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Screening, treatment of osteoporosis in premenopausal women unclear

By Jennifer Southall
1st on the web (October 12, 2009)

Recent research suggests that a higher percentage of premenopausal women than previously reported may have idiopathic osteoporosis, in turn experiencing one or more low-trauma fractures and/or having very low bone density.

In a study published in the Journal of Women’s Health, researchers at Columbia University in New York evaluated 61 premenopausal women at an osteoporosis referral center. Of these women, 39% were considered to have idiopathic osteoporosis, with no known secondary cause identifiable.

“It is important to evaluate premenopausal women for secondary causes of osteoporosis in order to guide treatment of their condition,” Adi Cohen, MD, MHS, of the division of endocrinology in the department of medicine at Columbia University College of Physicians and Surgeons, told Endocrine Today, a sister publication of Orthopedics Today. “In some women, no secondary cause can be found. More information is needed to determine appropriate clinical management for these women.”



She added: “There is an important distinction between people diagnosed on the basis of low bone density and those diagnosed based upon fracture. Those who have low trauma fractures are said to have osteoporosis, but those who have only low bone density and no known secondary cause may or may not actually have compromised bone strength.”

Fractures and low bone mass are less common in premenopausal women than postmenopausal women and are usually attributed to secondary causes such as estrogen deficiency, glucocorticoid exposure or hyperparathyroidism, according to Cohen. Low bone mass in premenopausal women may be related to inadequate peak bone mass acquisition or ongoing bone loss.

Who to screen, who not to screen

Bone density screening by DXA is not routinely recommended to define osteoporosis in premenopausal women.

“Bone density measurements do not clearly predict fracture risk in young premenopausal women the same way that they do in postmenopausal women. Data obtained from a bone density test in a younger woman are not nearly as helpful in determining the need for treatment,” Cohen said.

On the other hand, bone density measurement is recommended for premenopausal women with known secondary causes of osteoporosis or history of fragility fracture.

“There are categories of young women who should have bone density testing, and that includes women who have a secondary cause of osteoporosis, such as glucocorticoid treatment, gastrointestinal malabsorption, anorexia nervosa or other causes of amenorrhea,” Cohen said.

Medical record review

In the Journal of Women’s Health study, Cohen and colleagues reviewed medical records for all premenopausal women with low BMD and/or low-trauma fracture evaluated at the Columbia University referral center during 2005 (n=61; mean age, 37 years; 93% white). Fifty-seven percent of women had a family history of osteoporosis and 43% had been given bisphosphonates. The researchers aimed to estimate the proportion of premenopausal women with idiopathic osteoporosis as opposed to secondary osteoporosis.

The most common secondary causes of osteoporosis were amenorrhea (34%), anorexia nervosa (16%) and glucocorticoid exposure (13%). After exclusion of secondary causes, 39% of the overall cohort and 48% of women with fractures had idiopathic osteoporosis.

“A certain percentage of the group did not have any cause after extensive evaluations,” Cohen said. “We learned a lot from this chart review.”

In addition, women with known secondary causes had lower BMD z scores at the spine and hip compared with those with idiopathic osteoporosis. Women with low BMD and no fractures had shorter stature and weighed less than women with fractures.

Breast Cancer, what you should know about Testing and Diagnosis

The chance, that breast cancer is found early, it is more likely to be treated successfully. Checking for cancer in a person who does not have any symptoms is called screening.

Screening-Tests for breast cancer include, among others, clinical breast exams and mammograms and there is a very important base in the health-service for women.

The doctor or other health care professional can check the breasts and underarms for lumps, during a clinical breast exam, which could be a sign of breast cancer.

What is the “mammogram”?

“The mammogram is a special x-ray of the breast and that can often detect cancers that there are too small for a woman or her doctor to feel them. “

A lot of studies show's that mammography screening has reduced the number of deaths from breast cancer. But also, some other studies have not shown a clear benefit from mammography. So- you can't get a 100% results!

But, to day there are no other ways to check out the breast cancer with a good percentage. Concerning that, the Scientists are continuing to examine the level of benefit that mammography can produce. The National Cancer Institute recommends the following:

• you are a woman in your 40s, you should have mammography screening every one to two years.

• you are a woman age 50 and older, you should have mammography screening every one to two years.

• If you are a woman who is at higher than average risk for breast cancer, you should seek expert medical advice about whether to begin screening before age 40 and how often to have screening mammography.

The results are between 5 and 10 percent of mammogram not normal and require more testing. The one good information - the most of these follow-up tests confirm that no cancer was present.

What will be this "more testing"? The doctor will call it a “Biopsy”. The procedure which is needed is to take a small amount of fluid or tissue must remove from the breast to make a diagnosis. A doctor might perform fine needle aspiration, a needle or core Biopsy, or a surgical Biopsy.

This tissue goes to in the lab, this tissue will be checked on the pathologist examines under the microscope and the results let him see if any of the cells are cancerous.

In the last time, the Doctors are studying another new type of surgical biopsy that removes less breast tissue. This new type is called an image-guided needle breast biopsy, or stereotactic biopsy.

With this new system - If approved for general use, we can await, that the result's are much more efficient and clearly, so that the doctors would become an important surgical tool.

Please take note, that eighty percent of U.S. women who have a surgical breast biopsy do not have cancer!

***But take also note, that women who have breast biopsies are at HIGHER RISK of developing breast cancer than women who have never had a breast biopsy.***

If you know that “- you will have perhaps a second opinion of the doctor's information's.

The last technical review - With the magnetic resonance imaging, or MRI, and ultrasound we have two other techniques which the researchers think might detect breast cancer with greater accuracy and with lower risk!

What's can help you?

Other new techniques used to find cancer include a new way of reading mammograms called digital mammography.

Magnetic resonance imaging, or MRI, and ultrasound are two other techniques which researchers think might detect breast cancer with greater accuracy.

The Cause Of Cancer

Cancer is the disease of the cells. It is an abnormal
growth of cells, which tend to reproduce in an
uncontrolled way and, in some cases, spread or
metastasize. A cancerous growth or tumor is also
known as a malignant growth or tumor. A growth or
tumor, which is non-malignant is called benign. Such
tumors are not cancer.

Cancer is not a single disease. It is a group of more
than hundred different and distinctive diseases. It is not
contagious. Cancer can involve any tissue of the body
and have many different forms in each body area. Most
cancers are named for the type of cell or organ in which
they start. If a cancer spreads (metastasizes), the new
tumor bears the same name as the original(primary)
tumor.

Cancer is the Latin word for crab. The ancients used
the word to mean a malignancy, doubtless because of
the crab-like tenacity a malignant tumor sometimes
seems to show in grasping the tissues it invades.
Cancer may also be called malignancy, a malignant
tumor, or a neoplasm (literally, a new growth).

In medicine, common term for neoplasms, or tumors,
that are malignant is known as Cancer. Like benign
tumors, malignant tumors do not respond to body
mechanisms that limit cell growth. Unlike benign
tumors, malignant tumors consist of undifferentiated, or
unspecialized, cells that show an atypical cell structure
and do not function like the normal cells from the organ
from which they derive. Cancer cells, unlike normal
cells, lack contact inhibition; cancer cells growing in
laboratory tissue culture do not stop growing when they
touch each other on a glass or other solid surface but
grow in masses several layers deep.

Cancer results from mutations of certain genes that
allow the cells to begin their uncontrolled growth. These
mutations are either inherited or acquired. Acquired
mutations are caused by repeated insults from triggers
(e.g., cigarette smoke or ultraviolet rays) referred to as
carcinogens. There is usually a latency period of years
or decades between exposure to a carcinogen and the
appearance of cancer. This, combined with the
individual nature of susceptibility to cancer, makes it
very difficult to establish a cause for many cancers.

The most significant avoidable carcinogens are the
chemical components of tobacco smoke. Dietary
components, like excessive consumption of alcohol or
of foods high in fat and low in fiber rather than fruits and
vegetables that contain antioxidants and necessary
micronutrients, have also been linked with various
cancers. Some cancers may be triggered by hormone
imbalances. For example, some daughters of mothers
who had been given DES (diethylstilbestrol) during
pregnancy to prevent miscarriage developed vaginal
adenocarcinomas as young women. Aflatoxins are
natural mold byproducts that can cause cancer of the
liver.

Certain carcinogens present occupational hazards. For
example, in the asbestos industry, workers have a high
probability of developing lung and colon cancer or a
particularly virulent cancer of the mesothelium (the
lining of the chest and abdomen). Benzene and vinyl
chloride are other known industrial carcinogens.

Risk to humans from carcinogens depends upon the
dose and a person's biologic susceptibility. Factors
influencing a person's biological susceptibility to cancer
include age, sex, immune status, nutritional status,
genetics, and ethnicity.

Cancer Diet - Minerals

A cancer diet needs a good balance of minerals because minerals are needed by all cells for proper function. Patients are often found to be mineral deficient, so this is an area of the diet that needs particular attention.

There are two classes of minerals. Macrominerals, such as the well known calcium, magnesium, sodium, potassium and phosphorus, and microminerals, such as boron, chromium, copper, iron, iodine, germanium, sulfur, silicon, vanadium, zinc, manganese and molybdenum.

The good news is we will get most of the minerals we need, provided we are eating a diet based on a wide variety of fruits and veggies, with the addition of nuts, seeds and grains.

Where we can get in to trouble is that minerals are washed out of soils with constant rain, and modern fertilizers don't usually contain the wide variety of minerals we need. Organic gardeners usually use rock minerals on their soils and this results in organic produce have a much higher and broader range of minerals.

Germanium is one micromineral that cancer patients are often low on. It is essential for immune function and is critical to tissue oxygenation. Cancer grows rapidly where there is low oxygenation of cells. Germanium is found in broccoli, celery, garlic, onions, rhubarb, sauerkraut and tomato juice as well as aloevera and ginseng.

Iodine deficiency has been linked to breast cancer in more than one study. Seasalt contains iodine and a variety of minerals rather than the isolated highly processed iodine additive in table salt. Asparagus, garlic, lima beans, soybeans, sesame seeds all contain natural iodine along with the nutrients needed for good absorption.

Large amounts of brassicas eg brussels sprouts, cabbage and cauliflower, along with peaches, pears and spinach can block absorption of iodine, so ensure there is a balance of iodine rich foods in your diet.

Selenium has been linked to cancer. Selenium and Vitamin E work together to attack free radicals. Selenium is critical for pancreatic function, and pancreatic enzymes are critical to the bodies ability to fight tumour activity. This mineral is generally found in meat and grains, however countries such as New Zealand and much of America is known to have selenium deficient soils.

As there have been several studies showing that good selenium levels have significantly reduced the risk of cancer, this is one mineral you want to have enough of.

Food sources that should be included frequently in a cancer diet are: brazil nuts, broccoli, brown rice, brewers yeast, chicken, kelp, onions, salmon, seafood, tuna, wheatgerm and whole grains. Garlic, chamomile, ginseng and parsley are all easy to use concentrated forms that can be added to the diet daily.

A couple of warnings:

Be very careful about self-dosing with minerals as several of them will block absorption of others if the dose is too high.

Again, eating a variety of foods, with particular notice taken of those that have high mineral levels is the safest way to go. If you wish to explore mineral supplementation further, talk to your naturopath or nutritionist. But whatever you do, don't ignore the importance of these vital elements to your well being.