Osteoporosis – Controversies and Promising Treatment Options
description
Transcript of Osteoporosis – Controversies and Promising Treatment Options
![Page 1: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/1.jpg)
Keith R. Holden, M.D.
Ponte Vedra Beach, FLwww.Dr-Holden.com
![Page 2: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/2.jpg)
Guidelines for prevention and tx vary
Bone quality versus bone quantity
Same BMD can have different fx risk (age)
Cumbersome dosing requirements
Drug side effects
![Page 3: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/3.jpg)
Esophagitis
Esophageal stricture
Esophageal cancer
Osteonecrosis of jaw
Atypical Femur Fracture
![Page 4: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/4.jpg)
Bisphosphonates ↓ osteoclast fxn & induce osteoclast apoptosis
Suppress bone resorption = hard, brittle bone
Path: ↓ bone heterogeneity = ↓ bone quality Complete lack of TCN labeling = severe ↓ bone formation Stress injury-like cortical hypertrophy in other femur with
unilateral AFF
![Page 5: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/5.jpg)
↑ BMD does not always = ↑ bone strength
T-score not consistent predictor of osteoporosis outside of elderly postmenopausal white♀
Other populations, Z score may be better predictor of low bone density
![Page 6: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/6.jpg)
www.shef.ac.uk/FRAX/tool.jsp
FRAX estimates 10-yr. fx risk based on BMD femoral neck + osteo risk factors
![Page 7: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/7.jpg)
Bone quality = bone strength (cortical bone structure/quality of collagen) + rate of remodeling
Bone densitometry measures BMD (quantity), helps assess fx risk, aids in dx of osteo, but does NOT measure bone quality
![Page 8: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/8.jpg)
Healthy bone requires a balance of:
Bone building by osteoblasts
Resorption by osteoclasts
![Page 9: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/9.jpg)
90% collagen (majority Type 1)
Osteoclast degradation & osteoblast synthesis create circulating peptides of Type 1 collagen
Type I collagen is cross-linked by deoxypyridinoline (DPD)
DPD provides rigidity and strength (quality) to bone
![Page 10: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/10.jpg)
Reflects bone remodeling yrs. before BMD ∆
↑ T score + ↑ biomarker → fx risk (odds 4.1)
Allow tracking of response to therapy
May improve adherence to therapy
![Page 11: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/11.jpg)
Cross-link Type IC (relatively selective)
Measure of bone resorption - ↑ urine level > bone loss
Unaffected by diet
Easy to measure spot AM urine
Recheck within 30-90 days after initiating therapy
Covered by Medicare
![Page 12: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/12.jpg)
Calcium Vitamin D Magnesium Boron Strontium ranelate Ipriflavone Vitamin K Choline stabilized orthosilicic acid (ch-OSA)
![Page 13: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/13.jpg)
Ch-OSA = bioavailable silicon
RDBPC trial: added to calcium and D3 showing improved bone biomarkers and BMD ↑ 2%
RDBPC trial: ↑ tensile strength of hair
RDBPC trial: + effects of skin surface changes, mechanical properties, ↓ brittleness hair/nails
![Page 14: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/14.jpg)
Pulsed Electromagnetic Field (PEMF) therapy has shown promise in clinical trials for tx and prevention of osteoporosis
Mediates process via cell signaling proteins – growth factors, cytokines, and prostaglandins
![Page 15: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/15.jpg)
![Page 16: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/16.jpg)
PEMF 72Hz 10 hrs daily for 12 wks to radius of “osteoporosis prone” ♀
BMD showed sig. inc. in exposed areas 36 wks
Similar but weaker response in non-treated arm
(Tabrah, et. al., 1990)
![Page 17: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/17.jpg)
Evaluated rats with surgically induced DOP
After 8 wks, PEMF sig. ↑BMD, ↑ TGF-beta 1, ↓IL-6 in proximal femur
Conclusion: PEMF efficiently suppresses bone loss in DOP via local factors
(Shen, et al., 2010)
![Page 18: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/18.jpg)
Evaluated CR with PEMF in ovariectomy-induced osteoporosis in rats
12 weeks, (OVX-DPEMF) group had better prevention against OVX-induced bone loss
↑BMD, ↑osteoblast activity, ↑ trabecular health markers; ↓bone markers of resorption (uDPD)
(Jing, et. al., 2010)
![Page 19: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/19.jpg)
Rats with streptozotocin-induced DM bone loss
PEMF daily 8 hrs x 8 wks
PEMF improved biomechanical bone quality DM bone
PEMF partially reversed DM-induced bone deterioration
Conclusion: PEMF might become an additive method for inhibiting DM osteoporosis
(Jing, et al., 2011)
![Page 20: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/20.jpg)
Study on in-vitro osteoblastic cell culture
PEMF ↑osteoblastic growth, ↑ TGF-beta 1
PEMF ↓ prostaglandin E2
Conclusion: Study sheds light on mechanism of action of PEMF in non-union fx & prevention of osteoporosis
(Li, et al., 2007)
![Page 21: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/21.jpg)
Studied rats subjected to bil ovariectomy
PEMF augmented/restored trabecular bone mass/architecture in PEMF groups
PEMF attenuated higher serum PGE(2) of OVX rats and restored levels to that of controls
Conclusion: PEMF may be useful in prevention of osteoporosis resulting from ovariectomy
(Chang, et al., 2003)
![Page 22: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/22.jpg)
PTH used to tx osteoporosis; Insulin & IGF-1 anabolic roles in osteogenesis
Cell signaling proteins IRS-1, S6 RSK, & eNOS were phosphorylated by PTH, Insulin, & PEMF to the same extent in osteoblast-like cells
Conclusion: Anabolic affects of PEMF may be mediated through these proteins
(Schnoke, et. al., 2007)
![Page 23: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/23.jpg)
↑ BMD
↑ TGF-beta 1
↓ IL-6
↓ PGE(2)
↑ osteoblast growth
Phosphorylation of IRS-1, S6 RSK, eNOS
![Page 24: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/24.jpg)
![Page 25: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/25.jpg)
Alkalinizing plant based diet
Address food sensitivities Mineral rich foods
![Page 26: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/26.jpg)
Remove
Replace
Reinnoculate
Repair
Rebalance
![Page 27: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/27.jpg)
Foci of interference (ANS) Stress Inflammation Toxins Allergy Infection (occult, dysbiosis, dental) Heavy metals
![Page 28: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/28.jpg)
Resistance training
Nutritional supplementation
Hormonal balance
PEMF
![Page 29: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/29.jpg)
![Page 30: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/30.jpg)
66 y.o ♀ with osteoporosis (T-score -3.1) Baseline: mostly plant based diet,
resistance training, Ca, Mg, and D (1/27/11) uDPD 9.7 nM/mM Cr (NL < 6.5) Weekly 1 hr PEMF sessions x 2 mos
(3/16/11) uDPD 4.5 (53% drop!) Maintenance: Monthly 1 hr PEMF
(7/21/11) uDPD 5.5 (10/24/11) uDPD 4.5
![Page 31: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/31.jpg)
![Page 32: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/32.jpg)
63 y.o. ♀ osteoporosis (‘09 T-score LS -3.9; ‘11 T-score LS -4.1)
Hx FMG, CFS, IBS, MCS & hx multiple fxs Baseline: BHRT, Ca, Mg, D Added ch-OSA + tx gut dysbiosis Started PEMF (3/26/11) monthly; (7/26/11) inc.
freq. to weekly; (9/12/11) 2-3 X week (4/13/11) uDPD 9.7; (10/4/11) uDPD 5.0
(48.45% drop!)
![Page 33: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/33.jpg)
![Page 34: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/34.jpg)
![Page 35: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/35.jpg)
![Page 36: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/36.jpg)
![Page 37: Osteoporosis – Controversies and Promising Treatment Options](https://reader036.fdocuments.us/reader036/viewer/2022062519/56814d58550346895dba96b8/html5/thumbnails/37.jpg)
Keith R. Holden, M.D.
822 A1A North, Suite 310Ponte Vedra Beach, FL 32082
(904) [email protected]
www.Dr-Holden.com