From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.pharmacy,sci.med.nutrition,sci.med Subject: Re: Bone density drugs for osteoporosis Date: 7 Jul 1998 00:38:49 GMT In <6nq388$nh@tictac.demon.co.uk> $news1$@tictac.demon.co.uk (Ellen Mizzell) writes: >Steven B. Harris (sbharris@ix.netcom.com) wrote: >> In <6npbvg$8km@bgtnsc03.worldnet.att.net> "Jeffrey Dach" >> <jdach@worldnet.att.net> writes: >> > >> >Didronel, Fosamax: >> >Does any one have any information about the type of bone formation >> >induced by these drugs. They increase bone density, but is the bone >> >structure defective in any way? Or is it normal, strong trabecular >> >bone? >> >> It is. Unlike bone formed from fluoride. If you want a nice review >> of osteoporosis treatments which looks ONLY at regimens (drugs, >> nutrients, and hormones) which have been proven to reduce FRACTURE >> rates in controlled trials (the BOTTOM line clinically), I recommend a >> recent New England Journal of Medicine review: March 12, 1998 (vol 338, >> pp 736-746). > > >Scuse me but that's not what I've heard. What I've been told, >as a person with osteo, is that the original structure can't be >rebuilt. The drugs may increase the density of the bone where it >remains, but the "bridges" of the structure don't reform. So >you still end up with defective bone structure, though possibly >a stronger defective bone structure. > >If it's been found that any of the drugs *can* recreate the >normal architecture, could you please post cites, as this would >be very interesting to know. > > > >-- >Ellen Mizzell I posted a cite with ALL the relevent papers reviewed in it. Look it up. It is true that in theory once you lose a delicate trabecular fiber, it's gone. But before that, before it goes away completely to nothing, it can still be rebuilt and thickened at any time. And even after some filiments are gone, the arches or filiments that are left can be strengthened to take up a bigger load. The bottom line is the vertebral fracture rate goes down on these treatments, compared to placebo. Theory must bow before this fact. However, it's not too difficult to see how theory can be consistent with it. Steve Harris, M.D. From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: osteoporosis and food supplements Date: 13 Dec 1998 04:52:07 GMT In <mPlc2.177$ux3.457465@news.bctel.net> "R.Hamilton" <a3a37464@bc.symaptico.ca> writes: >>I suppose you've heard that countries with high milk consumption per >>capita have a hihgh rate of osteoporosis than countries with low milk >>consumption. This may be true in some cases, but such comparisons are >>confounded by cultural and genetic differences. If you look at >>populations *within* a country, you always find that people who drink >>more milk are less likely to develop osteoporosis. > I knew you'd have a reasonable explanation for 25,000,000 women >suffering from osteo in a country with a per capita consumption of >over 580 pounds of milk per year. Yes, he did. Genetics. Non-costal "nordic" peoples living at high latitudes and covered against the cold have bodies adapted to live with a lot less vitamin D (the light skin is only part of that adaptation), and another part is apparently that their bones are lighter and less dense, and give up calcium more easily in times of low estrogen (such as nursing). Alas, this also causes them grief after menopause, a fact which evolution/Mother Nature does not really concern herself with. The babies and good breastmilk are what are important to mother nature. Now that we have that out of the way, let's hear YOUR explanation for the fact that the Masai tribe of Africa drink a LOT more milk than 500 lbs a year, but have little osteoporosis. And the fact that osteoporosis is less frequent in Asian countries amoung women who drink at least some milk. We're waiting. Steve Harris, M.D. From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: Calcium/Milk Myth Toppled {Fwd} Date: 10 Mar 1999 13:06:41 GMT In <36E59318.5CF3@erols.com> "physical (Droll Troll)" <physical@erols.com> writes: > But, and this is old news, it is epidemiologically irrefutable >that _milk-drinking_, high _meat-eating_ cultures have higher >incidences of osteoporosis than places with nnary a volt of >electricity. What about the Masai? I don't think you can claim that all that milk only becomes good for them because they replace a lot of meat with blood. It's still a heck of a high protein diet. If we were eating too much protein in this society, we'd have negative correlation here WITHIN racial groups, between milk consumption and osteoporosis incidence or risk. I defy you to find me that paper. Yes, if you put people or rats suddenly on a very high protein diet, they go into negative calcium balance. But the body, so long as hormones are present, adapts. Women hardly hever break things before age 50 in any society. Nor men. And it's exactly in the group of post menopausal women that you can prove that milk consumption is negatively correlated for fracture rate. That's true in Japan, true in Hong Kong, and true in the USA. Steve Harris, M.D. From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med Subject: Re: Osteoporosis Date: 26 Apr 1999 09:30:38 GMT In <FAryA5.3qo@pen.k12.va.us> dschaffe@pen.k12.va.us (Deborah Lynn Schaffer) writes: >Please tell me the difference between osteopenia and >osteoporosis. I am a 46 yr old premenopausal woman whose >op dexa bone density study showed significant osteopenia in the >lumbar spine (-1.2) and hip (-1.5) with focal osteoporosis in >the femoral neck (-2.7). > >Thanks > >--- >dschaffe@pen.k12.va.us Once upon a time, osteopenia (literally: little amount of bone) meant having so little bone it was apparent on X-ray that the bone was more transparent than normal, and this generally required about 50% loss in density to see clearly on a normal X-ray. You didn't get a formal diagnosis of "osteoporosis" until you actually had a fracture. Generally, this was a compression fracture in trabecular, or "woven" bone (like your vertebrae, supported with spiderwebs of bone inside), and the usual kind of displaced fracture in cortical bone (the thick tube of bone in your long bones, like your hip bones). The trabecular bone is most sensitive to lack of hormones, which is why women after menopause get back fractures usually (not always) before they get hip fractures. Nowadays with the DEXA scanners, the disease has been re-defined (one reason to distrust the concept of "disease" in medicine-- it's far from objective). What was done was very like what happened in AIDS with T-cell counts. They NOW formally give you "osteoporosis" if you have bone density greater than -2.5 standard deviations down from a young person of your sex and height, even if you're assymptomatic with no fractures, yet. They picked this because it's where the fracture risk starts to climb fast. That's the "t score" you see. (The z score adjusts for your age, but isn't used in the definition, because nature doesn't give you any points for being older-- your bones break when they get to a certain density, and that's it. All the z score does is let you compare with your cohort, which has all the same diseases you do). A t-score of -2.5 SD turns out to be roughly 50% of your 30-year old ideal bone mass. You now get a diagnosis of "osteopenia" (low bone) for a t score from -1.0 standard deviations to -2.4. It's the same thing, but milder and more reversable (since you're less likely to have lost woven bone that can't be replaced when gone, but can be thickened and built up by drugs and hormones, if still there). As you can guess, the DEXA scanner made the number of women with "osteopenia" go WAY up. As is typical, existance of a way to diagnose the problem early, plus more knowledge of it's natural history, plus existence of drug and hormone treatments, all made for a change in the definition of pathology. If you were cynical you'd call it capitalism. If not, you'll note that it's also just the natural evolution of language. For example, hypertension formally became a disease long before we had any good blood pressure pills. BTW, osteopenia is a little like anemia, in that it's not disease per se, but a condition. Osteoporosis as defined by DEXA is also not a disease in this sense. All these conditions can be caused by several factors, and it's not clear how many ways the underlying pathology for osteoporosis should be split. Historically, people have talked about type I and type II osteoporosis, with the difference being that the hormone sensitive trabecular bone attack spoken of, above, is the classic type I, and type II is the age-related disease. But you can't tell one from the other by DEXA, though you can guess, if you see more spine involvement than hip in a female, that hormones loss is most to blame. This mechanism of rapid bone loss after estrogen loss may have something to do with necessity to mobilize calcium from the skeliton of nursing female mammals. Nursing depletes the skeleton of calcium, and even supplements don't stop that, while it's going on (only when nursing stops and estrogen levels rise, does it rebuild). It's much the same in menopause. Steve Harris, M.D. From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: sci.med,sci.med.cardiology,sci.med.pharmacy,misc.health.diabetes Subject: Re: study: statins may induce neuronal apoptosis Date: 22 Jul 2005 17:12:47 -0700 Message-ID: <1122077567.435412.235410@o13g2000cwo.googlegroups.com> Hawki63@sbcglobal.net wrote: > point being....pleiotrophic (BTW,,,you cannot even spell the word...) is > NOT specific to statins.... COMMENT: Of course not. It's probably stretching it to use it outside the field of genetics. Many phenotypical effects for a single genotype. A gene that helps you in one way hurts you in another. Or (my favorite) a gene that helps early in life, hurts later. A good clotting system is great for childbirth and fighting, not so good later when your arteries are mildly damaged by age. Genes that make your trabecular bone dissolve in response to sudden estrogen fall, are good for providing calcium for milk for nursing, during which fertility and estrogen production is (by and large) supressed. But the same hormone fall in menopause is interpretted badly by the same gene, since there's no need to make milk. Now a good gene becomes a bad one, as the spine falls appart for years instead of months, until it collapses. Pleio = many. Those stars the pleiades are named partly because there are so many of them. They are the many, many grieving daughters of Atlas and a weather nymph. Pleione is a sort of figure vaguely associated with surprising fecundity in early Greek myth. The lady who lived in a shoe. SBH From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: sci.med.cardiology Subject: Re: 'Statin' drugs reduce fracture risk in men Date: 28 Sep 2005 17:03:48 -0700 Message-ID: <1127952228.475510.53830@o13g2000cwo.googlegroups.com> Zee wrote: > Fosamax is not what you and pharma portray it to be: > > http://www.cwhn.ca/network-reseau/7-4/7-4pg3.html > > "Fosamax may reduce hip fractures by just **one percent** (although > even this is disputed). In real terms, this means that 90 at-risk women > would need to be treated for three years to prevent one hip fracture in > one of them. The remaining 89 would receive no benefit. It is estimated > that hundreds of women aged 50 years with low bone density would need > to be treated for more than three years to prevent one hip fracture in > one of the groups. > Leading osteoporosis authority Professor Ego Seeman of the University > of Melbourne, Australia, poses the question: COMMENT: That may well be true, but understand that hip fracture is the worst outcome of osteoporosis, and the least sensitive to treatment. Fosamax is also give to prevent spinal compression fraction, which is far more common and far more treatable (due to type I osteporosis' differential effect on trabecular bone). Some of the outcome of prevention of spinal compression is merely cosmetic (you can choose to get that dowager's hump, or not). But some prevents longterm disability, too. SBH From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: sci.med.cardiology Subject: Re: 'Statin' drugs reduce fracture risk in men Date: 28 Sep 2005 19:38:31 -0700 Message-ID: <1127961510.985723.230770@g14g2000cwa.googlegroups.com> Zee wrote: > Steve Harris wrote: > > Zee wrote: > > > Fosamax is not what you and pharma portray it to be: > > > > > > http://www.cwhn.ca/network-reseau/7-4/7-4pg3.html > > > > > > "Fosamax may reduce hip fractures by just **one percent** (although > > > even this is disputed). In real terms, this means that 90 at-risk women > > > would need to be treated for three years to prevent one hip fracture in > > > one of them. The remaining 89 would receive no benefit. It is estimated > > > that hundreds of women aged 50 years with low bone density would need > > > to be treated for more than three years to prevent one hip fracture in > > > one of the groups. > > > Leading osteoporosis authority Professor Ego Seeman of the University > > > of Melbourne, Australia, poses the question: > > > > > > COMMENT: > > > > That may well be true, but understand that hip fracture is the worst > > outcome of osteoporosis, and the least sensitive to treatment. Fosamax > > is also give to prevent spinal compression fraction, which is far more > > common and far more treatable (due to type I osteporosis' differential > > effect on trabecular bone). > > Overwhelmingly when I see a woman who has osteroporosis, I see a woman > who has spent a lifetime dieting to be adorable, who thinks lifting > weights and working out is not feminine (and she may have it right as > our society in her generation defined femininity). She may be fat, she > may be thin; she is malnourished and a victim of sexism. Femininity > maims. > > Zee Bah. You're just seeing a generation gap in views. Racism doesn't give you a hump either. From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: sci.med.cardiology Subject: Re: 'Statin' drugs reduce fracture risk in men Date: 29 Sep 2005 12:26:41 -0700 Message-ID: <1128022000.974765.55110@g14g2000cwa.googlegroups.com> Zee wrote: > I should have said "the smallest thinnest woman I know will never have > osteoporosis." You assume. But you can't tell these things by looking, or by lifestyle. It's far too complex a mix of genetics and environment. Many a person looking at Fixx, running his long distances, no doubt said "There's a guy who'll never get heart disease." No doubt he did manage to improve on his genetics by some years. But he couldn't escape it completely. The question is whether or not by being even smarter, he could have done even better. Life is poker-- a game of partly chance and partly skill. Some people are dealt hands so bad that even a master player would go bust with them. Some people are dealt hands so good that even being something of a doofus they manage to win (see our present Fearless Leader in the US, born with the silver foot in his mouth, as Ann Richards remarked). All the rest of us are somewhere between. So, you must do (as TW Rooseveldt always said) what you can with what you've got, where you are. SBH From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: sci.med.cardiology Subject: Re: 'Statin' drugs reduce fracture risk in men Date: 29 Sep 2005 12:54:47 -0700 Message-ID: <1128023687.576945.179520@o13g2000cwo.googlegroups.com> Hawki63@sbcglobal.net wrote: > sorta llike measuring the bone density of a professional athlete..and > comparing it to Bill Gates....SURELY the football player would be expected > to have denser bones... > > duh Sort of like measuring the heart-attack rate of women who chose to take HRT vs. those that don't. Surely those that do, will have less heart disease? And in fact this is so--- a fact that everybody quoted for years as evidence that HRT is overall good for women. But evidentally, there's a big self-selection bias you have to get through before you begin to see the real effects, which are very complex. This is why we do randomized prospective controlled studies. Self-selection things bite you in the butt, in all epidemiology. People who are married and go to church are healthier. Can you therefore change your health by going to church or taking vows? Professional atheletes have bigger coronary arteries. Can you therefore dilate your coronaries by running? Tall people have higher blood pressure. Perhaps surgery to remove some leg bone is in order? SBH |
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