medicine—- is rapidly growing in popularity. alternative therapy (nutritional Center for Complementary & Alternative Medicine. Alternative Therapies …
Alternative Therapies for Osteoporosis:
Effects on BMD and Fracture Risk
Rogene Tesar, PhD, CMRT, RD, LD Austin Thyroid Endocrinology Austin, TX
Alternative Medicine
Alternative medicine —sometimes called complementary medicine—- is rapidly growing in popularity Surveys show that over 40 million Americans use some form of alternative therapy nutritional supplements, herbs, meditation, prayer, acupuncture, Ayurveda, etc Why? Standard Western medicine does not have all the answers NIH has responded to this overwhelming interest several years ago by opening a branch dedicated to alternatives: the National Center for Complementary Alternative Medicine
Alternative Therapies
In US, value of a drug is determined by large-scale, double-blind, placebo-based studies Many alternative therapies are naturally occurring substances; they cannot be patented No incentive for pharmaceutical companies to invest millions of dollars on clinical trials to determine effectiveness Numerous
relatively small-scale studies on alternative therapies; many show promise Pharmaceutical firms are testing some synthetic forms for their potential in treating various diseases
Standard Preventive Treatment Methods for Osteoporosis
Adequate calcium Vitamin D Weight-bearing resistance type exercise Avoiding smoking Avoiding excessive alcohol consumption Bisphosphonates: alendronate, risedronate, ibandronate, zoledronate Teriparatide Estrogen Calcitonin
Raloxifene
Soy Isoflavones
Soy contains phytoestrogens which act like mild estrogens phytoestrogens in soy are called isoflavones Receptors for estrogen are on both osteoblasts and osteoclasts Estrogen enhances calcium phosphorus absorption and bone deposition Observational studies suggest that women who consume large amounts of soy have fewer fractures
Ipriflavone
Laboratory-manufactured derivative of daidzin substance found in soy Used for many years in Japan and Italy to preserve bone strength and density in PMP
women May encourage osteoblast action discourage osteoclast action Some studies from Japan Europe: ipriflavone can help slow bone loss rate
Vitamin K2
Factor discovered in fatty components of food in 1939 that aids in clotting of blood Vitamin K: really 3 related substances K1 phylloquinone found in plants K2 menaquinones produced in human digestive tract by bacteria K3 Menadione a synthetic variant
Strontium
A naturally occurring mineral present in water and food Different from radioactive strontium-90 formed by nuclear fission Trace amounts in human skeleton with affinity for bone Incorporated onto the crystal surface of bone Researched since 1950; recent findings: promotes bone formation and decreases bone resorption Supplemental forms: over 20 different compounds Strontium renelate 340 mg strontium/1 g compound
DHEA
DHEA: dehydroepiandrosterone Most abundant hormone found in the human body Produced in the adrenals, ovaries, testes, brain skin
Regulates 18 or more other steroid hormones; increasing lean muscle mass, burning fat, and stimulating bone growth Converted in bone cells into estrogen estrone, progesterone testosterone Only ? hormone that increases cellular activity of osteoblasts and also inhibits osteoclasts SLeVert, The Promise of Eternal Youth 1997 Requires D3 to form estrone; D3 requires DHEA to stimulate osteoblasts Positive correlation between DHEA levels BMD in women 50 DHEA levels decline with age, concurrent with onset of osteoporosis
Natural Progesterone
Manufactured in the laboratory from wild yams and soy beans; not to be confused with yam extracts sold in health food stores Recommended for treating everything from menopausal symptoms, migraine, loss of libido and depression to water retention and fibrocystic breasts Skepticism abounds in the health field; however, many women find it effective in bringing relief from premenstrual syndrome, menopausal symptoms, dysfunctional bleeding and
endometriosis Most information is anecdotal Isolated studies since the 1970s have suggested a bone effect Proof of protection against osteoporosis is lacking In 1990, a study by John Lee, MD, generated excitement about 63 women who gained bone using Pro-Gest cream
Summary
In terms of osteoporosis prevention, the rules are that drugs must be shown to reduce the risk of fracture in properly designed, executed, presented, and interpreted clinical trials If this is not done, the drug may well be efficacious, but the evidence is not there one way or another, so the decision of whether to prescribe the drug will be according to feeling-based medicine or opinion-based medicine but not evidencebased medicine The studies must be double-blind, placebo controlled, involve large sample sizes and have few drop-outs, predefined primary end points, etc The studies must be reproducible and consistent, done by different investigators in different parts of the world, with similar results observed
The best studies follow most of the criteria mentioned; the best studies available are those of alendronate, risedronate, raloxifene, parathyroid hormone, and strontium ranelate The quality of data for other drugs such as calcitonin, etidronate, menopausal hormone therapy, vitamin D metabolites, and calcium is not as compelling so that inferences are more difficult to make
Ego Seeman, MD, PhD
Source:nmanet.org
