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.
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