Month: May 2023

Do adults also need routine Vaccinations?

/ Subash Rau / Leave a comment

It’s not only children who need to be vaccinated. Even adults need vaccinations to boost their immunity against common infections and to help them stay healthy. It is a commonly held belief that in terms of physical strength from birth, human beings reach a peak at age of 20, maintain it between the ages of 20 to 30 after which it is all downhill.

A similar phenomenon happens with regards to our body’s immunity against infections and it is referred to as immuno-senescence. This usually occurs after the age of 50 yrs. Young children and adults build up their immunity by acquiring infections and by vaccinations. This keeps them protected. Immunosenesence affects all parts of the immune system,both the cellular arm as well as the humoral (antibody) arm reducing their ability to produce antibodies as well as the ability to gobble up bacteria and digest them.

Recently, after the Covid pandemic, talk about vaccinations seems to upset many people. Many believe that vaccines are a gimmick and are employed by the pharmaceutical industry and doctors only to make money. Many others also believe that vaccinations have some common and terrible side-effects and therefore must be avoided at all cost. What must be recognised is that except for the Covid vaccines most vaccines have been vigorously evaluated for safety, potency, side-effects and have taken many years to be developed. But even Covid vaccines have been shown to reduce the pneumonia to just a mere flu like illness! While I am not denying the the possibility of side-effects to the vaccines, it is my opinion that vaccines have a significant benefit in keeping people healthy and away from hospitals!

Why are vaccines important?

Vaccines are the most important methods of improving our immunity against specific infections. If people stop taking vaccines, it could possible lead to the increase in previously uncommon infectious diseases. Vaccinations have ensured that quite a few diseases have been eradicated or completely suppressed. Smallpox is no longer prevalent in the world. Many other infections like polio are less of a problem today than they were in the past. Therefore, you cannot deny that vaccines have made a big difference. The WHO says that vaccine hesitancy as one of the biggest threats to global health (when people who have access to vaccines delay accepting or refuse the vaccine).

How to look at Vaccines?

Do we ask if vaccines are needed for our children. A majority of the vaccines are given to our children without us referring to google or questioning the rationale because childhood vaccination as they have stood the test of time. Vaccinations has been proven beyond doubt to be helpful and necessary to have healthy children. However, of late the medical fraternity is getting the same amount of confidence to recommend certain vaccines to adults i.e., those above the age of 60-65 yrs and younger especially when they have certain disease conditions. In one study done in the US on those above the age of 60 yrs who received “routine” adult vaccinations and were then followed up for 10 yrs, showed a 40% reduction in pneumonias, 40 % reduction of heart attacks (which often happen after a pneumonia) and a 40% reduction of hospitalization and all cause mortality. This changed my perspective completely! There are 6 vaccines (if Covid is included) that must be offered to those above the age of 65 yrs routinely and for those above 60 if they have specific diseases.

Below are the vaccinations that are recommended for adults based only on age.

Vaccines recommeded based on Age criteria alone.

Contact me for any clarifications!

The low down on Osteoporosis

/ Subash Rau / Leave a comment

1 in 2 women and 1 in 5 men above age of 50 suffer a osteoporosis related fracture in their lifetime. Bone mineral density is a balance between osteoclastic resorption and osteoblastic formation. Numerous hormonal and dietary factors influence the balance between bone production and resorption. However Osteoclasts work faster than osteoblasts leading to bone loss after menopause. Osteoporosis is typically asymptomatic until a fracture occurs, spine and hip fractures are the most common.

What are the risk factors for osteoporosis?

Advancing age (>70 yr), previous fragility fractures, steroid therapy, parental history of hip fractures, low body weight (BMI <20-25), current cigarette use, excessive alcohol consumption physical inactivity are risk factors for osteoporosis.

What are the medical conditions that are associated with osteoporosis?

Endocrine conditions such as hyperthyroidism, hyperparathyroidism, Diabetes mellitus, steroid excess, hypogonadism (primary or secondary to Androgen deprivation therapy), Systemic conditions such as malabsorption (Inflammatory bowel disease, Primary biliary cirrhosis and after gastric bypass surgery), malignancies (myeloma and mastocytosis), Chronic kidney failure, chronic lung disease (COPD), Rheumatogic conditions and drugs such as anticonvulsants, steroids, aromatase inhibitors, cancer chemotherapy, heparin, lithium and hormonal (antihormonal) therapies and infections such as HIV are associated with Osteoporosis.

How is Osteoporosis diagnosed?

Osteoporosis is diagnosed based on the DEXA scan and using an online tool called the FRAX score.

Who should be screened for osteoporosis?

Women older than 65yr and men above 70yrs should be screened. If the age is between 50-69, they can be screened if they have risk factors or if they suffer from conditions mentioned above that cause osteoporosis.

How is the DEXA scan interpreted?

The DEXA scan gives two values, the T score and the Z score (which is the score matched to age and gender). The Z score is used when the DEXA is done for men <50 yrs of age, healthy premenopausal women and children. (Z score of -1 to -2.5 indicate Osteopenia and > -2.5 indicate osteoporosis)

How frequently should the DEXA scan be done?

The recommedatons for the frequency of the DEXA scan is based the result.

How do you interpret the FRAX score?

The T score from the DEXA scan can be misleading as it has been validated only on white women and may not be accurate for others. The WHO therefore developed the FRAX score which gives an estimate of the 10 yr risk of an osteoporotic fracture and could help planning appropriate treatment for the condition.

How is Osteoporosis treated?

1. To correct lifestyle risk factors: patients must be encouraged to eat healthy, stop cigarette smoking and take alcohol in moderation, to exercise regularly (antigravity exercises) and weight loss. A fall assessment must be made and all possible interventions to prevent falls must be made.

2. Calcium and Vit D supplementation: as below

3. Medical management of Osteoporosis?

Initial management would include resorption inhibitors call bisphosphonates. Oral medications include Alandonate, Residronate and Ibandronate. Annual intravenous medications are also available such as Zolendronate. Those intolerant to Bisphosphanates or unresponsive or have contraindications can be started on Denosumab which is a monoclonal antibody directed towards the osteoclast and therefore reduces bone resorption. Denosumab course must be followed by bisphosphonate therapy. Bisphosphonate therapy isnt forever. Oral bisphosphonates must be stopped after 5 yrs and i.v Zolendronate must be stopped after 3 yrs of use (3 annual doses).

If antiresorptive therapy doesnt help anabolic agents such as Teraparatide, Abaloparatide or Romosozumab and Estrogen antagonist such as Raloxifene can be tried. Teriparetide must be stopped after 12-26 months of continuous use and must be followed up with Bisphosphonate therapy.