Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Estrogen: For newly menopausal women, estrogen replacement is one way to prevent bone loss. Estrogen can slow or stop bone loss. And if estrogen treatment begins at menopause, it can reduce the risk of hip fracture up to 50%. It may be taken orally or as a transdermal (skin) patch (for example, Vivelle, Climara, Estraderm, Esclim, Alora).
Many women past menopause also choose estrogen replacement therapy because of its proven usefulness in slowing the progression of, or preventing, osteoporosis.
Recent studies question the safety of long-term estrogen use. Women who take estrogen have an increased risk for developing certain cancers. Although it was once thought that estrogens confer a protective effect on the heart and blood vessels, recent studies have shown that estrogens cause an increase in coronary heart disease, stroke, and venous thromboembolism (blood clots). Many women who take estrogens have side effects (such as breast tenderness, weight gain, and vaginal bleeding). Estrogen's side effects can be reduced with proper dosing and combination. If you have had a hysterectomy, estrogen alone is needed. For women with an intact uterus, progestin is always part of hormone replacement therapy. Ask your doctor whether estrogen is right for you.
SERMs: For women who are unable to take estrogen or choose not to, selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) offer an alternative. For example, many women who have first-degree relatives with breast cancer will not consider estrogen. The effects of raloxifene on bone and cholesterol levels are comparable to those of estrogen replacement. There appears to be no estrogen stimulation of the breasts or uterine lining, which reduces the risk profile of hormone replacement. Raloxifene may cause hot flashes. Its risk of blood clots is at least comparable to the risks with estrogen. Tamoxifen (Nolvadex), commonly used in the treatment of certain breast cancers, also inhibits bone breakdown and preserves bone mass.
Calcium: Calcium and vitamin D are needed to increase bone mass in addition to estrogen replacement therapy.
A daily intake of 1,200-1,500 mg (through diet and supplements) is recommended. Take calcium supplements in doses of less than 600 mg. Your body can only absorb so much at one time. The best way may be to take one supplement with breakfast and another with dinner.
A daily intake of 800-1,000 IU of vitamin D is needed to increase bone mass.
Bone Mineral Density TestsOsteoporosis (or porous bone) is a disease in which bones become weak and are more likely to break. Bone mineral density tests check the strength and solidness ...learn more >>