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