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Osteoporosis

Mechanisms

  • Decrease in bone anabolism (building, done by cells called osteoblasts)
  • Increase in bone catabolism (resorption, accomplished by osteoclasts)
  • Damage to the structure of the bone. When bone is resorbed, the trabecular bone (also called cancellous bone) loses entire trabecular struts. (With antiresorbing drugs the disconnected trabeculae are not reconnected but the existing trabeculae widen.)
  • Osteoporosis is an inflammatory disease. [How does this work?]
  • Elevated homocysteine hinders collagen cross-linking, resulting in defective bone matrix.

Nutritional requirements for bone building

  • Calcium
  • Vitamin D
    • Vitamin A (retinyl palmitate) appears to interfere with the action of Vitamin D. Beta-carotene, a precursor of A, does not have this problem — but some people don't convert beta-carotene well to Vitamin A.
  • Boron
  • Magnesium
  • Phosphorus
  • Strontium [?check]
  • Vitamin K
  • Vitamin B6
  • Vitamin B12
  • Folic Acid
  • Glutathione
  • — And more! for a discussion of interactions between factors, see Osteoporosis on The World's Healthiest Foods, a website of the George Mateljan Foundation.

To increase bone building

  • Parathyroid hormone (PTH)
    • When elevated, PTH is a good predictor of hip-bone mineral density.
      • Low levels of estrogen increase sensitivity of bones to PTH, resulting in increased resorption of calcium from bones.
    • However, when administered intermittently, PTH has exactly opposite effects, stimulating osteoblasts.
      • approved to treat both men and women at high risk of fracture.
      • side effects called "generally mild" [what does that mean?]
      • must be injected daily for up to 2 years
  • Teriparadide (brand name, Forteo: Synthetic PTH, made using recombinant DNA.)
  • Calcitonin, a hormone produced by the thyroid gland -
    • stimulates calcium absorption by bones when blood calcium levels are excessive.
    • increases bone mass in women who are more than 5 years past menopause
  • Natural progesterone.
  • Exercise

To reduce resorption

  • Eating less animal protein, which results in an acid metabolic condition. See Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans by Marc Maurer et al, Am J Physiol Renal Physiol 284: F32-F40, 2003
  • Estrogen
  • Fosamax (alendronate, a biphosphonate) — One critic, at UltraPMS.com, describes it thus:
    "a metabolic poison used to make chemical cleaners. A common use of this chemical is the manufacture of cleaners that remove soap scum from your bathtub.

    FOSAMAX — BUYER BEWARE!

    Since its approval, Fosamax (alendronate) has become the world’s best-selling osteoporosis treatment. The drug is heavily advertised to doctors and women as a bone fracture preventive.

    Two studies, both funded by Merck, the manufacturer of Fosamax, showed virtually no change in bone density or bone growth after two years of testing. Fosamax is the eighth drug in this class of drugs that has failed. There is no evidence whatsoever that Fosamax prevents osteoporosis or prevents bone fractures.

    Fosamax is a poison that actually kills the osteoclasts. It is quite clear that if you kill these cells your bone will get denser. Four years later the bone actually becomes weaker even though it is denser. Fosamax does not build any new bone.

    The problems with this drug are extremely dangerous, widespread, and growing. One in three women taking Fosamax complain of upper gastrointestinal symptoms such as abdominal pain, ulcers, and heartburn.

    The company's own medical insert warns consumers not to lay down after taking Fosamax for fear that the drug will burn a hole in the stomach or esophagus."
  • Sodium fluoride - does result in increased bone density, especially in the spine. However the structure of the bone is damaged, and the bone is weaker. See Fluoride and Bone - Quantity Versus Quality, by Robert Lindsay, M.B., CH.B., PH.D. From the New England Journal of Medicine, March 22, 1990, Volume 322, Pages 845-846.

Tests

  • Bone Density scanning, with DEXA (Dual Energy Xray Absorptiometry) is the test most often used — precise, widely available and inexpensive (or free).
    • However, it takes 18-24 months for changes to show up.
    • Interpretation is an issue too. See Bone mass measurements: reasons to be cautious by S. M. Ott (BMJ 1994;308:931-932 [9 April]) which points out (among other things, and with references) that
      • "the size of clinically important changes in bone mass is less than the measurement error. A walk around the room causes the measurement to change by up to 6% (at the hip), which corresponds to six years of bone lost at the usual rate."
      • "pharmacological interventions that increase bone mass by [50%] do not necessarily decrease fracture risk by 50%"
        • One reason is irreversible loss of trabeculae
        • Another: old bone is denser than newly formed bone. Lowering bone turnover thus increases bone density without increasing volume.
  • Urine tests for cross-linked bone protein show how bone modeling is currently affected by a treatment.
    • N-Telopeptides (Ntx)
    • Pyridinium (pyd) — considered more sensitive. See Great Smokies Lab's description of their Bone Resorption Assessment.

For more information...

See also Menopause