First Mammogram
Most women used to start mammographic screening years before menopause, but you many want to begin at age 50 which will generally mean that the start of menopause will be the strat of mammogrphic screening. Mammography is an x ray, and total life x ray dosages are important to think about, but the amount of radiation is low and mammography remains a safe, appropriate as a screening tool for many women, and has saved many lives. When to get a mammogram is an important decision for each womean. Individualized evaluation and risk assessment for your risk of breast cancer should occur on an annual basis. Factors that we should consider will include: (among others) your personal history, your family history, hormone and medication history, nipple discharge, breast pain, cysts or masses, and prior breast surgery.
New guidelines calling for fewer mammograms, and mammograms beginning later in life are being recommended by the U.S. Preventive Services Task Force Breast Cancer Screening group. These guidelines are in conflict with some of the recommendations I have given most of my patients over the past few years. As a Board Certified Obstetrician and Gynecologist the organization I belong to called the American Congress of Obstetrics and Gynecology (ACOG). They are studying the new guidelines, but they have not yet had time to complete their review or revise their guidelines.
Insurance coverage for medical exams are based both on medical necessity and on recommendations of organizations such as these. Insurance coverage you may have had in the past may be affected by these changes. REmember, your individual physician can help you with preauthorizing medical tests, but it's important that you specifically ask before any medical exam if the insurance issues have been clarified and questions resolved or there may be unplanned on costs that cannot be undone.
Heart Health
Basic recommendations are to normalize weight, improve exercise, and get tested to figure out your risk status. American Heart Association; American College of Cardiology are good sources of more detailed information on your cholesterol and other ways to control heart heath risk.
Vitamin D, Calcium and Nutrition for Your bones
Osteoporosis
is a disorder of the bone which has deficient bone strength, and much
of our bone health advice is aimed at avoiding this disease. No matter
what your age, you need Calcium and Vitamin D for bone health and
getting the right diet is critical for energy, for pregnancy, and when
undergoing treatment for many conditions. Adequate calcium is important
to prevent osteoporosis or thin bones, which affects an estimated 8
million American women and 2 million American men, and can start in your
thirties or forties if you don’t take care of your nutrition. Another
34 million Americans have poor amounts of calcium, so essentially
thinner bones or low bone mass, placing them at increased risk for the
actual medical disease of osteoporosis as they age. 4/10 white women in
the of the age 50 or older will suffer a hip, spine or wrist fracture
sometime during the remainder of their lives.
Should you get a Calcium Blood Test?
Calcium
consumption in your diet can help maintain bone density by preventing
the body from stealing the calcium it needs from the bones. If you think
you have a reasonable diet but just aren’t sure if it is enough both
calcium and Vitamin D are able to be measured in the blood. Whether you
should have a blood test is another issue, and the answer may very well
be yesas many as 40% of women in menopause might have a low D level.
Medicines and Bone Health
Some
medications can harm bone health. As October is Breast Cancer Awareness
it is another fact that bones of breast cancer patients tend to age
prematurely as a result of chemotherapy and aromatase inhibitor therapy,
according to research reported at the American Society for Bone and
Mineral Research in 2009. And in 2010 the FDA began to warn about increased fracture risk in women on PPIs or proton pup inhibitors those over the counter medicines to reduce stomach-acid.
Do You Need a Bone Density Test
The
most important tools we use for determining the need for treatment are
by bone density testing with a Densitometry machine (DXA). DXA scans are
painless, they have minimal x-ray exposure and reveal a lot of
important information. They are for all women over 65 and others with
risk factors, and for all men over 70 unless risk factors,but many need
this test younger than this age, you really should consult your gyno
about what is best for you.
And we really want to know
not just the thickness but the strength of your bones. Bone strength is
strongly determined by the density of the bone. This is what we measure
when you go and have you Bone Densitometry test or the “DXA” test that
gives you a T score and and a Z score. Thickness has to do with how
thick your bones started. A teenage girl will accumulate about 90% of
her bone mass by age 20, and she accumulate the amount from age 13 to 15
that is about equal to the amount she’ll loose in the last 4 decades of
life! So exactly what sort of genes you were born with will affect your
overall bone strength but diet can dramatically alter what you were
given. Poor bone health from ages 13 to 15 for a girl has significant
potential consequences. Call your grand daughters now and make sure they
swig down a calcium chew mid-day (not with pop) and boost those bones!
And if you still have questions, get them to call me, as it’s a topic
I’m very interested in.
So How Strong are Your Bones
So
just how strong are your bones. Having strong bones is important,
Stronger bones means less of these types of fractures. Osteoporosis is a
disorder that is due to compromised bone strength that predisposes to
fractures. All strategies for diagnosis and treatment have to do with
fracture assessment and prevention. So knowing how strong your bones are
can help tailor exercise, diet, therapies and monitoring. And
establishing how likely you are to fall, is actually part of prevention
of fractures as well. But how to establish an accurate representation,
especially in the doctors office? This turns out to be an interesting
question. Several components are important and in truth your physician
may not know exactly how strong your bones are. But looking at you
across the doctor’s desk will not usually give you the answer. Probing
intently really answers the question.
In the most
simplistic terms bone strength is the sum of the thickness of the bone
and it’s internal structure or the “quality” of that bone. Quality has
to do with the actual architecture, the damage accumulation, the
turnover rate of bone, as our bones grow and develop our whole lives,
and how the calcium is deposited on the underlying bone structure. For
instance some people are born with a structural abnormality: say very
bowed shins, that bone has a different inherent quality than a very
straight leg. Bones that are most susceptible to osteoportic fractures
(the hip the spine the end of th wrist) have a chain link fence-like
structure called trabecular structure. In bones of high quality bone the
trabeculae are greater in number, thicker and more platelike and better
connected. Interestingly the pace of this bone turnover is very
important too. Slow bone turnover can be less optimal, but very fast
turnover is not ideal either.
Signs of poor bone heath
Many
times poor bone health is not symptomatic, although poor tooth health
may be a clue! Acute or chronic back pain might be an osteoporotic
fracture which is most common at the spine vertebral bodies labled T12
or L1, these are located approximately in your mid back.
Vertebral fractures and How You Can test
As
I said earlier, gynos care about your real balance, not just how good
you are on kittens or stilletos! Balance as we get older determines
whether we fall, and falling on weak bones will lead to fractures.
Simple tests of balance seat on the floor, she’s not impolite, so do it,
and then stand up without using your hands, and then stand on one foot,
and now just the other. Bad balance can mean muscular weaknesses,
postural deformities, or pre-existing fractures.Your gyno will only make
a firm diagnosis with x rays and testsand assess your risk you should
have a bone densitometry test, known as a DXA scan (see above). This
will give you a T-score and a measurement of the strength. There is
actually no specific number that is known to be completely “safe” from
fracture, but the denser your bones on this test the less likely it is
that you will get a fracture. Here's an odd fact: half of all
osteoporotic fractures occur in individuals with out a diagnosis of
osteoporosis, yes, sometimes you just haven't gotten the right
diagnosis, and othertimes it's just that the strength of the bone is
compromised, but not the thickness (see notes above as well!). In one
study of men with osteoporotic fractures their bone thickness measured
by the actual BMD (remember, this is the number you get when you do a
DXA test) was not different from the group that did not have a fracture!
And not all fractures are preventable with strong bones. You slip too
hard on that fru-fru rug in the foyer you might just get a fracture
anyway!
Sunshine or Sun for Vitamin D and Bone Health?
At
my gyno office we recommend the most complete sun protection you can
get, and I never hesitate with that recommendation. There are medical
grade sun screen products to help you do this, and no sooner had I
carried our #1 best seller at my spa the Colorescienc, did I hear of
three new offices, and the local breast center taking up the sales of
the same product lines for sunscreen, so I did set a bit of a mini
treand! However, The Surgeon General’s report of 2004 recommends that
patients adopt several interventions to decrease the risk of developing
osteoporosis, especially increasing their vitamin D. Former guidelines
were 400 IU of vitamin D daily for adults, and for women past menopause
and men over 65 they need 800 IU. Newer studies show even greater
amounts are important, up to 2000 IU daily for many can help protect
bones while giving other positive health benefits. Poor vitamin D intake
leads to muscle aches, incoordination and loss of balance, that factor
we just discussed as so critical.Not just sunscreen that leads to
vitamin D deficiency. As we age the skin precursor substances start to
wane. So the skin is unable to produce the vitamin D it used to produce
in youth. If you are unsure of your vitamin D intake, ask for a vitamin D
blood test. Here’s another interesting fact: low vitamin D is a major
cause of chronic fatigue.
Back Pain and Bone Health
Low
back pain is one of the most common complaints in every gyno office.
Many patients self treat with glucosamine, stating they see dramatic
improvement in their doggies or their friends with the treatment.
Unfortunately scientific study says something is wrong with that doggie
study of one, and there is no evidence that it relieves pain at the 6 or
12 month time period as studied in clinicaltrial.gov NCT00404079.
And for more bone health and osteoporosis news, look at the other posts on Gynogab.com
