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Life Extension Magazine April 2009
Reports

New Strategies for Optimizing Bone Strength

By Laurie Barclay, MD
New Strategies for Optimizing Bone Strength

Mainstream medicine focuses almost exclusively on prescription drugs to reduce the risk of osteoporosis in aging men and women. What many people do not know is that the most popular class of prescription medications used to treat osteoporosis, bisphosphonates, focus on limiting additional bone loss, rather than actually building more bone, in aging men and women. This class of drugs is also associated with potentially serious side effects, including heart arrhythmia.

Exciting scientific research has discovered the power of collagen for supporting optimal bone tensile strength. New data suggest that a unique, patent-pending nutritional supplement consisting of collagen chelated to calcium, along with a new plum extract can help support strong, resilient bones.

The Osteoporosis Epidemic

Too often, osteoporosis is diagnosed late in its progression resulting in rapidly declining bone integrity that leads not only to disfigurement but also painful and potentially lethal fractures. Today’s epidemic of osteoporosis causes up to half of all women over age 50 and one in four men in the United States to suffer disabling bone fractures.1 When an elderly person slips or loses their balance, it could mean the end of their life, since up to 20% of those who sustain a hip fracture die within one year.2 Since an estimated 250,000 Americans suffer a hip fracture annually, broken hips may lead to 50,000 deaths per year in the US alone.2

Sadly, very few doctors focus on preventing this silent disease through lifestyle adjustment such as weight-bearing exercise, bioidentical hormone replacement (if indicated), and broad-spectrum nutritional supplementation to feed and nurture healthy bone. Instead, pharmaceutical companies push bisphosphonate drugs (such as Fosamax® and Actonel®) as a one-stop solution. These drugs work by reducing bone resorption, not by building new bone directly. Of interest, evidence suggests these medicines are associated with potentially serious side effects.3-5 Few doctors understand that even when these drugs are used to reduce the risk of fracture secondary to breast or prostate cancer metastasis to bone,6 it is critical that patients also take a full complement of bone-building minerals along with these medications for optimal benefit.

What You Need to Know: Optimizing Bone Strength
  • Osteoporosis is a widespread condition associated with reduced bone mineral density (BMD) and strength leading to bone fractures.
  • Risk factors for osteoporosis include female sex, postmenopausal status, advanced age, Caucasian or Asian race, diabetes, metabolic syndrome, slim stature (underweight), sedentary lifestyle, and cigarette smoking.
  • Bisphosphonate drugs are widely prescribed for osteoporosis, but they may be associated with serious side effects including osteonecrosis (bone decay) of the jaw and atrial fibrillation (an irregular heart rhythm associated with stroke).3-5
  • Optimal bone health requires not only preservation of bone mineral density, but also of bone strength, which results from the dynamic structure of bone involving a matrix of collagen fibers reinforced with calcium, phosphorus, and other minerals.
  • Collagen calcium chelate has been shown in experimental studies to support bone strength.
  • Dried plum extract has been shown in experimental studies and in clinical studies to improve bone structure and function, even in situations in which bone loss was thought to be irreversible.

The Power of Collagen

The Power of Collagen

Recent advances in understanding normal bone structure and function have revolutionized the nutritional approach to optimizing bone health. Researchers are now discovering the vital importance of collagen for achieving optimal bone tensile strength.

Most people will be very surprised to know that collagen, a resilient type of protein molecule, makes up most of the structure of bone.7 The spongy matrix of collagen fibers and crystalline salts within bone is crucial to absorbing compression forces to resist stress fractures,8 much as the tensile supports of steel bridges provide flexibility so that the bridge can withstand gale force winds and heavy traffic.

Amazingly, the compressional strength of bone is even greater than that of reinforced concrete.9 Many fractures, however, result from twisting or torsional forces, and neither bone nor concrete has a very high degree of torsional strength. However, the dynamic collagen matrix within healthy bone allows it to better redistribute and deflect a variety of forces, thereby reducing fracture risk.

Like suspension cables on a bridge that sway to absorb forces that might otherwise disrupt the main structure, collagen fibrils within bone are made up of strings of alternating collagen molecules and hydroxyapatite crystals that are connected by weak chemical bonds within the strings and between them.10

Force applied to collagen fibrils in bone causes some of these weak bonds to break. This is actually a beneficial action because by allowing stretching within the collagen matrix to spread the pressure over a broader area, the result is a protective effect on stronger bonds within the collagen molecule itself.7,10 Without both collagen and minerals, bone becomes brittle and can be easily fractured, much as a bridge with a missing cable could snap under the weight of one too many cars.

Understanding Bone Anatomy

Depending on their location within the skeleton and their function, bones can be classified as long (e.g. arm and leg bones), short (e.g. small wrist and ankle bones), flat (e.g. ribs, skull), or irregular (e.g. spinal vertebrae). A long bone has an expanded portion at each end called an epiphysis, which forms a joint with another bone, and a bone shaft, or diaphysis, between the epiphyses. Articular cartilage covers the ends of each epiphysis to form the joint surface, and the rest of the bone is completely encased in a tough covering called the periosteum.

The solid, strong, bony layer within the periosteum is called compact bone, which is resistant to bending. The compact bone in the diaphysis forms a rigid tube with bone marrow filling the hollow chamber, known as the medullary cavity, within the tube. Because the epiphyses are subjected to the greatest forces of compression during weight-bearing activities, the epiphyses are made mostly from spongy or cancellous bone offering elastic strength.

A New Type of Calcium

As we have seen above, bone strength and resilience depends on collagen fibers, as well as calcium, several trace minerals, and vitamins D and K2, which act together to generate a strong, complex matrix structure. Most bone supplements recommended by doctors contain only calcium, an inadequate nutritional strategy for optimal bone health.

A New Type of Calcium

Recently, scientists have developed a new form of calcium that molecularly binds collagen. Named KoAct™, this unique form of collagen calcium chelate is designed to enhance collagen support and turnover while increasing bone mineral density and bone strength.11

Scientists at the prestigious Tokyo University found that supplementation with collagen calcium chelate improved bone strength to a greater extent than the same amounts of calcium and collagen either given separately or together but in a non-chelated form. Specific improvements with collagen calcium chelate were seen not only in bone mineral density but just as importantly in femur (thigh bone) weight, bone collagen production, and bone flexibility and strength.11

In an experimental model of osteoporosis, the test group received a low-calcium diet for one week. In addition to their low-calcium diet, some of the test group consumed a high-dose collagen calcium chelate. The cohort receiving high-dose collagen calcium chelate had an increase in femur bone weight by an impressive 9.6%, compared with the group given the same amount of calcium in non-chelated form. The test group receiving the collagen calcium chelate had dose-dependent increases in bone mineral density, which were 3.5% to 11.1% higher than those seen in the group receiving the same amount of non-chelated calcium. The investigators concluded that collagen calcium chelate had an additive effect on bone mineral density, better than that of calcium alone or of a simple calcium and collagen mixture.12

Collagen calcium chelate was also associated with increases in femur bone strength, by about 9.9% to 25%, compared with the group receiving the same amount of calcium.12 Remarkably, the benefits of collagen calcium chelate were evident after only eight weeks of supplementation! Given these encouraging results, a large clinical study is planned for next year, in collaboration with the US Army, to look at the effect of collagen calcium chelate on bone fractures in hard-training recruits.

Determining Bone Fracture Risk

For ease and efficiency of movement, bone must be lightweight, yet strong enough to support far more than its own weight. Although BMD (bone mineral density) is important, so is bone strength and resilience. The World Health Organization (WHO) has recently concluded that BMD, as measured by dual-energy X-ray absorptiometry, is not the single best predictor of fracture risk, because it misses a significant proportion of individuals who have clinical or epidemiological risk factors for osteoporosis.19,20

Various clinical factors associated with bone strength must also be considered when deciding who is at risk for fracture and could benefit from preventive supplementation and/or treatment.19-21 Prescribing bisphosphonates to younger postmenopausal women based on BMD alone may therefore unnecessarily or prematurely expose them to the risks associated with these drugs.

To predict the 10-year risk of sustaining a major osteoporotic fracture, the WHO has developed a clinical assessment tool known as FRAX (fracture risk assessment), using composite scores that rely both on BMD and on validated clinical risk factors for fracture.19,20 The test uses easily determined clinical features, such as age, race, weight, and smoking history, to go above and beyond BMD and to evaluate bone strength.

FRAX allows doctors to enter clinical information online, so that a computer program can calculate the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture) for any given individual, based on information collected from large population samples in Europe, North America, Asia, and Australia.19,20

Plum Extract Supports Bone Health

New research has shown that plum extract can be an important component of an intelligent bone health program. In a study of 58 postmenopausal women,13 those who were randomly assigned to receive 100 grams of a concentrated plum product in their daily diet for three months were shown to have positive effects on bone. These women showed significantly increased serum levels of biological markers that reflected greater rates of bone formation.13

Laboratory studies also demonstrated that concentrated plum polyphenols down-regulate (decrease) cellular signals that cause bone resorption.14,15

Plum Extract Supports Bone Health

Plum polyphenols promote bone deposition by increasing osteoblast (bone-building cell) activity and function via their effects on increasing certain cell-signaling compounds and by enhancing expression of an enzyme that is involved in collagen cross-linking.16

In an experimental model of bone loss caused by surgical removal of the testicles, adding dried plum extract to the diet had similar effects to parathyroid hormone (PTH), which is involved in bone metabolism.17 The test group given concentrated plum extract had an 11% increase in vertebral (spine) and femoral (thigh bone) bone mineral density compared with controls, whereas those receiving PTH had increased bone mineral density by 20.7% at the vertebrae and 17.9% at the femur. Other changes in bone volume and structure seen with concentrated plum extract relative to controls were similar to those seen with PTH.15,17

Even more compelling, experimental studies18 suggest that bone changes previously thought to be irreversible can, to a great extent, be improved by dried plum extract. In an experimental model of postmenopausal osteoporosis, the test group that already had deterioration of bone structure had improvements, relative to controls, after two months of a diet containing dried plum extract. Femoral and tibial bone densities were restored and lumbar bone density was increased. Improved bone quality also resulted in a 6.9% improvement in overall yield and a 6.0% improvement in ultimate force. The architectural microstructure of trabecular bone was also significantly improved in rats receiving dried plum extract compared with controls.18

Standardized plum extracts provide a convenient way to obtain plum’s beneficial bone-supportive properties—without the concentrated calories and sugar content.

Adverse Effects of Bisphosphonates

Bisphosphonate drugs such as Fosamax® (alendronate), Actonel® (risendronate), Zometa® (zoledronic acid), and others are a mainstay of osteoporosis treatment. More than one-third of outpatients seen for osteoporosis at >60 years of age are treated with bisphosphonates.22

Unfortunately, these drugs are often poorly tolerated. Gastrointestinal symptoms are common, and bone and joint pain occur often.3

Bisphosphonates also have potentially serious adverse effects.3 Osteonecrosis of the jaw (death and decay of the jaw bone) is a serious, potentially disfiguring complication in women taking bisphosphonates who have a tooth extraction.5 A study at the University of Southern California, Los Angeles found that use of alendronate pills for one year or more increased the risk for jaw osteonecrosis after a tooth extraction or was associated with denture-related ulcers. Of 208 patients who had taken alendronate, 70 mg once per week for one to 10 years, 9 (4%) developed jaw bone osteonecrosis. None of more than 13,500 dental patients who had not taken alendronate developed jaw bone osteonecrosis.

Additionally, people treated with alendronate or zoledronic acid may have double the risk of serious atrial fibrillation, or irregular heart rhythm causing the heart to pump blood less efficiently, potentially resulting in pulmonary edema (fluid in the lungs), congestive heart failure, stroke, or death. A study showed that 2.5-3% of patients taking bisphosphonates developed atrial fibrillation and 1-2% developed serious atrial fibrillation, with complications including hospitalization or death.4

Because bisphosphonate treatment may facilitate management of bone metastases, patients with breast or prostate cancer should consider treatment in consultation with their physician.6 Individuals who use bisphosphonate medications under a physician’s guidance can help reduce their risk of osteonecrosis of the jaw by receiving a dental examination and undergoing any necessary dental procedures such as tooth extractions before initiating drug therapy.23 Additionally, individuals using bisphosphonate therapy are advised to practice good dental hygiene, stop smoking, limit alcohol consumption, and avoid jaw trauma.23,24

If possible, individuals should avoid undergoing dental surgery during bisphosphonate treatment.23

Clinical Considerations for Bone Health

Collagen calcium chelate, magnesium, silicon, boron, dried plum extract, and vitamins D and K2 work to synergistically support bone health. Individuals who may derive particular benefit from supplementation with these nutrients include those at risk of threats to bone strength, such as those with a family history of osteoporosis and advanced age.

For optimal bone strength, a comprehensive approach using a variety of nutrients is essential. Collagen calcium chelate and concentrated plum extract are two powerful additions for men and women focused on having healthy bones that last a lifetime!

If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370.

References

1. Available at: http://bones.nof.org/site/PageServer?pagename=NOF_25th_Anniversary_Bone_Facts. Accessed January 27, 2009.

2. Available at: http://emedicine.medscape.com/article/825363-overview. Accessed February 11, 2009.

3. Arum SM. New developments surrounding the safety of bisphosphonates. Curr Opin Endocrinol Diabetes Obes. 2008 Dec;15(6):508-13.

4. Miranda J. Osteoporosis drugs increase risk for serious heart arrhythmia problems. Presentation Oct. 28, 2008 at CHEST 2008.

5. Sedghizadeh PP, Stanley K, Caligiuri M, et al. Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. J Am Dent Assoc. 2009 Jan;140(1):61-6.

6. Coleman RE. Risks and benefits of bisphosphonates. Br J Cancer. 2008 Jun 3;98(11):1736-40.

7. Available at: http://www.iop.org/EJ/abstract/0957-4484/18/29/295102. Accessed February 6, 2009.

8. Gupta HS, Seto J, Wagermaier W, et al. Cooperative deformation of mineral and collagen in bone at the nanoscale. Proc Natl Acad Sci USA. 2006 Nov 21;103(47):17741-6.

9. Available at: http://www.nsbri.org/HumanPhysSpace/focus6/ep_development.html. Accessed February 9, 2009.

10. Buehler MJ, Ackbarow T. Nanomechanical strength mechanisms of hierarchical biological materials and tissues. Comput Methods Biomech Biomed Engin. 2008 Dec;11(6):595-607.

11. Available at: http://www.nutraingredients-usa.com/smartlead/view/226058/4/Bone-Strength-is-Critical. Accessed February 6, 2009.

12. AIDP, Inc., unpublished data.

13. Arjmandi BH, Khalil DA, Lucas EA, et al. Dried plums improve indices of bone formation in postmenopausal women. J Womens Health Gend Based Med. 2002 Jan;11(1):61-8.

14. Bu SY, Lerner M, Stoecker BJ, et al. Dried plum polyphenols inhibit osteoclastogenesis by downregulating NFATc1 and inflammatory mediators. Calcif Tissue Int. 2008 Jun;82(6):475-88.

15. Franklin M, Bu SY, Lerner MR, et al. Dried plum prevents bone loss in a male osteoporosis model via IGF-I and the RANK pathway. Bone. 2006 Dec;39(6):1331-42.

16. Bu SY, Hunt TS, Smith BJ. Dried plum polyphenols attenuate the detrimental effects of TNF-alpha on osteoblast function coincident with up-regulation of Runx2, Osterix and IGF-I. J Nutr Biochem. 2009 Jan;20(1):35-44.

17. Bu SY, Lucas EA, Franklin M, et al. Comparison of dried plum supplementation and intermittent PTH in restoring bone in osteopenic orchidectomized rats. Osteoporos Int. 2007 Jul;18(7):931-42.

18. Deyhim F, Stoecker BJ, Brusewitz GH, Devareddy L, Arjmandi BH. Dried plum reverses bone loss in an osteopenic rat model of osteoporosis. Menopause. 2005 Nov;12(6):755-62.

19. Fardellone P. Predicting the fracture risk in 2008. Joint Bone Spine. 2008 Dec;75(6):661-4.

20. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A; National Osteoporosis Guideline Group. Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int. 2008 Oct;19(10):1395-408.

21. Lewiecki EM, Watts NB. New Guidelines for the Prevention and Treatment of Osteoporosis. South Med J. 2009 Jan 9.

22. Teschemaker A, Lee E, Xue Z, Wutoh AK. Osteoporosis pharmacotherapy and counseling services in US ambulatory care clinics: Opportunities for multidisciplinary interventions. Am J Geriatr Pharmacother. 2008 Dec;6(5):240-8.

23. Weitzman R, Sauter N, Eriksen EF, et al. Critical review: updated recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in cancer patients—May 2006. Crit Rev Oncol Hematol. 2007 May;62(2):148-52.

24. Khan AA, Sandor GK, Dore E, et al. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008 Jul;35(7):1391-7.