Bone health
I’m back to blogging again! At least I hope so - if nothing else comes up that prevents me from writing more regularly.
And as I hinted at last time - bone health is what is on my mind lately so I decided that would the topic of my first post back.
I can’t believe that the last time I wrote anything about osteoporosis or bone health was back in February! And unfortunately I don’t see a lot in the news lately about it. Maybe I missed something - but this is all I have for now on the subject:
Estrogen and bone loss
- Way back in March a study was presented that helps explain how the main form of estrogen in humans - called estradiol - helps to keep bones more dense. The bones in our bodies are constantly being broken down and built back up. Osteoblasts are bone cells that are responsible for bone formation. The researchers discovered that the enzyme caspase-3 which is involved in the programmed cell death (also called apoptosis) of osteoblast cells is inhibited by estradiol. After menopause, estrogen levels decrease and women become more likely to have their bones become more brittle and break more easily. The press release for this study can be found here: Study describes action of estrogen in protecting bone.
Bisphosphonates and jaw necrosis
- Another study linking the use of bisphosphonates for the treatment of osteoporosis to jaw and facial bone deterioration was published recently in the Journal of the National Cancer Institute. Osteonecrosis can occur when the blood supply to the area is poor, leading to bone death or deterioration. A causal relationship between the drug’s use and jaw necrosis is not certain at this point however. Read more here: Bisphosphonate treatment is associated with jaw bone problems
SSRI’s and bone health
- A study published in Archives of Internal Medicine provides some evidence that the use of SSRI’s (selective serotonin reuptake inhibitors) prescribed commonly for depression may have a negative effect on bone health in older people. The study showed a correlation between SSRI’s and bone health, but some other factor such as being less physically active could be responsible. Learn more: OHSU scientists find antidepressant, bone loss link.
Exercise in the elderly
- Concerning the elderly is a study in Journal of the American Geriatrics Society showing that exercise training can improve people’s balance and decrease their fear of falling. A related study (BMC Geriatrics) showed that balance-training exercises may improve balance in elderly people and possibly reduce the chance of them falling.
Hip surgery and recovery
- Lastly, a researcher in St. Louis recently published a report indicating that many people recovering from hip surgery may develop problems with depression afterward due to being confined to their bed or home or other factors.
That’s all I have for now - but remember - weight bearing exercise along with calcium and vitamin D can go a long way in preventing osteoporosis!
February 1, 2007
Bone health in the news
Since a large percent of bone mass increase takes place during adolescence, dieting during this time can be particularly harmful for bone health in young women. Young women with anorexia are at an even greater risk. Eating healthy foods including those high in calcium and vitamin D, such as dairy products, is very crucial at this age. For more information about this topic, please see the International Osteoporosis Foundation’s (IOF) web site.
I’ll be honest - I’m in a grumpy mood today. In part because of the headline that Reuter’s used when they reported the above story: “Skinny teens warned about osteoporosis risk”. What the IOF was actually saying is that young women who diet or are anorexic should be concerned about their bone health. Some of us are naturally skinnny, and were so when we were young too. Just because someone is skinny doesn’t mean they are dieting or anorexic. Every so many years the media becomes all ‘anti skinny’ and we seem to be in that phase again lately. Yes, anorexia is bad but just because someone is thin doesn’t mean they are unhealthy or anorexic. If we want women - all women - to feel good about themselves and their bodies we can’t start making thin people feel like they are doing something bad or wrong anymore than we should make overweight people feel that way.
Ok, I got that out of my system - I feel better now.
On to more bone health news - a study in The Journal of Clinical Endocrinology & Metabolism has more evidence that magnesium plays an important role in bone formation. A population of girls were were divded into groups - one which received magnesium supplements and one that didn’t. Those which took the magnesium had bone mineral content that was significantly larger than those who didn’t. All the girls in the study had lower than recommended levels of magnesium to start with. It is not yet known if these same results would be seen in girls who were getting enough magnesium in their diet already. Foods high in magnesium include spinach, tofu, sesame and sunflower seeds, brocoli and various legumes.
Two studies recently evaluated bone mineral density (BMD) testing. In one, published in Archives of Internal Medicine, suggests that repeating BMD tests before 8 years doesn’t help to predict the chances of an older woman having a bone fracture. If a woman has been sick, taken certain medications or going through menopause an additional test may be more helpful. It sounds like this study was done by someone associated with a health insurance company though - maybe they are just trying to get out of paying for more testing?
The Journal of the American Medical Association reports that both men and women over 60 who have already had one bone fracture are just likely as the other gender to have another fracture. Osteoporosis is often thought of an a women’s issue - and of course I include it on my blog -but really, men should be aware of the risks too.
Some good news for women with endometriosis - some new research indicates that endometriosis may not increase the chances of eventually having a fracture, which somewhat contradicts earlier studies. This new study was published in Fertility and Sterility.
(Technorati Tags: anorexia, bone, health, osteoporosis, magnesium, endometriosis)
January 18, 2007
Osteoporosis, testing and prevention
Your dentist may soon have another job to do - testing you for osteoporosis in addition to looking for cavities! Some British researchers have a developed a method for detecting bone thinning in the lower jaw with x-rays. Currently people who are high risk are checked for osteoporosis with a test called a dual energy X-ray absorptiometry (DXA). It is expensive and insurance coverage for it could be better. As an alternative these researchers have showed that software that can analyze dental X-rays may do just as well. They examined both the dental x-rays and DXA scans of over 600 women and found that the x-rays were able to detect osteoporosis in over half of the women with it. This research was in the journal Bone in December.
Of course preventing the development of osteoporosis altogether would be preferable to most people. But that may be more difficult to do if you also have acid reflux problems. New research in the Journal of the American Medical Association has evidence that use of some medications for acid reflux is associated with a greater chance of hip fractures possibly due to the drugs inhibiting the absorption of calcium. This study at the University of Pennsylvania School of Medicine examined data from close to 150,000 people. Those who were taking proton pump inhibitors had a 44% higher chance of a hip fracture than those that weren’t. The risk was increased for those taking a higher dose and taking it for a longer period of time. So what do you do if you are high risk for osteoporosis and have bad acid reflux problems? I don’t know - I wish I did because I am high risk and can’t go without my Nexium without getting really sick.
At least there is some good news for those who want to increase their calcium intake and are concerned about weight gain. A report in the American Journal of Clinical Nutrition has published research showing that adults who consume whole dairy products tend to gain less weight over time than people who don’t. Then again this another one of those correlational studies that really don’t prove anything. All the women in the study were of normal weight to start with and other research has not shown any connection. So once again - be careful when listening to short health stories on the news or in magazines - they often don’t tell the whole story.
Another thing to be careful of is who is funding the research. Or who is influencing it. The FDA is considering letting food products with calcium and vitamin D state on their labels that they may help reduce the risk of osteoporosis. Orange juice companies who sell juice with calcium added have a lot to benefit from a label like this. Not that getting calcium from orange juice is bad but that alone is unlikely to prevent osteoporosis. Doesn’t do a lot of good for those of us with acid reflux problems either!
If you do get osteoporosis despite taking all precautions to prevent it - another study in the Journal of the American Medical Association shows that a break from some osteoporosis drugs might be ok. It seems the drugs provide protection for some time after taking them.
But better yet - now that you are almost done reading this - get up and walk around or run up and down some stairs for a few minutes! Then drink a glass of milk. Or eat some cheese. Weight bearing exercise and regular calcium intake is still probably the best way to keep your bones healthy.
(Technorati Tags: osteoporosis, calcium, bones, acid reflux, health, exercise)
December 18, 2006
Osteoporosis Update
Recently in the CDC’s Morbidity and Mortality Weekly Report a study by Judy Stevens, an epidemiologist with the U.S. Centers for Disease Control and Prevention noted that the rate of death in elderly people from falling has gone up. Falling is the 14th leading cause of death of elderly people.
Many people fall as they age due to vision loss, inner ear and other balance problems and strength loss.
Hip fractures however have gone down which may be part due to Medicare paying for bone density tests to check for osteoporosis in elderly people since 1998.
More data pointing to a connection between drinking colas and bone loss was reported in the American Journal of Clinical Nutrition. In this study by Dr Katherine L Tucker of Tufts University in Boston of 2500 people showed that women who drank colas on a daily basis had lower bone mineral density in their hips than those who drank it infrequently. The phosphoric acid in colas impairs the absorption of calcium and increases excretion calcium from the body.
Since 90% of bone mass is in place by the age of 18 it is important that young girls learn how to increase their bone mass. In one promising study in the Archives of Pediatrics and Adolescent Medicine girls 14 - 16 years old were put into a lifestyle intervention program. In this program the girls had overnight retreats, fitness center membership, individual health coaches and more. After 2 years the girls had increased their spine and thigh bone density and had increased their consumption of calcium, vitamin D and other healthy foods. Now, if they could start programs like this in all schools we would be getting somewhere. Maybe cut down in the obesity problem in kids too!
And lastly, at Howard Hughes Medical Institute researchers published a study in Developmental Cell where they demonstrated that a slight modification of the NFATc1 in mice could result in more bone growth presumably by triggering the production of more osteoblasts.
(Technorati Tags: osteoporosis, bone, calcium, death)
May 1, 2006
May is Osteoporosis Awareness and Prevention Month!
Its Osteoporosis Awareness and Prevention Month!
Remember the basics to prevent osteoporosis:
1) Do weight bearing exercise on a regular basis
2) Make sure you get enough calcium in your diet
3) Make sure you get enough vitamin D from either food or sunlight
4) Avoid smoking
5) Keep alcohol consumption at a moderate level
6) Keep up to date with developments in research for the treatment and prevention of osteoporosis
For more information see: the National Osteoporosis Foundation web site.
(Technorati Tags: osteoporosis, calcium, vitamin D, exercise, women)
April 24, 2006
Possible role of FSH in osteoporosis.
Follicle-stimulating hormone, usually abbreviated as FSH, is a hormone produced by the anterior pituitary. FSH stimulates immature follicles in the ovary to mature and to release estrogen.
Normally the ovary also responds to FSH by releasing inhibin, another hormone, which then results in a decrease in FSH levels - creating a sort of feedback system to regulate the levels of each other and other hormones such as estrogen. At menopause when estrogen levels fall, the pituitary starts releasing even more FSH as if it is trying to get the estrogen levels back to where they once were. Consequently, post-menopausal women have high levels of FSH.
Osteoporosis is pretty common in post menopausal women, when the amount of bone mass being broken down (resorbed) is greater than the amount of new bone being formed. It has long been believed that estrogen has a major role in this process since estrogen levels decrease after menopause and many of the molecules involved in the resorption of bone are affected by estrogen.
However some recent research now shows that FSH also plays a role in this bone loss. A group led by Mone Zaidi - a researcher at the Mount Sinai School of Medicine in New York City - has recently published a paper demonstrating this.
Earlier experiments by other groups showed that mice without estrogen activity only show a mild or no bone loss.
Mone Zaidi’s group showed that ”FSH stimulates the formation and function” of cells that resorb bone in female mice, and that FSH is necessary for this bone loss. They also showed that in mice without FSH receptors (FSH will not function as usual with no FSH receptors present), bone loss decreased compared to ovariectomized (no ovaries, no estrogen) mice. In addition they showed that the decrease in bone loss was not due to the FSH causing an increase in bone formation
So what does this all mean? In a nutshell - most of the bone loss after menopause is likely not due to the decreased levels of estrogen, but rather due to the increased levels of FSH. In the future medications that inhibit the activity of FSH could be used to prevent osteoporosis. Much more research will be needed first of course before a drug like that would be ready for human use - but this is a very big step in osteoporosis research!
This work of Zaidi’s has been published in the April 21, 2006 issue of Cell (Volume 125, Issue 2, pp. 247-260, titled: FSH Directly Regulates Bone Mass).
(Technorati Tags: osteoporosis, bone, health, FSH, women, research)
April 11, 2006
New treatments for osteoporosis on the way!
- a transdermal patch to deliver human Parathyroid Hormone 1-34 fragment (hPTH 1-34) to treat osteoporosis just finished its first human clinical trial. Currently hPTH 1-34 is given as a injection only. This patch is being devloped by TransPharma Medical Ltd - it uses a radio frequency (RF)-micro channel technology. This system involves a handheld battery control unit, a microelectrode array and a patch with the medication. The radio frequency waves open microchannels in the skin for the drug to be delivered through.
- a generic nasal spray of calcitonin-salmon - (if I understand this right, the spray has already been approved by the FDA, but the company that makes it now has another facility approved to manufacture it. ) . At any rate, the company - Nastech Pharmaceutical Co. - will be making a generic version of the spray which has been around for a while.
- a new injectable drug for the treatment and prevention of osteoporosis. Denosumab injections were found to be safe and effective as an oral bisphosphonate. Denosumab is a fully human monoclonal antibody and works by binding to and inhibiting the activity of RANKL (receptor activator of nuclear factor-kB ligand). RANKL is involved with the activation of bone-resorbing osteoclast cells. Denosumab is being developed by Amgen and the results of its open-label multicenter phase II study of 412 postmenopausal women was reported in the February 23 issue of the New England Journal of Medicine
- Reveromycin A - this one has quite a ways to go yet, but a promising discovering by Riken (a research institute in Japan) shows that reveromycin A can inhibit bone loss in mice. Reveromycin A is secondary metabolite Streptomyces sp. SN-593 which is a type of soil actinomycete. It can induce the apoptosis (cell death) of osteoclast cells. Their results will be published in the Proceedings of the National Academy of Sciences.
(Technorati Tags: osteoporosis., calcitonin, women)
February 11, 2006
Corticosteroids and osteoporosis
If you are taking oral corticosteroids on a long term basis for the treatment of a chronic skin disease you should be especially careful to make sure you don’t develop osteoporosis. Osteoporosis caused by this is called glucocorticoid-induced osteoporosis (GIOP).
The use of bisphosphonates to treat or prevent osteoporosis should be considered if you are taking corticosteroids.
The January issue of the journal Archives of Dermatology has more information on this subject.
(Technorati Tags: osteoporosis, corticosteroids, bisphosphonates)
January 17, 2006
Osteopenia
Osteopenia is a medical condition characterized by a low bone density. It is related to osteoporosis, but without as much bone loss. People who have ostepenia have are very likely to eventually get osteoporosis if they don’t take steps to prevent it.
So what causes ostepenia? The answer to this question isn’t fully known, but some things are known to contribute to the development of it. These include smoking, diet and a sedentary lifestyle.
Heredity is also involved - if members of your family have had ostepenia or osteoporosis you are at risk too. Caucasian women have the greatest risk of developing it and African American women have the lowest risk. Petite, small boned women are at greater risk too. Low levels of calcium and vitamin D in the diet can also contribute to it.
You can have your bones tested for ostepenia by having a dexa scan to measure your bone mineral density. Will your insurance pay for it? I don’t know. If you are over 65 or post-menopausal it most likely will. If you are someone like me - high risk, but younger, I don’t know. I haven’t contacted my insurance company to find out. I’ve heard it can cost less than $250 to have the dexa scan done, so if you can afford to spend that much then you could have it done even without health insurance paying for it.
So what if you have the scan and find out that you do have ostepenia? Treatment includes things like diet modification, increasing physical activity - especially weight bearing exercise, and prescription medications. If you are diagnosed with ostepenia you should talk to your doctor about all your options.
You can learn more about ostepenia at this site: http://www.osteopenia3.com/osteopenia.html.
(Technorati Tags: ostepenia, osteoporosis, women, exercise, bone)
January 9, 2006
Magnesium also important in preventing Osteoporosis
Magnesium is one of the major minerals and a study recently published in the Journal of the American Geriatrics Society (November 2005, Vol 53, No 11, pp 1875-1880) suggests that it may have a role in increasing bone density.
In the study the amount of magnesium in the diet of over 2000 people in their 70’s were analyzed. They compared the amount of magnesium they were getting to their bone density and facture rate from soft bones.
The RDA for magnesium for those over 70 is 320 for women and 420 for men. Only around 25% of the people in this study were getting RDA levels in their diets.
The authors of the study found that increasing the magnesium intake resulted in greater bone mineral density and less fractures. This effect was seen in both men and women who are white, but not in those that are black.
So make sure you eat foods that contain reasonable amounts of magnesium!
Some foods that are high in magnesium include: spinach, tofu, sunflower seeds, legumes, shrimp and brocoli.
(Technorati Tags: osteoporosis, magnesium, bone, women, health)
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