Men's Osteoporosis Support GroupOsteoporosis therapy initiation while an in-patient; the Calcium-Alkali Syndrome J Am Geriatr Soc. 2010 Apr;58(4):650-7. Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. Jennings LA and others. PMID: 20398147. This was a very large study of over 51 thousand individuals who had been hospitalized after osteoporotic hip fracture. Noting that, " . . .osteoporosis treatment can dramatically reduce fracture risk," the authors were checking to see if any form of osteoporosis therapy was initiated in the hospital after osteoporotic fracture. They found 6.6% received calcium and vitamin D while 7.3% received antiresorptive or bone-forming medications. Only 2% were prescribed ideal therapy of the combination of calcium and vitamin D along with antiresorptive or bone-forming medications. Only 27.2% of the people who received antiresorptive or bone-forming medications also got calcium and vitamin D. Editor's comments. In one of the most understated conclusions I've ever read, the authors said, "Rates of in-hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care." In essence rates of in-hospital initiation of osteoporosis treatment wasn't low, it was virtually non-existent. But, in defense of the orthopedists who treated the fractures, their primary concern was the acute problem of a broken bone. It is possible that many of these patients were given referrals to see a physician after they were out of the hospital. But sadly, this was not mentioned in the abstract if that was the case. There is no way to describe the issue of a person with an osteoporotic fracture who either isn't started on approved osteoporosis medication while an in-patient, or referred for diagnosis and treatment after they were out of the hospital, but medical malpractice. But, we don't know for sure that was the case because post-hospital treatment is not mentioned. As I've said many times before, if you have a fracture as the result of low-trauma fall, you must assume you have osteoporosis until proven otherwise. And you must assume your orthopedic surgeon doesn't know this and won't refer you unless you request it. I have a friend who recently fractured his femur in what nearby people described as a case of it fracturing before he hit the ground--they could hear the snap, then saw him fall. He doesn't recall the exact sequence of events. I wrote him initially and briefly mentioned getting checked for osteoporosis, but never got a response to that. So later I followed up more forcefully to ask if he had been referred for diagnosis and treatment. At that time he scheduled an appointment with an endocrinologist, was found to be almost -2.5 S.D. from normal, and was started on Fosamax, calcium and vitamin D. Note that even with normal or osteopenic bone density, he qualified as having osteoporosis just from the low-trauma fracture. So I repeat, after a low-trauma fracture, you must assume you have osteoporosis until proven otherwise. Demand a referral to a qualified physician who can diagnose and treat osteoporosis. Here are links to find an endocrinologist or rheumatologist in your vicinity. To see what the consequences of not effectively treating the osteoporosis after a first fracture, here is a 2010 Finnish study by Kaukonen JP and others that followed 221 consecutive hip fracture patients for 5 years. They found 12% had a second fracture and that 76% of the time it was the same type fracture. They stated, "Concomitant use of calcium plus vitamin D and anti-osteoporotic drugs was insufficient among the patients." Note that 12% of the people in the Jennings and other study would be more than 6,100 people. One study found the cost of a fracture in people older than 72 years was over $19,000 U.S. dollars, not including the physician's care. So the savings would be enormous if therapy was instituted after fractures that prevented all future ones. Not to mention the savings if the first fracture could be prevented, too. J Am Soc Nephrol. 2010 Apr 22. [Epub ahead of print]. Got Calcium? Welcome to the Calcium-Alkali Syndrome. Patel AM, Goldfarb S. PMID: PMID: 20413609. These authors are recommending changing the name from the milk-alkali syndrome to the calcium-alkali syndrome. Although they state that women are most often affected by it, men are too. It can result from over-the-counter supplements of calcium and vitamin D which are commonly taken by those of us with osteoporosis. It causes hypercalcemia, excess blood calcium, which can cause very serious problems, especially kidney stones, but other potentially serious or fatal conditions can follow. So it must be taken seriously, or ideally, prevented by not taking an excess of calcium from diet or supplements. Editor's comments. Obviously the best thing here is to avoid this condition entirely. And that is quite simple, don't take too much calcium and/or vitamin D. It is not the case of having a small amount be good, so a large amount would be better. Recommendations for calcium intake suggest no more than 1,200 mg/day for any age level, and the safe upper limit is 2,000 to 2,500 mg/day. And you have to remember that antacid mediations that many people use are often calcium carbonate items. So you likely don't need to take calcium supplements along with antacids.
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