Bone/Cartilage Health - Drugs and Nutrition

I'm not a fan of drugs. The motivations in that game are not favorable - doctors are hard-sold by drug companies, and are too busy managing relations with the insurance companies. Patients come in demanding drugs after seeing ads on TV. They're expensive. They don't adequately inform of the side effects, and.... it's all about the money. But for what it's worth, this is the current state of the bone density drugs as far as I've been able to determine:

Fosamax - both enhance bone density by inhibiting bone resorption, not by stimulating new bone formation. Bone strength and bone density are not the same and there's plenty of examples that the correlation is fairly loose. Without stimulating new bone, I'm skeptical that these drugs are that helpful. And they only increase density by 1-2%/year, which is quite minimal. Nasty multiple side effects of the esophagus for all the biphosphonates, and suggestions of osteonecrosis of the jaw. All biphosphonates have worrisome side effects and don't stimulate new bone growth.

Calcitonin - also inhibits resorption. Effectiveness is not strong, but minimal side effects. More promising is...

Protelos - Servier Inc's formulation of strontium ranelate. It both inhibits bone resorption and stimulates osteoblasts to produce new bone. It's available in Europe, but not FDA approved in the U.S. Your tax dollars at waste work.

Osteologix Inc is developing a slightly different strontium formula - strontium malonate. Osteologix is a public company, and the S.E.C. filings are worth reading, particularly the recent form 10KSB. This isn't advertising, it's legal by-the-book disclosures. My take-away is that it isn't the strontium ranelate, or the strontium malonate - it's strontium which is the active ingrediant, and an element of nature isn't patent-able. Drug companies are highly motivated to tailor an unpatentable substance into a patentable one for which they can charge high fees to recover the expensive FDA approval process, and to make a profit. Why not just go through a nutritional supply house for strontium supplements? Save a lot of money, and a few years too, since Osteologix is still years away from successful conclusion of phase III trials and then approval of their candidate.

Over-the-Counter Supplements

First, I have no financial interest in recommending anything. No web-advertising income, no stock ownership, no nothing - except the desire to help others, and especially those who want to take their own health into their own hands by doing the digging like I have done. While I'm not a doctor nor do I have a medical degree, I do have a PhD in astrophysics, 9 years of post-graduate work in science, I have read, refereed, and written numerous scientific papers and I know what to look for in good studies. I also know that the standards of "proof" are quite different when you are a patient looking for solutions vs. being a legally liable doctor who's main interest is not getting sued. Good evidence of safety, decent evidence for effectiveness, and low cost, are enough to give something a try. I'm very skeptical of drugs as the (cost+risk)/benefit ratios come out poorly in my opinion. Why not piggy-back on the medical research out there and then look for non-patentable formulations, if the science suggests it's just as good? So what are the proven building blocks of healthy bone? Calcium and Vitamin D of course, but others are also important...

Strontium: studies show it increases bone density. Here's a starting point. A quick check (7/9/2007) found this as an on-line source

Potassium: strong positive correlation between bone mineral density and potassium intake. Lots of fruits/veges are best, but supplementation too.

Potassium bicarbonate has been shown to decrease calcium excretion, and presumably calcium extraction from bone (but this is not yet proven) in post-menapausal women.

Boron: evidence is weak that it's a valuable supplement for bone health.

Soy genistein: an isoflavone found in soy products. Preliminary evidence is good.

Bone Density and Milk

Milk was my first thought as a source of bone building nutrition as I contemplated my recovery. Milk is created to have all the ingredients for rapidly building mammalian bodies, including bones, right? I've got no lactose-intolerant problems, after all. However, I have been keeping track of my urine pH along with everything I eat, and notice that contrary to my expectation, milk has a fairly strong acidifying effect. After convincing myself this correlation was real, I did some web searching on the subject of milk and bone health.

Milking your Bones - finds bone health is adversely affected by milk consumption

Excess retinol intake may explain the high incidence of osteoporosis in northern Europe - but retinol (vitamin A) in milk may be the culprit? More refs: 1, 2, 3. But this large study finds no significant correlation between osteoporosis and vitamin A intake in postmenopausal women.

Bone Density and pH Regulation

Your system will use the calcium in your bones as a buffering agent to keep your blood pH regulated to 7.35. Your diet will affect the pH of your body. In general, protein, sugars, and refined carbohydrates have an acidifying effect, while fruits and vegetables and some dairy have an alkalizing effect. Your kidneys will send the offending H or OH ions into your urine and by testing the pH of your urine you can monitor whether your body is habitually having to alkalize your body because of an acidifying diet (typical American diet). If so, you may be drawing calcium out of your bones to do it. I'm currently monitoring everything I eat and how calcium/magnesium supplements will help in alkalizing. I'm a little dismayed that despite having a pretty good diet (no sodas, sugary nonsense, coffee, alcohol, red meat, and plenty of fruits and veges) that my morning urine pH is typically about 6.6, slightly acid and hence tending to draw skeletal calcium.

I'm playing with calcium tablet dosage and timing to find a good plan. Here's some references...

Acid-Alkaline Balance and Its Effects on Bone Health

Nutritional Factors That Influence Bone Health Throughout the Life Cycle

Influence of organic salts of potassium on bone health: Possible mechanisms of action for the role of fruit and vegetables

BONE BUILDERS: THE SECRET OF AN ALKALINE DIET AND LIFESTYLE

New Perspectives on Dietary Protein and Bone Health

Home pH test paper rolls