Bone/Cartilage Health - Drugs and Nutrition, and Dangers

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 serious 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 - enhances 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 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 clinical evidence of osteonecrosis of the jaw and increased fracture rate in the femur even with very mild activity. All biphosphonates have worrisome side effects. Consumer Affairs complaints on Fosamax . And here at the end of 2011, is the latest hard science (i.e. peer-reviewed medical journal) on the duke-out between vitamin D vs. the drug companies' bone meds... a KO for vitamin D

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.

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...

Magnesium. Especially if you get a lot of dairy, you're getting too high a ratio of calcium to magnesium. Roughly 10:4 ratio is considered proper. Supplement with extra magnesium. Read here.

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. However, it's not clear that strontium isn't just substituting for chemically similar calcium, an atom which is lighter. Whether you actually get stronger bones with strontium is not yet established with studies, so far as I can tell as of 2007.

Potassium: strong positive correlation between bone mineral density and potassium intake. Lots of fruits/veges are best, but supplementation too. Potatoes are very high in potassium and, in my experience, are even better at alkalizing urine than bananas. 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. Potassium Citrate may be even better.

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. However, there is other evidence that soy consumption is adverse to testosterone levels, and testosterone is necessary for any growth, including bone growth. I've cut soy milk (I love chocolate soy milk! It was hard to give it up) out of my diet.

Mushrooms: mushrooms are a powerful aromatase inhibitor, and so inhibits the conversion of testosterone into estrogen. Aromatase inhibitors raise the level of free testosterone and if you're low in free testosterone, like I am, this could help. I've been unsuccessful in getting my doctors to help with my relatively low testosterone even though there is plenty of evidence low T is part of the osteoporosis story. Alas, finding ways to circumvent the many ways the medical profession gets in the way of my health is a large part of my total effort. For this I pay among (if not the) highest medical insurance costs in the industrialized world? Adding white button mushrooms at the moment seem to best way to deal with the low T w/o prescriptions. Some refs here, T-nation. I haven't yet found references which directly correlate white button mushroom consumption with raised testosterone levels, so that is still only a reasonable logical inference.

Here is a recent journal paper providing solid science that bone health and nutrition are intimately related (Genius and Schwalfenburg 2007).

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.

However, the whole issue of animal vs plant protein and bone health is getting murkier as more studies are done. At the moment (June '09) I think the best advice is to get plenty of protein, calcium, magnesium, vitamin K, vitamin D, and don't worry so much about the source. There do seem to be more studies showing that taking at least some types of vitamin supplements are not that helpful to health, but that taking vitamins and nutrient rich foods IS very much beneficial, for bone and everything else. Seems common sense, as we evolved consuming foods, not vitamin supplements. Vitamin D is one important exception. We humans don't live where our genetic stock originated, for one thing, and we just plain don't get enough vitamin D in a typical diet, or even a reasonably sound diet.

Bone Density and pH Regulation

Your system might 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 urine. 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, or sugary nonsense, coffee, alcohol, red meat, and getting plenty of fruits and veges) that my morning urine pH is typically about 6.6, slightly acid and hence tending to draw skeletal calcium. However, the evidence for (acidifying) protein causing bone mass density reductions, is not at all strong and seems to be mostly based on supposition from in-vitro studies. Here's a provocative review article on the issue.

This study published in 2013 verifies that alkalizing your system through diet (including potassium citrate) improves bone density and strength - Jehle, S., Henry N. Hulter, Reto Krapf. 2012. Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: A randomized controlled trial. Journal of Clinical Endocrinology and Metabolism, doi: 10.1210/jc.2012-3099. URL: http://jcem.endojournals.org/content/early/2012/11/14/jc.2012-3099.abstract (accessed 08.01.2013)

I'm playing with calcium tablet dosage and timing to find a good plan. So far, my experience shows that potatos are by far the most potent food for alkalizing my urine. (Now, a big question - is alkaline urine a good indicator of a properly alkaline balance in the body? I've been unable to find solid evidence that this is true. Dr. Susan Brown believes so, but in my attempt to personally communicate with her and find hard evidence, I've not been successful). 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
Here's an article in a quality, peer-reviewed journal on alkaline diet's effects. (Schwalfenburg 2011)
A new (2013) article on potassium citrate supplementation helping bone density (Jehle et.al. 2012) and here
Results of studies of paleolithic diets vs today's diet; bone nutrients and implications.

Prunes: The best bone strength and bone density "drug" may also be the cheapest and the safest
Good summary with journal article references
Prunes and bone density, from ScienceDaily
Another prune article
Oct '09, another summary on prunes and bone building.
Dr. Susan Brown's summary on human studies Sept '09
2010 article summarizing how prunes improved bone density in old mice (but interesting caveats at the end)

However, a caveat of my own - these articles are based on the research of Dr. Arjmandi at Florida State U, who has done much work on prunes and health, and much of it is published in reputable peer-reviewed medical journals, such as the Journal of Bone and Mineral Research. However, this research has been funded by the California Prune Board, so that at least brings in a question.

What about over-the-counter painkillers? NSAID's to get you through the day? Not a good idea!
Atrial fibrillation and NSAIDs
NSAID's and kidney damage, and here , here As of 2011, appreciation of these dangers is "very low" - here . Personal stories

Glucosamine Sulfate (GS) and Glucosamine Hydrochloride (GH) and osteoarthritis
2012 review article (Belguim) showing GS more effective than GH, and as good as ibuprofen (NSAID), w/o bad side effects (see above)