Posts Tagged ‘osteoclasts’
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.
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.
The FDA has approved Prolia for men with osteoporosis, who are “at high risk for fracture”. This affects a sizeable number of men. High fracture risk includes men with crumbling spine “humpback” vertebral fractures (kyphosis), other fractures (especially hip), inhaler and other steroid use, parental history of fractures, and smoking. See the posts about these topics and FRAX.
Prolia is especially useful in individuals with Heartburn or Reflux Disease (GERD) and decreased kidney function, including many older individuals with older, tired kidneys. Women have had Prolia available since 2010. Having this additional option for men is important.
Human Estrogen is the natural means of preventing bone loss before menopause in women. The huge drop in estrogen levels during menopause leads to increased bone loss during and after menopause.
Estrogen stimulates the formation of Osteoblasts (the cells that make new bone). Estrogen lengthens the lifespan of Osteoblasts and Osteocytes (the cells that live in and maintain bone). Estrogen supresses the formation and activation of Osteoclasts (the cells that eat bone away).