osteoporosis – controversies and promising treatment options
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Osteoporosis – Controversies and Promising Treatment Options. Keith R. Holden, M.D. Ponte Vedra Beach, FL www.Dr-Holden.com. Osteoporosis Controversies. Guidelines for prevention and tx vary Bone quality versus bone quantity Same BMD can have different fx risk (age) - PowerPoint PPT PresentationTRANSCRIPT
Keith R. Holden, M.D.
Ponte Vedra Beach, FLwww.Dr-Holden.com
Guidelines for prevention and tx vary
Bone quality versus bone quantity
Same BMD can have different fx risk (age)
Cumbersome dosing requirements
Drug side effects
Esophagitis
Esophageal stricture
Esophageal cancer
Osteonecrosis of jaw
Atypical Femur Fracture
Bisphosphonates ↓ osteoclast fxn & induce osteoclast apoptosis
Suppress bone resorption = hard, brittle bone
Path: ↓ bone heterogeneity = ↓ bone quality Complete lack of TCN labeling = severe ↓ bone formation Stress injury-like cortical hypertrophy in other femur with
unilateral AFF
↑ BMD does not always = ↑ bone strength
T-score not consistent predictor of osteoporosis outside of elderly postmenopausal white♀
Other populations, Z score may be better predictor of low bone density
www.shef.ac.uk/FRAX/tool.jsp
FRAX estimates 10-yr. fx risk based on BMD femoral neck + osteo risk factors
Bone quality = bone strength (cortical bone structure/quality of collagen) + rate of remodeling
Bone densitometry measures BMD (quantity), helps assess fx risk, aids in dx of osteo, but does NOT measure bone quality
Healthy bone requires a balance of:
Bone building by osteoblasts
Resorption by osteoclasts
90% collagen (majority Type 1)
Osteoclast degradation & osteoblast synthesis create circulating peptides of Type 1 collagen
Type I collagen is cross-linked by deoxypyridinoline (DPD)
DPD provides rigidity and strength (quality) to bone
Reflects bone remodeling yrs. before BMD ∆
↑ T score + ↑ biomarker → fx risk (odds 4.1)
Allow tracking of response to therapy
May improve adherence to therapy
Cross-link Type IC (relatively selective)
Measure of bone resorption - ↑ urine level > bone loss
Unaffected by diet
Easy to measure spot AM urine
Recheck within 30-90 days after initiating therapy
Covered by Medicare
Calcium Vitamin D Magnesium Boron Strontium ranelate Ipriflavone Vitamin K Choline stabilized orthosilicic acid (ch-OSA)
Ch-OSA = bioavailable silicon
RDBPC trial: added to calcium and D3 showing improved bone biomarkers and BMD ↑ 2%
RDBPC trial: ↑ tensile strength of hair
RDBPC trial: + effects of skin surface changes, mechanical properties, ↓ brittleness hair/nails
Pulsed Electromagnetic Field (PEMF) therapy has shown promise in clinical trials for tx and prevention of osteoporosis
Mediates process via cell signaling proteins – growth factors, cytokines, and prostaglandins
PEMF 72Hz 10 hrs daily for 12 wks to radius of “osteoporosis prone” ♀
BMD showed sig. inc. in exposed areas 36 wks
Similar but weaker response in non-treated arm
(Tabrah, et. al., 1990)
Evaluated rats with surgically induced DOP
After 8 wks, PEMF sig. ↑BMD, ↑ TGF-beta 1, ↓IL-6 in proximal femur
Conclusion: PEMF efficiently suppresses bone loss in DOP via local factors
(Shen, et al., 2010)
Evaluated CR with PEMF in ovariectomy-induced osteoporosis in rats
12 weeks, (OVX-DPEMF) group had better prevention against OVX-induced bone loss
↑BMD, ↑osteoblast activity, ↑ trabecular health markers; ↓bone markers of resorption (uDPD)
(Jing, et. al., 2010)
Rats with streptozotocin-induced DM bone loss
PEMF daily 8 hrs x 8 wks
PEMF improved biomechanical bone quality DM bone
PEMF partially reversed DM-induced bone deterioration
Conclusion: PEMF might become an additive method for inhibiting DM osteoporosis
(Jing, et al., 2011)
Study on in-vitro osteoblastic cell culture
PEMF ↑osteoblastic growth, ↑ TGF-beta 1
PEMF ↓ prostaglandin E2
Conclusion: Study sheds light on mechanism of action of PEMF in non-union fx & prevention of osteoporosis
(Li, et al., 2007)
Studied rats subjected to bil ovariectomy
PEMF augmented/restored trabecular bone mass/architecture in PEMF groups
PEMF attenuated higher serum PGE(2) of OVX rats and restored levels to that of controls
Conclusion: PEMF may be useful in prevention of osteoporosis resulting from ovariectomy
(Chang, et al., 2003)
PTH used to tx osteoporosis; Insulin & IGF-1 anabolic roles in osteogenesis
Cell signaling proteins IRS-1, S6 RSK, & eNOS were phosphorylated by PTH, Insulin, & PEMF to the same extent in osteoblast-like cells
Conclusion: Anabolic affects of PEMF may be mediated through these proteins
(Schnoke, et. al., 2007)
↑ BMD
↑ TGF-beta 1
↓ IL-6
↓ PGE(2)
↑ osteoblast growth
Phosphorylation of IRS-1, S6 RSK, eNOS
Alkalinizing plant based diet
Address food sensitivities Mineral rich foods
Remove
Replace
Reinnoculate
Repair
Rebalance
Foci of interference (ANS) Stress Inflammation Toxins Allergy Infection (occult, dysbiosis, dental) Heavy metals
Resistance training
Nutritional supplementation
Hormonal balance
PEMF
66 y.o ♀ with osteoporosis (T-score -3.1) Baseline: mostly plant based diet,
resistance training, Ca, Mg, and D (1/27/11) uDPD 9.7 nM/mM Cr (NL < 6.5) Weekly 1 hr PEMF sessions x 2 mos
(3/16/11) uDPD 4.5 (53% drop!) Maintenance: Monthly 1 hr PEMF
(7/21/11) uDPD 5.5 (10/24/11) uDPD 4.5
63 y.o. ♀ osteoporosis (‘09 T-score LS -3.9; ‘11 T-score LS -4.1)
Hx FMG, CFS, IBS, MCS & hx multiple fxs Baseline: BHRT, Ca, Mg, D Added ch-OSA + tx gut dysbiosis Started PEMF (3/26/11) monthly; (7/26/11) inc.
freq. to weekly; (9/12/11) 2-3 X week (4/13/11) uDPD 9.7; (10/4/11) uDPD 5.0
(48.45% drop!)
Keith R. Holden, M.D.
822 A1A North, Suite 310Ponte Vedra Beach, FL 32082
(904) [email protected]
www.Dr-Holden.com