The Collison Newsletter August 2015

 

            PROTECTION  AGAINST  OSTEOPOROSIS          

                         How Beneficial are Drugs?*  

 

Osteoporosis is defined by the World Health Organisation (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young healthy adults) as measured by duel-energy X-ray absorptiometry; the term 'established osteoporosis' includes the presence of a fragility fracture.

 

Osteoporosis has no symptoms. Its main consequence is the increased risk of bone fractures. Osteoporosis fractures occur in situations where healthy people (with normal bones) would not normally break a bone. They are therefore regarded as 'fragility fractures'. Typically, fragility fractures occur in the vertebral column, rib, hip and wrist.

 

Osteoporosis affects more than one million Australians. Professor Marcus Seibel, who runs the fracture liaison service at Sydney's Concord Hospital, has said that 70-80% of people who go to a GP, hospital or specialist with a bone fracture are not being properly diagnosed and treated for osteoporosis. Each year, 140,000 Australians have fractures due to osteoporosis, at a direct annual cost of A$1.6 billion.

 

Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, causing a loss of bone thickness (bone density or mass). Any bone can be affected by osteoporosis, but the most common sites are the hip, spine and wrist. Because osteoporosis causes no symptoms, it is often called the 'silent disease'.

 

Osteoporosis means 'porous bones' or 'bones with holes'. Healthy bones, as seen under the microscope, have a honeycomb-like structure. In osteoporosis, there are holes or spaces in the honeycomb that are much larger than normal.

Risk Factors for Osteoporosis

  • Some 80% of osteoporosis occurs in females, especially during and after menopause. This is when there is a marked drop in oestrogen which may cause the bones to lose calcium and other minerals at a faster rate than they can be replaced. 
  • A positive family history of osteoporosis 
  • Low vitamin D 
  • Low calcium levels
  • Medical History
    • Treatment with steroid drugs 
    • Hormones: low oestrogen in females, low testosterone in males 
    • Over active thyroid (hyperthyroidism) 
    • Overactive parathyroid (hyperparathyroidism) 
    • Malabsorption due to coeliac disease or inflammatory bowel disease 
    • Some chronic diseases such as rheumatoid arthritis, chronic liver disease and renal disease 
    • Certain medicines used in the treatment of breast and prostate cancers, epilepsy and depression
  • Lifestyle Factors
    • Low levels of physical activity 
    • Smoking 
    • Excess alcohol 
    • Weight: too thin and obesity. 

Diagnosis of Osteoporosis 

The diagnosis of osteoporosis is made by a bone density scan, generally of the hip and spine, but may include the wrist. A 'T-score' is measured, referring to the number of standard deviations from normal healthy bones. The bone density scan is:

 
·         NormalT-score+1 to -1
·         OsteopeniaT-score-1 to -2.5
·         OsteoporosisT-score-2.5 or lower

The Orthodox Treatment of Osteopenia and Osteoporosis 

If the bone scan has a normal T-score (between +1 and -1), it is recommended that there is an adequate intake of calcium, enough vitamin D and regular exercise.

 

If osteopenia is present, immediate action should be taken to minimise further bone loss by ensuring that calcium and vitamin D levels are adequate, and that regular weight bearing exercise is carried out.  It is important to address risk factors. It is generally recommended having repeat bone scans every 1-2 years to monitor progress. It should be remembered that osteopenia is not a disease, but merely a measurement of bone density or strength. It does not mean that there is a medical problem.

 

The orthodox management of osteoporosis is treatment with specific osteoporosis medications, as well as the recommendations for osteopenia.

 

The main drugs in the treatment of osteoporosis are the bisphosphonates.

Bisphosphonates 

Bisphosphonates are a group of drugs used to treat osteoporosis.

 

Bones are dynamic ... they are constantly being broken down and reformed. There are two different cell types responsible for this process:

  • Osteoclasts. These bring about bone resorption (breakdown or removal). They dissolve the bone and make small cavities within the honeycomb-like structure of the bones. 
  • Osteoblasts. These cells fill the cavities with new bone.

These two cell types work in close sequence.

 

The bisphosphonates work by slowing down the activity of the cells that breakdown bone, namely the osteoclasts. Therefore they slow down bone loss, allowing the osteoblasts to work more efficiently laying down new bone. Thus they help to strengthen bone and slow down the progression of osteoporosis. It is claimed that people who take bisphosphonates are less likely to fracture a bone.

 

There a five bisphosphonates:

 
·         Alendronate sodium (with or without vitamin D)Fosamax
·         Ibandronate sodiumBoniva
·         Risedronate sodiumActonel
·         Zoledronic acidReclast
·         Etidornate disodiumDidronel
 

They all work in essentially the same way, and have similar side effects. It takes several months for bisphosphonates to work. Usually there is an increase in bone density 6-12 months after you start the treatment. It is generally recommended to take the tablets for at least five years.

Side Effects of Bisphosphonates 

It is important that the medication is taken according to the instructions the prescribing doctor or pharmacist will give you. For example, the tablets should be taken on an empty stomach with no food for at least an hour. Plenty of fluids are essential to protect the kidneys.

 

Fosamax is widely prescribed in Australia. It is manufactured by Merck (or outside of the USA and Canada, Merck Sharp and Dohme) an American pharmaceutical company.

 

The following information, re cautions and side effects of Fosamax, is from their website (www.merck.com):

 

"You must take once weekly Fosamax exactly as directed to help make sure it works and to help lower the chances of problems with the esophagus."

"If you have chest pain, new or worsening heartburn, or have trouble or pain when you swallow, stop taking Fosamax and call your doctor."

 

Possible serious side effects of Fosamax:

  • Fosamax may cause troubles in your esophagus (see caution above) 
  • Esophagus problems may get worse if you continue to take Fosamax 
  • Mouth ulcers (Do not chew or allow Fosamax to dissolve in your mouth) 
  • Flu-like symptoms, typically at the start of treatment 
  • Allergic reactions (hives, swelling of the face, lips, tongue or throat) 
  • Jaw-bone problems - infection, delayed healing after tooth extraction. 
  • Abdominal pain - "most common side effect"

Less common side effects:

  • Nausea 
  • Vomiting 
  • Bloated feeling 
  • Constipation 
  • Diarrhoea 
  • Black or bloody stools 
  • Gas 
  • Eye pain 
  • Rash, may be made worse by sunlight 
  • Hair loss 
  • Headache 
  • Dizziness 
  • Altered taste 
  • Joint swelling or swelling in the hands and legs 
  • Bone, muscle or joint pain.

"These are not all of the side effects with Fosamax".

The 'Medication Guide (for patients) on Fosamax states:

"Fosamax can cause serious side effects including:

1.      Esophagus problems

2.      Low calcium levels in your blood (hypocalcemia)

3.      Bone, joint or muscle pain

4.      Severe jaw bone problems (osteonecrosis)

5.      Unusual thigh bone fractures".

[italics mine]

[No pharmaceutical company will list a side effect unless it has been reported in someone at sometime.]

 

The above illustrates the potential side effects of the bisphosphonate group of drugs, using the information from the manufacturer of one the most popular ones. It should be noted the use of the word "serious".

 

It is recommended to take calcium and vitamin D supplements when taking bisphosphonates. This is to make sure that there is enough calcium and vitamin D in your body for bone health.

 

Bisphosphonates may react with other medicines. These include some pain killers such as non-steroidal anti-inflammatory drugs (NSAID's) and antibiotics.

How Effective are the Bisphosphonates? 

Bone has a dense outer coating, called cortical bone, and an inner sponge-like or honeycomb-like filling, called trabecular bone. Once bone loses its trabecular bridges, drugs cannot build them back. The build up of bone from a drug such as a bisphosphonate is primarily thickening of the cortical bone, with resultant improvement in the bone scan.

 A word of caution has been raised by Dr John Abramson in his book Overdosed America: The Broken Promise of American Medicine, 2011. He dissected the raw data in the osteoporosis trials and found that the risk of hip fracture in these trials was actually worse for women with osteopenia that were treated with bisphosphonates. The risk of hip fracture increased 84% and the risk of wrist fracture increased 50%.

The Natural Approach to Prevent, or Treat, Osteopenia and Osteoporosis and to Minimise Related Fractures 

Osteoporosis is clearly a major problem in our modern world. Over the last 30 or so years, we have been led to believe that drugs are the answer to all our ailments. The reality is that our diet and lifestyle determine our overall health, not drugs. The following are strongly recommended:

  • Exercise

It is estimated that nine out of ten hip fractures result from falls and an individual's risk of falls is better indicated by strength and balance skills rather than a bone density score. It is known that the size and strength of muscles and bone decrees with age. The strength and density of bone is directly proportional to the muscle strength that moves that bone. Just as muscles build with regular exercise, the bone strengthens and increases its density too, right along with the muscle. Like muscles, bones weaken and literally shrink if not used.

 

Muscle strength is an accurate way to predict bone strength and strengthening muscles has been shown to be the most effective way to strengthen bone and protect against osteoporosis-related fractures. It has been suggested that, when compared to exercise, medications (bisphosphonates) are relatively ineffective.

 

It is essential that the exercise is 'weight bearing' in nature. Thus, walking (said to be the best exercise), jogging and running are preferable to swimming, bike riding, rowing machines etc.

  • Correct Poor Nutrition with the Ideal Diet

The importance of a diet that is 75-80% alkali-forming and only 20-25% acid-forming is well accepted as the basis of good health. It is also the key to preventing the development of osteopenia and osteoporosis. To balance excessive acid (from the acid-forming foods) it has to be neutralised, and this is done by mobilising minerals from the bones, especially calcium. When the acid is excreted via the kidneys, the calcium is also lost from the body.

 

This has been discussed in detail in my September 2005 newsletter Acid / Alkaline Balance - The Ideal Diet. In brief, alkali-forming foods are plant-based, unrefined, unprocessed vegetarian foods, while acid-forming foods are of animal origin, including milk. ‘Acid-forming’ or ‘alkali-forming’ refers to the residual after the food has been digested and absorbed: some acid foods, eg citrus fruits, have an alkali-residue after digestion, hence are alkali-forming.

  • Calcium

Calcium is essential for healthy bones. Ideally it should be obtained from the diet (as referred to above), and from alkali-forming foods in the diet and not from acid-forming foods such as dairy.

 

Again, this important mineral has been discussed in detail in my October 2007 newsletter Calcium.  This sets out the calcium content of the different foods.

  • Vitamin D

Vitamin D is “the sunshine vitamin”. The best vitamin D is manufactured by the body when it is exposed to sunlight.

 

My November 2007 newsletter Sunlight and Health addresses this all important subject.

  • Supplements of Boron and Strontium

For better bones and healthy bones it is well worth while to take supplements of boron and strontium. This recommendation is to help prevent or delay the development of osteoporosis, especially when combined with the above recommendations.

These two minerals have been discussed in detail in my October 2012 newsletters Healthy Bones (Part1) - Strontium for Bone Health and Healthy Bones (Part 2) - Boron for Better Bones.

In Summary:

The primary causes of (hip) fractures are:

  • Poor nutrition
  • Sedentary lifestyle 
  • Muscle weakness 
  • Side effects of prescription drugs (due to sedation etc) 
  • Declining vision (tripping over something by failing to see it etc) 
  • Cigarette smoking 
  • Excess alcohol 
  • Vitamin D deficiency.

All these can be summed up in one word - "lifestyle"

 

If there is severe osteoporosis, appropriate medication with a bisphosphonate drug would be indicated.

 For less severe osteoporosis and osteopenia, attention to lifestyle as described above will give better results than taking bisphosphonates ……thus avoiding all their potential side effects.

 

 

*Copyright 2015: The Huntly Centre. 

Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.

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