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“Bisphosphonates and the bone crew”
This is Dr Sandy from Spoonful of Science, helping you create better body chemistry.
In today’s video we will look at how bisphosphonates interact with your bone crew.
Your bones are a lot like the walls of your house, they continuously need to be touched up. To keep your bones in tip top shape, there are a team of renovators working on the bone building project.
The first set of guys on the bone crew, concentrate on cleaning things up.
They are officially known as the osteoclasts and their job is to clean all the grime off the bone, in preparation for the other half of the bone renovation team, the osteoblasts, who paint the primed surface with a fresh coat of bone paint.
The osteoblasts spruce up the bone the a fresh coat of a very special bone paint, which is made up of calcium plus a whole bunch of other goodies.
In a normal healthy person, both teams do their job methodically.
The osteoclasts give the bones a good rub down, cleaning off the junk.
The osteoblasts then build the bones back up by applying a fresh coat of paint.
Bone density, which is a measure of just how “thick” the bone is remains stable.
This perfect system can go awry. A bigger trigger for trouble, is when estrogen leaves, around menopause – the members of the painting crew, become a little lazy.
Other things that cause bone crew troubles are gut troubles and certain drugs, especially those that interfere with estrogen and acid suppression drugs.
So more bone is rubbed down than is built. The wear and tear is usually quite gradual…………. but the end result is lower bone density. When bone density is too low, bones are vulnerable to breaks – and the bone barer is diagnosed with osteoporosis.
So more bone is rubbed down than is built. The wear and tear is usually quite gradual…………. but the end result is lower bone density.
When bone density is too low, bones are vulnerable to breaks – and the bone barer is diagnosed with osteoporosis.
The family of drugs, most often prescribed to “fix” the problem are the bisphosphonates.
NOTE : Bisphosphonates are marketed at Actonel, Aredia, Boniva, Didronel, Fosamax, Reclast, Skelid and Zometa.
The way bisphosphonates help, is they “incapacitate” the osteoclasts. The guys who are responsible for scraping away the junk in preparation for the fresh coat of paint.
With the osteoclasts unable to do their job, the osteoblasts i.e. the painters soldier on. Painting over the “dirty” bone.
The initial result, is that bone density improves – because more layers of paint are being put on the bone.
But…. the trouble is, the paint is going onto a dirty surface.
When you paint over a dirty surface, it looks good shortly after the application of the coat of paint, but it doesn’t weather well. In a really short time, the painted object looks shabby and dirty because the fresh coat of paint peels off.
This is what is happening to bones treated with the bisphosphonates.
Initially, the bones are in fabulous shape because they’re a whole lot stronger, but over time, the inherent structural weaknesses, which can cause the bones to snap.
They typically snap in odd places.
So, using a bisphosphonate for a very long time ………… can mean the bone is not longer being protected, instead it is at risk.
So how long is a very long time ? Somewhere between 3 and 5 years.
What should you do ?
It is never a good idea to wake up one morning and STOP taking the medicines you have been prescribed.
But, if you have been taking a bisphosphonate for three or more years, it might be a good idea to have a chat with your doctor to explore your options.
Maybe it is time for a drug holiday. No, this is not a holiday sponsored by the drug company to some exotic destination – it is just taking a break from taking the pill. Doing this, gives the osteoclasts, the cleaners a chance to clean things up and get rid of all the “rough” spots.
Maybe it is time to try something new
Osteoporosis is for keeps – once your bones have begun disappearing, they’re weaker than they should be and you’re going to need to keep an eye on things. A broken bone can KILL and it often does.
That said, taking a bisphosphonate for the rest of your life…………… the risk-benefit profile shifts, the benefit becomes very small and the risk slowly increases.
Want to read the science behind this ……………. here is a good place to start.
Long term bisphosphonate use in osteoporotic patients; a step forward, two steps back. J Pharm Pharm Sci. (2012) 15(2):305-17. Salari P, Abdollahi M.
The article crunches the numbers on bisphosphonates and bone breaks.
Got friends or family taking a bisphosphonate to PROTECT their bones – share this video with them.
Want to know how to create better body chemistry ? Visit www.betterbodychemistry.com to learn more.
Interested in learning more about the chemistry behind stronger bones ?
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