Men`s Osteoporosis Support Group
Volume II, Issue 2	April 1, 1998

April Fools Day Greetings

What`s new?

I would like to see all members get a computer, modem and Internet access. To encourage you to do this, I plan on publishing the newsletter only on the Web site by the end of this year. This means that members need to either buy a computer or find friends, family, or a public library or other source of access to the Internet. If you are incapable of getting Internet access, I will continue to mail your newsletter. Please call or write if that is the case for you.

If you would like help with deciding which computer to purchase, I will be glad to assist you. I can give you a written summary of computers available in your price range and will recommend trustworthy manufacturers to order from. Additionally, I will assist in getting you started any way I can. There are a couple of things that are important to successful computing. It really helps if you can type now or are willing to learn how. It is also helpful if you are adventuresome and willing to explore and learn new things. If you are afraid of the computer and unwilling to play with it, you will probably have a hard time. You learn to compute by doing it, not by reading about it, or watching someone else compute. As I explain elsewhere in this newsletter, owning a computer has become a potential life-saving need for you and your loved ones. Everyone should have one and be proficient at using it.

I received notification from Michele Johnson and John Francis about the RUN FOR VITALITY: "Feel It in Your Bones." This will be May 21, 1998, at 6:00 P.M. at West Goshen Park, West Chester, PA. All proceeds will be donated to the National Osteoporosis Foundation. Michele said she already had $4,000 raised in corporate sponsorships by February 7, 1998. She is hoping to get a total of $10,000. For more information, call Michele at 610-918-2820 or send e-mail to JFran86287@aol.com.

Ask the Experts

Dr. Felicia Cosman has volunteered to answer additional questions from the members. This quarter our questions concern diet, nutrition, and nutritional supplements, and their effect upon osteoporosis. NOTE: Dr. Cosman is an endocrinologist and osteoporosis expert at Helen Hayes Hospital in West Haverstraw, NY. She is also the Clinical Director of the National Osteoporosis Foundation in Washington, D.C. and Associate Professor of Clinical Medicine at Columbia University, New York, NY.

Q. The vegetarian magazines and brochures often suggest that excess milk consumption may actually be a negative bone mineral density factor. The theory being that the excess animal (acidic) protein actually causes calcium loss from bones notwithstanding the high calcium content of the milk. Is there any controlled research to back up this claim? Additionally, excess dietary protein is often quoted as a potential source of bone calcium loss. How significant a factor is this?

A. There is simply no data that milk consumption is a negative bone mineral bone density factor. The adverse effect of the protein in milk is far more than overshadowed by the calcium content of milk. A greater concern with milk consumption than the protein quantity is the fact this it is filled with fat. Skim milk, however, contains the same quantity of calcium and is an excellent source of calcium in the diet. Please note that the current calcium recommendations are made based on calcium balance information with average American diets which do contain a fair amount of protein. If the calcium recommendations are followed, then protein in general should not be a factor. Furthermore, it is not only animal protein, but also plant protein that may be associated with a slight increase in calcium excretion in the urine.

Q. Excess wheat bran can apparently prevent absorption of calcium from food or nutritional supplements. How much is considered excess and is this considered a major problem or possible contributing factor for osteoporosis?

A. With regard to wheat bran, it is true that phytates contained in wheat bran can decrease calcium absorption to a slight degree. Unless the wheat bran consumption is really dramatic, I do not see this as a clinically relevant finding. Again, if calcium recommendations are followed to obtain between 1,000 and 1,500 mg of elemental calcium per day, I don`t think the quantity of fiber is going to be an important factor.

Q. Concerning the previous dietary risk factors, what is the potential of a combination of them causing osteoporosis? For instance, what is the combined effect of a high-protein diet, excess wheat bran consumption, and low calcium intake?

A. Clearly the low calcium intake is the major factor. All of the other factors combined can be overshadowed by an adequate calcium intake.

Q. All the literature describes excess alcohol as a contributing factor to osteoporosis. I have read several research abstracts that relate moderate alcohol intake to improved BMD. What are the facts on alcohol and osteoporosis based upon results of research studies?

A. There is no doubt that excess alcohol is a major contributing factor to osteoporosis. The problem is that we don`t know exactly what dose is detrimental. The effects of alcohol on the skeleton are similar to the effect of alcohol on other organ systems, i.e., the heart. There, low doses of alcohol may actually decrease the risk of heart disease, whereas, high doses clearly increase the risk of heart disease of various types, including causing cardiomyopathy. In the skeleton, this is also true. Recent literature indicates that low to moderate doses of alcohol may actually benefit the skeleton whereas high doses are detrimental. The alcohol is clearly toxic to the cells that make bone, the osteoblasts. We recommend that patients with osteoporosis do not consume more than two ounces of hard liquor per day or the equivalent of two drinks of wine or beer to avoid excess exposure. Smoking is an even bigger risk factor than alcohol in many patients. Smoking increases fracture risk through its effect on bone mass as well as other independent, poorly understood factors.

Q. The most common nutritional supplements mentioned for osteoporosis treatment are calcium and vitamin D. Other minerals, such as, magnesium, zinc, etc., are also mentioned. What is the importance of these other minerals? How concerned should we be to see that our calcium supplement also contains other minerals?

A. It has taken us a very long time to determine that calcium and Vitamin D are actually good for the skeleton. There are very few data available on other supplements, including magnesium, zinc, boron, Vitamin B12, Vitamin K, and others. Currently, without any good information on these supplements, there is no indication to take them. Furthermore, patients without malabsorption syndrome who are not on chemotherapy and not alcoholics do not need to take magnesium supplements to help absorb their calcium. There is simply no data to indicate that need unless there is a true magnesium deficiency.

Q. How important is it to separate out the dosage of calcium supplements at different times of the day? What is the maximum amount that can be taken at one time and still be absorbed by the body?

A. We know that calcium doses higher than 500 mg per dose will suppress the fractional absorption of calcium at that time. This makes it preferable not to take more than 500 mg as a supplement at a time. Additionally, it is better to take calcium with food. The Nurses Health Study recently reported that calcium supplements taken on a fasted stomach might increase the risk of kidney stones slightly. This risk was not dramatic, but conversely, calcium supplements taken with food or high dietary intakes of calcium might actually reduce the risk of kidney stones.

Book review

One of our members, Jon Liebowitz, e-mailed me with a recommendation to read Infomedicine, A Consumer`s Guide to the Latest Medical Research. At Jon`s suggestion, I ordered it from amazon.com (http://www.amazon.com), and it arrived in three days. I found the book very interesting, informative, and pertinent in today`s information and computer age. The material is not dedicated to osteoporosis, but is certainly applicable to osteoporosis or any other disease you want to find more information about. Infomedicine is published by Little, Brown, and is written by Fred D. Baldwin and Suzanne McInerney. Here is a summary of what you can learn from this book.

From the foreward to the book, Larry M. Weisenthall, M.D. Ph.D., states that, "Medical information of every kind and depth is available to anyone with the desire to use medical libraries, online resources reachable with a home computer, or institutions and patient organizations that provide many kinds of information." He goes on to describe the purpose of the book. "[It is a] `how-to manual,` describing available tools for obtaining information necessary to find the best treatment and for using that information. Real-life stories of extraordinary patients illustrate the principles-and benefits-of becoming medically informed." A couple of these real-life stories follow.

Infomedicine describes several instances of people becoming involved in their own (or their loved one`s care) in an effort to improve the outcome. Why is this necessary? There are more than 380,000 medical papers published yearly, so even medical specialists cannot always keep up with the latest in medical research. The authors say it is in your best interest to help your care provider stay abreast of the latest information and technology, and they provide methods to do this. For example, the coauthor, Suzanne McInerney`s mother was diagnosed with colon cancer metastatic to the liver. Her physician offered them little hope. Suzanne, however, went to the medical library and spent many hours to uncover the name of a physician that had excellent success doing liver surgery on patients with metastatic cancer. After successful liver surgery, Suzanne`s mother lived four healthy years, eventually dying from a cause other than her cancer. Had she accepted the first physician`s bleak outlook, she would have been dead within a year.

In another example, Gayle had visited several physicians over a ten-year period complaining of ringing in the ears, dizziness, nausea, and headaches. None could find her problem until one eventually did an MRI of her head and discovered an acoustic neuroma. This is a benign, but serious (or even fatal) tumor. Surgery can often remove the tumor, but leaves secondary damage that is often worse than the effects of the tumor. Often enough damage is done to leave the patient classified as fully disabled by insurance companies.

Gayle called the Acoustic Neuroma Association for information. She was told that surgery was the only option other than the gamma knife. This is a high intensity radiation beam directed into the tumor often causing it to shrivel and die. Even though her physician recommended against the "nonstandard" gamma knife, Gayle had found sufficient medical research to cause her to decide to have gamma knife surgery done. It took three years for total recovery, but it was indeed total. Gayle says in summary of her experience. "If a doctor becomes insulted [by questions] you`d better look for another doctor."

The bottom line from these and other examples is that no one is more vitally concerned about your health that you. So, the authors suggest you use their book to find out what search tools are available to help you locate the best care available for your condition. Here are some of the tools they mention: Medical dictionaries, popular medical guides, Merck Manual of Medical Diagnosis and Therapy, textbooks of medicine, Physicians` Desk Reference, public and medical libraries, consumer health information resource libraries, and, perhaps most important, your home computer. Here is more information about how using the home computer can help you locate valuable medical information.

Infomedicine was published in 1996. A lot has happened since then to affect online medical searches, a very important topic in the book. Most important, MEDLINE is now available for free. The Internet address (URL) for MEDLINE is: http://www.ncbi.nlm.nih.gov/PubMed/.

Anyone with a home computer, modem, and Internet access thus has ready access to the most important medical information in the world.

Once you reach MEDLINE, just type in a search word such as "osteoporosis" or the words "osteoporosis" and "men," for example. Click on the Search button, and almost instantly you will see articles and abstracts (if available) about the subject. Additionally, there is the ability to search for related articles by clicking those words near the author`s name for each article. This allows you to narrow the search once you find an article specific to the subject you are searching. Additionally, you can search the database by authors` names if you want to see everything he or she has published. It is possible to search for several years` data or limit it to just one or two years if you know approximately when an article was published.

I recommend "cutting and pasting" the abstracts to a word processor document that you can later print. This is faster and easier than printing each abstract from the screen. An other option is to order the entire article online from "Loansome Doc." There is a charge for each article, but this can be quite convenient. You can also go to a medical library once you have the abstract and look up the article to read in its entirety or to photocopy. Here is a practical example of using MEDLINE to help a friend.

I recently received a call from a good friend who had what sounded like a herniated cervical disc (slipped disc in the neck region). I was concerned for her as my thoughts were that this surgery was dangerous and risky with a questionable chance of success. In just a short time on MEDLINE, I was able to find many abstracts that showed excellent results with modern microsurgical techniques for repairing herniated discs. I also found an article describing the best type of MRI to have (there are several types available that I didn`t know about), and an article showing good success with non-surgical therapy. I was able to reassure my friend and myself and to send her copies of the abstracts to provide her with guidance.

I can`t say enough good about MEDLINE. If it was the only reason to own a computer and Internet connection, it would be worth the investment many times over. It is a prime example of why owning a computer with Internet access is no longer a luxury. It is a necessity--one that could save your life or that of a friend or family member.

Infomedicine describes in much greater detail how you can learn to use all the available resources to obtain medical information. This knowledge could help you get the latest and best medical care available and improve your survival chances. Everyone should have a copy of this book.

Member profile

Here is the story of Dick, one of our members, and his battle with osteoporosis. In November 1996 he went to his HMO-assigned physician for an annual physical. He was 53 at the time and in good health, had no particular complaints, and weighed 170 lbs. The physician was a woman, whom he thinks was more tuned into osteoporosis than the previous male doctors he had always seen before. Apparently, because of his posture, height loss, and back aches, she suspected that he had osteoporosis. He was once 5` 10" and was then 5` 7". He can`t recall when he lost the height, but notes that he even takes a shorter pant length by almost 2" now. (The people at work gave him a bad time about the height loss calling him the "Amazing Shrinking Dick." He says he gets no respect!).

The physician sent him for blood tests and then to a specialist after seeing the test results. The specialist arranged for more blood testing and a bone densitometry. The blood tests showed loss of calcium well above normal and the bone scan showed that he had severe osteoporosis. Further tests ruled out everything else as a cause, and he was told he had idiopathic osteoporosis. He was told he was ten times more likely to break a bone than another male his age, which got his attention.

His history was not significant. He ate well, got above average exercise, had no significant past illness, and all broken bones were related to trauma that should have caused fractures. He took no supplements, did not smoke, used alcohol moderately, did not drink much milk, but did eat other calcium-rich food. He also has a sister with osteoporosis, but she smoked, drank, did not exercise, and was postmenopausal.

Dick`s treatment included 10 mg Fosamax, 1,000 mg of calcium (Tums) per day, and he now takes vitamins D, E, and C. He exercises three or four times a week, to increase resistance gradually, and alternates between upper and lower body every other day. Exercises include rowing, walking, jogging, weight resistance machines, especially concentrating on the neck, back, and hip areas.

Recent bone density results show the spine T-score improved from -2.5 to -1.5. The physician told Dick that his spine improved to the point that he would not be considered as having osteoporosis now. The left hip femoral neck has improved from T-score of -2.7 to -2.2, although not as dramatic as the spine, these results are positive. So, this is another case with good results since taking Fosamax. Incidentally, Dick was told by a Merck representative that FDA approval of Fosamax for men could come in 1998 as results on men have been favorable so far.

Calcium supplement article review

In last month`s newsletter I mentioned Bone-Up(TM) as having been suggested to me as a possible good source of supplemental calcium. I called the company and was sent The Little Book on Bone-Up(TM) which is really more of a position paper that describes the product and lists research related to it and some other calcium-containing products. I will try to summarize the information.

The author, Jarrow L. Rogovin, states that "Bone-Up(TM) is the most complete nutritional regimen for healthy bones and joints. It starts with calcium from microcrystalline hydroxyapatite (MCHA) and includes other nutrients. Bone-Up(TM) uses the finest source of calcium available: Australian bovine bone from chemical free, range-grazed, young (less than two years old) cattle." Besides hydroxyapatite, in Bone-Up(TM), "[There are] lesser amounts of magnesium and trace levels of copper, boron, zinc, strontium, iron, manganese and other minerals." The key factor in all this is that "Hydroxyapatite (HA) is the same form of calcium found in bone tissue." The HA in Bone-Up(TM) has not been heated or ashed as other bone meal products have. This, according to the author, gives HA the ability to slow the rate of osteoporosis in some instances and to increase bone mass.

In a 1982 study (Am J Clin Nutr, 1982; 35:426-430), three groups of women with seriously impaired calcium absorption and accelerated bone loss received either vitamin-D, vitamin-D plus calcium gluconate, or vitamin-D plus HA for fourteen months. There was no change in serum levels of calcium or phosphorous during the study. The only group that showed a significant increase in bone thickness of forearm bones was the HA plus vitamin-D group. There were 15 women in this group. Several other studies from the 1980s involving either HA or MCHA are cited to back up the use of Bone-Up(TM). The number of people in the studies was small or moderate, at best, but most studies report positive results with HA or MCHA.

The remainder of the article is a description of bone, osteoporosis, and other calcium supplements or associated products. These segments are interesting and educational.

In summary, there appears to be some evidence to show that Bone-Up(TM) is an acceptable alternative for persons desiring to supplement their dietary calcium intake. The studies involved small populations and never addressed the very important issue of fracture risk. Ideally, it would be helpful to see the results after large prospective studies comparing Bone-Up(TM) to other calcium supplements, and to compare the effects on bone mineral density and fracture risk. Until those studies are available, each person will have to use their own judgment as to whether Bone-Up(TM) is a better product than they are currently using. The booklet does not tell how much the product costs or mention its national availability. For more information contact Jarrow Formulas, Los Angeles, CA 90035-4317, 800-726-0886.

Disclaimer

Diagnosis and treatment of osteoporosis are the responsibility of the patient and his or her physician. Nothing in this newsletter is to be interpreted as a recommendation for treatment or to change treatment that your physician has prescribed. Although we attempt to assure that information in this newsletter is factual, errors will occur. It is the responsibility of the reader to verify that information they are acting on is factual. There is no relationship between this newsletter and any national osteoporosis group, including the National Osteoporosis Foundation. All references to any such groups are for informational purposes only.

Jerome C. Donnelly
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