Doctor
Steven R. Goldstein MD, is a top Gynecologist in NYC in private practice for over 25
years. Dr. Goldstein had this to say regarding an April 9th NY Times article on
Osteoporosis.
In
yesterday‘s New York Times (April 9th 2019), a teaser on the front
page was entitled “Treatment for brittle bones”. The article itself was
entitled “Osteoporosis drug deploys genetic tool to build bone”. On Tuesday the
FDA approved a new drug known as Evenity (generic is romosozumab-aqqg). The
article talks significantly about the fact that this is the first drug that
restores bone without breaking it down. Understand that bone is a dynamic
organ. It is constantly being laid down and taken away until the day you die.
Estrogen is a potent inhibitor of taking bone away. This is why when women at
menopause stop making estrogen they lose bone rapidly. Most of the commonly
employed medications to prevent and treat osteoporosis are such
“anti-resorptives” (they inhibit the taking away of bone like estrogen did
yielding a net positive balance). There are some injectables that are anabolic
bone drugs (like Forteo or Tymlos) that actually build bone but do not inhibit
some of it’s taking away. Previously these have been reserved for the most
severe cases and are limited to 18 months of use because of some bone cancers
observed in rodents. This new drug, Evenity, actually uses genetically
engineered blocking antibodies to restore bone without breaking it down.
To some of
you who may have read the article, this may sound like a wonderful breakthrough
and something you might in fact be interested in. Understand, this was a
clinical trial of close to 8,000 women. All of them had
osteoporosis and at least one pre-existing
osteoporotic fracture of the vertebral column. In other words, all these women
were extremely high risk. Bone health is
increasingly one of the most important issues for my patients. As longevity has
increased dramatically over the last generation or two, so many women are
living into their early 90s. Suffering a hip fracture will result in 25% of
women never living independently again and 20 to 30% will be dead within one
year. My patients should be as concerned about their bone health as any other
aspect of their lives as they pursue “healthy aging.”
My take-home
point, however, is that this drug is an excellent “arrow in the quiver” of
clinicians who take care of women with severe osteoporosis and previous fracture. It is a monthly injectable. It is
not for patients with average bone loss or early osteoporosis. It should be
reserved for the most severely affected patients. It is not without potentially
serious side effects. The most serious ones, as pointed out in the article,
were a statistically significant increase in heart attacks, strokes, and even
sudden death among women who used this medication. That is why, obviously, it
should only be reserved for severely affected women with osteoporosis and
pre-existing fracture.
Dr.
Steven R. Goldstein MD is a top Gynecologist
in NYC. Dr. Goldstein is a Professor of Obstetrics and
Gynecology at New York University School Of Medicine. He is also a Past
Chairman of the American College of Obstetrics and Gynecology, New York section,
Past President American Institute of Ultrasound in Medicine and is currently
the Director of Gynecologic Ultrasound at NYU Langone Medical Center. He is a
Certified Menopause Practitioner and holds many other positions and
accreditations. You may visit Dr. Goldstein’s website at www.goldsteinmd.com for more information
on him and to make an appointment with a top Gynecologist in NYC.
No comments:
Post a Comment