 Our speaker now is Dr. Paul Ralston, and he's going to speak on osteoporosis, a bone to pick with conventional medicine. Hi, everyone. It sound good? Everyone hear me? Okay. I have 20 minutes to do about a three-hour talk, so I probably got to run right up to the end, so if you want to ask questions, just come grab me when we're done. What I'm going to do is go over just briefly some facts about bone. Then we're going to go over just briefly some physiology of bone building and bone destruction. Then we're going to go over statistics on osteoporosis and then risk factors and diagnosis. Then we're going to go over some medical management and then some alternative management of it. Okay, so I found this humorous. The biggest point I want to get, if everyone leaves today and they don't get anything else, please understand this. Oftentimes we think of bone as this, and in fact, bone is very much alive. A lot of times people think of bone as more of a coat hanger, and our coat that goes over it, that's kind of our body, but the bone, the hanger itself isn't necessarily alive. Bone is a very metabolic tissue. It's a very active tissue, and it's very much alive. We have 206 bones in the human body, and over half of those are just actually in your hands and your feet. The outer surface of bone is called cortical bone, and the inner, like the struts in the matrix, sort of like a bridge, the zig-zags on a bridge, that is your trabecular bone. Collagen provides your framework, and then calcium and phosphorus will combine with about 4600 other known nutrients to give bone, make it hard, yet actually bone can actually be flexible. So five functions of bone, aids in support and movement. It adds protection for the body, so for instance vital structures, hearts, lungs, brain are all protected by bone. It's your mineral bank. It produces blood. All your blood is made in your bone, bone marrow, and storage of energy later in life. So as you age, red marrow can turn to yellow marrow and become an important source of fat and energy. Okay, so process, in bone there's a constant process of life and death. Bone is constantly being built and destroyed. Osteoblasts are cells responsible for forming new bone, and the cells called osteoclasts break down and remove old broken down bone. All this process of balance between osteoblasts and osteoclasts are governed by hormones like parathyroid hormone, vitamin D, estrogen, calcitonin, testosterone, etc. So around age 30. So most of us, I think most literature will agree that most of our bone mineral banks have been built up by the age of 30, I think 90% by the age of 20. After that, the tip, basically the scale starts tipping towards osteoclasts and we start overdrafting our bone account. So we start writing basically bad checks with our bone. So a big thing to do is to maximize your bone account very early in life and this will ensure that you have strong bones lifelong. So we're going to go over some stats on osteoporosis and actually this condition, we really focus a lot on, especially in the ancestral health community, about stroke, cancer, heart disease, things like that. Most people don't really, I don't think they really give osteoporosis the credit for how actually unfortunate how bad of a disease it is. 54 million Americans have osteoporosis or low bone mass and 2 million fractures will occur each year, fragility fractures from osteoporosis. And far more people will have osteoporosis or a fragility fracture, I'm sorry, than will have a heart attack, cancer or stroke. Now 50% of women after the age of 50 will have a fragility fracture. So one of every two women, one of every four men, we oftentimes think this is more of a woman's disease, but it's not necessarily true. One in four men will actually suffer this fractures after age 50. Jamie Scott said yesterday about hip fractures, a lot of people think, oh, okay, I fractured a bone several weeks, it's going to heal up, what have you. Actually, hip fractures are quite deadly. The 30-day mortality rate on a hip fracture is 9%. So one in 10 people are dead inside of 30 days from a hip fracture. If you add a side order of another health problem like congestive heart failure or pneumonia, this rate goes up exponentially. So again, hip fractures are quite serious and they're quite expensive. Just treating fractures alone, 19 billion a year, just to treat fractures from osteoporosis. So briefly, I like to, sometimes people get the wrong impression. When you fracture a hip, you're fracturing the leg, the femur bone. So a lot of times people, you know, grandmother fell and they broke their hip on the ice or whatever. Although you can break the pelvis very much so, so when most people are discussing a hip fracture, it's actually a fracture right in the femoral neck and then right below the neck and then right below, this is the trochanter, right below the trochanter, those are the areas in which we refer to hip fractures. As a chiropractor, I see a lot of images of spines and some of them are not so good. This is a vertebrae, it's probably a lumbar spine vertebrae and this is normal, this is osteoporotic. So as I told you, the zigzags and kind of like the struts of the bone, the trabecular bone, this is the stuff that kind of gets worn out with osteoporosis and gets destroyed and now it's required to support this weight. So if you can imagine five bones in the lower back, you have 12 in your mid-back and seven in your neck, if you started getting a couple of these compression fractures in there, you can lose quite a bit of height. A lot of times the patient will come in and say, well, I used to be 5'7 when I was 23, now I'm 5'4.5 or 5'5.5 and a half and they've in fact lost quite a bit of height from bone disease. So major risk factors for osteoporosis, the big ones are going to be your age, gender of course, women are affected more, how big you are. So Asian women, smaller petite bones, when you're petite and small, you're not going into later in life with a lot of bone mineral density because you just don't have a large structure to support, so that puts you at an increased risk. Other risk factors, smoking and drinking habits, history of fracture, certain medications such as glucocorticoids like prednisone, steroid use, and ameprazole and some proton pump inhibitors long-term have been shown to destroy bone. Oh yeah, history of eating disorders, so bulimia and anorexia can also be a source, a risk factor. Bone mineral density can be assessed with a DEXA scan, dual X-ray absorbitometry and a DEXA scan is typically done on the wrist, it's done on the neck of the femur, and it's done on the spine. It does have limitations, so certain populations have no reference values, so children have no reference values, so that's certainly a limitation in that. Another thing is bone mineral density doesn't always indicate resistance to fracture. So in other words, you can have good bone mineral density, it doesn't always mean that the bone itself is actually going to be more resistant to fracture. So that's a little bit of a confounder. The hip, I feel, is probably the most important or the most reliable area. When you start doing actually DEXA scans on patients older than 50, like on the spine, the abdominal aorta lays across the spine and so it will commonly calcify after the age of 50 and that's going to skew the reading of a DEXA scan. So femoral neck is definitely your most, I think, important area. So other tests like blood calcium, parathyroid hormone, 24-hour urine calcium, and then you can go into things like bone scans, things like this. These are all going to help diagnose or determine if it's a secondary osteoporosis, so something like metastatic bone cancer will cause osteoporosis or some bone loss, glucocorticoid treatment. So we want to make sure the source of the osteoporosis, kind of like anemia. Anemia can be just iron deficiency anemia, however it can be nothing to do with your iron and be caused by a pathological process underlying that so it's important to determine that. Okay, so to calculate your individual risk, you guys can go to this website. It's a new thing that's called FRAX, developed by the WHO, the World Health Organization. And what FRAX does is it weighs your clinical risk factors of osteoporosis and then it weighs that with your femoral neck bone mineral density and then it gives you like a 10-year probability of fracture. And it's a pretty complicated algorithm, but yet you can access it at this side here. And this... Okay, so that's done. Done with that one. Typical medical management, bisphosphonates are the main medical management of osteoporosis at this time. There's anabolic agents, I think one called pteroparotide as a parathyroid hormone. I think it's the only drug shown to be actually FDA approved for building bone, but the bisphosphonates basically what they do is they keep you from... They don't affect bone production or bone, the osteoblast activity. They basically will keep bone from being broken down at a higher rate. So side effects of these include heartburn, bone, muscle and joint pain, gastric ulcers, and a recent thing that's been reported is sub-trochanteric fractures. So that is, again, the side of your leg where you feel kind of the bone on the hip, that's your trochanter, the greater trochanter. For some reason they have been reporting patients that come in and they have like a dull bone ache there. It can actually be bilateral. It's really interesting. It's very important is if you are in primary care and you're dealing with patients, if they are coming in with an elderly person with unexplained deep, dull pain in that area, definitely something to look into and to consider is in fact, are they on bisphosphonates and have they been on them for a while? Because you don't want, if that is a fracture in there, you want to definitely keep it from getting worse. Okay, so I'm going to go into calcium because we're running out of time. So calcium, osteoporosis has been, I think, mismanaged a lot. We tend to thought of it as a kind of a calcium deficiency disease. In fact, just piling an extra calcium really hasn't done anything to fix the problem and in fact, much research has been shown to make it worse and to cause other problems in the body. It's sort of the same way. Just because calcium is the largest amount in your bone, that doesn't mean just taking more is going to cause bone growth any more than if a person who is working out just starts taking a ton of protein. It actually doesn't work out and it takes a ton of protein. They're not just going to form muscle out of that. Like dumping a pile of 2x4s in drywall and saying go frame a room out. Well, if you don't have the workers to put that stuff where it's supposed to be and how it's supposed to be, it doesn't really make a lot of sense. What I'll tell you about calcium briefly, it's basically just passing through just like all of other minerals. It's broken down over millions of years into dust. It mixes with the soil, the plants take it up, the animals eat the plants to take it up. We eat the animals and the plants. Basically, we're all just kind of borrowing calcium for a while. 99% of it is making up your teeth and bones. The other 1% is busy with muscle contraction, nerve conduction, intracellular signaling, et cetera. Best sources, I think everyone kind of knows, dairy products, vegetables can meet like sardines and salmon are actually an excellent source of calcium because of the bones in there. An amazing amount of calcium products have been sold over the past few decades. I've been through it all. The coral calcium came and went. Calcium citrate, calcium lactate, calcium malate. The best form still is just plain old unsexy calcium carb. It's the most elemental and it's very cheap. However, I always recommend make sure you're taking and getting the proper amounts of the other supporting nutrients like D3, K2, magnesium, et cetera. Before you start adding calcium in, I really hesitate to give a lot of people calcium just because of the fact that if those other nutrients aren't in place, calcium starts ending up in the soft tissues and endothelial tissue like your arteries and bad places. Calcium in tendons and soft tissue and it can be a very bad thing. Magnesium is another mineral. It's essential for the structure of all animals involved in about 300 enzyme reactions in the body. Now, what we're showing is that diets that provide the recommended levels of magnesium enhance bone health but more research is definitely needed to determine the optimal amounts of magnesium for prevention of osteoporosis. We don't really know the right amount for it and it's hard to test because magnesium is in the bone and it's also inside the cell. Sometimes it's hard to get a good read on how much magnesium you have. Teenage girls, especially athletes, almost all of them are deficient. If they're not taking magnesium, they're probably deficient. It's very hard in this population. They definitely can benefit from magnesium supplementation or they're definitely increasing it in their diet. Preferred supplemental form is citrate, magnesium citrate. It's a very high bioavailability. Some other amino acid chelate forms are effective as well. I tend to just avoid the magnesium oxide. It just has a lower bioavailability. It's not going to hurt you or anything. Kidneys are quite adept at excreting excessive magnesium in the absence of disease, of course. Vitamin K was discovered in the 20s by Henrik Dam. Vitamin K, I think we all are probably hip on, especially K2, but what I want you to understand is a little bit of the history of it. The reason why many physicians were actually, they were taught that it was the blood clotter, it came out and obviously vitamin K1 is essential for the 13 proteins involved in blood clotting. However, when it was discovered, the work was published in a German journal and it was called Coagulation Spelled with a K. So a lot of physicians just determined, oh, K, that's the blood clotter, we don't want our blood clotting about. So the two forms that were discovered were K1 and K2, but the researchers didn't consider them to have much difference in function. It wasn't until osteocalcin, the protein which is involved in kind of pulling calcium into bone and telling calcium where to go, it was discovered in 75, so it wasn't until much later this protein was discovered that the function of vitamin K2 was appreciated. Okay, I'm really running out of time. Okay, so Kellogg says that this is the good source of vitamin D. It's not, so don't do that. We all know vitamin D, so I'm not even going to actually go over this slide because I think we all know vitamin D is important for bone health. It's not really much of a secret. We get it through sun exposure and it's more effectively absorbed and utilized for prevention of osteoporosis through animal products. Stronium, I'm not going to go over it, I don't have time. And I have to do a little bit of hormones, but I'm not going to go hormonal on you because we don't have the time for it. But women are affected by osteoporosis more because of their estrogen loss, okay? So women can lose up to half their bone mass between perimenopause, menopause, and the 10 years following menopause. And the specific role of estrogen hasn't been perfectly and completely sorted out yet, but we know the answer to two questions, which is does estrogen loss affect bone negatively? Yes, does estrogen replacement enhance bone health? Yes, it does. However, that being said, I definitely within organ hormones such as estrogen testosterone, I definitely recommend a good progressive doctor, a functional medicine doc, get your levels tested, use bioidentical hormones. I just, I had to put a slide on here. I just, really because of time, I don't have time to get into the specifics of it. Okay, so exercise. We know that exercise is huge for bone, okay? So something called space flight osteopenia, and that is the astronauts are losing like 1% of their bone mass per month in space. It's unbelievable how much bone mass you lose. And I put exercise on a kind of a spectrum for patients. And what I mean by that is how much exercise and what exercise you need for your bone health depends on what you're currently doing. So if you're sitting on the couch, eating Doritos and doing nothing, getting into, let's say, for instance, a pool and doing water aerobics, which isn't a lot, but that person, that patient will actually get some benefit from just water aerobics, which is generally considered not to be very helpful for bone because of the zero gravity in water. However, they will get something. If the person is currently doing water aerobics for the basis of their exercise, then get them onto the land and they tell me I'm done. So, sorry. Please come and ask questions if you want to know more. Thank you.