I would like to introduce you to a test procedure that would be able to identify if you are losing bone tissue before excessive bone loss, or damage, has occurred.  This enables me to use preventative measures prior to the onset of rapid bone loss.  Bone is an active and living tissue and is called an endrocrine organ.  Bone is very active.

Bone loss begins between ages 30 and 40.  Most of you have had a DEXA test which is excellent for identifying if the patient is in immediate danger of developing a fracture.  The limitations of the DEXA is that we can only perform this test every two years and it will not predict those who will lose bone or develop osteoporosis to suffer fractures in the future.  Another factor that is poor in DEXA testing is people can already be undergoing accelerated bone loss and have a current normal score because they started with a higher than normal bone mass due to a healthy life style, calcium supplementation, and weight-bearing exercises.

Genova Diagnostics is the lab that I use and will give a reading on what is called Pyridinium Crosslinks. This is a urine test performed at home.  These crosslinks measure not only if there is bone resorption, or bone being let loose, but will also measure if connective tissue and cartilage within the bone are being lost also.  If the Cross links or the Deoxypyridinoline is elevated, this indicates a rapid rate of bone loss.

Another test is possibly run with the bone resorption test and it called an IGF-1, or Somatomedin.  This is a fasting blood draw performed at the clinic and is an indirect measurement of what we call the Growth hormone.  This test provides information that there is growth happening within the connective tissue or the matrix of the bone so that the bone can hold onto the calcium, magnesium, and other minerals that are being taken.  Among other things that this IGF-1 test measures is that it ensures if the results are normal or slightly elevated, that there is going to be an increase to bone formation.  If there is inflammation of the bone and the whole entire system, the IGF-1 can be decreased suggesting that I, as the doctor, need to treat the system or the entire patient for inflammation, looking to other organ systems that could be inflamed.  These other organ systems could be the large intestine, small intestine, cardiovascular system, liver, and/or pancreas.

Hormones are relevant also and there are times when I will ask you to do a female hormone panel to track estrogen and another hormone called DHEA.  Also, testosterone in women produced by their adrenal glands will enhance bone integrity.  Lack of digestive enzymes or malabsorption, bacterial overgrowth, and yeast overgrowth in the colon will also be causative factors of osteoporosis.  When people use aluminum in the form of antacids, cooking in aluminum foil, and antiperspirants, this will also enhance a magnesium deficiency which will influence the bone.

Inflammation: Literature is now showing that if a person has inflammation in the vessels such as elevated cholesterol, high triglycerides, high LDLs, and high blood pressure, that most likely there is also inflammation in other areas of our bodies and organs, including the bone.

Currently, one of the tools that I have been using at Tipton Chiropractic & Health Center to combat inflammation is the FirstLine Therapy Lifestyle. This has been conducive to preventing osteoporosis and osteopenia because it reduces inflammation anywhere there is inflammation in the body, including your bone.

Medications that are given when osteoporosis is diagnosed help to prevent cells called osteoclasts from eating away or resorbing bone.  What this does not do is allow the osteoblasts from laying down new bone.  If a person fractures a bone, the osteoclasts will eat away the inflammation, the extra bone and tissue, and then the cells burst when they are done.  It is with this burst, or the correct term apoptosis, that the osteoblasts, or the bone laying cells, can begin to work and make new bone.  Synthetic estrogen therapy is also recommended to prevent osteoporosis.  The side effects of taking hormone therapy can be serious and most women want to avoid those risks. My goal for not only menopausal or post-menopausal patients but younger men and women alike, is for you to maintain healthy bone mineralization through lifestyle and natural products that do not have side effects and that support our bodies natural bone forming process.

What are some factors that influence the development of osteoporosis?

Genetic Factors:

• Sex
• Age
• Ethnic background
• Body build
• Family history of osteoporosis

Lifestyle Factors:

• Lack of exercise
• Alcoholism
• Smoking
• Crash dieting
• Dietary factors, including calcium deficiency, moderate vitamin D deficiency, trace mineral deficiency, high protein diet, acid ash diet, excessive sugar, fat, soft drinks, salt and caffeine.

Physiologic States and Disease:

• Postmenopausal deficiencies of estrogen
• Calcitonin, androgens, and weakened adrenal function
• Increased steroid production
• Hyperthyroidism
• Hyperparathyroidism
• Cushing’s disease
• Oophorectomy

Severe Malabsorption:

• Inadequate stomach acid (from hypochlorhydria, achlorhydria, subtotal gastrectomy)
• Lactose intolerance

Medications:

• Steroids
• Anticonvulsants
• Antacids
• Thyroid medicine
• Heparin

Other Factors:

• Connective Tissue Disease
• Rheumatoid Arthritis

Dietary considerations in maintaining bone mass:

• Increase calcium intake by eating foods high in calcium and by taking calcium supplements if necessary.
• Select foods from whole grains to increase intake of vitamins and minerals.
• Aim for emphasizing magnesium-rich foods such as dark green leafy vegetables.
• Don’t over eat meats, as they are rich in phosphates, which lead to calcium loss through the urine.
• Avoid carbonated soft drinks, which are also high in phosphates.  High acidity from phosphates leads to calcium mobilization from the bone in order to buffer the acid.
• Restrict consumption of caffeine and sugar which can result in urinary calcium excretion.
• Avoid alcohol, which may cause osteoblastic dysfunction, leading to decreased bone formation and increased demineralization.

Nutritional products that are being used at Tipton Chiropractic and Health Center to ensure increased bone mineralization and decreasing resorption of bone rates include Cal Apatite and or Bone Guard Forte (Calcium combination products), Magnesium Glycinate which is magnesium.  A progesterone like supplement in a natural form called ProgonB is also known to restore bone matrix and mineral.  Boron, vitamin K, vitamin D, folic acid, B6, zinc, and copper also are needed.

Along with the list of nutritional needs and products that I listed above, comes an introduction of a product from Metagenics called Ostera. Ostera promotes healthy bone remodeling bio- markers to support not only the minerals but the ability for the bone to have that scaffolding or matrix to hold onto the minerals.  Ostera is shown in post-menopausal studies of women with low estrogen to beneficially influence bone remodeling, and offers more effectiveness than just diet and exercise alone.  It also has what is called SKRMs in the form of hopps, vitamin D, vitamin K, and berberine to help healthy bone remodeling.  There are no adverse side effects to this nutrient.

In summary, why is this test important? Next to cardiovascular disease, osteoporosis is the most common disease effecting women in the U.S. today.  More than 50% of healthy American women aged 30-40 are at risk of developing fractures as they age due to osteoporosis.  Unlike bone scans, this urinary Bone Resorption Assessment and the IGF-1 test can identify current levels of bone resorption.  Many factors influence bone resorption.  These tests are then used in monitoring the effectiveness of calcium supplementation and nutritional lifestyle therapy, drug therapy, and other treatment programs.

How to get started?

1. Please call and ask for the Crosslinks kit to be set aside for you to pick up.
2. Set up a fasting blood draw to test the IGF-1.
3. Bring your last DEXA bone test results.
4. Ask to view the 10 minute DVD on what First Line Therapy is all about!

As of August, 2010:

Cost of Crosslinks urine test billed to Dr Ehlers by Genova Lab is:  $73.19.  Patient cost $73.19

Cost of IGF-1 lab test billed to Dr Ehlers by Quest Labs is: $80.60.  Patient cost $80.60.  Drawing fee $10.00.

Interpretation fee and product recommendation:  $45.00

Typical Nutrient Schedule used for abnormal readings with adjustments made to the patients particulars:

{The “# of bottles” column are figured for an eight month period, until the retest date}

If abnormal, these tests are repeated about every 8-9 months, if normal, one year retest.