Akshay Jain Clinical and Research Endocrinologist, Surrey, BC Chairman, American Association of Clinical Endocrinologists (AACE) Canada Chapter Dr. Akshay Jain is one of the best Endocrinologist in Mumbai, India. Dr. Akshay Jain moved to the USA after medical schooling to pursue specialization in Internal Medicine. There, he became the only 4-time winner of the prestigious Rochester Academy of Medicine Award during residency.
While working in Rochester, New York, Dr. Akshay Jain worked on many research projects in the field of diabetes. Dr. Akshay Jain also had the opportunity of working at the renowned Cleveland Clinic Foundation Hospital, where his interest in Endocrinology solidified after working with the likes of Dr. Adi Mehta, Dr. Robert Zimmerman and Dr. Sethu Reddy. Dr. Akshay Jain subsequently completed a fellowship in Endocrinology, Diabetes and Metabolism at the prestigious Harbor-UCLA/ City of Hope hospital in Los Angeles, California under the tutelage of Dr. Ron Swerdloff, Dr. Andrew Gianoukakis and Dr. Behrouz Salehian.
It is during this time that he got elected to the Board of Directors of the American Association of Clinical Endocrinologists, becoming the youngest physician to receive this honour. After completing his fellowship, he moved to Calgary, Canada in 2013 where he practiced alongside Dr. Stuart Ross. In the 3 years he worked there, Dr. Akshay Jain was ranked the #1 endocrinologist in Calgary and Alberta (#3 In Canada) on the basis of patient reviews on www.RateMDs.com.
Osteoporosis and newer medications
Our understanding of bone health has changed dramatically over the years. We now know that bones are living organs. They consist of osteoblasts, which are cells that are constantly laying down new bone, and osteoclasts, which are cells that are chewing away old bone.
Between the osteoblasts and the osteoclasts, there is a constant rate of bone formation and a rate of bone destruction. When the rate of bone destruction is far greater than the rate of bone formation, bones become quite weak and that is how osteoporosis occurs.
There are two broad types of bone medications. Antiresorptives, which decrease the rate of bone destruction, and anabolics, which increase the rate of bone formation. The newer medications are either stronger, safer antiresorptives, or are anabolics, or even a combination of the two.
It is very important to note that osteoporosis is a chronic condition and one that likely requires treatment for a very long period of time. Some of the newer antiresorptives have long-term data that show these agents have ongoing benefits and are safe even when used for a prolonged period.
The anabolic agents, on the other hand, help build up a bone bank very quickly, and are used for a short duration. The increased bone mass can be maintained for a long duration by ongoing use of antiresorptives.
Bisphosphonates continue to be a good low-cost, generic option that works well for most cases of mild to moderate osteoporosis. However, some people may develop side effects like gastric reflux on oral pills or bisphosphonates, or flu-like symptoms on intravenous bisphosphonates. Also, if despite taking bisphosphonates one still develops worsening bone density, suffers from a fracture, has poor kidney function or has a significant degree of osteoporosis, then other agents should be considered, and these can also be considered as firstline.
Bisphosphonates typically work only on the surface level of the bone and not deep within, which is why many people might still need medications that are more potent. Options include six monthly skin shots of Denosumab, which works at a much deeper level of the bone, or bone-building agents like Teriparatide or Romosozumab, which increase the bone mass, after which one can continue on antiresorptives ongoing.
The risk of osteoporotic fractures in women is higher than the risks of breast cancer, heart attacks and strokes combined. A previous fracture increases the risk of future fractures by 40%, and nearly 23% of women with a hip fracture will die within one year of the fracture. It is very important to use safe and effective osteoporosis medications that reduce the occurrence of such fractures.
Presenter: Dr. Akshay Jain, Endocrinologist, Surrey, BC
Local Practitioners: Endocrinologist