Osteoclasts Gone Wild Revisited
Osteoclasts are the cells that eat away bone. Osteoclasts are normally kept under control by Estrogen in women and Testosterone in men. Women lose Estrogen suddenly at Menopause. Men lose Testosterone gradually over time.
Osteoclasts are much like teenagers. They behave only as long as controls are in place. Once control is lost, it is “Osteoclasts Gone Wild”.
Steroid medicines in pills or inhalers for asthma or other diseases can block the controls holding back Osteoclasts. Smoking also allows bone to be eaten away faster.
Osteoporosis happens when bone is eaten away faster than bone is formed by the cells that make new bone matrix, the Osteoblasts. We need to restore the balance of bone formation and resorption to treat or prevent Osteoporosis. We have several options:
1. Slow down the Osteoclasts – Antiresorptives
2. Disable or Kill the Osteoclasts – Bisphosphonates
3. Prevent Osteoclast Formation and Activation – RANK-Ligand Blocker – Prolia – Denosumab
4. Reassert Hormonal Control – Modern Hormone Replacement Therapy
Estrogen-Agonist-Antagonist –Evista – Raloxifene
Testosterone for Men
Jay Ginther, MD
Copyright November 2010/Revised September 2011