Posts Tagged ‘estrogen therapy’

Don’t Swallow That Spider

Saturday, July 18th, 2009

Last week, we discussed the causes of osteoporosis, or low bone density, and mentioned how you can usually prevent it by eating whole natural foods, exercising, and avoiding drugs of any kind whenever possible. This week, we can focus on a special kind of bone in your jaws an around your teeth, called alveolar bone, and how bisphosphonates, a class of drugs used to treat osteoporosis, affects you.

In review, remember that bone is a living tissue which contains, among other things, osteoblasts, which are cells that deposit calcium from the blood into the bone structure, and osteoclasts, which are cells that remove the damaged structure and waste products and return them to the blood. In this way, the bone can be a vital tissue in your body that can stay healthy and respond to your environment. Constant exposure to things that increase blood acidity, such as drugs, sodas, and processed foods will induce excess osteoclastic activity in order to neutralize the blood. Over many years this results in a net deficit in bone density because more calcium is being removed than being restored by the osteoblasts. Unfortunately, life is never that simple. The process by which the osteoclasts and osteoblasts work is orchestrated by your endocrine (hormone) system in a way scientists don’t understand. Any condition or drug which affects your endocrine system will usually inhibit the osteoblastic activity, so that after the osteoclasts remove the unwanted tissue, little or no new bone is deposited in its place, resulting in a more rapid decrease in bone density and osteoporosis.

The most common condition that leads to hormone imbalance of course is menopause in women and impotency in men. After menopause, a decrease in blood estrogen is observed. In an attempt to restore the hormone balance and avert post-menopausal osteoporosis, doctors routinely prescribed artificial estrogen. Now, in spite of the fact that some research suggests it actually contributes to osteoporosis and estrogen therapy is proven to cause breast cancer, they stubbornly insist on continuing this practice.
The most common classification of drugs that affect the endocrine system is glucocorticoids, such as prednisone, prednisolone dexamethasone, and cortisone. These are usually used to control rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosis. These drugs have a devastating effect on your entire body because the endocrine system is so powerful yet fragile. But glucocorticoids affect bone density in several ways, so osteoporosis will follow swiftly and certainly. Because of that, physicians that prescribe these drugs routinely also prescribe bisphosphonates in hopes to counteract that inevitability.

That brings us to the focus of this article…finally. Different brands of bisphosphonate preparations constitute the hands down drug of choice for “treating” osteoporosis. The names you are most familiar with are Fosamax, Actonel, Boniva, Aredia, and Zometa. A drug called Forteo is occasionally used, but don’t go there. It is a synthetic parathyroid hormone which has among its nightmarish list of effects that it actually causes bone cancer.

Bisphosphonates work by suppressing osteoclastic activity, so that the damaged bone and debris remains there, as new bone continues to be deposited. The result is that the bone becomes denser and less likely to fracture, for now. I’m reminded of Sally Field’s line in a Boniva commercial saying that it “makes your bones stronger and healthier.” Well, that’s a lie. Bisphosphonates also suppress the production of blood vessels, so that no nutrition is received, the cells all die, and the bone becomes dead – petrified. That doesn’t sound too healthy. If it stopped there, it wouldn’t be so bad, but eventually a process called necrosis occurs. The bone putrefies and turns to mush. I can just see all the lawyers licking their lips.

I know this because in the dental field we are seeing the tip of the iceberg. There’s even a name for it, Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ). This is becoming more prevalent each year and it is surfacing because this special kind if bone I’ve been talking about, alveolar bone, is a much more active bone because of the constant changes associated with the development, growth, infection, and loss of teeth. Because it is so active, the problems caused from bisphosphonate use are showing up earlier than in other bones, and it’s not pretty. Horrendous infections that are virtually untreatable because of the lack of circulation are destroying jaws. Drastic surgeries and drugs are used to counteract the effects of other drugs. It is like swallowing the cat to catch the bird that ate the spider. Just don’t swallow that first pill.

But before you jump out a window, let me tell you that it’s just a fraction of one percent of bisphosphonate users that are showing these signs in the jaws, although that fraction is increasing each year. And, admittedly, much suffering has been averted by the decrease in bone fractures from the use of bisphosphonates. The medical profession is playing a numbers game, betting that more people will benefit than suffer from these drugs. The drug industry is trying to sell more of them, and you’re caught in the middle. Just be sure you know the odds, and before you take bisphosphonates, make sure you correct and maintain your dental health. Also, remember what my mother told me as I went off to college, “Drugs are not the answer.” There are many alternative, natural methods of correcting and preventing osteoporosis that are just as effective, so take control of your own health and research and study these things so you can make the choice that is best for you.

Dr. Moulton’s article was published in the Desert Valley Times, December 2007

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