BY DR. ANDREA PURCELL
I was having a “virtual happy hour” with a group of my colleagues the other day and we were discussing Integrative medicine and how it always seemed to have the other side of the story.
Lets take bone health for example. When we think of bone health we instantly think of bone mineral density (BMD). This is what is measured in the gold standard test, the DEXA scan, to evaluate osteoporosis risk. All of the bisphosphinate drugs are focused on maintaining and improving BMD, and all fracture prevention efforts have been focused on it. However BMD is one component of bone health, it contributes to the density and the rigidness of the bone.
The other side of bone health is its flexibility, which is determined by its collagen content. It is both of these that determine how susceptible a bone is to fracture; we must have both for good bone health.
The collagen matrix provides the bones with its shock absorption nature and its spring and helps to complement bone mineral density. We can easily think of our bones like a tree. Without a certain level of flexibility a tree in a windstorm would snap in half if it did not have a collagen matrix.
Bone health declines with age so it is important to provide and supplement our bones with a combination of items that will support the bone at both levels.
Medications that lead to bone demineralization:
**Oral Glucocorticoids – increase fracture risk significantly
**Antibiotics – interfere with Vitamin K absorption
**Acid Blocking Medications – interfere with mineral absorption
Testing to determine bone health:
In addition to the DEXA scan, blood markers of homocysteine and osteocalcin are useful in determining vitamin deficiencies that can lead to weakened bones. Elevated homocysteine shows vitamin B6, B12, And folate deficiencies and Osteocalcin shows vitamin K deficiency.
Supplements for better bone health:
**Calcium citrate, Magnesium & Vitamin D
**Vitamin K can improve bone health and improve fracture risk. In the US it comes in K1 , found in leafy greens, and K2 (MK4 & MK7), produced by digestive bacteria, both of these are non-toxic and important for bones. K2 has the most impact on bones and collagen formation and a dose of 45 mg has been approved for treatment of osteoporosis in Japan.
**Strontium ranelate (SR) at a dose of 2.0 g/day was been shown to reverse osteoporosis, without side effect. Due to its higher mass than calcium, strontium can alter DEXA scans and the radiologist doing the test must be informed of this. Strontium citrate is the most common form in the US but is it best to find SR when at all possible.
Note from Dr. P:
Bone Health is just another example that without holistic medicine we are missing key pieces to the story. When we only focus on one component of a disease or expect one action of a drug to completely fix a problem we are setting ourselves up for failure and more disease. By only treating bone Mineral Density we are completely ignoring 50% of the bone story and that’s why women are still falling and breaking bones! It is essential that we embark on comprehensive care so that all pieces to the story are addressed and the patient is restored to health!
Wishing You Well,
Dr. Purcell
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