National Osteoporosis Foundation  invites you to participate in the following free, live educational webinars as part of this year’s Healthy Bones, Build Them for Life webinar series.

Safe Pilates and Yoga for Bone Health Presented by: Sherri Betz PT, GCS, CEEAA, PMA® and Matthew J. Taylor PT, PhD, RYT Date: Thursday, October 20, 2011 Time: 2:00 pm to 3:15 pm (EST)

Balancing the Benefits and Risks of Osteoporosis Treatment Presented by: E. Michael Lewiecki MD, FACP, FACE Date: Tuesday, December 6, 2011 Time: 1:00 pm to 2:00 pm (EST)

Each webinar will be presented live through the internet. Online participants will have an opportunity to submit questions to the presenters. If you don’t have internet access, you can listen to the presentations by phone.

Register now: Please visit www.nof.org/webinars or call Peach New Media toll-free at 1 (866) 702-3278 to register.

written by Deborah McBain, CNM MSN

written by Deborah McBain, CNM MSN

Changes in mammogram recommendations this year have confused alot of us.  Most experts agree that the benefits of mammograms far outweigh the risks.  The primary risk of mammograms is “false positives”.  This is when a mammogram detects a potential problem which turns out  not to be cancer.  This results in unneccessary testing, pain and anxiety.  Whether benefit outweighs risk is more controversial for women younger than 50. 

Below is information about new research being published soon:

The potential cancer risk that radiation from mammograms might cause is slight compared to the benefits of lives saved from early detection, new Canadian research says.

The study is published online and will appear in the January 2011 print issue of Radiology.

This risk of radiation-induced breast cancers “is mentioned periodically by women and people who are critiquing screening [and how often it should be done and in whom],” said study author Dr. Martin J. Yaffe, a senior scientist in imaging research at Sunnybrook Health Sciences Centre and a professor in the departments of medical biophysics and medical imaging at the University of Toronto.

“This study says that the good obtained from having a screening mammogram far exceeds the risk you might have from the radiation received from the low-dose mammogram,” said Dr. Arnold J. Rotter, chief of the computed tomography section and a clinical professor of radiology at the City of Hope Comprehensive Cancer Center, in Duarte, Calif.

Yaffe and his colleague, Dr. James G. Mainprize, developed a mathematical model to estimate the risk of radiation-induced breast cancer following exposure to radiation from mammograms, and then estimated the number of breast cancers, fatal breast cancers and years of life lost attributable to the mammography’s screening radiation.

They plugged into the model a typical radiation dose for digital mammography, 3.7 milligrays (mGy), and applied it to 100,000 hypothetical women, screened annually between the ages of 40 and 55 and then every other year between the ages of 56 and 74.

They calculated what the risk would be from the radiation over time and took into account other causes of death. “We used an absolute risk model,” Yaffe said. That is, it computes “if a certain number of people get a certain amount of radiation, down the road a certain number of cancers will be caused.”

That absolute risk model, Yaffe said, is more stable when applied to various populations than relative risk models, which says a person’s risk is a certain percent higher compared to, in this case, those who don’t get mammograms.

What they found: If 100,000 women got annual mammograms from ages 40 to 55 and then got mammograms every other year until age 74, 86 breast cancers and 11 deaths would be attributable to the mammography radiation.

Put another way, Jaffe said: “Your chances are one in 1,000 of developing a breast cancer from the radiation. Your changes of dying are one in 10,000.”

But the lifetime risk of breast cancer is estimated at about one in eight or nine, he added.

Due to the mammogram radiation, the model concluded that 136 woman-years — that’s defined as 136 women who died a year earlier than their life expectancy or 13 women who died 10 years earlier than their life expectancy — would be lost due to radiation-induced exposure. But 10,670 woman-years would be saved by earlier detection.

The data to estimate deaths from radiation exposure was gathered from other sources, such as from patients who received radiation from the nuclear weapons used in Japan. “We really don’t have any direct evidence that any woman has ever died because of radiation received during the mammogram,” Yaffe said.

“I’m not minimizing the concern of radiation,” Rotter said. “Everything is a balance.” For example, younger breasts, particularly those of women aged 40 to 49, are more sensitive to radiation than breasts in older women, but the new study shows it’s better to get the screening mammography than skip it.

written by Deborah McBain, CNM MSN

You may recall in 2002 when news that the WHI  study was stopped  due to unexpected increased incidence of  heart attacks and stroke,  media coverage caused multitudes of women to abandon their hormone therapy cold-turkey.    Lots of women did not understand that the risk may not have actually applied to them personally.   It is a pretty complicated issue to be covered in a headline.   Now new data from the Women’s Health Initiative (WHI) regarding estrogen plus progestin hormone therapy and breast cancer published in Journal of American Medical Association (JAMA) on 10/20/10 (Chlebowski RT, et al) has experts buzzing.

 The study:  ”Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women“ is a further analysis of the Women’s Health Initiative randomized study of postmenopausal women taking conjugated equine estrogen plus medroxyprogesterone acetate, conjugated equine estrogen  alone or placebo (sugar pill).    After a follow-up of 11 years,  it is found that  the women taking estrogen with progestin had increase risk of  invasive breast cancer compared with women taking placebo.   Even more important was the evidence that women on the combined hormones had a  higher risk of dying from the disease. Ok, I know this is scary, but before you trash your hormones…

This is what you need to consider:

•  A 2004 report published in JAMA on the estrogen-alone component of the WHI found no increase in breast cancer risk among women with hysterectomy over an average of 7 years of randomized treatment.  
• The absolute risk  amounts to 2.6 deaths from breast cancer (in the combined hormone group) vs 1.3 deaths (in the placebo group) per 10,000 women per year.
• While the absolute risk of breast cancer death  is small, it is  increased for women taking combined estrogen plus daily progestin.
• Experts continue to recommend hormone therapy for menopause symptoms only, using the lowest dose for the shortest period of time.

This is what you should do:   

• If you have had a hysterectomy and are on estrogen only, don’t sweat it.
• Weigh the risks and benefits. Can you manage your symptoms with life style changes?   Exercise, weight, stress and alcohol management can make a huge difference.  It takes more committment than taking a pill but the rewards are worthwhile.   
• Consider a trial off your hormones every 6-12 months. Things change. Maybe your symptoms have too.
• Lower your dose.  Use the lowest effective dose, for the shortest period of time.
• If  life is so much better with hormones that you decide to continue, there are other ways you can reduce your risks.  To repeat: Exercise, weight, stress and alcohol management can make a huge difference. 

Remember that if you have a uterus, taking estrogen alone can cause cancer of the lining of the uterus.  Progestins are needed to prevent that from happening.  Good for the uterus, bad for the breasts.  So researchers continue their quest for answers to the following questions:

• Do the same risks for breast cancer apply for different kinds of progestins such as micronized progesterone?
• Can risk safely be reduced by reducing exposure to progestins by taking them intermittently,  like every 3 months instead of daily?

Stay tuned, talk to your health care provider and keep asking your own questions.

written by Deborah McBain, CNM MSN

I can’t count how many times I have had a patient sigh and ask me, ” How long does menopause last?”  I want to sigh back and say, “until you die’”, but I cannot be that mean.  Of course what they are really asking is how long do the symptoms last.  I can assure them that hot flashes generally subside over time, even if it takes years.  The craziness of perimenopause with its irregular bleeding and mood swings will calm down as well once  menstruation completely stops.   The thinning of the vaginal tissue is an inevitable consequence of the waning estrogen of menopause but can usually be effectively treated. 

But once these symptoms are addressed there is something very important that I want every woman to know about menopause.   That while the symptoms subside, the effects of menopause do last a lifetime.  The awareness on your body changes is an opportunity for you to reevaluate your health.  The decisions you make about your life style now can make the difference in how well you will live the rest of your life and how long that life will be.  Even more important than addressing the symptoms of menopause is addressing health risks as you age.  This includes the increasing risk of heart disease, thinning bones. cancer ( not just breast but lung, colon, skin as well) and diabetes.    The age of menopause is often a time of other life changes as well.  Managing  the stresses of aging parents, retirement or job loss and relationship issues are common challenges.   There is much you can do with exercise, weight management and nutrition that can add health and vigor to  your life.  Gathering resources, information and social support can make a huge difference as well.  Check out the variety of subjects of the classes and events offered at various  Henry Ford Health System locations.   The link is on the right.  In November we are addressing stress and depression.  Just in time to shore up for the holidays and the long dark days of winter.  It’s all part of the big picture of being healthy and it may be more than you think.

written by Deborah McBain, CNM MSN

 If you missed the support circle meeting on October 13 at Fairlane Medical Center in Dearborn, you missed an inspirational discussion about what it means to be diagnosed with breast cancer.  Three of the eight women attending had that experience.  The women who did not have that experience got a valuable insight into how the disease may be diagnosed and  the various ways each individual copes with the process of emotionally coping with and fighting the disease and healing.  Those who shared their breast cancer experiences with the group received support and catharsis.  With their permission I share their picture with you.  Breast cancer concerns each one of us.  It’s good to feel we are not alone.

written by Deborah McBain, CNM MSN

 Are we  aware already?!  When I was feeling that  this  month’s pink ribbon blitz was getting a bit much, I had to stop and reflect.  Why does this disease trigger such emotion?  And why is this bugging me?  It’s bugging me because I suspect, highly, that many companies are more interested in exploiting the high emotion of this disease  for commercial gain than they are in supporting the cause.  There isn’t much that doesn’t sport pink  in October from soup to soap, football players to hard lemonade. See http://www.usatoday.com/yourlife/health/medical/breastcancer/2010-10-05-1Aalcoholcancer05_ST_N.htm?csp=hf .   On the other hand awareness is good and pink is a good color on me.  So, I suppose,  this is a case where capitalism pays off for all.   I will choose to overlook the likely less than pure motivation.

As far as emotion, I think the fear of breast cancer is bred in to every woman.   It was described  3500 years ago by Egyptian physicians as always fatal and remained so until relatively recently.  A hundred fifty years ago Dr. Halstead, a New York surgeon, pioneered the radical masectomy.  This is a surgery removing the whole breast, chest muscle and underarm lymph nodes.  This offered some hope but left women disfigured and in chronic pain.    In the early 20th century breast cancer survival rate was 10%.   The first mammogram machine debuted in 1966.  Routine mammograms became standard for breast cancer detection just 34 years ago.  Now with early detection, a woman with stage 1 breast cancer has a 100% survival rate.  Less than 10% of women need more than a lump removed from their breast.   Radiation and chemotherapy side effects are improving.  Three years ago when I was diagnosed with breast cancer, the fear was numbing.  But it did not turn out as bad as (anywhere near)  what I imagined and more and more women are relieved to have that same experience. 

Which brings me to my next subject: breast cancer survivors.   I always shy away from this label.  To me, survivors have endured something life threatening.  And if you have been diagnosed with Stage 1, then not so much.   But this term is now generally defined as anyone who has been diagnosed with breast cancer.  To read more about the pros and cons of this label, read Elaine Schattner’s interesting post discussing this issue: ttp://www.slate.com/id/2268104/pagenum/all/.

To get a real perspective on the breast cancer experience come join us on Wednesday, October 13, 6:30-8:00 pm at Fairlane Medical Center, Dearborn.  See Support Circle page  for link to register and click on Fairlane link for direction.  This promises to be a very enlightening evening and we will also have a fun drawing for “pink stuff” for all participants.  Hope to see you there. Go pink!

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written by Deborah McBain, CNM MSN

Received a request  to pass on the following information from Ms. Anne Tkaczyk  at University of Michigan.  They are looking for volunteers for a menopause research project.   Please check out the details below if you are interested.

  Title: Hormones and Cognitive Processing in Early Postmenopausal Women Study
number: HUM 00023241

Women between ages 45 and 55 are needed for a study of the neurobiological
effects of hormone therapy in healthy early postmenopausal women.  The study
includes general health assessment at the U-M Medical Center, memory testing,
fMRI scans of the brain and hormonal treatment.  Maximum compensation $500.
Please call Anne at (734) 647-7266 tkaczyk@umich.edu

Website: http://www.umclinicalstudies.org/

written by Deborah McBain, CNM MSN

These are the latest recommendations from  the National Endocrine Society:   The following was taken from a recent Medscape report.  The bottom line is that for certain groups of women, namely healthy women younger than 60, benefits of hormone therapy may very well outweigh the risks.   And so the pendulum begins to swing again…

June 29, 2010 — A new Endocrine Society scientific statement published in the July 2010 issue of the Journal of Clinical Endocrinology & Metabolism evaluates benefits and risks for postmenopausal hormone replacement therapy (HRT), now known as menopausal hormone therapy (MHT). The statement, entitled “Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement,” was also posted online ahead of print on June 21 and presented in San Diego, California, at ENDO 2010: The 92nd Annual Meeting & Expo.

Although MHT was in widespread use in the 1990s in hopes of lowering cardiovascular disease risk as well as to treat menopausal symptoms, the Women’s Health Initiative (WHI) Study showed that MHT was actually associated with an increased risk for heart disease, stroke, and breast cancer. However, recent evidence suggests that these risks may be affected by time after onset of menopause when MHT was started, a factor not considered in the WHI assessment of MHT safety and efficacy.

“Before the WHI, MHT was believed to prevent heart disease, fractures, memory loss and dementia in addition to relieving uncomfortable menopausal symptoms,” said task force chair Richard J. Santen, MD, professor of medicine at the University of Virginia in Charlottesville, in a news release. “Following the WHI reports of increased health risks associated with MHT, MHT use declined by 80%. New data however [show] that these health risks may not apply to all women using MHT, and that MHT may in fact be very beneficial to some women.”

Controversy regarding WHI’s applicability to women just entering menopause stems from the fact that the average age of participants was 63 years, and only 3.5% of the women were aged 50 to 54 years, which is the age range when women typically decide whether to start MHT. Furthermore, the WHI did not address menopausal symptom relief. Therefore, this scientific statement considered new data from later studies evaluating the effects of MHT in women aged 50 to 55 years.

Compared with women who begin MHT after age 60 years, those who begin MHT a short time after onset of menopause at ages 50 to 59 years appear to benefit. According to recent evidence, women in the short-time group using MHT for 5 years had a 30% to 40% reduction in mortality risk and no increased cardiovascular disease risk. In addition, they had a 90% decrease in hot flashes, overactive bladder, or other menopausal symptoms.

“Some women in the short-time group still developed breast cancer but only with the combination of estrogen plus a progestogen, not with estrogen alone,” Dr. Santen said. “This may be due to the stimulation and uncovering of very small, undiagnosed breast cancers, rather than causing these cancers de novo.”

Conclusions Reached

Evaluation of the new data along with WHI evidence led the task force to reach the following conclusions, with level of evidence A:

• “Standard-dose” estrogen used with or without a progestogen is associated with marked reduction in frequency and severity of hot flashes. For many women, lower doses of estrogen are also effective.
• For symptoms of vaginal atrophy, very low doses of vaginal estradiol are effective.
• Symptoms of overactive bladder may be reduced by estrogen given vaginally or systemically.
• Vaginal estrogen is associated with lower rates of recurrent urinary tract infections.
• For women in late postmenopause, estrogen given with or without a progestogen is as effective as bisphosphonate therapy for preventing early postmenopausal bone loss and increasing bone mass.
• Use of estrogen alone and estrogen plus a progestogen is associated with a lower incidence of hip and vertebral fractures.
• Treatment with the selective estrogen receptor modulator raloxifene is associated with increased bone mineral density and lower rates of vertebral, but not hip, fractures.
• Use of MHT containing estrogen plus a progestogen is linked to a lower risk for colon cancer.
• Raloxifene is associated with a lower risk for breast cancer.
• Mammographic density is increased in women taking estrogen alone or with a progestogen.
• Sexual function is improved by physiologic amounts of transdermal testosterone, but not by dehydroepiandrosterone.
• Risk for venothrombotic episodes is approximately doubled in women using MHT, and this risk is multiplicative with baseline risk factors such as age, increased body mass index, thrombophilias, surgery, and immobilization.
• Use of raloxifene is associated with an increased incidence of venothrombotic episodes.
• Raloxifene is not associated with any increase in stroke risk.
• In older women with preexisting vascular disease, hormone use does not reduce stroke incidence.
• Although continuous estrogen plus a progestogen does not cause endometrial cancer, estrogen alone without a progestogen is associated with an increased incidence in endometrial cancer. 
• Risk for gallbladder disease is increased in women using estrogen alone or with a progestogen.
• MHT started after age 60 years does not improve memory.

“It is important to remember that most women considering MHT are between the ages of 50 and 55 and in this group MHT may have many benefits,” Dr. Santen concluded. “Physicians and their patients need to re-think the use of [MHT] based on data pertinent to the 50-55 year old and therapy should be individualized based on symptoms and underlying risks of breast cancer and heart disease.”

written by Deborah McBain, CNM MSN

Keeping our bones strong is essential to our overall health and quality of life.  Throughout life we constantly lose old bone and form new bone, reaching our peak bone mass between the age of 25 and 35. But after age 35, women tend to lose bone, a loss that accelerates after menopause. Women can lose up to 20 percent of their bone density in the five  to seven years after menopause. Therefore, it is important to protect our bones and keep them healthy by maintaining a balanced diet rich in calcium and vitamin D.

Calcium is the building block for bones. Calcium is found in milk, leafy green vegetables, soybeans and foods fortified with calcium. Over the age of 50, the US RDA is 1200-1500 mg per day. Some great ways to meet these recommendations is eating a well balanced diet rich in calcium. One cup of skim milk=300 mg, one cup of plain yogurt=400 mg, one cup of broccoli=72 mg, one cup of spinach=150 mg and one cup vanilla frozen yogurt (soft serve)=205 mg. For more information on calcium rich foods, visit http://www.whfoods.com/genpage.php?tname=nutrient&dbid=45

Vitamin D is essential for the absorption of calcium. Most vitamin D comes from the sun. However for those of us who live above the Mason-Dixon line, we may not be getting enough sunlight, especially during the winter months. Thirty minutes of sun provides from 10,000-12,000 IU of vitamin D. Vitamin D is found naturally in a few foods such as salmon, mackerel, canned tuna,  sardines and eggs. Many foods are fortified with vitamin D, including milk and breakfast cereals.

Taking calcium with vitamin D can provide a nice supplement to your dietary intake. It is important to take the calcium and vitamin D with food to promote absorption, and if taking 1200 mg of calcium daily, it should be taken in two divided doses to maximize effectiveness.  Also important to remember, if you are taking thyroid medication, synthroid and calcium supplements should be seperated by four hours.

Strong bones support us, provide the framework for our muscles and allow us to move. Our bones are a storehouse for vital minerals, they protect our heart, lungs, brain and other vital organs. It is important to take care of our bones, so they can continue to take care of us.

written by Suzanne Mahoney, FNP-BC