Search results for bone loss

Wednesday Bubble: Your bones, your health. The lowdown on bisphosphonates

Posted by Liz on Sep 8, 2010 in bone health, osteoporosis | 0 comments

For decades, physicians have been prescribing a class of medications known as bisphosphonates (e.g. Fosamax, Actonel, Boniva) to preserve bone health in menopausal women and prevent fractures in both men and women with osteoporosis at high-risk for them).  Bisphosphonates are often offered as an alternative to hormone replacement therapy or HRT.

Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year.  However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.

If you consider these statistics, it seems that using bisphosphonates is a good thing, right?

Well, not so fast. Earlier this year, I wrote a post highlighting reports of jaw bones collapsing among women taking bisphosphonates over a certain period of time. Included within the information were tips from the American Dental Association for protecting your jaw before any major dental procedures. This week, I want to add another facet to the bisphosphonate story, one that is definitely worth considering when weighing the benefits and risks of these drugs:

It is possible that use of oral bisphosphonates may increase the risk for developing cancer of the esophagus by as much as two-fold.

Here’s what you need to know:

• In this particular study, researchers compared over 15,000 men and women who had been diagnosed with esophageal, gastric or colon cancer over the age of 40 to five healthy individuals with similar characteristics. All study participants had been prescribed bisphosphonates at least once, with some receiving more than 10 prescriptions, which would imply that they used the drugs over time (over the 7-1/2 year period of times examined, a majority used bisphosphonates for at three years or more).
• Use of bisphosphonates over three years and having received at least 10 prescriptions was linked to a significant increase in cancer of the esophagus but not gastric or colon cancer.  People who used bisphosphonates for five years or more had twice the risk compared to those who did not. Note that these rates of cancer held regardless of the exact agent used.
• An increased cancer risk remained even after actors for esophageal cancer, such as age, smoking, alcohol and body mass intake, were accounted for.
• This increased risk, may be due, at least partly, to drug side effects that affect the esophagus directly, such as irritation and inflammation of the esophagus (i.e. esophagitis).

Now, mind you, esophageal cancer is extremely rare, affecting roughly 16,000 people in the US in 2010. However, death from esophageal cancer, is high and the disease is often fatal. Moreover, esophageal cancer tends to affect three to four times as many men as women, which is why this latest bit of information is as critical for men as it is for women entering menopause.

One important thing to keep in mind when you consider the risk and benefits of bisphosphonate therapy is that this particular study compared actual cases of these three types of cancer to healthy individuals in the population. Sometimes, the information yielded in these studies is not considered as conclusive as studies that are conducted proactively, and not retroactively. Still, this is not the first time that bisphosphonates have been linked to cancer of the esophagus.

Maintaining bone health and strength as we age, particularly as hormones decline, is critical to our health in the later years. It’s important to make the right decisions now, while we are still relatively young. Flashfree has plenty of posts on bone health and osteoporosis, and I encourage you to peruse them.  When it comes to your bones, it’s not just about ‘use it or lose it,’ but also, the three P’s:

Protection

Proactive

Prepared

Your bones, your health.

Hormone therapy and bones – fuggedaboutit

Posted by Liz on Aug 16, 2010 in bone health, breast cancer, HRT | 1 comment

Another HRT-busting post…straight from the archives of  the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.

The loss of lean body mass as we age contributes to redistribution of fat and  apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.

The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.

In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that  I will continue to write about what’s really going on until more women understand how fucked up HRT really is.

If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.

This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.

Next.

Wednesday Bubble: protein, weight and bones – keep it in balance

Posted by Liz on Aug 4, 2010 in bone health, diet | 1 comment

Weight loss improves health, right? Well, yes, and no. Because it turns out that weight loss also increases the rate that the bone loses density, so in midlife and menopause, weight loss can be a double-edged sword.

In two recent studies published in the online edition of the Journal of Gerontology, researchers are reporting that women already at risk for osteoporosis due to their age and menopausal status may want to pay attention to what they eat when they try to lose weight. In fact, consuming large amounts of protein derived primarily from animal sources, e.g. lean meats like pork, beef and chicken, may negatively impact bone density and in turn, further increase osteoporosis risk.

Here’w what you need to know:

• In the first study, women between the ages of 43 and 80 reduced their daily caloric intake by 750 calories. Over three months, about half of the women ate meat-free diets that derived about 18% of their daily protein from vegetarian, dairy and egg sources and other half, ate diets comprised of about 30% protein derived from lean pork.

• In the second study, women between the same ages consumed about 1,250 calories a day in five meals over nine weeks. While the bulk of these calories were from a vegetarian diet, women were asked to eat either 250 calories of carbs daily (shortbread cookies, sugar coated chocolates), chicken (plus 10 grams of butter) or the equivalent in fat/saturated fat but as beef.

• Although women in the first study lost about the same amount of weight (~19 lbs), those eating animal protein has a 1.4% greater loss of bone mass. Likewise, in the second study, all the women lost weight but those women eating animal protein sources lost significantly more bone mass compared to women eating carbs.

• Women in both of these studies were considered overweight or obese based on their body-mass indices (BMI).

Importantly, many of the today’s popular diets for weight loss (e.g. South Beach, Atkins) emphasize increased intake of protein over carbohydrates (although the former also emphasizes good versus bad (i.e. glycemic index) carbs. What this means is that while you are cutting back, you may also be losing more bone mass than you normally would with weight loss.

Consequently, one of best approaches for women who are going through menopause and trying to keep the weight off may be to increase the daily  amount of so-called “good fats,” which as my friend Mollie Katzen, suggests should include nuts, avocados and fatty fish like salmon. Many of these foods are also good sources of protein and while not necessarily working to build bone, may stave off bone mass loss while you are trying to lose a few pounds or maintain your current weight.

At the end of the day, it’s all about balancing the good, the bad and the ugly. Our skeleton is fragile and it’s critical that we do all we can to keep it in one piece.

Want to learn more? I’ve dedicated several posts to osteoporosis, bone loss and bone health.

No bones about it: the best things in life are sea

Posted by Liz on May 28, 2010 in bone health, diet | 3 comments

Did you know that eating fish that live in the sea might help boost bone health and density? Although most of the attention on the link between osteoporosis and diet has focused on calcium, milk and soy, a few studies suggest that other nutrients, such as polyunsaturated fatty acids and omega-3s, may also play a role.

According to novel research published in the journal Osteoporosis International,  a greater intake of sea fish, but not shellfish or freshwater fish, is linked to as much as almost a 7% increase in bone-mineral density and an almost 10% increase in bone mass in general and in the hip areas in particular. On average, the women studied, all of whom were menopausal, were eating about .8 ounces of sea fish a day — about 16% of their total daily protein intake, and about 2 ounces daily of sea fish and shellfish combined. Factors like body weight, smoking, and alcohol did not appear to influence the association between fish from the sea and bone benefits. (Note – the study did not specifically address the exact types of fish that they women were eating other than to say, it wasn’t freshwater or shellfish.)

Interestingly, prior studies have found similar links between higher bone mineral density and a high consumption of seafood among menopausal women. Researchers say that a higher intake of fish versus animal protein or low quality foods may account, at least in part, for the higher bone mass.And while they are unable to offer any reasonable explanation for why sea fish, especially the oily types like salmon or mackerel or tuna benefit bone health while freshwater fish does not, they say that it might be due to the high level of vitamin D , which has long been associated with favorable bone mass. Omega-3 fatty acids are also thought to play important roles.

The take-away on this is to eat more fish from the sea. Clearly, environmental concerns, like overfishing and high level of mercury, may influence your seafood selection, however, Seafood Watch offers some great resources how to make safe and careful choices.  What I love about this information is that it not only serves to encourage healthier eating, which can help keep those pounds away (My friend Danielle Omar wrote a great guest post about sea veggies and weight about a month ago), but also provides another strategy for keeping bones healthy as we age. Yup, the best things in life are sea.

Beer boosts bones

Posted by Liz on Aug 21, 2009 in bone health | 2 comments

Beer boosts bones. Say that three times fast.

Seriously, the weekend is fast approaching and it’s a beer sort of day; well sort of. A newly-published study is touting the news that bone density is better in beer drinkers than in non-beer drinkers. On the otherhand, drinking more than two alcohol drinks a day can be harmful to bone. Confused yet?

Researchers say that at appropriate doses, alcohol stimulates calcitonin, a hormone that inhibits the breakdown of bone cells and stimulate bone formation. As women age, they experience a deficit in calcitonin, which is one reason why osteoporosis is so prevalent after menopause. Key components in alcohol that promotes calcitonin and also inhibit postmenopausal bone loss are flavones, which are a type of flavanoid primarily found in certain cereals and herbs. Evidently, beer contains flavones.

In this particular study, which was published in the journal Nutrition, researchers measured bone density of the bones in their fingers, and evaluated weight, age and alcohol use in 1697 women. Women who participated in the study were on average, 48 years old; 710 were premenopausal, 176 were perimenopausal and 811 were postmenopausal. All participants were classified as moderate drinkers (1/2 cup to 10 ounces of alcohol per week), light drinkers (less than 1/2 cup alcohol per week) or non-drinkers, and were also classified according to whether they were beer or wine drinkers.

Study findings showed that women who were characterized as moderate beers drinkers had superior bone density compared to non-drinkers and wine drinkers, regardless of menopausal status and independent of age.

The researchers point out that it is likely that certain components of hops, namely the female flowers, have high estrogen-like properties. Moreover, they say that two isoflavones — daidzein and genistein — have been shown to have bone-protective properties and are present in beer. Beer is also a major dietary source of silicon, which studies show plays a major role in bone formation.

So, what to make of this study? Should you run out and buy a six-pack? Forgo that glass of wine for a cold one? The researchers say that they are not recommending that peri- and postmenopausal women start drinking beer to decrease their risk of osteoporosis. Still, one or two beers can’t hurt, right?