTH) Analog
Teriparatide Forteo® Injection Daily Women & Men

Parathyroid Hormone-Related Protein (PTHrp) Analog

  
Abaloparatide Tymlos Injection Daily Women
*Estrogen is also available in other preparations including a vaginal ring, cream, by injection and as an oral tablet taken sublingually (under the tongue). The vaginal preparations do not provide significant bone protection.

Osteoporosis Medication and Medication Guidelines (nof.org)

Reference:
JEMDSA 145 2017; 22(1) (Supplement 1)

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