Monday, February 27, 2017

Bone Density Loss is Associated with Blood Cell Counts


For over 10 years now, I have been using laboratory biomarkers as therapeutic targets to lower fracture risk for people with osteoporosis. As I explain in my book, The Whole-Body Approach to Osteoporosis, a snapshot of your health record, including results from your bone density (DXA) examinations and special laboratory tests are useful in diagnosing the cause(s) of bone loss and ruling out other disease processes. Some of these tests, can then be repeated to help monitor effectiveness of treatment. Any abnormal test results provide therapeutic targets for improvement. On subsequent testing, positive changes will indicate that the therapies you and your doctor have initiated are making an impact - and that your health, and that of your bones, is improving.

Convincing others to treat osteoporosis using a whole-body approach can be difficult at times, however. One example: 
About five years ago, I was out on a bike ride and came upon an acquaintance, Dr. R, a medical doctor at the local university. I slowed down and rode with him for a while since I had done a hard workout the day before and this was an "easy" ride day. We got on to what I was doing in my practice and I explained my approach in detail. As an allopathic physician with no experience in functional medicine or nutrition, Dr. R just COULD NOT accept what I was saying. When I explained that I regularly see lab tests change due to diet and nutritional intervention he just kept saying..."no you didn't, there is NO way you can change lab results with just nutrition." Dr. R just could not accept these concepts that were so foreign to his allopathic training.

Despite some continued naysayers, I'm buoyed by ongoing research exploring more integrated approaches - addressing not just symptoms, but the real causes of illness. Such an article (1) appeared in the February 2017 Journal of Bone and Mineral Research. Valderrabano et al. takes an expanded look at some of the blood biomarkers that we can look at when evaluating patients with osteoporosis. Instead of simply relying on bone density exams (DXAs) to determine efficacy of treatment, it is possible to look at changes in laboratory test results as surrogate indicators of improved bone health.

Clinical and molecular research shows us that what goes on in a person's bone marrow strongly
affects his or her bone quantity and quality. By observing a person's changes in red and white blood cell counts over time we can see how this correlates to their improving or loss of bone density. [In my practice, two of the markers I use with almost every person with osteoporosis are the red blood cell and the lymphocyte counts.] Oxygen carrying red blood cells are often low because the cells that form them (hematopoietic stem cells) are being crowded out by a buildup of bone marrow fat. Chronic systemic inflammation contributes to this build-up of marrow fat. A decline in lymphocytes (the white blood cells responsible for the adaptive immune response) and a rise in neutrophil counts, are also seen in people with osteoporosis. The reason is the same, chronic inflammation.

What was particularly important about this research by Valderrabano et al. was their insight into the association of these biomarkers not just to bone density but to the "rate" of bone loss. Anemia (low red blood cell count) plus low lymphocytes and high neutrophils can be indicators of higher bone loss rates. By addressing factors to help reduce systemic inflammation, we can see early changes in these surrogate biomarkers (and others) of bone health. This is so much more efficient than waiting two years for the next DXA scan.

When I meet with a person in my office in Massachusetts or I work with someone from another state or country via a telephone consult, my method is the same; gather as much information as possible including laboratory tests and identify "therapeutic targets" to monitor and guide therapy. The focus of treatment for individuals with bone loss should be to reduce fracture risk. This is most effectively achieved by taking a comprehensive approach that includes diet and lifestyle changes, exercise, nutritional supplements, and, when necessary, pharmaceutical intervention. Using this personalized method, patients can be helped to find their own individual path to the management of osteoporosis.


1)  Valderrabano, R.J., et al. 2017. Bone Density Loss is Associated with Blood Cell Counts. Journal of Bone and Mineral Research Vol. 32, Issue 2; 212-220.


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