Bone Loss in Menopause -The Latest Info on Bone Health
Unless you break a bone, you may not be paying attention to your bone health. Bone loss is a silent process. The transition to menopause is the time when bone loss accelerates due to the loss of estrogen. The American Society of Bone and Mineral Research (ASBMR) annual meeting brings together thousands of researchers and clinicians from around the world to present the latest research. I chatted with Diane L. Schneider, MD, Author of The Complete Book of Bone Health and Cofounder, 4BoneHealth.org to find out the latest info.
Here are her “Top Five” takeaways:
1.Under Treatment of Patients at High Risk for Hip Fractures: One of the major focuses of the meeting was the crisis we have in osteoporosis. Despite effective treatments to prevent fractures, too few receive therapy. Fewer than 20% of patients discharged from the hospital after a hip fracture are receiving treatment for osteoporosis. Yet the risk of another fracture is high. The risk of dying with the next fracture is even higher.
This would be like sending someone home after a heart attack with absolutely no treatment and telling them, ‘Good luck. I hope you don’t have another one and die from it.’ The goal is to close the treatment gap by 2020. Education of clinicians and patients will play a major role.
2. New Treatment Options Coming Soon: Fracture Study in Postmenopausal Women with Osteoporosis (FRAME) results detailed the safety and effectiveness of romosozumab. Romosozumab developed by Amgen has the dual effect of promoting bone formation and slowing bone breakdown. The medicine reduced the number of new spine fractures as well hip and other nonspine fractures after 12 months of therapy. Report of the findings was simultaneously published online September 18, 2016, in the New England Journal of Medicine with an accompanying editorial.
Trial results investigating the parathyroid-hormone–related protein analog abaloparatide (Radius Health) was reported on August 16, 2016 edition of JAMA. Ongoing evidence of effectiveness and safety in high-risk postmenopausal women with osteoporosis was presented. In addition, the development process for a patch delivery system was reviewed.
These two medicines for the treatment of osteoporosis are under review by the FDA. If approved next year, they will be expanding the agents available that stimulate bone formation. At the present time, we only have one drug Forteo (Lilly) that targets bone formation. These would expand the choices for treatment of osteoporosis.
Merck announced two weeks prior to the meeting discontinuation of the investigational odanacatib because of increased risk for stroke. The independent safety review of 5-year data from the Long-Term Odanacatib Fracture Trial (LOFT) was presented that led the company to its decision. The risk of stroke by the end of five years was 37% higher in those women taking the study medicine.
3. Gut Microbiome (bacteria in your intestine) and Bone: Research over the past five years has exploded in the area of gut microbiome as a potentially important regulator of health and contributor to a variety of diseases. In 2012, researchers found gut microbiota regulates bone mass in mice experiments. Who knew? The old saying “you are what you eat” rings true.
Since that time studies have looked for nutritional factors that would decrease bone loss. Modification of microbiota in mice with probiotic supplementation showed a beneficial effect on general bone health under non-diseased conditions and reduced bone loss in estrogen-deficit mice. The connection between the gut and the skeleton offers the potential for novel treatment strategies. Stay tuned this is an exciting new area of research!
Side Note: Want to know your gut microbiome? You can through a crowdfunded research study at the University of California San Diego. Anyone can contribute to and participate in the American Gut Project FundRazr. You can enroll for a $99 fee or other options are available that include family members. You get a kit, use it to swab your gut (stool, that is) and mail it in. The American Gut Project team extracts the microbial DNA from the sample and uses a genetic sequencing technique to map which types of bacteria are there and how many there are of each type.
Why would anyone want to mail their poop to the American Gut Project? Not only do American Gut participants get information about what’s living in their own bodies, they can see how they compare to other participants with similar (or different) ages, diets, and exercise habits. What’s more, participants are also contributing valuable information (stripped of their personal info) to an open access database. Since the microbial data is paired with lifestyle information such as diet and exercise, researchers can use these data to study things like how exercise influences the microbiome and how that microbial makeup is associated with health problems. For more information, go to americangut.org.
4. One Yogurt a Day Boosts Bone Density: Because of a possible protective effect of fermented dairy products on postmenopausal bone loss, Swiss researchers examined yogurt consumption in Geneva Retirees Cohort made up of healthy men and women who were recruited at the age of 65. Women who eat at least one serving of yogurt a day had better bone density and were thinner than those who did not eat yogurt. These findings were independent of any other factors that could account for differences in bone density, such as physical activity, protein, and total calcium intake.
The researchers hypothesize that bacteria contained in yogurt populate the large intestine, where it improves calcium absorption and decreases inflammation. This refers back to #3 and the gut microbiome as a real world example.
5. Obesity and Frailty: Obesity is a well-known villain linked to all sorts of health risks including breaking bones. But being obese may be problematic for frailty. A large Canadian study suggests that older obese men and women increase their chance of becoming frail compared with normal weight individuals. Researchers examined the relationship between baseline BMI and frailty change over 10-years in 7753 adults aged 50 years and older participating in the Canadian Multicenter Osteoporosis Study (CaMOS).
Frailty appears to have a ‘U’ shaped correlation between body mass index (BMI) and frailty, suggesting that both under- and overweight individuals were more likely to be frail. Yet another reason to maintain a healthy weight. (Finally, I understand why my body will not allow me to be underweight!)
Bottom line, Dr. Schneider says, “Talk with your doctor about treatment options if you are at high risk for fracture, particularly if you have already had one fracture. The good news is more treatment options are on the immediate horizon. Your gut impacts your health, including your bones. Think about adding a yogurt or other fermented dairy products, like kefir, to your daily diet. Maintain a healthy weight to lessen the risk of getting frail with age.”
Speak with your menopause specialist about the effects of estrogen loss on your bones. To measure this you will need to get a bone density scan – often called DEXA. It is simple, quick and noninvasive. It’s also the most accurate method for diagnosing osteoporosis.
I am off to the grocery store to buy some yogurt. If eating yogurt every day will give me better bone density and make me thinner – count me IN!
My motto: Suffering in silence is OUT! Reaching out is IN!