The Unknown About Bone

Five to seven percent of bones, organs of the skeletal system, are recycled per week. Old, brittle bone is dug out by osteoclasts to make way for osteoblasts, which replace the trenches with new, healthy bone. When the cycle breaks down, osteoclasts break down bone faster than osteoblasts can create. This is called bone resorption, the main cause of osteopenia and osteoporosis. The holy grail for Big Pharma is to find drugs that can reduce bone resorption and build back healthy, dense bone. The current class of drugs, called bisphosphonates, are able to block resorption, but in turn reduce bone building activity, thus leaving old, brittle bone. These drugs also come with a growing list of side effects.

So where does the future lie in mitigating bone resorption?

Reduce Inflammation
Osteoporosis is a chronic inflammatory disease. If you "put out the fire," you reduce reduce the severity of the condition. Diet and balancing omega 3 to omega 6 ratio are crucial to reducing inflammation. Our Pain Relief Diet and Best of the Mediterranean Diet are two anti-inflammatory food plans we highly recommend. Reducing stress (see Improve Your Mood Action Plan) is also very important.

Calcitonin (Miacalcin)
Calcitonin is actually an old drug that was kicked to the curb because Big Pharma never saw it as a blockbuster. It has a very safe track record when administered intranasally. The naturally occurring peptide hormone (derived from salmon) participates in calcium and phosphorus metabolism, inhibits osteoclast activity, increases bone mineral metabolism, may help regulate Vitamin D levels, and may even positively affect osteoarthritis.

The most relevant clinical trial to evaluate the effect of calcitonin in the prevention of bone fractures was the Prevent Recurrence of Osteoporotic Fractures (PROOF) study, a 5-year double-blind, randomized, placebo-controlled trial showing that salmon calcitonin nasal spray at a dosage of 200 IU/day can reduce the risk of vertebral osteoporotic fractures by 33%.

This drug is prescription only, so speak to your physician or pharmacist.

Ostera
Ostera is a non-prescription alternative. The revolutionary nutraceutical has just been introduced by Metagenics. Researchers screened thousands of natural substances for their effectiveness in reducing bone resorption in vivo. Upon choosing berberine and hops extract, they conducted a 77 subject human trial with impressive results. Along with seeing lower osteoclast activity, there were increases in bone formation. Complete with magnesium, calcium, adequate vitamin D, optimal diet, and weight-bearing exercise, you have the ideal natural combination for osteoporosis prevention in postmenopausal women.

Vitamin D
For those who have not had their vitamin D3 level [25(OH)D] checked yet, what are you waiting for? Normal vitamin D levels are as essential to proper bone remodeling as any component. The daily maintenance dose has also risen sharply in the last few years, but is completely based upon individual needs. Please check with our office or your physician.

Teriparatide (Forteo)
Approved by the FDA in 2002, Recombinant human parathyroid hormone is administered by daily subcutaneous injection for a maximum of 18 months (oral and nasal delivery systems are in the pipeline). When given alone to a patient with osteoporosis, it will stimulate bone formation (5 to 10 percent per year in lumbar spine) within each remodeling cycle and cause a positive bone balance within each cycle.

It is currently recommended as second line therapy to bisphosphonates because of increased risk of bone cancer (osteosarcoma in rats). In typical FDA fashion, long-term safety studies are being performed well after approval. When the FDA approved Forteo, it did so conditionally, requiring, among other things, that the manufacturer conduct a 10-year study to learn whether patients taking it are more likely to develop bone cancer. The manufacturer also agreed not to advertise Forteo directly to consumers and to educate physicians that the drug is intended only for patients at high risk of fractures. So far, only one case of osteosarcoma has been reported among the 250,000 patients for whom Forteo reportedly has been prescribed since it was introduced in 2002.

Teriparatide is the first FDA approved agent for the treatment of osteoporosis that stimulates new bone formation. Not one bisphosphonate drug can claim that.

Natural Hormone Balance
Being a Certified Menopause Educator, there are numerous natural methods for balancing hormones post-menopause. The two safest options I usually recommend are natural, standardized, topical hormone creams (for more, see Bonnie on Bioidenticals), and the herb Black Cohosh. A study that appeared in the April issue of Fertility and Sterility reported that postmenopausal women treated with Black Cohosh underwent a decrease in the urinary concentration of N-telopeptides, a marker of bone resorption, and an increase in alkaline phosphatase, a marker of bone formation, at the third month of therapy. Dosage regmines vary and need to be administered to the individual.

Absorbable Calcium and Magnesium
In recent years, the recommended average of supplemental calcium has gone down while magnesium has gone up. The sources of these two nutrients are essential for absorption. We prefer MCHC (microcrystalline hydroxyapatite) for calcium because it rarely constipates and its trace minerals mirror the matrix of bone which greatly enhances absorption. For magnesium, we prefer the glycinate source because it does not disturb the GI tract, and being bound to the amino acid glycine, assures supreme absorption.

For further information, refer to our Healthy Bones Action Plan.

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