Osteoporosis

[saysfaa]

This thread is to help anyone interested in bone health. Please share and discuss anything that might be helpful.

 

[saysfaa]

This link to source has the best overview of the anatomy and physiology of bones as they relate to osteoporosis and of the varieties of osteoporosis that I've found so far.


Front Psychiatry. 2019; 10: 200.

Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions​

Ryan R. Kelly,1,2,† Lindsay T. McDonald,1,2,† Nathaniel R. Jensen,1,2 Sara J. Sidles,1,2 and Amanda C. LaRue1,2,*

 

[saysfaa]

Good news.
The article above included the SSRI class of medicine. I took one of them for several months before figuring out my depression was largely SAD (seasonal affective disorder) and solved by getting enough blue light in the morning. Sunshine did it or light from a broad spectrum light bulb. Anyway, I don't think the dr told me anything about possible affects of SSRIs on bones. It makes sense because serotonin does so many things in the body as well as in the brain.

That led me consider what I knew about Dr Brownstein (Center for Wholistic Medicine, West Bloomfield). He is an MD who didn't like treating only the symptoms of his patients - often the treatment caused worse problems as well as not addressing the cause of the symptoms. That is what he found in mainstream medicine. He wanted to find the cause of the symptoms.

In looking for what Dr. Brownstein said publicly about osteoporosis, I got sidetracked by this website
https://saveourbones.com/osteoporosis-reversal-program/
that seems to take a similar approach.

She, and several of the people who commented, said they had reversal - not just slowing of the progression.

A lot of the dangling threads are resonating with a lot of things I already knew and/or believe. I'm not ready to buy the program but I think I can find at least some of the information she found. If enough of it checks out, I will strongly consider buying the program to get a faster start and to lower the risk of missing something.

 

[saysfaa]

• https://www.goodrx.com/conditions/osteoporosis/exercises-for-osteoporosis
• https://www.health.harvard.edu/pain/effective-exercises-for-osteoporosis

In all strength building excercises - go slow, especially when returning to the start position (from my classes)

This source says:
"While many forms of excercise will assist falls prevention, only a certain type of exercise improves bone mass. ...even walking and jogging provide an insufficient stimulus. Only heavy lifting and impact training will increase bone mass - activities previously thought to be unsafe for osteoporotic bone. In fact, we have recently shown in the LIFTMOR trials at Griffith University (Gold Coast, Australia) that not only does high intensity resistance and impact training improve bone mass, muscle strength and balance in postmenopausal women and men with low bone mass, it is safe when properly supervised. This program has been rolled out into a 'real world' health service targeting osteoporosis with outcomes equal to that observed in the LIFTMOR trials
...
Exercise is rarely harmful for bones, but if diagnosed with low bone mass you should avoid deep forward flexion of the spine, particularly when lifting (e.g. lifting heavy gardening equipment, grandchildren, shopping bags, or even changing the bed). Heavy lifting per se is not of concern if performed with mindfulness and correct technique under supervision, but we often dispense with good technique outside of the gym. Sudden loading, particularly twisting motions, may also put an osteoporotic spine at risk of fracture....
What would having osteoporosis limit me from doing? Aside from the movements described above, nothing! Stay active."

This source says in the section "A Misnomer of Muscular Strength: Understanding Mind Over Mass"
"... Like many of you, I once thought physical strength was determined solely from muscular size or mass without giving thought to the neural aspects that contribute to purposeful force development. It was not until I started to study neuromuscular physiology, as a graduate student, that I began to learn about the various mechanisms that lie within the muscle and in the nervous system. And it was not until I became a postdoctoral research fellow that I began to dive into cellular neuroscience and its role in volitional force capabilities. ... To this point, my present research agenda is to determine how the intrinsic properties of various types of motoneurons contribute to the loss of strength following limb-disuse viaimmobilization...."

A Physical Therapist once told us strengthening starts with teaching the nerves. Expect there to be no noticeable improvement for a long time. I think of it like vegetable plants grow roots first - that is why they seem to not grow forever - then take off.

 

[saysfaa]

Quotes from Source [Section 3 is good too but this is long enough]

Chapter 3 Osteoporosis and Fragility in Elderly Patients

Section 4 The Physiology of Bone

…Bone remodelling is the process by which bone is renewed to maintain bone strength and mineral homeostasis. Remodelling involves continuous removal of discrete packets of old bone, replacement of these packets with newly synthesised matrix, and subsequent mineralisation of the matrix to form new bone. The main functions of bone remodelling are preservation of the mechanical strength of bone by replacing the older, micro-damaged bone with newer, healthier bone and calcium and phosphate homeostasis…

Osteoclast-mediated bone resorption takes only approximately 2–4 weeks during each remodelling cycle.

…Bone formation takes approximately 4–6 months to complete.

…Bone remodelling increases in perimenopausal and early postmenopausal women and then slows down with further ageing but continues at a faster rate than in premenopausal women.

…Normal rates of bone loss are different in men and women. In men, bone mass is lost at a rate of 0.3% per annum, while in women this rate is 0.5%. By way of contrast, bone loss after menopause, in particular during the first 5 years after its onset, can be as high as 5–6% per annum....

Chapter 4 Osteoporosis and Fragility in Elderly Patients...

2.1 The Nature of Sarcopenia

Sarcopenia is characterised by motor neurone loss, reduced muscle mass per motor unit, relatively more loss of fast-twitch fibres and reduced strength per unit of cross-sectional area. Muscle fibres are lost by drop-out of motor neurones. Reinnervation of fibres by sprouting from surviving neurones cause less even distribution of fibre types cross-sectionally and a relatively greater loss of type II fibres that are associated with the generation of power (the product of force generation and speed of muscle contraction).

Muscle mass and strength are of course related but not linearly. Function is more important than mass for physical performance and disability. Leg power accounts for 40% of the decline in functional status with ageing. Men who maintain physical activity into their 80s show compensatory hypertrophy of muscle fibres to compensate for the decrease in fibre number. Loss of efficiency also results from an accumulation of fat within and between fibres and an increase in non-contractile connective tissue material. Muscle strength and function also depend on neuromuscular integrity and muscle performance as well as muscle characteristics.

Current and Emerging Treatment of Osteoporosis

2.2 Before treatment it is important to make a differential diagnosis between primary and secondary osteoporosis because the anti-osteoporotic drug treatment would be useless if the main illness causing osteoporosis is not treated too.

In hospital, during the acute phase, it is important to investigate the osteoporosis to exclude secondary forms, by means of simple first-level blood tests (erythrocyte sedimentation rate, blood count, serum levels of protein, calcium, phosphorus, alkaline phosphatase and creatinine, 24 h urinary calcium) and some second level tests (TSH, Parathormone, 25-OH-vitamin D, serum protein electrophoresis). These tests are sufficient to exclude 90% of the secondary causes of osteoporosis. Only the evaluation of these parameters will guarantee that we are giving to the patient appropriate treatment

It is important to make at any age a diagnosis of secondary causes of osteoporosis, such as hyperthyroidism and hyperparathyroidism, because these can now be treated with drugs and not only by surgery.

The orthogeriatric patient with non-vertebral fracture has specific characteristics: they are normally very old (over 75 years) and present all the characteristics of frailty (reduced mobility, malnutrition, comorbidity, cognitive impairment, polypharmacy, neurosensory deficits). ...

 

[saysfaa]

this website has some nice rules of thumb - like if your shadow is shorter than you are tall, then the sun is high enough to make vit D. Or check a weather app for UV index over 3.

Notes from several websites about how much sun exposure for enough Vitamin D, and assuming healthy liver and kidneys (needs both as opposed to one or the other)
Relevant factors

• Darker skin; absorbs the less sunlight (maybe 1/6 as much)
• Age; Older people create Vitamin D less effectively (<70 years)
• Time of day. We are most efficient at making Vit D at noon. This sourcefound noon is also safer than later in the afternoon as far as dangerous skin cancers. - the similar articles look interesting, too.
• % of skin exposed - 25% of skin exposed in summer took 10 min to get a day's worth of sunlight vs 10% of skin exposed in winter took 2 hours.
• Latitude - 3 min in Miami =23 min in Boston (25% of skin exposed, noon, skin dark enough to tan well but light enough to still burn).
  - another source says north of 37 degrees the sun never gets high enough in the sky for UVB rays to penetrate the atmosphere. - but 13 min in the UK is enough and 30 min in Oslo. Oh. N of 34 or so has a part of winter when we can't make vit D
• Sunscreen - spf of 8 is enough to block, otherwise thickness of the layer and whether all exposed skin is covered matter
• Shade - still get some from scattered UVB rays
• Obesity - vit D is stored in fat so excess fat can affect something - that doesn't seem right and isn't a very solid source but may be worth a rabbit trail.
• "little and often" protects against skin cancer and sunburn. [maybe. At least some Dermatologists say never get vit D from the sun - take it via food and supplements. I tend toward sunshine is better - and probably does other things. One possible other thing is manage cholesterol better since that is used to make vit D. Or it might not; it seems unlikely enough cholesterol is used to make much difference.
• It doesn't have to be a daily dose. The fat soluble part allows uneven intake/production - sometime before next winter, look up how uneven is workable
• how clear the sky is matters - cloud cover and pollution matter

Vit D does much more than affect calcium and bones [I don't care much right now]
Vit D is found naturally only in a few foods -including fatty fish and mushrooms [all mushrooms or which???]. And egg yolks. It is fortified into most milk products.

"You never have to worry about making too much vitamin D from the sun because your body self-regulates by stopping production when it has reached its limit." [really? go down this rabbit trail]

 

[saysfaa]

To help with getting enough vitamin D via sun exposure while reducing risk of sun damage..

Rule of thumb is "Rule of Nines" for adults:

• Head is 9%
• each arm is 9%
• abdomen is 9%
• Chest is 9%
• Back is 18%
• each leg is 18%

That is both side of each arm and each leg, and the whole head.
Elbow up is about equal in skin area to elbow-fingertips.

 

[saysfaa]

According to the Salt Solution cookbook, "...When sodium intake increases, calcium excretion increases. Researchers think that your body leeches calcium from your bones to replace the calcium lost and keep your blood calcium levels stable. High-salt diets have been shown to increase calcium loss by an average of 20 to 60 milligrams of calciumlost for every 2,300 milligrams of sodium ingested."
And
"US dietary guidelines recently [book published 2011] recommended that the general population eat no more than 1,500 milligrams of sodium a day (about 2/3 teaspoon of table salt)... Instead Americans on average consume 3,436 milligrams od sodium daily."

I missed this so far. I was cutting back on salt because I saw staying hydrated is important. That is easier without extra salt.

I lost most of my sense of smell as a freshman in college. I think I probably have eaten much more salt than even the average American because salty is one of the few things I can taste. And I liked salty even before college.

Sigh. I had no idea high salt could affect bones.

I found it looking for things my son in law can eat. He recently found out he has very little kidney function left... and it gets progressively worse. Best hope is to slow the process.

They are very frustrated. Most "low sodium" and "low potassium" "recipes" just leave the salt out of recipes designed to have it. And/or use smaller serving sizes to get the amount per serving down. Not helpful.

 

[Sally PB]

Following! I will come back later, read this over again, and check out the links.

Osteoporosis is definitely on my radar. My maternal grandmother had it. She also had Parkinson's, and that limited her mobility, which surely did not help. She fell and broke her hip, and never walked again. A tragedy for a woman whose nickname in her middle age was "Evie-Go." As in, let's go work in the garden, or let's go shopping, or for a walk.

 

[saysfaa]

A side effect of Synthroid (Levothyroxine) is osteoporosis.

In looking at this source for other reasons, I noticed:

"...Selenium is an essential nutrient for humans and other organisms, including bacteria and algae. As a constituent of 25 selenoproteins, it plays key roles in the immune system, reduces viral infections, is essential for fertility and reproduction, acts in the metabolism of thyroid hormone, prevents cardiovascular disease, and possibly alleviates oxidative stress or inflammatory conditions in the human body. Se content in food is determined by the occurrence and bioavailability of this element in the soil and by the efficiency of the soil–plant transfer system, both of which are highly variable worldwide....

The intake of Se via consumption of Brazil nuts has been shown to have anti-inflammatory and antioxidant effects on patients under hemodialysis, improving glutathione peroxidase (GPx) activity, and thyroid hormone profile. Also, the consumption of Brazil nuts can improve both Se status and lipid profile, which has effects on the high-density lipoprotein cholesterol levels, and is thereby used by obese people to reduce risks associated with cardiovascular disease. The current recommended daily intake of Se has been established as 70 μg day−1 for adult men and 60 μg day−1 for adult women, while the suggested upper safe limit of Se intake is set at 400 μg day−1. An acceptable threshold for Se toxicity is 850–900 μg day−1, and excessive Se intake could result in adverse health problems..."