INTRODUCTION

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist.  Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia, by definition, is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.

 

Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.

 

Men as well as women are affected by osteoporosis, a disease that can be prevented and treated but it is most likely to occur in women after menopause, because of the sudden decrease in estrogen, the hormone that normally protects against osteoporosis. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass. But white and Asian women especially older women who are past menopause are at highest risk.

 

SYMPTOMS

Osteoporosis can be present without any symptoms for decades because osteoporosis doesn’t cause symptoms until bone breaks (fractures). Moreover, some osteoporotic fractures may escape detection for years when they do not cause symptoms. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. The symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the fracture. The symptoms of osteoporosis in men are similar to the symptoms of osteoporosis in women.

 

Fractures of the spine (vertebra) can cause severe “band-like” pain that radiates from the back to the sides of the body. Over the years, repeated spinal fractures can lead to chronic lower back pain as well as loss of height and/or curving of the spine due to collapse of the vertebrae. The collapse gives individuals a hunched-back appearance of the upper back, often called a “dowager hump” because it commonly is seen in elderly women.

 

A fracture that occurs during the course of normal activity is called a minimal trauma, or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.

 

Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial slip-and-fall accidents. Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone

 

However, once the bones have been weakened by osteoporosis, the following signs and symptoms may occur:

 

-Back pain, caused by a fractured or collapsed vertebra

-Loss of height over time

-A stooped posture

-A bone fracture that occurs much more easily than expected

 

FACTORS THAT DETERMINE BONE STRENGTH

Bone mass (bone density) is determined by the amount of bone present in the skeletal structure. Generally, the higher the bone density, the stronger the bones. Bone density is greatly influenced by genetic factors, which in turn are sometimes modified by environmental factors and medications. For example, men have a higher bone density than women, and African Americans have a higher bone density than Caucasian or Asian Americans.

 

Normally, bone density accumulates during childhood and reaches a peak by around age 25. Bone density then is maintained for about 10 years. After age 35, both men and women will normally lose 0.3%-0.5% of their bone density per year as part of the aging process.

 

Estrogen is important in maintaining bone density in women. When estrogen levels drop after menopause, loss of bone density accelerates. During the first five to 10 years after menopause, women can suffer up to 2%-4% loss of bone density per year! This is predominantly attributed to insufficient estrogen and can result in the loss of up to 25%-30% of their bone density during that time period. The accelerated bone loss after menopause is a major cause of osteoporosis in women, referred to as postmenopausal osteoporosis. This is true even in women who seem to otherwise have normal health.

 

CAUSES AND RISK FACTORS

The following are factors that will increase the risk of developing osteoporosis:

-Female gender

-Caucasian or Asian race

-Thin and small body frame

-Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture)

-Personal history of fracture as an adult

-Cigarette smoking

-Excessive alcohol consumption

-Lack of exercise

-Diet low in calcium

-Poor nutrition and poor general health, especially associated with chronic inflammation or bowel disease

-Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from bowel diseases, such as celiac sprue that can be associated with skin diseases, such as dermatitis herpetiformis

-Low estrogen levels in women (which may occur in menopause or with early surgical removal of both ovaries)

-Low testosterone levels in men (hypogonadism)

-Chemotherapy that can cause early menopause due to its toxic effects on the ovaries

-Amenorrhea (loss of the menstrual period) in young women is associated with low estrogen and osteoporosis; amenorrhea can occur in women who undergo extremely vigorous exercise training and in women with very low body fat (for example, women with anorexia nervosa)

-Chronic inflammation, due to chronic inflammatory arthritis or diseases, such as rheumatoid arthritis or liver diseases

-Immobility, such as after a stroke, or from any condition that interferes with walking

-Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave’s disease) or is ingested as thyroid hormone medication

-Hyperparathyroidism is a disease wherein there is excessive parathyroid hormone production by the parathyroid gland, a small gland located near or within the thyroid gland. Normally, parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis.

When vitamin D is lacking, the body cannot absorb adequate amounts of calcium from the diet to prevent osteoporosis. Vitamin D deficiency can result from dietary deficiency, lack of sunlight, or lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis.

-Certain medications can cause osteoporosis. These medicines include long-term use of heparin (a blood thinner), antiseizure medicine such as phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone).

-Inherited disorders of connective tissue, including osteogenesis imperfecta, homocystinuria, osteoporosis-pseudoglioma syndrome and skin diseases, such as Marfan syndrome and Ehlers-Danlos syndrome (These causes of hereditary secondary osteoporosis each are treated differently.)

 

DIAGNOSIS

A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than normal bones. Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, X-rays are not accurate indicators of bone density. Thus, the appearance of the bone on X-ray often is affected by variations in the degree of exposure of the X-ray film.

 

The National Osteoporosis Foundation, the American Medical Association, and other major medical organizations recommend a dual-energy X-ray absorptiometry scan (DXA, formerly known as DEXA) be used for the diagnosis of osteoporosis. DXA typically measures bone density in the hip, the spine, and the forearm. The test takes only five to 15 minutes to perform, exposes patients to very little radiation (less than one-tenth to one-hundredth of the amount used on a standard chest X-ray), and is quite precise.

 

The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race. This score is called the “T score” or T-score, and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass.

 

Osteoporosis is defined as a bone density T score of -2.5 or below.

Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5.

It is important to note that while osteopenia is considered a lesser degree of bone loss than osteoporosis, it nevertheless can be of concern when it is associated with other risk factors (such as smoking, cortisone steroid usage, rheumatoid arthritis, family history of osteoporosis, etc.) that can increase the chances for developing vertebral, hip, and other fractures. In this setting, osteopenia may require medication as part of the treatment program.

 

Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.

 

In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point that they may crumple, which can result in back pain, lost height and a hunched forward posture.

 

COMPLICATIONS

Osteoporotic bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability. Up to 30% of patients suffering a hip fracture will require long-term nursing-home care. Elderly patients can develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after the hip fracture. Osteoporosis has even been linked with an increased risk of death. Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture. In addition, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another such fracture in the near future (next few years). About 20% of postmenopausal women who experience a vertebral fracture will suffer a new vertebral fracture of bone in the following year

 

STANDARD TREATMENT PRACTICE

Treatment recommendations are often based on an estimate of the risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

 

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

 

-Alendronate (Fosamax)

-Risedronate (Actonel, Atelvia)

-Ibandronate (Boniva)

-Zoledronic acid (Reclast)

Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don’t cause stomach upset but can cause fever, headache and muscle aches for up to three days. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.

 

Using bisphosphonate therapy for more than five years has been linked to a very rare problem in which the middle of the thighbone cracks and might even break completely.

 

Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur typically after a tooth extraction in which a section of jawbone fails to heal where the tooth was pulled. There should be a recent dental examination before starting bisphosphonates.

 

Hormone-related therapy

Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.

 

Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.

 

In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

 

Other osteoporosis medications

If the more common treatments for osteoporosis cannot be tolerated or if they don’t work well enough,doctors might suggest trying:

 

Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.

Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It’s given by daily injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.

 

NEW HOPE/ALTERNATIVE TREATMENT PRACTICE

Reduction in skeletal mass appears to be associated with increased osteoclastic and decreased osteoblastic activity. Oxidative stress has an inhibitory effect on osteoblasts. ROS, such as superoxide and hydrogen peroxide,have been implicated as regulatory factors in the control of osteoclastic bone resorption. Generated superoxide from osteoclasts directly contributes to bone degradation. The presence of superoxide at the osteoclast bone interface proposes a direct effect of superoxide in osteoclastic bone resorption. In addition, inhibition of osteoclastic superoxide availability causes a reduction in bone resorption

 

Oxidative stress also damages fibronectin, one of the major components of the extracellular matrix of bone. This glycoprotein acts as a substratum of the osteoblast and is involved in various cellular activities such as adhesion, proliferation,migration, cell shape and differentiation. Since the metabolic turnover of fibronectin is generally much slower than that of other cellular components, it will be affected by various

nonenzymatic modifications, including the formation of oxygen-free radicals during the aging process. ROS causes partial degradation and modification of fibronectin molecules. These damaged fibronectin molecules lose their function in bone nodule formation

 

Estrogen is an important hormone influencing. Estrogen deficiency, after menopause leads to bone loss through increased osteoclastic function and subsequently demonstrates the major pathologic determinant responsible for postmenopausal bone loss, as a result of osteoclast stimulation by ROS

 

IMMUNOCAL is a natural protein isolate with bonded cysteine the precursor of the very powerful antioxidant glutathione which helps to repair,sustain and optimize cellular functions. Here’s a list of some of the constituents, molecules and enzymes of IMMUNOCAL that it modulates their production in the cells:

– Cysteine,

– Immunoglobulin,

– Lactoferrin,

– Sialic Acid,

– Gluathione precursors,

– Alpha-lactalbumin,

– Glycomacropeptide,

– Lactoperoxidase,

– Lysozyme

– and Beta-lactoglobulin

just to mention the key components.

A combination of these bioactive constituents of Immunocal (Cysteine delivery, Glutathione precusor, Lactoferrin synthase, Immunoglobulin, Sialic Acid and others) that are modulated intracellularly considerably helps in preventing various chemical process that contributes to the development of osteoporosis. One of such critical chemical process is called Reactive Oxygen Specie Production.

 

IMMUNOCAL would be helpful to balance the hormones estrogen and progesterone and ensure that the estrogen levels are not too low especially during menopause and within the range that helps to maintain bone density thus reducing the occurrence of osteoporosis to the barest minimum

 

IMMUNOCAL as a combined therapy in the management of osteoporosis can also help to reduce the adverse side effects of conventional treatment and help such medications work better by ensuring that the cells are receptive to such medications for optimum results

 

RECOMMENDED DOSAGE:

There’s no limitation to daily dosage or duration of using IMMUNOCAL. However, we recommend minimum of 1-2 sachets daily and the patient can keep using until desired result is achieved and even beyond to maintain health. Though, the more the patient can afford to use daily, the faster and better it works. Some people observe improvement within days while others take longer. It all depends on how their body respond.