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Monday, March 20, 2006
Dumaguing: 'Fosavance'
By Dr. Vic Dumaguing
OSTEOPOROSIS has become a public health problem of epidemic proportions, affecting an estimated 77 million people in as varied countries as the United States, Europe and Asia, as well as in the Philippines, affecting one of three postmenopausal women and majority of the elderly, including men. Despite its prevalence, the disease continues to be under-recognized and therefore, not treated, thus fractures occur. As a result, large numbers of individuals are subjected to disability and chronic pain. Because there are no warning signs, very few people are diagnosed in time for effective treatment to be administered in the pre-clinical phase.
Osteoporosis is a disease characterized by low bone mass and deterioration of the micro-architecture of bone tissues, which leads to increased bone fragility with a resulting increase in fracture risk. Fractures occur when applied loads are in excess of the capacity of the bone. This capacity is dependent on the degree of mineralization and its architecture. As osteoporosis progresses, both the mineralization and internal architecture deteriorate, increasing the risk that a given load will result in fracture. Osteoporosis is the most common of the metabolic bone diseases. When it occurs without association with other medical conditions, it is referred to as involutional osteoporosis, which is postmenopausal osteoporosis in women (Type I) and senile osteoporosis (Type II). Fractures of the vertebral column are common and are largely responsible for the "Dowager's hump (nakukuba)" deformity, which are very common in elderly women. The morbidity associated with osteoporotic fractures is high in terms of hospitalization and rehabilitation care, with hip fractures leading in incidence in the United States.
Usually, these fractures result in temporary disability, with most patients recovering functions to near pre-fracture levels. However, many patients suffer consequences of fractures resulting in deformity, loss of function, dependence and institutionalization. Of course, depression usually sets in.
However, let us not despair, there is hope! Feb. 26, 2006 was a milestone in the management of osteoporosis in the Philippines when a novel drug, Fosavance, was launched. Fosavance is the first and only osteoporosis medication to provide the unsurpassed fracture prevention at the hip and spine in a single one-weekly tablet containing Fosamax (alendronate) and a weekly dose of vitamin D. The single weekly dose contains 70 mg alendronate and 2,800 IU of vitamin D or cholecalciferol.
Fosavance is indicated for the treatment of postmenopausal osteoporosis in patients at risk of vitamin D insufficiency, and to reduce the risk of spine and hip fractures. Major clinical trials have shown that Fosamax continued to be absorbed and used to reduce bone resorption or demineralization, even in combination with vitamin D.
Vitamin D is an essential component in osteoporosis treatment. Vitamin D plays a vital role in ensuring that the body can absorb calcium from diets as well as from calcium supplements. The fat-soluble nature of vitamin D allows the cholecalciferol to be stored and used in the body for the week, thus allowing Fosavance its very convenient, thus patient-compliant once-weekly dosing. Studies have consistently demonstrated that weekly administration of vitamin D resulted in achieving and maintaining blood levels of 25 (OH) D levels. Calcium levels (normal 9-11mg percent) need to be maintained to support normal bone turnover, build strong healthy bones and prevent fractures.
Like other biphosphonates, Fosavance may cause local irritation of the upper portion of the gastrointestinal tract, particularly the esophagus. To facilitate delivery to the stomach and thus reduce the potential or possibility for esophageal irritation, Fosavance should only be swallowed upon rising for the day 30 minutes before the first food, beverage or medications with plain water only, as mineral water could reduce absorption or alendronate. Patients should not lie down after the intake of Fosavance.
Ageing is a fact of life. Rich or poor, we all grow old. Whether we like it or not, the attrition of age will befall all of us. However, there are many ways to modify and possibly conquer some of those onslaughts. It is our bones that keep us upright. With Fosavance, we can walk towards the sunset years of our lives, our heads high, walking straight and tall, casting a giant shadow behind.
(March 20, 2006 issue)
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