Posts Tagged ‘Bone Matrix’
Bones are over 80% protein. The organic part of bone is collagen, which is protein. Calcium is gradually deposited into the organic bone matrix to make bone stiffer. Ideal bone is mildly flexible, like a titanium airplane wing.
Healthy bones require adequate protein in your diet. Milk, cheese, and yogurt are good. Lean meats like chicken, turkey, and fish have less cholesterol than beef or pork. All sorts of beans, lentils, garbanzos (humus), nuts are vegetarian alternatives.
Protein needs are higher when you are growing, and again starting in your 60’s. The basic guideline during adulthood is 1 gram of protein for each kilo of lean weight. See our previously posted Protein Chart.
Muscle is mostly protein. Strong muscles keep bones strong by tugging on them and by compressing them. Strong muscles maintain balance and prevent falls.
Preparing protein foods from scratch can be time consuming. Some days I take the shortcut of Premier Protein Shakes. 30 grams of protein, only 1 gram sugar, low fat, only 160 calories, made from milk solids, and they have 500 mg Calcium.
Take Control Naturally by getting enough Protein in your diet.
Jay Ginther, MD
You have started taking Osteoporosis Medication. You think you have entirely eliminated your Fracture Risk. Then, WHAM – you have a Fracture! What went wrong?
It is time to re-evaluate. There are many possible reasons for your fracture.
First, all osteoporosis medications gradually become effective over months. Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.
By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3. That is very good, but not perfect.
Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day. You need to have a high enough Vitamin D level to absorb the Calcium. You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough. You also need Protein (1gram per kg of body weight). If you had Secondary HyperParathyroidism, it must be resolved.
Third, Bisphosphonate pills are sometimes not absorbed adequately. When they work, we actually absorb less than 1% of the drug taken. If this is a problem, Reclast or Prolia can get around the absorption issue. Of course, skipped doses do not work at all.
Fourth, there may be other issues causing fragility. A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc. These need to be fixed too.
Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives. Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.
Fracture while on medication? Time to re-evaluate. Then modify your program if needed.
Jay Ginther, MD
Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD). This is good? WRONG !!
High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen. This means that glucose (sugar) molecules are incorporated into the collagen protein chains. This distorts and stiffens the Bone Matrix.
Normally, stiffer is better, Calcium stiffens the bone matrix, which strengthens the bone. But too much of a good thing is bad. Too stiff becomes brittle. Brittle bones break more easily than “stiff enough” bones.
Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics. Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.
We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves. Now we know that high blood sugars in diabetics are bad for bones too.
Take Control of Your Future. If you have diabetes, work with your primary doc to get your blood sugars under control.
Jay Ginther, MD
Dentists and Oral Surgeons are sometimes wary of their patients being on ANY Osteoporosis Medications when they undergo tooth extractions or other dental proceedures. One osteoporosis medication is different from all the others. Forteo is the only Anabolic medication currently available in the USA. Forteo does not cause dental and jaw problems. Forteo can be used to treat ONJ and other bone problems of the jaw.
OsteoNecrosis of the Jaw (ONJ) is a rare complication of tooth extraction. If you have cancer, are on chemotherapy, have uncontrolled diabetes, or are on the higher doses of Antiresorptive Osteoporosis Medications used in Cancer Patients with Metastases, ONJ is less rare.
ONJ is the result of too slow bone repair by the OsteoBlasts (the cells that make new bone matrix). Antiresorptive medications slow down both OsteoClasts (the cells that resorb bone) and OsteoBlasts.
Forteo cannot cause ONJ. Forteo (Teriparatide) stimulates OsteoBlasts. That increases new bone matrix formation. Therefore, Forteo can prevent and treat ONJ.
Forteo has been shown to improve bone healing in dental surgery, including implant osseointegration and healing alveolar defects. Ref: Batshutski JD, Eber RM, Kinney JS, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010, 363:2396-2405. Ref: Kuchler U, Luvizuto ER, Tangl S, et al. Short-term Teriparatide delivery and osseointegration: a clinical feasibility study. J Dent R. 2011:90(8):1001-1006.
As a former orthopedic surgeon, I have discussed these issues with several of our local oral surgeons and dentists.
If you are facing oral surgery or tooth extraction, discuss your osteoporosis medications with your dental surgeon. Most osteoporosis medications should be held for your surgery. Forteo is the exception. Forteo actually helps your jaw heal after dental surgery.
Jay Ginther, MD