Osteoporosis

An article on the front page of the New York Times was entitled “FDA is Wary of Lengthy Use of Bone Drugs”. Many of my patients or else members of their family may be taking medication to help reduce osteoporotic fracture. Some of these women are on drugs mentioned in this article and other women are not. Such information may be confusing and frightening to many patients and so I believe it is worthy of discussion in this space.

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Pap Smear Screening

There was an article in the New York Times by Tara Parker-Pope entitled “The annual appointment loses some relevance”.  It was about the highly publicized, but not so very different, pap smear guidelines by the USPSTF (United States Preventative Services Task Force).  The guidelines had already been changed several years ago making the recommendation for less screening in some women.  At that time, as a member of the Editorial Board of Contemporary ObGyn, I wrote a piece entitled “If it ain’t broke, why are we fixing it”.  The pap smear is one of the single biggest success stories of modern medicine (barely behind the discovery of polio vaccine).  The number of cases of invasive cervical cancer in this country has fallen dramatically over the last 60 years mainly because of the pap smear.  Currently, 50% of new cases of cervical cancer today are in women who have never had a pap smear and another 10% in women whose pap smear is abnormal, but have never bothered to follow-up!  In my 25 years of practice I have had two cases of invasive cervical cancer and both of those women walked into my office with the disease already.  No one who has been under my care has developed invasive cancer.

Calcium & Vitamin D

Recently, there has been a lot of medical attention vis-a-vis calcium, and to a lesser extent, Vitamin D.  Many patients are confused, hence this post.  Make no mistake – calcium and vitamin D are crucial for healthy bone.  The current recommendation is for 1000mg of elemental Calcium for women up to age 50 and 1200 mg for women above age 50.  I have been telling my patients for years that you are best off getting your calcium from diet.  Some evidence suggest that calcium supplements may be a factor slightly raising risk for heart disease and kidney stones.  In addition, this is from calcium supplements not dietary sources.  If you are consistently below 1000-1200mg per day depending on your age some supplementation would be appropriate.

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