INTEGRATED MEDICINE AND LEAKY GUT SYNDROME

OSTEOPOROSIS –Is it a disease or just aging bone?

I have written about osteoporosis many times before but each time I revisit this topic because a new question comes up for me and a whole new perspective and viewpoint emerges. It is amazing how entrenched viewpoints become so that one just accepts the prevailing view because that is all that seems to appear in the literature that one reads.

I have often wondered about the question of osteoporosis being diagnosed as a ‘disease’ for the simple reason that if it is just a process of aging, then is aging itself a ‘disease’? If aging is not a disease and osteoporosis is just aging, then how can this be called a disease?

It makes a big difference to my way of thinking calling something a disease or a declining physiological event. I can understand that if doctors believe that osteoporosis is a disease they may want to then treat it with drugs, but if osteoporosis is just a process of aging then perhaps doctors may be prepared to think about improving health. What a healthy older person needs is not drugs, but an improvement in health, or in other words moving the system to greater efficiency. For example I have yet to see an older person with normal vitamin D levels and this would surely contribute to that person having less dense bone. If that less dense bone is diagnosed as osteoporosis, a disease needing drugs, then that is very different to recognizing osteoporosis as just thin bones due to aging and perhaps lack of exercise and vitamin D deficiency.

There is good reason to think differently about osteoporosis

Santora L From brittle bones to standard deviations: The historical development of osteoporosis in the late twentieth Century. Science Technology Human Values 2011;36(4):494-521

Here are some interesting facts:

1. Bone density does not equal bone strength.

 The lead in a pencil is very dense but has little strength quality and can break easily.

2. The Japanese have a low calcium diet and lower bone density on average than American women, yet have a much lower fracture rate.

Fujita T Osteoporosis in Japan: factors contributing to the low incidence of hip fracture. Adv Nutr Res 1994;9:89-99

These differences in bone density and fracture rates are not uncommon around the world, and even in the same country within different races.

3. Osteoporosis is a common disorder of western civilization but is much less common in other parts of the world, especially amongst indigenous and traditional peoples.

4. Other medical conditions seen less commonly amongst indigenous people include coronary heart disease, diabetes, periodontal disease, obesity and diseases of the colon.

This suggests that these diseases are possible due to or more likely because of  the lifestyle habits of modern western civilization, including use of refined foods, sugar, cigarette smoking, lack of sunshine and exercise, poor sleep patterns and the increasing intake of large amounts of environmental toxins.

Osteoporosis is a common and costly disease carrying a significant morbidity and mortality. The lifetime risk of a fracture in a Caucasoid woman is 30-40%. Up to 20% of hip fracture women die within 1 year and more than 50% never regain functional ability to lead an independent life. A 50 year old Caucasian American woman has a one in six chance of experiencing a hip fracture during her lifetime. Of those women surviving into their late 80s and beyond, the figure rises to one in three. Prophylactic treatment can therefore be lifesaving and improve the long term quality of life.

Peak bone mass is attained during early adulthood (20 to 30 years), remains relatively stable for about 5 years and then  begins to decrease long before menopause (0.3-0.5% annually). Peak bone mass is mainly determined by heredity and gender while age-related bone loss results mainly from menopausal hormone deficiency, the process of aging plus a range of other factors that need to be included in the profile.

The accelerated bone loss at menopause is in the order of 3-5% per year and lasts approximately for 5 to 7 years before slowing down again. The reason for the accelerated loss is that osteoclast activity (bone re-absorption) and osteoblast activity (bone formation) are controlled by systemic hormones and cytokines such as parathyroid hormone, calcitonin, estrogen, and vitamin D3. The fall in estrogen therefore is a major cause of accelerated bone loss as this deficiency affects circulating levels of some cytokines which lead to increased osteoclastic recruitment.

Management

Management should include the consideration of prevention.  All women are losing bone mass from about 30 to 35 years onwards, by which time they have reached peak bone mass.

Osteoporosis- what’s new?

In asking what’s new it’s always good to remind oneself that generally what’s new is all about the latest drug. And that’s really not exciting anymore because we are all beginning to realise that drugs are problematic. As indicated above, new research is so biased that in general the issues become confused so that it is always good to review what we know.

Osteoporosis is a decrease in bone mass and density causing bones to become fragile and increase the risk of fractures. It is useful to keep in mind that bone scans measure bone density, but not bone strength. Bone density does not equal bone strength, just as the lead in a pencil is easy to break despite its very high density. What seems to be true is that in many western countries there appears to be a correlation between bone density and bone strength, or what is often referred to bone quality. Bone quality is an amalgamation of all the factors that determine how well the skeleton can resist fracturing and includes the micro-architecture, accumulated microscopic damage, the quality of collagen, the size of mineral crystals and the rate of bone turnover. There is increasing sensitivity towards all features of bone health rather than just a focus on bone density. This is good news for Integrative practitioners who have always felt uncomfortable in the use of drugs to increase density alone. New research is also beginning to show that even the most popular drugs for treating osteopenia and osteoporosis do more than just increase density. There is increasing evidence that the bones when treated with these drugs become stronger even before they become denser. In other words the drugs start to reduce the risk of fractures before the increases in bone density reached their maximum. Raloxifene, for example, significantly reduces the incidence of fractures within 6 to 12 months of starting treatment, whereas the maximum increase in spinal bone density of 2 to 3% is seen at 3 years.

[Qu Y et al  Curr Med Res Opin 2005;21:1955-1959]

This kind of information does suggest that perhaps these drugs not only affect bone density but also other factors required for bone strength. It might also suggest that when using natural approaches bone density may not be the primary factor of importance and that a person may in fact have osteopenia, but still have a good quality of bone. With this in mind the World Health Organization (WHO) has developed new tools for assessing fracture risk called FRAX based on bone mineral density of the femoral neck combined with other factors: the peron’s age, gender, weight and height, whether the person has a personal or family history of fractures, and whether the patient smokes, uses glucocorticoids, has RA, has secondary osteoporosis, or consumes alcohol in excess.

Anti-depressant drugs may be dangerous to your health

Aropax, a selective serotonin re-uptake inhibitor has now a new side effect added to its list of side effects. Use if this drug has been linked to an increased risk of suicidal thoughts and tendencies among adult patients. This is not the first time that this link has been identified. In the present study there was a nearly sevenfold increase in suicide attempts in those taking Aropax vs those taking a placebo. The FDA in America has at last placed a ‘black box’ warning on this drug which generally means that it is one step away from being taken off the market. It just requires a few more side effects reported and another negative study. In the meantime more people may be negatively effected  by this drug.  Aropax like many other anti-depressants have also not been shown to work much better than a placebo in the majority of people that use it but in addition these drugs have major side effects. This should not surprise anyone.  Serotonin uptake which is blocked by this group of drugs is a major natural requirement of good healthy mental function but serotonin is not only important for mental function but also has major functions in the gastro-intestinal tract and on the immune system. Interfering with this function will invariably cause stress in the body.

Keep in mind that while doctors often call depression a chemical problem there is no evidence for this. If it was a chemical problem then sending blood to the laboratory to diagnose depression would be possible. Depression is not a chemical problem although it may have chemical consequences. The strange thing is that once a person starts taking a drug which interferes with serotonin uptake the body must make an adjustment for this interference. It responds by shutting down serotonin production and decreases the receptor sites for serotonin uptake. So from not having a chemical problem one now ends up with a chemical problem. It is for this reason that stopping the drug causes withdrawal symptoms until the body has returned back to its previous normal function. The longer one stays on the drug the greater the chance that these changes may even become permanent.

There are a range of natural products which really work for depression and should always be tried first. They include the classic herb St Johns Wort which has been shown in numerous double blind studies to work just as well as drugs. I often add tryptophan to this herb together with omega 3. Other products include 5-hydroxytryptophan or 5HTP , phenylalanine and tyrosine,  S-Adenosyl methionine or SAM and the vitamin B combination.