Posts Tagged ‘Osteoblasts’
Recently a patient asked me to review all osteoporosis medications for her to consider¬†and choose from. ¬†We had already optimized her Calcium intake, 25-hydroxy Vitamin D level, Protein intake, Multiple Vitamins & Minerals, and Exercise program. ¬†These had all helped substantially, but not enough for her peace of mind. ¬†She feels that she needs osteoporosis medication¬†too. ¬†Here they are:
Forteo (Teriparatide) increases the thickness of the struts making up spongy (cancellous) bone. ¬†Forteo is the only osteoporosis medication to do that. ¬†It also makes the hard outer shell (cortical bone) thicker. ¬†How? ¬†Forteo stimulates OsteoBlasts. ¬†They make bone matrix, the collagen protein that is more than 80% of bone.
Forteo also stimulates bone turnover. ¬†Healthy bone is constantly being resorbed and replaced. ¬†This allows bone to eliminate the micro-cracks that gradually accumulate with activity. ¬†Bone is strongest when it is a mixture of older more calcified (stiffer) material mixed thoroughly with younger less calcified (somewhat bendable) material. ¬†Cracks cannot enlarge. ¬†Strength is better. ¬†More force is required to fracture the bone.
Anabolic medication for osteoporosis actually increases bone thickness and strength! ¬†Antiresorptive medications for osteoporosis (Fosamax, Alendronate, Actonel, Atelvia, Boniva, Evista, Reclast, Prolia) only preserve bone.
We have talked about all of the Antiresorptive medications over the last 2 months.¬† They are excellent treatment if slowing down the OsteoClasts (cells that eat away your bone) is sufficient.¬† That is not always the case.
Now it is time to talk about something completely different.¬† Anabolic medication stimulates the OsteoBlasts (cells that make new bone matrix).¬†¬†OsteoBlasts can rebuild your bones.¬† If you have Fractures, your bones may need to be rebuilt.
Forteo (Teriparatide) is the only Anabolic medication for osteoporosis in the USA.¬† Close cousins of Forteo are available in other countries.
You may need the Anabolic, Forteo, if you have a hip fracture, multiple other fractures, or if VFA testing reveals a Vertebral Compression Fracture.¬† A DXA T-score well below -2.5 can be reason enough without fracture.
Glucocorticoid (Cortico-Steroid) medications (Prednisone, Steroid Inhalers) specifically supress OsteoBlasts (cells that make new bone).¬† Stimulating the OsteoBlasts with the Anabolic, Forteo, can offset the bone loss from Steroid medications.¬† Smoking also supresses OsteoBlasts, leading to bone loss.¬† Stopping Smoking would be best, but Forteo can help.
Not everyone needs an Anabolic, but some individuals do.¬† A Complete Bone Health Evaluation will tell you if an Anabolic is right for you.
More about Forteo (Teriparatide) next time.
Jay Ginther, MD
A delicate balance between bone formation and bone resorption is needed for Healthy Bone. ¬†This balance is naturally present until menopause in a woman or “Low T” in a man. ¬†The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). ¬†OsteoClasts are cells that resorb or take away bone (Resorptive). ¬†Both live on the surface of bone. ¬†OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). ¬†OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. ¬†Women make Estradiol from Estrogen. ¬†Men make Estradiol from Testosterone. ¬†Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. ¬†Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. ¬†Estrogen is back on board. ¬†Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. ¬†They both mimic the natural process, but in different ways. ¬†We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD