Osteoporosis, affecting 25 million Americans, is a condition in which the bones become fragile and fracture easily. This article will discuss the causes, testing methods and treatments available for prevention and reversal of Osteoporosis.
For many years, I used to think that Osteoporosis was a calcium deficiency disease. However, this is not really true. The reality is that we get plenty of calcium in our diet and the real problem is actually excess calcium loss due to our American Diet and Lifestyle. Simply put, our diet is the culprit. For example, soda pop, refined foods and animal protein promotes bone loss. According to Dr T. Colin Campbell from Cornell, there is considerable evidence for this, and the solution is to eat more fruits and vegetables and less animal protein.
According to Dr. Susan Brown, dietary factors which influence acid-alkaline balance determines this rate of calcium loss from the bones. An acidic diet high in animal protein will cause loss of calcium. An alkaline diet high in fruits and vegetables will prevent calcium loss from bones. See her excellent article: Acid-Alkaline Balance and Its Effect on Bone Health by Susan E. Brown, Ph.D., CCN, and Russell Jaffe, MD, Ph.D., CCN, International Journal of Integrative Medicine, Vol. 2, No. 6 Nov/Dec 2000
Caffeine, Soft Drinks, Smoking, Alcohol and lack of exercise are major lifestyle factors leading to Osteoporosis. Weight bearing exercise is useful for building strong bones. Remember all the T.V. Ads with the milk mustache on the celebrity? The actual research says that milk and dairy products don't help strengthen bones. In the Sept. 2000 issue of A.J. Clinical Nutrition, Dr. Roland Weinsier, M.D., reviewed 57 research studies and concluded that milk and dairy foods do not promote bone health.
The xray at the right shows severe osteoporosis of the spine. Dark glue has been injected to strengthen the weakened vertebral body. This is called a vertebroplasty and is the final stage of severe osteoporosis.
Diagnostic Testing-Bone Density Scan:
For years we had no idea how to test for Osteoporosis until 1994 when the DEXA Scan was invented. This machine measures bone density by passing a dual energy x-ray beam through your body. However, the DEXA Scan reveals nothing about the actual strength of the bone which is more important than bone density. The DEXA test result is called a T-Score and this is based on comparison with a healthy 20-30 year old bone density. The T-Score concept is misleading and probably should be changed. Everybody loses bone density as they age and you don't necessarily have a disease because your bone density isn't the same as your daughters. The Z-score which compares your bone density to other women of your age group is closer to reality. Although Bone Mineral Density (BMD) measurement can predict the risk of fracture, it cannot identify individual women who are going to fracture.
There are two simple urine tests which measure bone protein loss (Urinary NTx and Dpd ). These are helpful in determining if your bone building program is successful. However, most doctors are unfamiliar with these simple urine tests.
Drugs Commonly Prescribed forOsteoporosis:
Fosamax and Actonel:
These drugs were thought to be useful because the Fracture Intervention Trial (FIT) with Osteoporotic women who already had fractures showed increased bone density on DEXA Scan and decreased fracture rate over the four years on the drug. However, these drugs kill bone cells called osteoclasts and cause a dramatic reduction in bone formation which some researchers think will eventually lead to weak bones which fracture more easily. In support of this cautionary note, Dr. Odvina at the University of Texas (Mar 2005 J Clin Endocrin Metab) reported on nine patients who sustained spontaneous nonspinal fractures while on Alendronate (Fosamax) therapy, six of whom displayed either delayed or absent fracture healing. "Public health campaigns to encourage women with osteopenia and no additional fracture risk factors to take antiresorptive medications (Fosamax) do not appear to be justified," stated Dr. John T. Schousboe from Park Nicollet Clinic, Minneapolis, MN, in the May 3rd issue of the Annals of Internal Medicine.
Other drugs such as Forteo which is recombinant Parathyroid Hormone given by daily injection does stimulate new bone formation, however, this drug requires a special warning label because lab tests showed formation of cancerous bone tumors in rats on the drug. In addition, elevated parathyroid hormone levels are known to cause bone erosions called "subperiosteal erosions" and "brown tumors" which are holes in the bone.
Calcitonin, another hormone type drug was previously available by injection, is now available as a nasal spray. This shows some usefulness for patients with existing painful vertebral body fractures, but is not recommended for mild osteoporosis.
What about Nutrtional Supplements?
Calcium Doctors are recommending and everyone (including my wife) is taking extra Calcium. Is this really necessary? There is plenty of calcium in the diet in green leafy vegetables. If you insist on taking Calcium, then at least take an absorbable form such as Calcium Citrate or Calcium Lactate. However, extra Calcium may cause kidney stones, constipation, and arterial calcifications, so be careful.
Many researchers think that the average American diet is deficient in Magnesium which has a multitude of health benefits. This mineral is important to balance the Calcium you are taking. Trace minerals such as boron, manganese, zinc, copper, silicon, strontium are all important. Low levels of stomach acid (called hypochlorhydria) common in the elderly can prevent absorption of calcium and other minerals needed for strong bones.
A publication in Osteoporosis International, Dec 2002 by Dr. JReginster examined the effects of strontium on early postmenopausal bone loss. Women who took 340 milligrams of strontium a day for two years had a 3 per cent increase in bone mineral density, compared to the placebo group which decreased in bone density. This means that Post-Menopausal women without osteoporosis and no hormone replacement can take only strontium and calcium and still benefit with an increase in bone density with strong, normal bone with no adverse side effects.
Here are some recent references showing that strontium supplementation reduces risk of osteoporotic fracture:
Osteoporosis Int. 2005 Oct;16(10):1291-8. Epub 2005 Jun 29.
Ugeskr Laeger. 2005 Sep 12;167(37):3485-7. Strontium ranelate: a new therapeutic principle for postmenopausal osteoporosis Mosekilde L, Nielsen LR, Vestergaard P.
J Clin Endocrinol Metab. 2005 May;90(5):2816-22. Epub 2005 Feb 22.
Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study.
Strontium a nutritional supplement in the U.S and does not require a prescription and is available from Pure Encapsulations, (800-753-2277)
www.purecaps.com and is contained in Osteo-Mins, the Osteoporosis formulation of Alan Gaby, M.D., and Jonathon Wright available from Progressive Laboratories (800-527-9512; www.progressivelabs.com)
Vitamin D is made by the body from natural sunlight exposure and is needed for proper calcium absorption and strong bones. If you live in Florida, you can get vitamin D from sunlight exposure. Too much supplemental vitamin D can cause toxicity and make serum calcium levels go up which will alarm your doctor. If you avoid the sun, or dont know how much you need, a blood test called 25-OH vitamin D will determine how much supplemental Vitamin D you need.
The K stands for "Koagulation" in Danish. This vitamin is often given as an injection in the hospital to correct blood thinning disorders of the liver and to reverse the blood thinning effect of Coumadin. Vitamin K is important in bone formation because it activates osteocalcin, a protein which attracts calcium to bones.
Serum vitamin K levels are much lower in hip fracture patients than in normals of the same age. Vitamin K administration in patients with non-healing fractures may cause the fractures to unexpectedly heal. The best sources of dietary vitamin K are green vegetables. Vitamin K is manufactured by friendly intestinal bacteria which are susceptible to routine use of antibiotics. This is another good reason to replace friendly colonic bacteria with Probiotics after antibiotic administration.
Results of bone-loss testing suggest 5 to 10 milligrams of vitamin K daily is sufficient to retard bone loss. Fortunately, vitamin K is virtually nontoxic. However, use caution as Vitamin K will reverse the effect of the blood thinner drug, Coumadin. So if you are takingCoumadin, DONT take vitamin K. Sources of vitamin K: Super K (10 milligrams per softgel ) Life Extension Foundation (800) 544-4440 www.lef.com
Vitamins B6, B12, and Folic acid deserve mention, because they bring elevated levels of homocysteine down to normal. (In addition to contributing to atherosclerosis, homocysteine also promotes bone loss.)
Bio-Identical Hormone Therapy:
Synthetic hormones derived from horse urine are no longer recommended by the FDA for treatment of Osteoporosis because of adverse side effects, namely breast cancer and heart disease. On the other hand, Bio-Identical Hormones such as Human Estrogen (Estradiol), Progesterone and Testosterone have been shown to be excellent at promoting new bone formation, and are safe to use under the care of a knowledgeable physician. In a study published in the August 2003 Journal of the American Medical Association (JAMA) by Dr. Prestwood at the University of Connecticut Center on Aging, women 65 years of age were given low dose (0.25 milligrams) Estradiol daily for three years and showed significant improvements in bone mineral density with no reports of breast cancer.
The following nutrients and doses constitute a typical and thorough daily bone-rebuilding supplement program:
calcium citrate 800-1,500 mg
magnesium glycinate 300-500 mg
manganese 5-10 mg
zinc 15-30 mg
copper 2-3 mg
boron 3-6 mg
silicon (plant source)
folic acid 1-3 mg
omega-3 fatty acids
bio-identical hormone replacement
Celiac disease: A considerable number of women with osteoporosis will have gluten intolerance or celiac disease as the cause. There is a blood test to screen for this. and the treatment is to avoid foods that contain gluten found in wheat and various breads. However, the blood tests such as serum transglutaminase are unreliable because they show only late end-stage disease, so you may need a dietary trial of withholding gluten products to see if this helps.
Henri deToulouse-Lautrec's Disease:
(the short, famous artist)
What does this Man have in Common
with the Biphosphonate Osteoporosis Drugs ?
Toulouse-Lautrec had PYCNODYSOSTOSIS, which means "dense bone disease", a rare bone disease caused by defective cathepsin K, found only in osteoclasts. The osteoclasts are non-functional resulting in dense bones which fracture easily. At age 12, Toulouse-Lautrec fractured his left mid femur from minor trauma, and at age 14 he suffered a similar fracture of the other femur. The fractures failed to heal properly, so he only attained a height of 4.5 feet.
Look at the similarities in this Comparison Chart:
Toulouse-Lautrec Biphosphonate Drugs
Defective Osteoclasts Defective Osteoclasts
Dense Bones Dense Bones
Spontaneous fractures mid femur Spontaneous fractures mid femur
Delayed fracture healing Delayed fracture healing
Osteomyelitis of Jaw Avascular necrosis of Jaw
Severe bone and joint pain Severe bone and joint pain
The obvious conclusion is that Biphosphonate drugs create the findings of Toulouse-Lautrec's rare genetic bone disease called "pycnodysostosis".
See Dr. Dach's recent : "Bisphosphonate Drugs Are Creating a New Generation of Toulouse Lautrecs" on the blog.
Books on Osteoporosis:
Better Bones, Better Body : Beyond Estrogen and Calcium, by Susan E. Brown PhD, Russell Jaffe MD (c) 2000 Keats.
see her educational web site: www.betterbones.com
Jefffrey Dach MD 4700 Sheridan, Suite T, Hollywood, Fl 33021 Phone: 954-983-1443
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