Osteoporosis, time for some different ideas:

by Dr. Alan Kadish

Osteoporosis has become a massive disease entity with two distinct medical opinions. There are those that feel that this disorder needs treatment to address the symptoms. They employ the calcium and a medication rational. On the other end of the spectrum is the approach that considers that osteoporosis is a sign of other underlying disorders. The concept is to address the underlying causes that lead to this diagnosis. Treatments consist of first ascertaining the issues and then in a systematic fashion resolving the problems.

At the Center of Health™ we choose to address your medical concerns, with an integrated approach. This allows you to choose your options from a number of potentials after thoroughly being able to understand the disorder.

Who ?

When we discuss osteoporosis the magnitude is quite startling. Did you know that according the NIH ( National Institute of Health) Osteoporosis is responsible for more than 1.5 million fractures annually, including: 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures, and 300,000 fractures at other sites. 80% of those affected by osteoporosis are women.

8 million American women and 2 million men have osteoporosis, and millions more have low bone density. One out of two women and one in eight men over age 50 will have an osteoporosis-related fracture in their lifetime. 10% of African-American women over age 50 have osteoporosis; an additional 30% have low bone density that puts them at risk of developing osteoporosis.

Why it matters:

Most people fail to realize that the impact of a fractured hip bone will potentially change your whole life. Let’s review some statistics for hip fractures: 25% , the minority will recover fully…..yes another 50 percent a large majority will neither fully recover (1) or ~12-37 % will ultimately die (2-3) from the fracture generality seconday to hospitalization, a clot, or infection.

Going back to the initial 25% who “fully” recovered consider their newly revised life plan. Forget any potentially high impact sports or even more torsional activities…..I’ll leave your imagination to this comment. When you find it necessary to change your activities of daily living to accommodate a disorder it’s completely disruptive and more than just a pain.

How would you feel if you feared a fall ? What type and level of anxiety would you or your loved ones experience on a daily basis ? How would you change your posture, cloths and a host of other considerations ?

Bone 101:

Bone is a living tissue, in a dynamic equilibrium between building and breakdown. During our first 20+ years of life we have the opportunity to increase the ultimate maximal density.

There are many factors that contribute to either the strong or weak bone mass. The sole concept of calcium, as the key agent responsible for the end result, is absolutely incorrect.

Bone is made up of mineral components which comprises between 60 to 70 percent of the mature bone matrix, with the remainder basically collagen and water. The mineral components provides strength and the organic components provides flexibility.

The bone matrix is composed of both calcium and phosphate salts, and an organic component, that is largely collagen fibers. The calcium and phosphate salts combine to form hydroxyapatite crystals and give bone its amazing tensile strength.

So what  can you do ? Quite a bit as the science of bone metabolism is now much better understood.

The first step is to evaluate our risk factors which are divide into two formats. Those that we can change and those that are fixed.

Risk factors, not under your control

There is an extensive array of factors contributing to your bones integrity. The following lists are intended to give you an outline and start the conversation. Remember that you can modify most of the risks and reverse this disorder.

A family history of osteoporosis…. there probably are some genetic or lifestyle components

Post menopause, including early or surgically induced menopause…assuming no replacement therapy is put into action

Abnormal absence of menstrual periods (amenorrhea)… this is a great indicator of a significant hormonal problem

Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well                                                  

Being female

Thin and/or  having a small frame

“Advanced age”

Factors Under Your Control

Diet, including:

1. Fats…. direct influence on your hormonal status

2. Sugar…really we need to say much here

3. Caffeine use…. mixed issues and probably most conversation should be on amounts

4. Excessive Salt…clearly changes the mineral loss via the kidneys

5. Alcohol Intake…acts as a diuretic and influences mineral loss, but is dose related

Live Style Considerations:

1. Sun exposure… with the extensive conversations conflicting from skin cancers to vitamin D production it’s a balancing act.

2. Exercise….always a good idea and clearly very specific to bone integrity

3. Smoking….sorry this is just plain dumb and the statistics are way to telling so even occasional use is health robbing

4. Medications, there are so many but see the list below for a starting place in evaluating your risk/benefits from your RX’s

5. Emotional and physical stress….adverse amounts will influence the balance and cause multiple organs to impact this disease

Does Osteoporosis have Symptoms ??

There are a number of warning symptoms are available to many, although the classic broken bone without any trauma is like waiting for the light on your dashboard to tell you your out of oil.  You’ve heard sounds for hours or days, before the engine failed.

Have you experience any of these potential danger indicators ? Please keep perspective, these symptoms and signs many also indicate a host of other health concerns so don’t get overly upset if you have some of these symptoms.

This is where good preventive medicine can truly save you from the grief of this disorder.

Cramps in the leg or feet…this can be a warning sign regarding mineral imbalances

Dowager’s hump…a bit late in the process but a clear sign of loss

Periodontal disease….often associated with bone loss before any bone testing is done

Rickets….most children will report pain with activity and it’s a unique reported pain in the bones

Bone pain….see above but it also especially in adults can be a very serious disorder, not osteoporosis

Brittle or soft finger nails….think minerals and absorption both key to good bone health

Heart Palpitations….possibly a mineral issue

Premature gray hair….new research has shown connections with antioxidant status and premature bone loss

Non-traumatic fractures….obviously the bone should not have broken
Associated Diseases to consider that cause bone loss:

A number of diseases can mimic osteoporosis. They have a negative effect on the bone mass, due to their processes of decreasing bone deposition or increasing loss.

Some affect both aspects at once, hence they can result in a very high bone loss rate. We can easily check for these disorders during typical examinations.

Primary Biliary Cirrhosis

Anorexia Nervosa
Hypercalciuria

Cushing’s disease

Bone marrow disorders

Connective Tissue Disorders

Rheumatoid Arthritis

Chronic Obstructive Pulmonary Disease (COPD)

Testing:

The gold standard in testing your bone density is a DEXA machine, that will evaluate both the femur and lumbar spine. ( your hip and back)  

It sends out 2 x-rays and a calculation is done between the difference in energy waves which results in a  measurement of the bone density. The X-ray radiation dose is equivalent to a cross country airline flight.

However it has a time issue when doing retesting. It’s not a good means of checking for changes and will not be used until 18 to 24 months, after the initial study.

There are two FDA approved simple urinary tests which measure the rate of bone remodeling, via cross-linked protein excretion. These include the N-Telopeptides (Ntx) and Pyridinium (pyd) tests, both utilize the second morning urine, hence they are easy to collect and reasonably priced. We use the Pyridinium testing due to it’s apparent increased sensitivity. For further discussion of this test see the Genova Diagnostics Lab web site.

This test can be used, regardless of the time between tests, and are an accurate and non-invasive means of knowing if your therapy is working, well before the 18-24 months of a dexa test.

With dexa testing two scores will be reported : The  T and Z scores will determine your current density, with respect to your age and those in their 20s. The interpretation of the scores is simple. A T score is based on your density, in standard deviations, compared to a young adult.

Between 0 to -1 your bone density is within normal limits. -1 to -2.5 indicates a loss and is termed osteopenia. From -2.5 and greater your density is considered in the osteoporosis category. A Z score is age matched, to your peers.

The next step, in testing, is to determine if your choice of therapy is successful working. DEXA devices, although very accurate, need a lengthy time frame of between 18-24 months for sufficient changes, in your bone density, to give you this information. So a more frequent use is nonproductive. We use the urinary tests more regularly to monitor our therapy and make certain we are adding bone density.

Nutritional Considerations:

When we start our assessment we want to address two distinct aspects of nutritional status. The first is your intake. The questions are not only if and how much is present, but also the quality. The second has to do with timing and digestibility. As you will see a broad array of nutrients are essential for good bone health.

To shatter a myth, pervasively put forward by a particular industry…..calcium is not the key. Interestingly at the turn of the century in the US the average intake of calcium was only 324 mg and the non-traumatic fracture rate was very low. Yes they had differences in their typical lifestyles and there were other factors to consider, but this truly flies in the face of current beliefs.

Vitamins:

D….the advent of simple and cost effective testing makes this an absolute and regular test especially for those of us in the NW
K.…understanding that the area where calcium is deposited is critical we need to know vitamin k status
C….you can’t make good bone without adequate amounts
B6….as a cofactor it’s an essential part in the process and if your using birth control pills your probably not getting enough
Folic Acid….making the proteins in bone and elsewhere makes this another critical player

Minerals:

Calcium…although it is the most discussed and clearly essential it’s not necessarily the main player (Milk is not a good source read the book, “Don’t Drink your Milk”)
Magnesium….this mineral may be the pivotal determining factor to your bones integrity
Boron….a necessary co-factor,  although needed in very small amounts
Zinc….one of the more important and commonly overlooked co-factors in proper maintenance and building of bone
Copper….in a ratio with zinc it determines many of the signals needed for your bones                                                                                                             Silicon….this mineral is one of those found to be necessary to good bone development

Protein:

Both the source and the amount are pivotal to determining your bone matrix density and if the bone will gain or lose it’s integrity.

Hormonal considerations:

The area of hormonal considerations is so intertwined and broad that a full discussion would likely become a book, at the minimum. To simplify the issues, always look in the direction of how the hormone in question will influence the loss or retention of bone components.

When we talk about the hormones affecting your bones we need to evaluate all of the following in order to get the complete picture:

Adrenal, Thyroid, Parathyroid, Ovarian/Testicular and Pancreatic

Consider as a common example the case of a hyperthyroid (excessive) thyroid output condition. This could be as simple as the incorrect dose of thyroid medication or a diseased thyroid.  With an increased metabolism the bone turn over and loss of minerals, via the urine, would be accelerated. Over a period of even months you would loose some degree of bone density.  

The correct balance of all the hormones is essential and very easy to test via saliva. With many of the newest laboratory techniques and the competition in the laboratory marketplace this set of tests is ~$100. Clearly a cost effective means of preventive medicine.

Drugs:

The television advertisements have for years been telling audiences, via a well known actress, that a group of medications known as bisphosphonates is the answer. You can even use a single shot once per year to fix the disease. Well so much for the rap…newer research has shown us that among some patients we may be placing them at  higher risk for other issues and not addressing the bone losses as once thought to be true.

Many have suggested the use of SERMS, a  group of selective estrogen receptor modulators, prescription medications. These can be of service in selected individuals however they are not ideal or a first step in addressing this disorder and can have some significant adverse side effects.

There also is the use of calcitonin a naturally occurring hormone, Teriparatide the only FDA anabolic steroid to build bone and  denosumab an anti-resorption medication.

Gastrointestinal:

This subject area is probably one of the most overlooked but necessary for anyone experiencing osteoporosis. In 30 years of practice I have yet to find an osteoporotic patient without some level of GI upset, that is contributing to their disease.

The evaluation can be easily accomplished with a simple stool sample or blood information and is strongly recommended for a complete overview of the bodies function.

Hypochlorhydria/Achlorhydria…. Lack of the necessary acid to break down ones foods
Lactose Intolerance…. contributes to malabsorption syndrome                                   Allergies….contributes to malabsorption syndrome                                                       Colitis and other diseases of the bowel                                                                           Diarrhea over a period of time…malabsorption syndrome

Adverse Drug List:

Steroids…certainly one of the worst offenders, even low dose over a period of time is significant
Anticonvulsants….
Antacids….creates a malabsorption syndrome                                                   Diuretics contributes to higher than nomad mineral losses                                       Excessive Thyroid medications….leads to an excessive metabolic rate with increasing losses of essential minerals                                                               Heparin therapy….if used for extended period of time                                                 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)  (Ibuprofen® Naproxen®,etc)       Caffeine containing medications

Additional Resources:

Most contain the usual and expected limited vision information and have an underlying story using a botanical, prescription or other miracle process.  As you can see from this article any and all proper medical interventions, for osteoporosis , by necessity should be done in an integrated fashion to get the whole picture and really accomplish positive long term healthy change.

Discussion:

The key consideration in the discussion of your potential, for or expression of osteoporosis, should be focused on the assessment of all causative factors. With the addition of many  long term well studied options to treat osteoporosis and the reduced cost of proper testing why would you consider any other course of action.

The first step in your regaining your health is a comprehensive history, followed by physical and chemistry examinations. Don’t allow this seemingly long listing of potential causes to diminish your resolve to eliminate your risk or disease.

One of the “nice” aspects of treating this disease, is the secondary effect of the enhancement of your overall health.

At the Center we want you to experience optimal health.

 

References:

  1. Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 1998; 128:1010.
  2. Panula J, Pihlajamäki H, Mattila VM, et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011; 12:105.
  3. LeBlanc ES, Hillier TA, Pedula KL, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med 2011; 171:1831.
  1. Some conventional resources
    Osteoporosis and Women’s Health
    National Osteoporosis Foundation
    Osteoporosis Society of Canada
    NIH site for Bone Disorders
    Doctors Guide
    National Osteoporosis Society

Copyright Center of Health™ 6/2014  For permission to reprint this article, please contact the author.

The following two tabs change content below.
Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.