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.

Tuesday, June 27, 2017

The Similarities Between "Boosting" Athletic Performance and Osteoporosis Outcomes

I must admit, I was a bit lazy last year. After running a 50 mile trail race, I laid low for the rest of the year nursing a heel injury. But I'm healthy now and back training. As per usual, I've set a few goals for the summer...some triathlons and a few running races. There is something about setting goals that keeps me on track--not just in athletics, but in life. Goals are important; they sharpen your vision, give you focus and help steer you to success.

The goals I set for myself are typically lofty ones. Whether it is competing in an Ironman, running up Mt. Kilimanjaro, or improving my bone density naturally through diet and supplements, they usually aren't easy tasks...but that's what makes them interesting. Besides hard work, I am always in search of ways to "boost" my abilities to help reach those goals. Now I am not talking about performance enhancing drugs in athletics or taking osteoporosis medications to temporarily improve bone density at the risk of adverse effects and building poor quality bone. I'm talking about doing things naturally but effectively. I hope you can relate to some of these ideas and use them to boost your own goal outcomes.

Improving Athletic Performance
Improving your performance in athletics, no matter what sport or activity, starts with making sure your body is healthy enough to sustain training for months on end. If you break down a few weeks before a race, all that training goes out the window.

Common sense suggestions:

First, maintain a healthy gut by eating a good diet and taking supplements. Putting high-octane fuel in the tank...lots of good green veggies, quality protein and plenty of minerals and electrolytes...allows the body to rejuvenate after each workout. Second, exercise regularly and focus on quality workouts. Third, get plenty of sleep. It is during the night-time hours that the body repairs itself and you can do a lot of damage to your body in a hard training session. Finally, keep a positive attitude and be patient.

Boost Suggestions:
I have found a few extra little things besides those basics that enhance my performance just enough to put me on a slightly higher playing field...enough to get me from 2nd place to 1st place in a race. For running and competing in triathlons, that edge or boost to performance comes from three things:
1) The nutritional supplement creatine. Creatine is a naturally occurring substance in the body that helps recycle adenosine triphosphate (ATP) energy. But creatine levels decline as we age making it more difficult to effectively utilize ATP.* Not only does creatine help give us more zip DURING a workout but it helps with after-workout recovery.
2) Strength training. This might include the use of free weights, weight machines, elastic resistance bands, and/or simply resisting against your own weight. A well-executed strength-training program contributes to my feeling strong all over, increases total body mass, reduces the risk of sports injuries and improves core stability. **
3) Ensuring adequate electrolytes. For optimal nerve conduction and muscle contractions you need to have plenty of minerals and electrolytes. Nerves fire optimally and muscles respond best when the body is electrically alive and swimming in electrolytes.

Improving Osteoporosis Outcomes
My quest to improve bone health runs parallel to how I approach sports. I treat this goal as a huge challenge that arouses my competitive juices and makes me SO WANT TO SUCCEED. The key is to stay focused every day on the key factors that will keep bones strong and healthy.

Common sense suggestions:
First, maintain a healthy gut (probiotics, fiber, eliminate food allergens and sensitivities, digestive enzymes if needed), eat a good diet and take supplements. Second, engage in weight-bearing exercise regularly. Third, get adequate sleep. Finally, keep a positive attitude and have patience. Sound familiar?

Boost suggestions:
I have found that a boost to improved bone health comes from similar sources as those that I use to enhance my athletic performance:
1) The nutritional supplement creatine.
2) Strength training.
Muscles release myokines, chemical signaling molecules that tell bones to get stronger. This makes sense. Bones have to be strong enough to take the torque produced by muscles; so muscles and bones have to be in close communication with each other. The stronger your muscles, the stronger your bones will be; taking creatine and engaging in frequent strength training are two of the best boosts to this mechanism.
3) Ensure not just adequate minerals but minerals that can be EASILY deposited into bones AND be transformed EASILY into electrolytes.
(Electrolytes are minerals with an electric charge.) In addition to providing one of the best sources of calcium possible for bone building, OsteoMineralBoost*** contains bio-active calcium, magnesium, and 72 trace minerals (from Aquamin red marine algae). It is easily incorporated into bone tissue, helps preserve bone, and is a natural source of electrolytes...perfect for people who suffer from bone loss...and athletes alike. 

It is my hope that you will use some of these ideas in your daily regimen to kick-start or help "boost" your goal attainment. And, if you haven't set goals yet, what are you waiting for?! Whether you are an athlete or an individual who wants to improve health outcomes, the goal-setting process is needed to understand where you are currently, and where you want to go. The fact that you aren't where you want to be, should be enough motivation.

* We can obtain creatine from our diet but the best sources are fish and meat which are acidic and large quantities of these foods may not be the best way to ensure adequate creatine levels. Because creatine is only obtained through animal products, vegetarians have difficulty maintaining adequate creatine levels. For these reasons supplementing with creatine, especially if you have bone loss, is a good idea. For more info on creatine go to:
** Of course, when any exercise program is undertaken by sedentary individuals, they should first check with their physician. In addition to the cardiovascular concerns of starting an exercise program, caution, especially in the osteoporotic individual, should be taken to avoid undue load on the spine or hips. For example, bending forward or lifting weights overhead can put a heavy load on the spinal vertebrae and if bone density is extremely low, this can result in a compression fracture.
*** OsteoMineralBoost provides one of the best sources of calcium possible for bone building...micro-crystaline hydroxyapatite. MCHA has been shown in research studies to contain growth factors for improved bone building activity in people with osteoporosis. OsteoMineralBoost also contains Aquamin trace minerals from red marine algae. Aquamin won the Ingredient of the Year for Healthy Aging at the 2016 Nutraingredients Awards in Geneva, Switzerland.

Tuesday, May 23, 2017

More on the Epigenetics of Osteoporosis

Our DNA's genetic code dictates much of who we are both physically and mentally. Genetics is also a determinant of health – good or poor.  Inherited genetic conditions can be caused by a single-gene defect or by complex factors including multiple genes and impacted by lifestyle and environmental factors. 

Earlier this month I wrote about epigenetics: the impact it has on our health and the possible connections later in life to diseases such as osteoporosis. Unlike our genetic makeup that is "hardwired", our epigenome (the way our genes are regulated and/or expressed) is malleable and can be influenced by the way we live.

In fact, recent findings published in the Journal of Bone and Mineral Research by researchers involved in the Southampton Women's Survey at the University of Southampton in the United Kingdom show that poor intrauterine and childhood growth may affect the epigenetic regulation of genes associated with bone development. The lead author of the study, Nicholas Harvey, stated "The health of a child's bone when they are young can influence the risk of osteoporosis in older age."   
By eating better and making wise lifestyle choices, especially early in life, we can influence our epigenome and prevent certain diseases from manifesting. 

Curtis, E.M., et al. Perinatal DNA methylation at CDKN2A is associated with offspring bone mass: Findings from the Southampton Women's Survey. JBMR. April 17, 2017. doi: 10.1002/jbmr.3153.

Monday, May 15, 2017

Reduce Your Risk of Fracture - Even a Little Exercise Is Better than Nothing at All.

We have all heard that exercise is good for bones, but exactly how much physical activity is needed to reduce your risk of fracture when you have osteoporosis? This question is what Karl Stattin, MD from Uppsola Science Park in Sweden, and colleagues, examined in a study soon to be published in the Journal of Bone and Mineral Research. Stattin, et al. followed 66,940 women and men for a maximum of 17 years and found that walking or biking less than 20 minutes a day helped to lower the rate of hip fracture compared to those who hardly ever walked/bicycled. At (less than) 20 minutes a day times 7 days...that is just over two hours of exercise a week that is needed to help lower your fracture risk! Not much at all!

Dr. Stattin pushed this question even more by examining if just 1 hour a week of exercise could lower fracture risk. Now, 1 hour a week is not much! The result, yes, just 1 hour a week of exercise DOES lower the rate of hip fracture, or ANY fracture for that matter, compared with those who exercised less than 1 hour per week.

So, the next time you get frustrated because of lack of time to fit everything in, remember, just one hour of exercise is better than nothing at all. Go have some fun.

Stattin, K., et al. 2017. Leisure-time physical activity and risk of fracture: a cohort study of 66,940 men and women. JBMR. DOI: 10.1002/jbmr.3161.

Saturday, May 13, 2017

Osteoporosis and Vascular Calcification

In a study published in Climacteric, C.E. Lampropoulos, et al. assessed the correlation between osteoporosis and vascular calcification in postmenopausal women. The goal was to determine not only if there was a correlation (there have been numerous studies linking these as comorbidities) but also to determine if low dose calcium supplementation plus vitamin D contributed to calcification of arteries.

The study concluded that "Calcified plaques were significantly correlated with osteoporosis."  Osteoporotic women were "16 times more likely" to develop calcification of the abdominal aorta and "seven times more likely" to develop plaques and thickening of blood vessels compared to normal individuals. It also concluded that "low doses of supplements do not appear to cause any increase in vascular calcification in osteoporotic women." In other words, although bone loss and calcification of arteries go hand in hand their connection is NOT due to taking calcium supplements. And this is key! We need calcium for our bones to be healthy.

Taking supplemental calcium is safe when used in moderation. Taking huge amounts of any supplement, including calcium, is never advisable. But a sensible intake of 600 to 1,000 mg/day of supplemental calcium (plus another 500 or so from the diet) is important for getting your 1,200 to 1,500 mg calcium/day as recommended by most bone-health experts. Making sure you get adequate vitamins D and K, and magnesium is also a vital part of the equation. You NEED these to ensure that the calcium you take in goes to the right places in your body: muscles, nerves and bone...and NOT settle into the blood vessels!
So what is it that makes women with bone loss be more susceptible to calcification and hardening of the arteries? The answer is INFLAMATION. We at OsteoNaturals know that simply taking in adequate calcium is NOT the total answer to improving bone health. The MOST important thing you can do for better bone health is to reduce inflammation-driven, excessive osteoclastic bone resorption. Inflammation, not a lack of calcium, is usually what fuels excessive bone loss. And that is where OsteoStim comes to the rescue. OsteoNaturals'OsteoStim has ingredients designed to do exactly that: modulate the activity between the osteoclasts and the osteoblasts so that the bone remodeling process comes more into balance. A balanced bone remodeling system is important for the skeleton to renew itself periodically...important for keeping it young, supple, and strong. AND, not only does OsteoStim have ingredients that promote balanced bone remodeling but it also has 200 mg of a very important antioxidant that, yes, you guessed it...helps prevent blood vessel calcification!

And as Lampropoulos, et al. showed in their research, since osteoporotic women are 16 times more likely to develop calcifications it is EXTREMELY important to address this head on! Alpha lipoic acid is THE perfect antioxidant that can help prevent this calcification. Studies such as the one by Ying, et al. demonstrate this beneficial effect. In this 2010  research, published in Life Sciences, Ying, et al. showed that lipoic acid "reduced atherosclerotic plaques in the abdominal aorta".

The combined effect of supplemental calcium, magnesium and other minerals from OsteoSustain and OsteoMineralBoost, plus improved bone remodeling and lowered atherosclerotic risk from our OsteoStim makes OsteoNaturals products your first choice for improved skeletal health.  

Lampropoulos, C.E., et al. 2016. Osteoporosis and vascular calcification in postmenopausal women: a cross-sectional study. Climacteric April 5:1-5.

Tuesday, May 2, 2017

A Handful of Broccoli Sprouts A Day / Keeps Bone Imbalance (and Bisphosphonates) Away

Bone remodeling in an adult is the biological mechanism where old bone is removed by osteoclasts and new bone is formed by osteoblasts at an equal rate. In other words, these cells function "in sync" with each other. The result, when all is healthy, is a continual renewal of bone without any substantial overall loss in bone density as a person ages. But if the osteoblasts are unable to effectively produce new bone, and/or the osteoclasts are overly aggressive and resorb too much old bone, then they are "out of sync" and there becomes a deficit. When this deficit continues for years, bone density declines and will eventually lead to osteoporosis. A number of factors can increase or decrease the likelihood of imbalance in the bone remodeling process. In this blog I would like to review four important factors.
1) An "out of sync" situation occurs with Bisphosphonates*, the drugs commonly used to COMBAT osteoporosis. These medications are so powerful that they not only poison the osteoclast cells but they also dramatically interfere with the ability of osteoblasts to form bone. The result is that the skeleton becomes more brittle, "older", and more prone to breaking. Continued use of these drugs also puts a person at risk of serious adverse effects such as atypical femur fractures, non-union fractures, and osteonecrosis of the jaw.
2) An “in sync” situation occurs with the consumption of fruits and vegetables. Eating 5 to 8 helpings of fruits and vegetables each day not only helps reduce excessive bone resorption but it is important for boosting osteoblastic activity. Fruits and vegetables help alkalinize the body which promotes bone formation and they also provide polyphenols (most noted for their anti-cancer properties). These powerful phytochemicals are antioxidants that provide great protection against bone loss. The flavonoid kaempferol, found in high amounts in onions, and another flavonoid quercetin, found in dried plums, both have beneficial effects on bone and have been used in the treatment of osteoporosis.
3) Another ‘In sync’ situation involves epigenetics – external modifications to DNA that turn genes “on” or “off”.  The DNA sequence is not changed, but the modifications affect how cells “read” the genes and subsequently how they produce proteins. When bone cells interact to build and maintain bone, these processes are orchestrated by regulators of gene expression. A person may have genes for strong bones but the regulators of how those genes manifest are, for some reason or other, not turned on or off correctly and the bone strength is not realized. It is the epigenetics, or how genes are expressed, that becomes important with nutrition. Good nutrition allows a person's genetic make up to be expressed its full potential. But poor nutrition may lead to an under-expression of a person's genetic expression. And such is the case with bone health.
One particular phytochemical that can orchestrate gene expression and provide benefits for treating
Broccoli Sprouts
osteoporosis is
sulforaphane – a naturally occurring isothiocyanate. In the Journal of Biological Chemistry, Thaler et al. reports that sulforaphane, found in high concentrations in cruciferous vegetables such as broccoli (especially broccoli sprouts), cabbage and kale, had substantial positive effects on the epigenetics of bone remodeling. In Thaler's study on mice, he found that sulforaphane helps to increase bone volume and reduce bone loss caused by a loss of estrogen. Sulforaphane acts as an epigenetic bone anabolic (building) agent and has a "two-pronged effect on bone formation and homeostasis by acting differently on osteoblasts and osteoclasts." Sulforaphane turns on genes involved in matrix mineralization and enhanced expression of osteoblastic activity. It also significantly decreases the expression of the osteoclast activator RANKL in osteocytes. The effect is that sulforaphane inhibits the production and activation of osteoclasts.
4) One final “in sync” factor is the promotion of a BALANCED bone remodeling system by promoting a RE-BALANCING of the remodeling process. Bone should be ENCOURAGED to GENTLY gain density, to enhance restructure and improved bone quality, and to gain strength. It should not be forced into an unnatural accrual of density without improvement in bone quality. OsteoNaturals’ OsteoStim contains ingredients that help reduce (not stop) EXCESSIVE osteoclastic activity and others to stimulate osteoblasts to build bone. The overall effect is that OsteoStim helps BALANCE bone remodeling. It helps encourage better bone QUALITY, not by destroying osteoclasts but by curtailing their activity and NUDGING osteoblasts to build new strong healthy bone. This is the key to OsteoStim's success. As a nutritional supplement for bone loss, OsteoStim isn't your source for minerals (those are found in OsteoSustain and OsteoMineralBoost); its job is to tackle remodeling. Without a balanced bone remodeling system, taking all the best minerals in the world won't do much good. A balanced bone remodeling process is key to supplemental minerals being effective and successfully combating bone loss.
Other strategies that MUST be included in one's quest to regain skeletal health include: a consistent regimen of physical activity, a diet that includes 60 to 90 grams of quality protein on a daily basis, supplementing with creatine and/or DHEA (when advised by a health care provider), reducing chronic systemic inflammation, and curtailing catabolic (cell destroying) lifestyle activities (such as smoking and heavy alcohol use).
The takeaway: there are lifestyle changes that you can make that actually alter the expression of your genes and your bone health; consider medications carefully; promote bone quality with OsteoNaturals' OsteoStim and eat your fruits and vegetables! For a double punch to overcoming osteoporosis, add broccoli spouts to your daily diet. It may help your genes, through epigenetic mechanisms, to boost bone building activity and reduce bone destruction.
* alendronate (Fosamax), residronate (Actonel), ibandronate (Boniva) and zolodronic acid (Reclast)
Thaler, R., et al. Anabolic and anti-resorptive modulation of bone homeostasis by the epigenetic modulator sulforaphane, a naturally occurring isothiocyanate. J Biol Chem. Jan 12, 2016.

Tuesday, March 14, 2017

Lactoferrin: Promising Strategy for Better Bone and Joint Health - Combats Osteoporosis and Osteoarthritis

Over the last ten years, lactoferrin, a natural bioactive glycoprotein from milk, has stirred considerable interest in the field of bone health. (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16) Lactoferrin limits inflammatory messenger molecules to reduce inflammation and reduce catabolic (tearing down) activity in the body. This includes a calming down of the destructive action of osteoclasts, the cells responsible for excessive bone resorption that leads to osteoporosis. This anti-catabolic effect not only helps people with osteoporosis but it also prevents the cartilage degradation seen in people who suffer from osteoarthritis. (17,18)

Lactoferrin, a multifunctional protein of the innate immune defense system.
Now, with solid evidence (19,20,21) that lactoferrin also enhances anabolic (bone building) activity in bones, it is currently one of the hottest and most promising neutraceutical on the market for combating osteoporosis. Lactoferrin's anabolic (building) effect on bone stems from its ability to reduce inflammation and osteoclastic activity, and also by improving osteoblast cell activity for enhanced bone formation.

Lactoferrin is one of those few molecules that is known to effect both the osteoclasts and the osteoblasts in the remodeling activity of bone...AND it is NOW in OsteoStim. OsteoStim already includes a stellar list of natural vitamins, herbs, and bioactive ingredients shown to help balance bone remodeling through a reduction in osteoclastic activity and a boost in osteoblastic bone-building action. This OsteoNaturals product has just gotten better.

  1. Blais, A., Malet, A., Mikogami, T., et al. Oral bovine lactoferrin improves bone status of ovariectomized mice. Am J Physiol Endocrinol Metab 2009:296(6):E1281-8.
  2. Bharadwaj, S., Naidu, A.G., Betageri, G.V., et al. Milk ribonuclease-eriched lactoferrin induces positive effects on bone turnover markers in postmenopausal women. Osteoporos Int 2009; Sept 20(9):1603-11.
  3. Guo HY, Jiang L, Ibrahim SA, et al. Orally administered lactoferrin preserves bone mass and microarchitecture in ovariectomized rats J Nutr. 2009;139(5):9586.
  4. Cornish J, Callon KE, Naot D, et al. Lactoferrin is a potent regulator of bone cell activity and increases bone formation in vivo. Endocrinology. 2004;145(9):436674.
  5. Lorget F, Clough J,Oliveira M, Daury MC, Sabokbar A,Offord E. Lactoferrin reduces invitro osteoclast differentiation and resorbing activity. Biochem Biophys Res Commun. 2002;296(2):2616. 
  6. Takayama Y, Mizumachi K. Effect of bovine lactoferrin on extracellular matrix calcication by human osteoblastlike cells. Biosci Biotechnol Biochem. 2008;72(1):22630. 
  7. Takayama Y, Mizumachi K. Effect of lactoferrinembedded collagen membrane on osteogenic differentiation of human osteoblastlike cells. J Biosci Bioeng. 2009;107(2):1915. 
  8. Yagi M, Suzuki N, Takayama T, et al. Effects of lactoferrin on the differentiation of pluripotent mesenchymal cells. Cell Biol Int. 2009;33(3):2839. 
  9. Grey A, Banovic T, Zhu Q, et al. The lowdensity lipoprotein receptor related protein1is a mitogenic receptor for lactoferrin in osteoblastic cells. Mol Endocrinol. 2004;18(9):226878. 
  10. Grey A, Zhu Q, Watson M, Callon K, Cornish J. Lactoferrin potently inhibits osteoblast apoptosis,viaanLRP1independent pathway. Mol Cell Endocrinol. 2006;251(12):96102. 
  11. Grey A, Zhu Q, Watson M, Callon K, Cornish J. Lactoferrin potently inhibitsosteoblastapoptosis,viaanLRP1independent pathway. Mol Cell Endocrinol. 2006;251(12):96102. 
  12. Naot D, Chhana A, Matthews BG, et al. Molecular mechanisms involved in hemitogenic effect of lactoferrin in osteoblasts. Bone. 2011;49(2):21724.  
  13. Hou, J.M., Chen, E.Yl, Wei, S.C., et al. Lactoferrin inhibits apoptosis through insulin-like growth factor 1 in primary rat osteoblasts. Acta Pharmacol Sin 2014;35(4):523-30. 
  14. Onubushi, T., Kawazoe, A., Miyauchi, M., et al. Molecular mechanisms of the inhibitory effects of bovine lactoferrin on lipopolysaccharide-mediated osteoclastogenesis. J Biol Chem 2012;287(28):23527-36.
  15. Ying, X., Cheng, S., Wang, W., et al. Effect of lactoferrin on osteogenic differentiation of human adipose stem cells. Int Orthop 2012;36(3):647-53.
  16. Montesi, M., Panseri, S., Iafisco, M., et al. Coupling hydroxyapatite nanocrystals with lactoferrin as a promising strategy to fine regulate bone homeostasis. PloS One 2015;10(7);e0132633
  17. Ahmadinia, K., Yan, D., Ellman, M., Im, H.J. The anti-catabolic role of bovine lactoferricin in cartilage. Biomol Concepts 2013;4(5):495-500.
  18. Kim, J.S., Ellman, EB,. An, HS., et al. Lactoferricin mediates anabolic and anti-catabolic effects in the intervertebral disc. J Cell Physiol 2012;227(4):1512-20.
  19. Amini AA, Nair LS. Lactoferrin: a biologically active molecule for bone regeneration. Curr Med Chem. 2011;18(8):12209. 
  20. Li, W., Zhu, S., and Hu. J., Bone regeneration is promoted by orally administered bovine lactoferrin in a rabbit tibial distraction osteogenesis model. Clin Orthop Relat Res 2015; 473(7):2383-93. 
  21. Zhang, W., Guo, H., Jing, H., et al. Lactoferrin stimulates osteoblast differentiation through PKA and p38 pathways independent of lactoferrin’s receptor LRP1. J Bone Miner Res 2014;29(5):1232-43.

Treatment Sequence with Osteoporosis Medications Matters

The effects of medications on bone can be dramatic. Glucocorticoids (e.g. prednisone and dexamethasone) for inflammation, thiazolidinediones (e.g. Avandia and Actos) for type 2 diabetes, and proton pump inhibitors (e.g. Prevacid and Nexium) all can lead to dramatic bone loss. In fact, bone loss can be so profound from drug therapy that it is very important to talk with your doctor about any possible impact on skeletal health when being prescribed a new medication.

Medications specific to osteoporosis treatment can also be very powerful. Many people are aware that drugs for osteoporosis can cause both minor and severe adverse effects. [The most common drugs available for the treatment of osteoporosis are the antiresorptive bisphosphonates (alendronate, risedronate, ibandronate and zoledronic acid) and Prolia (denosumab), and the anabolic Forteo (teriparatide - TPTD).] Most of these drugs can even lead to increased risk for fracture when taken for three or more years. But what many people don't realize is that these drugs are so powerful that it REALLY matters WHICH medication your doctor prescribes first. He or she needs to choose the RIGHT medication for the job...the FIRST time. Guessing is not good here. Getting it wrong can lead to life-threatening consequences. Unlike an antibiotic that can be changed if the first one doesn't seem to be working to kill off an infection, antiresorptive osteoporosis medications can limit the effectiveness of the anabolic drug order is everything when selecting which of these drugs to use in each individual case.

When someone has severe bone loss and they have sustained fractures, it is common to put them on a sequential treatment program of TPTD (the only anabolic drug therapy currently available) for two years followed by a course of treatment with an antiresorptive bisphosphonate or denosomab. This sequential drug therapy can have dramatic and positive results for reducing fracture risk when drug therapy is warranted.

But what if a person with osteoporosis were to be treated initially with a bisphosphonate and THEN, due to a lack of response (no improvement in bone mineral density (BMD) to the antiresorptive drug, was then prescribed TPTD? Is this a wise protocol? Can this sequence lead to increased fracture risk? This is exactly what Dr. Felicia Cosman of Helen Hayes Hospital in NY set out to evaluate. The importance of proper drug sequencing is the subject of her recent perspective in this months issue of the Journal of Bone and Mineral Research.

In a perspective reviews study, Dr. Cosman concluded the following:

1) When selecting a treatment protocol for someone with severe bone loss, if no osteoporosis drug therapy has been used before, Dr. Cosman recommends TPTD anabolic therapy first (if appropriate) followed by antiresorptive therapy.

2) She goes on to say,"...our observations clearly highlight that the common practice of providing patients with first-line antiresorptive therapy and then only after patients have an inadequate BMD response and/or an intercurrent fracture to switch to TPTD is not the optimal utilization of anabolic treatment." Dr. Cosman explains that this is extremely important especially when someone sustains a hip fracture. She states that to transition to TPTD after a course of antiresorptive therapy "might in fact lead to a transient loss of strength in cortical sites, including the other hip. This is critically important in patients with a recent fracture where we know the risk of a second imminent fracture is extremely high..."(Hip fractures are a common cause of premature death. Over 50% of people who fracture a hip will die within the year.) For these cases she recommends concurrent treatment with an antiresorptive agent and TPTD instead of sequential therapy. 

Cosman, F., Nieves, JW., and Dempster, DW. 2017. Treatment sequence matters: anabolic and antiresorptive therapy for osteoporosis. J Bone Miner Res 32(2):198-202.

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