Posts Tagged ‘Bone Turnover’

Bisphosphonates accumulate in your bone.  When OsteoClasts gobble up your bone, bisphosphonates are released into the Osteoclasts and disable or kill the Osteoclasts.  This is great news when the problem is Osteoclasts Gone Wild.  Bisphosphonates preserve bone by slowing down bone resorption.  However, after a few months, bone formation by OsteoBlasts also slows down, resulting in slow bone turnover.

Moderate and balanced bone turnover is good.  You repair microcracks in your bone when OsteoClasts resorb the bone around them and OsteoBlasts fill in the void with new bone matrix.  A mix of new and old bone is far stronger than all old bone.  Some OsteoClast activity is necessary to heal fractures, especially incomplete (stress) fractures.  That is where long term bisphosphonates can be too much of a good thing.

Match Medications to Your Needs

June 3, 2014 @ 6:48 am
posted by Dr Ginther

Are your bones still good enough and just need to be maintained?  Or have you fractured several times and need to rebuild your bones?  Are Steroid Inhalers supressing your Osteoblasts – the cells that build new bone?  (not good)  Or have your Osteoclasts – the cells that eat away bone – gone wild (even worse) now that you are post-menopausal or an older guy?

Different problems require different classes of medication.  Bisphosphonates, Hormone Replacement Therapy, Synthetic Estrogen Receptor Modifier – Evista, and RANK-Ligand Antibody – Prolia, are all Antiresorptives, which act in different ways.  They slow down the Osteoclasts that have gone wild and are eating up the bone.  The Anabolic, Forteo, stimulates the Osteoblasts that make new bone matrix.  Antiresorptive and Anabolic are radically diferent actions.

“Bisphosphonate Holiday” 2014

March 8, 2014 @ 8:56 pm
posted by Dr Ginther

“You are entering a Data-Free Zone”   That was unfortunately the messasge at the joint meeting of the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) last month.  We simply do not have data from a study involving tens of thousands of patients.  We do know some things that are helpful.

Bisphosphonates build up in bone over time.  After about 5 years of Bisphosphonate therapy, you should have enough medication in your bones to last for additional years.  How many years?  That depends.  Different individuals lose Bisphosphonates from their bones at different rates.  Different Bisphosphonates tend to stay in bone longer or shorter than others.  We call the time you are able to stop taking medication for a while (because you have enough in your bones already) “Bisphosphonate Holiday”.

Fracture Risk is much more than Bone Mineral Density and t-score.  Bone Health is affected by many medical conditions.  That is why we check blood tests.

Alkaline Phosphatase (alk phos) is the most interesting serum (blood) enzyme because it is produced in liver, bone, intestine and placenta.  High alk phos can mean rapid bone formation.  If Bone Alk Phos is high, we need to determine why.  Most commonly bone alk phos is high in bone healing after a fracture or orthopedic surgery, and will return to normal within 6 months.