Building Strong Bones Through Nutrition

Where Bone Strength Begins®

Welcome to OsteoNaturals. We invite you to shop our online store for quality nutritional supplements that promote skeletal health. In addition, our site is full of useful information about osteoporosis and insights about how it can be managed naturally.

Individuals who intend to stay active into retirement will need strong, healthy bones, and a strategy for maintaining muscle strength and overall fitness. Whatever your age or current condition, it is never too early or too late to make a positive difference. The "OsteoNaturals difference" = natural ingredients chosen for quality, safety, purity and potency.


Friday, December 2, 2016

Proton Pump Inhibitors Not Only Cause Osteoporosis but a New Study Points to Increased Risk for Stroke

I am continually dismayed at how many of my patients with osteoporosis are taking PPIs. They have
been prescribed proton pump inhibitors by their medical physicians to help reduce stomach acid and treat the symptoms of heart burn or GERD. But PPIs have the nasty side effect of reducing bone density and increasing a person's risk for breaking a bone. With GERD symptoms easily remedied through conservative, non-drug, therapy, I am always left scratching my head wondering WHY!...Why in the world would doctors prescribe PPIs, especially to their patients with osteopenia or osteoporosis. Most cases of GERD respond well to conservative therapy of dietary changes and the use of probiotics and digestive aids to improve gut function. For the majority of people who experience GERD symptoms, they should not have to use PPIs. And, if they do, these medications should be taken in low doses.

Findings from a recent study out of Denmark indicate there is another reason to stay far away from PPIs if possible. Thomas S. Sehested, a medical doctor from the Danish Heart Foundation, showed an "association between use of PPIs and increased risk of first-time ischemic stroke and a positive dose-response relationship between PPI dose and stroke risk." Dr. Sehested's findings are based on the medical histories of 244,679 individuals. Histories were accessed from nationwide Danish registries in this observational study. The investigation looked at 4 different PPI medications and found that stroke risk increased from 33% to 79% depending on the particular drug being taken. Also, the higher the dose, the higher the risk for stroke.

Sehested, T.S., et al. American Heart Association (AHA) 2016 Scientific Sessions. Abstract 18462: Proton Pump Inhibitor Use Increases the Associated Risk of First-Time Ischemic Stroke. A Nationwide Cohort Study. Presented November 15, 2016.

Tuesday, November 8, 2016

Calcium Supplementation IS Vital for Individuals with Osteoporosis

Over the years there have been numerous studies about the benefits and risks of calcium - much of it inconsistent - and this has led to a lot of confusion and frustration. It all began in 2008 when Mark Bolland and Ian Reid (1) from New Zealand studied 336 healthy, older women (mean age 74) and concluded there may be a slight increase in cardiovascular events when taking supplemental calcium. Although numerous researchers found fault in Bolland and Reid's research methodology, a new study by Norwegian researcher Gunhild Hagen (2016) concludes that although we don't know for sure if calcium has this negative
effect, “the modest effect of supplemental calcium and vitamin D on the risk of fracture is not large enough to outweigh the potential increased risk of cardiovascular disease."(2) Is your head spinning yet?

Since improving the strength and density of my own skeleton after a diagnosis of severe osteoporosis at age 45 (with 12 fractures in 5 years), I have been helping others with bone fragility for over 10 years now. Because I have a personal interest and bias, I review each published article on bone health and carefully evaluate it based on the type of study, the populations included in the study, the quality of the design and execution, analysis of the data, etc. I hope, because of this, I can continue to be your trusted source of effective, reliable information in your quest to combat osteoporosis.

Let's look at the facts: 

FACT: We need adequate calcium for good health. Calcium is important for skeletal health, as well as a host of other essential functions. Without calcium there would be no nerve transmission, muscle contraction, cell signaling, blood clotting, constriction and relaxation of blood vessels, or secretion of hormones like insulin.(3) Studies have consistently found that higher calcium intakes reduce the risk of hypertension, obesity, and type 2 diabetes.(4,5,6,7) In a 2015 study from the National Osteoporosis Foundation, Weaver, C.M., et al. found a "significant decrease in fractures with calcium and vitamin D supplements."(8)

FACT: People should strive to meet the calcium levels recommended by the Institute of Medicine (IOM), using food sources to the greatest extent possible. The Recommended Dietary Allowances (RDAs) for most adults (ages 19 to 70) is 1,000 mg of calcium daily, and women older than 50 and men older than 70 should aim for 1200 mg of calcium per day.(9) A healthful, well-balanced diet should include dairy (especially yogurt and kefir), dark leafy greens, and other calcium sources like sardines, almonds and beans.

Unfortunately, some people are sensitive or allergic to dairy. In addition, although many physicians recommend dairy as a calcium source, high dairy intake may come with other undesirable effects. Besides grave concerns over the dairy industries use of rBGH (growth hormones), milk is acidifying to the body (not good for bones) and casein, the major protein found in milk, has neoplastic (cancer) potential. Also, D-galactose (from the lactose sugar in milk) has been shown to increase inflammation, contribute to neuro-degeneration and reduced immune function. To this point, Michaelsson, et al. (British Medical Journal, 2014) observed a link between high milk intake (3 or more glasses per day) and higher rate of both mortality and fracture in women, and a higher rate of mortality in men. "There were positive associations between milk intake and concentrations of markers for oxidative stress and inflammation." The authors concluded "A higher consumption of milk in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death."(10)

FACT: Many Americans do not meet the RDA for calcium. The 2015 Dietary Guidelines Advisory Committee (DGAC) concluded that many Americans, due to a variety of socio-ecological factors and the concerns cited above, don't meet the IOM recommendations and declared calcium "a nutrient of public health concern for under-consumption."(11)

FACT: Inadequate intake from dietary calcium impacts individuals differently. Healthy, active individuals with strong bones may efficiently absorb enough calcium to maintain bone density. They are also more likely to have a balanced bone remodeling system without excessive osteoclastic (bone destroying) activity that would require a greater intake of calcium to keep up with demands. Individuals with bone fragility, on the other hand, are already at a deficit because their remodeling system is out of balance. The osteoclasts within their bones are destroying it faster than the osteoblasts can build new bone. "If there isn't enough calcium coming in from the diet, the body will pull calcium from the bones for all the things that need to be done,” notes Andrea J. Singer, MD, FACP, CCD, director of women's primary care and bone densitometry for the Department of Obstetrics and Gynecology at MedStar Georgetown University Hospital and clinical director of the National Osteoporosis Foundation.
FACT: Adequate calcium intake (1200 - 1400 mg), taken as directed, is vital for Individuals with bone fragility.  By now you may be thinking, "I know I need calcium for bone health yet it is difficult to get adequate calcium unless I drink a lot of milk. But high dairy intake doesn't sound wise either...so what am I supposed to do in light of the recent research concerning the safety of supplemental calcium?

First, always try to get as much calcium from your diet as possible. As they say, "you are what you eat." Eating foods high in calcium is good for you...and your bones. 

Second, take supplemental calcium (and magnesium and trace minerals) to ensure you are getting the minerals necessary for skeletal health. But, take your calcium in small doses through-out the day. It is not wise to take large doses of supplemental calcium such as those used in Bolland and Reid's studies. High amounts (400 mg or more) of calcium all at once can cause an excess spike of calcium in the blood - a problem that could potentially interfere with normal heart function. This may be the link between calcium and cardiovascular events, if indeed it exists.

Our OsteoNaturals’ OsteoSustain tablets contain only 175 mg because I believe in GENTLY providing the body with what it needs to build bone. Taking 3 tablets spread out over the day with meals provides 525 mg calcium in a safe, effective manner. For many patients with severe bone loss, I advocate taking an additional one or two tablets of OsteoMineralBoost for more calcium plus trace minerals in addition to the OsteoSustain. Taking one OsteoSustain and one OsteoMineralBoost at a sitting provides 315 mg calcium which is well below the 400 mg level.
As a general protocol for severe bone loss, 3 tablets of OsteoSustain and 2 tablets of OsteoMineralBoost provide 805 mg supplemental calcium daily. This, along with a diet rich in veggies, will put that person just right at 1200 to 1400 mg calcium per day - PERFECT for someone with bone loss. In addition, OsteoNaturals’ products provide the body with bioavailable magnesium, vitamins D and K, and trace minerals...all important for utilizing the calcium and helping your body put this vital mineral where it belongs...in your bones.
FACT:  In addition to ingesting an adequate (not excessive) amount of minerals for bone building, the key to fighting osteoporosis is to focus on balancing bone remodeling – reducing osteoclastic bone resorption and increasing osteoblastic bone formation. As explained in my book, The Whole Body Approach to Osteoporosis, regaining balance is best achieved by eating a healthful, well-balanced, alkaline diet; taking quality, nutritional supplements like OsteoNaturals' OsteoStim (our product designed to enhance balanced bone remodeling activity); exercising (both cardio and weight-bearing); and evaluating health-related lifestyle behaviors.
Calcium is important for skeletal and overall health. Most advocacy organizations and health policymakers stand by the IOM recommendations for daily calcium levels. It's best to get calcium through diet but this is often extremely difficult, if not impossible. Quality, trusted supplements – taken as directed – should be used to make up the shortfall. 

If you have bone loss, I urge you not to run from calcium because of some shaky research that used excessive amounts of an important mineral and came up with a possible link to an adverse effect. The same thing happened in 2001 with the Women's Health Initiative Study that concluded estrogen was bad for women. This study used excessive amounts of estradiol in a population of women they should not have used (advanced age and asymptomatic). The researcher's back then concluded that estrogen was BAD and did a huge dis-service to women. Because of this, instead of using estrogen PROPERLY (using smaller dosages and initiating it in women no more than 5 years after menopause) doctors ran the other way and stopped prescribing estrogen all-together. Let's NOT let this same reaction prevent us from obtaining the most abundant mineral in the body, calcium.


(1) Bolland, M.J., et al. 2008. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 336:262-6.
(2) Hagen, G., et al. 2016. The predicted lifetime costs and health consequences of calcium and vitamin D supplementation for fracture prevention - the impact of cardiovascular effects. Osteoporos Int 27(6)2089-2098.
(3) Linus Pauling Institute. Calcium dietary supplemental fact sheet. National Institutes of Health Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Updated November 21, 2013.
(4) Alender, P.S., et al. 1996. Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med 124:825-31.
(5) Bucher, H.C., et al. 1996. Effects of dietary calcium supplementation on blood pressure. A meta-analysis of randomized controlled trials. JAMA 275:1016-22.
(6) Villegas, R., et al. 2009. Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Am J Clin Nutr 89:1059-67.
(7) Teegarden, D., et al. 2003. Calcium intake and reduction in weight or fat mass. J Nutr 133:249S-51S.  
(8) Weaver, C.M., et al. 2016. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 27:367-376.  
(9) Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
(10) Michaelsson, K., et al. 2014. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 349:g6015.  
(11) US Department of Agriculture, US Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Published February 2015.

Wednesday, August 31, 2016

A Crisis in the Treatment of Osteoporosis can be Turned Around with a Paradigm Shift

According to an editorial by Drs. Khosla and Shane in the August 2016 Journal of Bone and Mineral Research, there is A Crisis in the Treatment of Osteoporosis.(1) I totally agree...but my call to action is different.

The point of the editorial is that even with all the “remarkable advances in the diagnosis and treatment of osteoporosis…many patients, even those who unequivocally need treatment, are either not being prescribed osteoporosis medications at all, or when prescribed, refuse to take them.” Khosla and Shane point out that this paradox has been brewing for some time, but the issue was brought to a head in a recent article by Gina Kolata in the New York Times titled, Fearing Rare Side Effects, Millions Take Their Chances with Osteoporosis. Coincident with media and public concern about side effects such as osteonecrosis of the jaw (ONJ), atrial fibrillation, and atypical femur fractures from osteoporosis medications, Kolata found bisphosphonate use declined by greater than 50% from 2008 to 2012. The pattern was confirmed by another recent study that used claims data from a U.S. commercial health plan. Those authors found that "among 22,598 patients with hip fractures, use of bisphosphonates decreased from an already dismal 15% in 2004 to an abysmal 3% in the last quarter of 2013." The editorial also notes that the scope of the problem may be worse because the underlying studies did not evaluate patient compliance. “…Most of us in practice have observed that a significant proportion of the patients we see clinically are reluctant to initiate bisphosphonate therapy and many on these drugs want to stop taking them and do so despite our best advice." Khosla and Shane are saddened (and rightly so) because they feel that the medical community has "failed our patients, and that is something we cannot allow to happen." Their call to action is to find ways to ensure that patients who need them are prescribed effective medications and equipped to make informed choices on taking these drugs.

I have dedicated my life to helping others with osteoporosis for the past 15 years and I feel the same sadness. Sad because a diagnosis of osteoporosis just does not have to lead to devastating life-altering consequences of chronic pain, loss of mobility, and the all-to-often "death-spiral" following a hip fracture. It just does not have to be this way.

I am particularly saddened because we (as doctors) have failed our patients by:
  • Pushing medications with potential serious side-effects and not "working with the body" to normalize physiology. We have turned people completely away from approaching osteoporosis treatment in a sane, effective, none-harmful manner. Many of these patients have become afraid of osteoporosis medications. So afraid that they will not use them even as emergency treatment. 
  • Not offering them a "balanced" treatment option. Medications are not inherently "bad" or necessarily harmful...if they are used properly. There are two issues here: (1) the unfortunate practice of prescribing them to patients who don't really need them and/or keeping patients on them for too long; and (2) little or no emphasis on normalizing the bone remodeling process naturally by encouraging a reduction in overly aggressive osteoclastic bone resorption and a boost to osteoblastic bone formation. This, can usually be accomplished through improved diet, exercise, and specific vitamins, herbs and nutritional compounds such as those found in our OsteoNaturals products.
  • Allowing the confusion and fear that media sensationalism causes in our patients to dictate their health care choices. Yes, osteoporosis drugs can cause serious adverse effects and too much supplemental calcium is not good for you but that does NOT mean that a person should never take medications and that does NOT mean that supplemental calcium should not be taken. EVERYONE with osteoporosis NEEDS to take at least 600 mg of calcium/day and there are SOME people that NEED to use osteoporosis medications at least for a short time.

I think the call to action should be to change the medical model for the treatment of osteoporosis. Drugs...and only drugs (ok...also some vitamin D) defines the current model for too many doctors. It is certainly true, osteoporosis medications CAN be helpful, but they should NOT be the primary emphasis of treatment except when the patient is in a situation of impending fracture. Then and only then can we look at medications as the primary short-term EMERGENCY or TRIAGE treatment. But our real effort, even in these situations, is to find a way to slowly change the biochemistry, change the way the patient’s body is functioning, and help promote healthy bone remodeling.

(1)  Khosla, S. and Shane, E. 2016 Editorial: A Crisis in the Treatment of Osteoporosis. Journal of Bone and Mineral Research 31(8):1485-1487.
 

Thursday, June 30, 2016

Early Detection and Intervention are Crucial to Stop the Progression of Bone Loss - How Biomarkers Can be Used to Improve Treatment of Osteoporosis

As you know from my book The Whole-Body Approach to Osteoporosis,(1) I am a strong advocate for working closely with your health care provider and using specific laboratory tests to gather critical information about your bone health.

Both men and women begin to lose a small amount of bone mineral density in their mid-thirties. A “healthy” person may lose 0.7% to 1.0% per year after they reach their 40s but this loss is slow and typically has a minimal detrimental effect on their over-all health longevity, especially if they had normal bone accrual as a young adult. But for women, the sharp loss of estrogen at menopause can precipitate a dramatic loss of bone density, up to 3 or 4% per year. A rapid decline in bone mineral density leads to unwanted changes within the microarchictecture of bone, such as cortical thinning and a loss of trabeculae – the microscopic support beams within bone. These changes cause a loss in bone quality. Together, when both bone quantity and quality are lost, there is a sharp decline in bone strength and an increased risk for fractures. Identifying women at greater risk for developing osteoporosis, and especially those who are loosing bone rapidly during transmenopause,* is of key importance. The earlier the detection the better!

When bone densitometry (a DXA exam) is used to determine bone loss, the doctor must compare two consecutive exams over a two-year period to assess the speed in which a person is loosing bone. The larger the loss in bone density, the more rapid is the bone loss and the greater is their risk of breaking a bone. Having to wait two years before identifying those at greater risk can, and often does, result in catastrophic results such as sustaining a hip fracture or spinal compression fracture. Once bone is lost it is very difficult to regain, placing these women at a much higher risk for fracture. With earlier
identification of those at high risk for rapid-bone loss…by eliminating this 2-year period of time…we can intervene with appropriate therapy and reduce the incidence of subsequent fractures.

The GOOD NEWS: Natural therapeutic methods to improve skeletal health works! Changing a person’s diet, taking quality supplements such as the OsteoNaturals line and engaging in bone-healthy exercise work to improve skeletal health by “gently nudging” bone cells into a new and healthier course of being. When working with nutrition, we aren’t just sprinkling more calcium into bones, we are changing the "habits" of cell metabolism. While we can't alter our genetic code - our DNA, we can improve the way a person's genes "express" themselves - the epigenetics of cells. It is through changes in a person's epigenetics that we can put a stop to rapid bone loss and move out of the "high risk for rapid-bone loss" osteoporosis category.

The “NOT SO GOOD NEWS”: Natural therapeutic methods to change skeletal health can take time to “engage”. If a person has had a poor diet for the past 20 years, is in a nutritionally sub-optimal state, and has low-level chronic systemic inflammation, simply improving his or her diet will NOT result in instant success. The sooner we can identify the heightened level of bone cell activity, the quicker we can start “encouraging” bone destroying cells to calm down and reduce their excessive level of bone resorption. Think of osteoclasts (the cells that break down bone) as a gang of wild maniacs on the loose. If you just tell them to stop their wild behavior they probably won’t just “normalize”….on the other hand, put them into a quality therapeutic counseling program, change their eating habits and destructive lifestyle habits and, over a period of years, they may be able to re-enter society as constructive members. The earlier a person is tapped into therapy, the better the results. Changing the way cells “behave” can take several years, several generations of cellular division, even after being immersed into a new, healthier environment.

Back to the GOOD NEWS: With the science of current biomarkers constantly improving and new, even more sophisticated biomarkers being developed, we have come a long way in our understanding of osteoporosis and ways to treat it effectively. Most recently, in a study published in the Journal of Bone and Mineral Research,(2) Shieh, et al. assessed the clinical utility of measuring N-telopeptide (a bone resorption laboratory marker) during the menopause transition as a way of identifying women at high risk for developing osteoporosis. The study included 604 women. The authors concluded that higher levels of N-telopeptide during the early postmenopausal period were most strongly associated with a higher rate of bone loss during transmenopause. This correlation, elevations in N-telopeptide to the rate of bone loss, was most pronounced in the lumbar spine but also in the hip. More studies like this are needed to ensure individuals at highest risk for rapid bone loss are identified as quickly as possible.

I have been using biomarkers such as N-telopeptide (and the other bone resorption markers C-TX and DPD) for over fifteen years to assess and monitor patients with bone loss. I have seen the benefits of early detection of those at great risk of developing osteoporosis and those who have rapid bone loss and thus even a higher risk for fracture. Please help pass the word to everyone you know – especially women approaching transmenopause – about the importance of specific laboratory tests to gather critical information about their bone health. Armed with this information, they can work with their health care provider to customize a plan to address the underlying causes of their bone loss, ultimately enabling them to improve bone health, reduce the risk of fracture, and enjoy a more active lifestyle.

* Transmenopause or menopause transition refers to the period of greatest estrogen loss. Rapid bone loss often begins 1 year prior to a woman's final menstrual period and lasts for 2 to 3 (or more) years after their last period. After this 3 to 5 year (up to 10 years in some cases) period, the rapidity of bone loss normalizes to prior menopause levels. 


(1) McCormick, R.K. 2009. The Whole-Body Approach to Osteoporosis, How to Improve Bone Strength and Reduce Fracture Risk. New Harbinger Publications.

(2) Shieh, A., Ishii, S., Greendale, G.A., Cauley, J.A., Lo, J.A., and Karlamangla, A.S. 2015. Urinary N-Telopeptide and Rate of Bone Loss Over the Menopause Transition and Early Postmenopause. Journal of Bone and Mineral Research DOI: 10.1002/jbmr.2889.

Thursday, June 2, 2016

Becoming Anabolic in the Face of Osteoporosis - Even While Running 50 miles at the 2016 Pinelands Salomon Trail Running Festival


Reducing fracture risk is about more than just making bones denser with calcium. It is also about: 1) reducing chronic systemic inflammation, 2) staying strong and supple, and 3) remaining positive as you navigate through life. 

As I was slogging through a 50-mile race in Maine a few days ago, I began to wonder if what I was doing was really a good idea. After all, going non-stop for over 10 hours....eating M&Ms, potato chips, pretzels and guzzling down gallons of disgusting sugary drinks as I beat my joints and muscles to a pulp...intuitively doesn't SEEM like a smart thing to do to reduce systemic inflammation! And, as far doing things to promote strength and suppleness...well, just watch the short video on our OsteoNaturals Facebook Page (please "like" us while you're there!) as I slowly hobble across the finish line, and you will see that running 50 miles at one clip doesn't promote suppleness (especially

when you have achilles pain that started at mile 2). Strength of will, maybe, but suppleness, certainly not!

OK, so last weekend I failed miserably at accomplishing the first two things that I say are so important for bone health. But what about the third?...the "remaining positive" bit? My thought is that ONCE IN A WHILE it is OK to indulge in TOTALLY WACKY THINGS to keep your engines running on all cylinders. I know what you are thinking..."Didn't Dr. M just go up Mt. Kilimanjaro last month and didn't he just do an Ironman last year?", and "Is this REALLY a 'once in a while' thing that he does?" Well for me, a guy who just 17 years ago was breaking so many bones from osteoporosis that running 50 miles, doing Ironmans, or going up Mt. Kilimanjaro were not only out of the question but total pipe dreams....these are all REALLY important things for me to do for promoting my positiveness factor.

While I may have questioned my sanity as I slogged through the miles at the 2016 Salomon Trail Running Festival, I also relished at how lucky I was to be able to do such a crazy thing once again in my life. Years of struggling with osteoporosis, breaking bone after bone, was quite a challenge. I know many of you have face a similar challenge. And that is why I founded OsteoNaturals. And that is why I write these crazy newsletters. I want you to know that there ARE solutions and that people CAN bounce back from osteoporosis. That YOU CAN bounce back from bone fragility and regain physical confidence. It took me years of constant vigilance to diet and consistently taking important healing supplements such as OsteoNaturals, but my bones are now strong enough to push the envelope again (on a limited basis). Yes, I get incredible satisfaction from these adventures, but what I am most proud of is when I receive letters from people who have been taking OsteoNaturals products and hear how well they are doing. THAT is the best! I did it...they are doing it...and you can do it.

In my book, The Whole-Body Approach to Osteoporosis, I cover all the key points you need to know about creating an anabolic body for improved bone health. I talk about the importance of exercise (sane exercise), diet (no, no M&Ms or potato chips), gut health, and taking nutritional supplementation for reducing chronic systemic inflammation and improving bone health. Some of the most critical supplements I talk about are: calcium, magnesium, vitamins D and K, alpha-lipoic acid, N-acetyl cysteine, and berberine. My book explains how these and other important vitamins, minerals, and herbs can help reduce chronic systemic inflammation and improve skeletal health. Our OsteoNaturals products combine all of these ingredients, in just the right ratios, making it easy to ensure you are getting exactly what you need for better bone health.

So last weekend I may have failed miserably in reducing systemic inflammation and promoting suppleness but I made up for it with an overdose of the "remaining positive" thing. I'm not saying I will ever do another 50 miler but I will certainly do many more wild and crazy adventures in my life. Now back to being anabolic by eating better, getting lots of sleep, and taking my OsteoNaturals supplements. Rock on and stay tuned for more adventures!

Wednesday, May 4, 2016

Probiotics May Be Repurposed for Therapy in Osteoporosis


In my book, The Whole-Body Approach to Osteoporosis, I write about the importance of gut health when treating osteoporosis. An unhealthy digestive tract can not only interfere with optimal nutrient absorption but it disrupts the immune system and can lead to chronic systemic inflammation. As with the loss of estrogen at menopause, another common cause of osteoporosis is when the immune system gets out of balance (especially in postmenopausal women). Since 70% of the immune system is housed in the gut, keeping it healthy is critical for skeletal health. In a study published recently in The Journal of Clinical Investigation, researchers (Jau-Yi Li et al) working with mice reaffirm this premise and suggest that giving the mice probiotics improved the immune response and improved bone density. In this blog, I would like to help readers better understand how a healthy gut keeps chronic systemic inflammation at bay, and why it is so important to keep inflammation to a minimum if you want healthy bones.


The gastrointestinal tract is home to literally billions of bugs. Some good...some not so good. When the gut is over run by the not so good ones, (often due to a poor diet, allergies to foods and/or frequent use of antibiotics) it can be damaged and begin to leak. A chronically inflamed digestive tract causes gaps to form through which partially digested food particles and microbes can pass. Now, instead of being a protective barrier, this "leaky gut" becomes a portal to ill health. The particulate and microbial toxins that filter through these newly opened gaps set off reactions, which are a constant source of inflammation that insidiously permeate the entire body. This "leaking gut syndrome" or intestinal dysbiosis not only causes a chronic inflammatory reaction and a disruption of proper immune function in the person but when the gut is damaged it can no longer absorb nutrients effectively. So we NEED "good" bacteria to thrive in the gut. When healthy microbiota predominate in the gastrointestinal tract we are much healthier and so are our bones.


Our immune system and bone cells use the same signaling molecules (cytokines) to relay messages. When the immune system is out of balance it sends out way too many abnormal signaling molecules and the bone cells, especially the osteoclasts (the cells that break down bone), "hear" these abnormal signals and become hyper aggressive, eating up excessive amounts of bone. In chronic systemic inflammation, a condition I talk a lot about in my book, the "out of wack" immune system ends up being the cause of excessive bone loss. With too much inflammation in the body the osteoclasts become turned on ALL the time and the result is bone loss...osteoporosis. People often think that the most important thing they can do for osteoporosis is to take supplemental calcium. Yes, calcium is important but it isn't the whole story. We need to take in approximately 1,200 mg/day which is best achieved through a combination of dietary and supplemental sources. But we also need to make sure we get enough magnesium and vitamins D and K. AND we also must make sure our gut and immune systems are functioning optimally. Having all the nutrients available won't help much if the gut can't absorb them or if there are so many inflammatory cytokines circulating in the blood that the osteoclasts just destroy all the bone that is being made. When we give the body the minerals and vitamins it needs, PLUS have a healthy gut and immune system...then better bones will follow. Take out just one of those from the equation and the whole system falls apart.


Postmenopausal osteoporosis is typically the result of two things: 1) the loss of estrogen production from the ovaries, and 2) chronic systemic inflammation. Often, these go together as estrogen helps to reduce inflammation. In the published study using mice, researchers found that with the loss of estrogen there was an increase in ‘gut leakage’ and the subsequent inflammation resulted in increased osteoclastic or bone resorbing activity. After giving the mice probiotics, there was improvement in the immune response and improved bone density. 


Taking oral probiotics and eating fermented or cultured foods such as yogurt, kefir, sauerkraut, and miso encourages healthy gut microbiota which in turn helps gut function (as a barrier to pathogens and for improved digestion and absorption of nutrients) and regulation of the body's immune system. The bottom line from this study is that the use of probiotics has potential in the treatment of postmenopausal osteoporosis.

 Jau-Yi Li, et al. Sex steroid deficiency-associated bone loss is microbiota dependent and prevented by probiotics. The Journal of Clinical Investigations. 2016;10.1172/JCI86062.
 

Monday, April 25, 2016

Zolpidem (Ambien) Increases Fracture Risk In Men and Women with Osteoporosis

People break bones when they fall. In fact, falling is the number one cause of fractures especially in the elderly. It therefore makes sense that people with osteoporosis should avoid taking medications that increase their risk of falling. That is exactly what a recent study published in Osteoporosis International concluded. Park et al. conducted a large (1,092,925 participants) systematic review and meta-analysis and concluded that Zolpidem (Ambien), a medication often prescribed for insomnia, was associated with increased risk for fracture. The study noted that the increased fracture rate was especially pronounced for hip fractures.

This finding makes total sense when you realize that Ambien, a short-acting nonbenzodiazopine hypnotic, can cause ataxia, poor motor control, difficulty maintaining balance, dizziness, and sleepwalking. The last thing a person with fragile bones needs to be doing is dizzily walking around in their sleep . The kicker here is that a 2012 NIH study published in the British Medical Journal concluded that much of Zolpidem's effectiveness is psychological...in other words, a placebo effect. The study concluded that greater caution should be used when prescribing Ambien to individuals at risk for fracture and that "increased attention should be directed at psychological intervention of insomnia".

Park, S.M. et al.  2016. Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporosis International April 22.

Huedo-Medina, T.B. et al. 2012. Effectiveness of non-benzodiazopine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ (Clinical Research ed.) 345:e8343.
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