J148 -- 6/30/99
FOSAMAX, NOT CALCIUM, TREATS OSTEOPOROSIS
You may have heard that a diet low in calcium-rich foods, such as dairy products, causes osteoporosis, but recent research shows that both high and low-protein diets may be even more important causes. Furthermore, a calcium-rich diet neither prevents (1) nor reverses osteoporosis enough to prevent bone fractures (1a). A recent report from the University of Connecticut shows that a low-protein diet can weaken bones by reducing absorption of calcium from your intestines (2). Several previous reports show that a high-protein diet weakens bones (3,4,5,6). When you take in more protein than your body needs, your liver breaks down the extra protein building blocks, called amino acids, into organic acids that acidify your bloodstream, causing your kidneys to neutralize the acidity by pushing calcium out through your kidneys. Drinking several carbonated beverages each day (7) and eating large amounts of salt may also leach calcium from bones (8).
The drug, alendronate sold under the brand name Fosamax, can prevent and treat osteoporosis (9). Both major female hormones, estrogen and progesterone, can be given at any age to strengthen bones with the combination far more effective than just estrogen (10). Adding bisphopshonate pills, such as alendronate and pamindronate, and a hormone nasal spray called calcitonin, strengthen bones even more (11,12). Exciting new research takes advantage of the observation that male hormones strengthen bones more than female hormones do. A readily available male-female hormone combination pill called Estratest strengthens bones in women. So does an anabolic male hormone called nandrolone (13). Diuretics also strengthen bones so they can be used to treat women who have both high blood pressure and osteoporosis (14).
1) DJ Hosking, PD Ross, DE Thompson, RD Wasnich, M Mcclung, NH Bjarnason, P Ravn, G Cizza, M Daley, AJ Yates. Evidence that increased calcium intake does not prevent early postmenopausal bone loss. Clinical Therapeutics 20: 5 (SEP-OCT 1998):933-944.
1a) Feskanich D et al. American Journal of Public Health June, 1997.
2) JE Kerstetter, KO Obrien, KL Insogna. Dietary protein affects intestinal calcium absorption. American Journal of Clinical Nutrition 68: 4(OCT 1998):859-865.
3) NEJM, 1994(June 23);330:1776-1781.
4) American J of Clinical Nutrition 1994;59(Suppl):1238S-41S.
5) SJ Whiting, DJ Anderson, SJ Weeks. Calciuric effects of protein and potassium bicarbonate but not of sodium chloride or phosphate can be detected acutely in adult women and men. American Journal of Clinical Nutrition 65: 5(MAY 1997):1465-1472.
6) R Itoh, N Nishiyama, Y Suyama. Dietary protein intake and urinary excretion of calcium: a cross-sectional study in a healthy Japanese population. American Journal of Clinical Nutrition 67: 3(MAR 1998):438-444.
7) G Wyshak, RE Frisch. Carbonated Beverages, Dietary Calcium, and Dietary Calcium/ Phosphorus Ratio, and Bone Fractures in Girls and Boys. Journal of Adolescent Health 1994(May);15(3):210-215.
8) G Jones, T Beard, V Parameswaran, T Greenaway, R Vonwitt. A population-based study of the relationship between salt intake, bone resorption and bone mass. European Journal of Clinical Nutrition 51: 8(AUG 1997):561-565.
9) M Mcclung, B Clemmesen, A Daifotis, NL Gilchrist, J Eisman, RS Weinstein, GE Fuleihan, C Reda, AJ Yates, P Ravn. Alendronate prevents postmenopausal bone loss in women without osteoporosis - A double-blind, randomized, controlled trial. Annals of Internal Medicine 128: 4 (FEB 15 1998):253.
10) Schneider DL, Barrett-Connor E, Morton DJ. Timing of postmenopausal estrogen for optimal bone mineral density. JAMA 1997(Feb 19);277(7):543-547.
11) SL Greenspan, S Holland, L Maitlandramsey, M Poku, A Freeman, WY Yuan, U Kher, B Gertz. Alendronate stimulation of nocturnal parathyroid hormone secretion: A mechanism to explain the continued improvement in bone mineral density accompanying alendronate therapy. Proceedings of the Association of American Physicians. 108: 3 (MAY 1996):230-238.
12) T Saarto, C Blomqvist, M Valimaki, P Makela, S Sarna, I Elomaa. Clodronate improves bone mineral density in postmenopausal breast cancer patients treated with adjuvant antioestrogens. British Journal of Cancer 75: 4 (1997):602-605.
13) L Flicker, JL Hopper, RG Larkins, M Lichtenstein, G Buirski, JD Wark. Nandrolone decanoate and intranasal calcitonin as therapy in established osteoporosis. Osteoporosis International 7: 1 (1997):29-35.
14) D Feskanich, WC Willett, MJ Stampfer, GA Colditz. A prospective study of thiazide use and fractures in women. Osteoporosis International 7: 1 (1997):79-84.