Wednesday Bubble: bisphosphonates…enough to make your jaw drop
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Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?
Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003. At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.
As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. 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.
Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.
What you need to know
Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.
The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:
- pain, swelling
- gum or jaw infection
- gums that don’t heal
- loose teeth
- jaw heaviness or numbness
- impaired range of motion
- exposed bone
Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of hip fractures in a very small amount of women taking these drugs for five years or more.
Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.
Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.
Read MoreNo bones about it: the best things in life are sea
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.
Read MoreWednesday Bubble: the soy controversy
Do they or don’t they?
Soy isoflavones have been touted as beneficial in everything from improving body composition and lowering breast and colorectal cancer, to addressing menopausal hot flashes and moods. You can read about some of these findings on Flashfree. This week, Reuters Health reported that eating foods rich in soy protein (i.e. 25 grams of soy protein and 60 mg isoflavones) daily did not provide favorable responses from blood fats, implying that soy has little benefit in terms of lowering cholesterol levels and in turn, promoting heart health.
Are you confused yet?
Increasingly, women are turning to soy and other compounds as alternatives to estrogen and hormone replacement therapy, which mounting evidence shows can be associated with a broad range of risks including increased breast, lung and ovarian cancer to heart disease. And yet, findings from clinical trials examining soy are often contradictory, making it difficult to come to any firm conclusion about its benefits.
What’s the problem? Well, researchers say that part of the problem is poorly designed studies, small number of study participants, wide range of ages and years from menopause, studies that don’t examine the pros and cons of an agent or strategy for a long enough period of time (i.e. longer than a year). In other cases (as I’ve argued previously), the study design does not account for certain factors that are critical to a therapeutic strategy, for example, the opportunity to clearly focus an intervention so that individual factors are accounted for (this was borne out by findings from a trial that examined and provided evidence for the role of acupuncture in easing hot flashes).
There’s good news though! Researchers finally appear to be getting their act together on the soy fron. They’ve announced that they are conducting a well-designed, large trial of soy phytoestrogens. Called SPARE (Soy Phytoestrogens as Replacement Estrogen), this new study will be looking at the effects of 200 mg soy versus sugar tablet daily — namely on bone health and symptoms — in 248 menopausal women over a two- year period. They will also be taking daily calcium carbonate plus vitamin D (in ranges of 500 mg to 1000 mg calcium and 200 to 400 IU vitamin D, depending on previous intake).
The study is specifically geared towards looking at spine bone density, but will also be looking at hip density, thyroid levels, menopausal symptoms, mood changes, depression, and quality of life, as well as any changes in blood fats. Study participants are between the ages of 45 and 60 and are within five years from menopause. What’s more, the researchers have also included a large percentage of hispanic women, which allows them to focus on how soy affects this minority group (Notably, the large multiethnic population of women in this study includes Asians, Blacks and Caucasians.)
The researchers say that they hope that the results of SPARE will provide a range of information that is especially relevant to Boomers reaching menopause. They also note that the dose of soy isoflavones being studied is much larger than what’s been studied in previously and are roughly twice that typically consumed in the Asian diet.
I realize that this post is pretty scientific. But what makes it most relevant is that it appears that researchers are finally starting to design studies that might actually show benefit of some of the alternative strategies we have available to us on the market. For those of you who insist on calling these alternatives “snake oil,” all I can say is ‘stay tuned.’
This bubble might finally be shattered; perhaps all that is needed is a better understanding of what it needs to test these substances appropriately.
Read MoreSeeds of change, part 2: flaxseed oil and bone health
Last year I wrote a post about the promising effects of flaxseed — a plant-based estrogen– on hot flashes. Flaxseed contains antioxidants with weak estrogen properties (lignans) and omega-3 fatty acids. It is also an excellent source of fiber. In addition to its potential ability to reduce the frequency and severity of menopausal hot flashes, it might also be a valuable tool for both heart disease prevention and boosting the effects of breast cancer therapies.
Another potential use of flaxseed, namely the oil, is to reduce osteoporosis risk. In an animal study published in the International Journal of Food Safety, Nutrition and Public Health, researchers analyzed how the addition of flaxseed oil to the diet of 70 diabetic rats (30 of which had had their ovaries removed) might affect bone health. Note that while studies have shown a clear link between type 1 diabetes and osteoporosis, the evidence is not quite as clear for type 2. Nevertheless, both types of diabetes have been linked with an increased risk for fractures.
After two months, insulin-like growth factor and osteocalcin ( a bone-creating protein) were increased in rats who received the flaxseed oil in their diet. In fact, the levels of these two markers actually reached normal. On the other hand, levels of a marker that actually breaks down bone, fell. The research team attributed the positive effects of flaxseed oil to its omega-3 component.
Certainly, studies are needed in humans to truly determine if flaxseed oil can have a beneficial effect on bone health, especially in post-menopausal women who also have diabetes. In the meantime, it can’t hurt to add a bit of flaxseed oil to your diet. A little prevention may go a long way towards protecting those bones!
Read MoreDem bones were made for dancing!
Get on your dancing shoes!
I was inspired to read that professional dancer Erin Boag from Strictly Come Dancing (the UK’s version of Dancing with the Stars), has teamed up with the International Osteoporosis Foundation to inspire all those armchair dancers to get off their butts and work their bones a bit. In fact, many bone experts agree that dancing may be an excellent (and non-boring) way to strengthen bones and muscle, prevent or at least slow osteoporosis.
Mind you, this program is being funded by DAIICHI SANKYO, a pharma company that manufactures drugs that treat osteoporosis. Nevertheless, it’s an important first step towards taking a cheesy premise that attracts millions of television viewers and repackaging some of its basic elements to help people who don’t normally like to exercise to change their habits. Currently available only in Europe and through doctors’ practices, the ‘Improvement through Movement’ DVD offers some easy waltz, rumba and quick step moves.
Osteoporosis is a tremendous problem as we age. In the US, it affects approximately 10 million people, 8 million of whom are women. Worldwide, more than 200 million women suffer from osteoporosis.
I’ve long been a proponent of more natural approaches to solving what ails. And bone health is one of those things that can be easily preserved through weight-bearing physical activity and a healthy diet that incorporates vitamin D and calcium-rich foods and isoflavones. You can read more about bone health in these posts.
In the meantime, this program sounds like a terrific idea that could be easily reproduced in this country as well. What say you ‘Dancing with the Stars?‘ Can we take a page from our European friends on behalf of our US bones?
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