Immune Supression for Osteoporosis?

UPDATE: August 25 - Feedback on bisphosphonate drugs which contain fluoride, crumbling bones right before your eyes.

I am a femur-fracture survivor...bilateral. The right leg broke in March, the left one in July, 2009. I also suffered a compression fracture at L1 in May.

I was given Fosamax 10 years ago as a preventive measure. Now I am worse than I would have been 20 years down the road. I cannot begin to tell you that there are women breaking a leg everyday! And they do not know why. It was through the fact, that the orthopaedic doctor who took my emergency case on the first leg, had just received some information about the bilateral fractures. If you held my x-ray up against several other womens, you could not tell us apart!

I hope you continue to write and correspond about this important subject. My life has been taken away from me in a way that I never dreamed would happen.

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These two articles arrived this morning in the same newsletter. I thought it interesting because I had just posted on saturated fat and mentioned how it is necessary to help make Vitamin D work.

Then there's the article about Vitamin D that arrived earlier in the day. There must be a message here.

Of course this is madness to me because there is no consideration of what natural approaches might be more effective and less expensive that a drug that the FDA now is worried about it suppressing immunity.

There's weight bearing exercise, even if you have to so it sitting. And there's Vitamin K, another fat soluble vitamin. Nettle can help too because it is a very potent cytokine reducer (what the TNF drugs do) without suppressing your immune system.

This drug is very much like the Rheumatoid Arthritis drugs, RA is often connected to wheat, gluten and gliaden allergy. Perhaps a RAST test might be a better place to start.

FDA Questions Denosumab Safety in Advisory Meeting Documents
FDA staff has expressed concerns that denosumab, the investigational biologic drug for osteoporosis, may increase risk of serious infections through its activity against an important immune system modulator. The agency believes the drug --... full story http://www.medpagetoday.com/ProductAlert/Prescriptions/tb/15486

Denosumab a Winner in Phase III Osteoporosis Trials
An investigational biologic drug for osteoporosis increased bone density and reduced fractures in men and women in two placebo-controlled trials. Three years of treatment with denosumab reduced radiographic spine fractures more than two-thirds in the... full story http://www.medpagetoday.com/Endocrinology/Osteoporosis/tb/15474

Related to the issue of osteoporosis and immune suppression is this information about fluoride based antibiotics. These drugs also increase risk of tendon rupture, interfere with proper thyroid function, as well as encourage brittle and weaker bones.

Wide Use of Fluoroquinolones Raises Fear of TB Resistance
The widespread use of fluoroquinolone antibiotics may be creating strains of tuberculosis resistant to the drugs, researchers said. Patients with more than 10 days of fluoroquinolone exposure before a TB diagnosis were seven times more likely to have... full story http://www.medpagetoday.com/InfectiousDisease/Tuberculosis/tb/15477

There's also something here that might explain why mainstream medicine might not be offering you the best care.

Read a review here

Even More Evidence Links Glitazones to Broken Bones

Along with the FDA warnings on asthma drugs we now get more data that glitazones are a hazard to bone health.

Perhaps this is another issue to be raised in the insurance debacle, cut payments to Big Pharma for dangerous drugs allowed on the market before real effects of the drugs are fully discovered.

See also: http://naturalhealthnews.blogspot.com/2008/12/avandia-increases-bone-risk-for-women.html
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15 June
ADA 2009: More Evidence Links Glitazones to Broken Bones
Shelley Wood

June 12, 2009 (New Orleans, Louisiana) - The largest study to date looking at whether the risk of bone fractures is increased in the setting of thiazolidinedione drugs (TZDs) suggests that fracture risk is more than 40% higher in people taking TZDs and that both men and women are vulnerable [1].

The analysis, presented by Dr Merri Pendergrass (Harvard University, Boston, MA) and colleagues during the American Diabetes Association (ADA) 2009 Scientific Sessions, looked at almost 70 000 patients taking either rosiglitazone (Avandia, GlaxoSmithKline) or pioglitazone (Actos, Takeda) and, unlike other studies, found no difference in fracture risk between the two TZDs.

"I think these agents should be avoided in people at high risk for fracture--unless, of course, particular benefits for a particular patient seem high," Pendergrass told heartwire --for example, a patient with high hypoglycemia risk who is not a good candidate for other classes of medications. Of note, Pendergrass continued, diabetes itself increases the risk for fracture. "So a postmenopausal woman with diabetes would have a particularly high risk--especially if she smoked, had a family history of fracture, or other additional fracture risk factors."

Pendergrass and colleagues reviewed the Medco database--more than 13 million people--looking for all patients between the ages of 43 and 63 at study onset with diabetes and a TZD prescription or any diabetic patients within the same age group taking metformin, exenatide (Byetta, Amylin/Lilly), or a sulfonylurea. They then used a linear-regression model to adjust for age, chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, stroke, and prior fracture to compare fracture risks in patients with "glitazone" prescriptions and in patients with no TZD prescription over the study period (January 2006 through June 2008).

They found that fracture rates were higher among all patients taking TZDs, with no difference between those taking pioglitazone vs rosiglitazone. Fracture rate was also higher in both women taking TZDs vs controls and in men taking TZDs vs controls (although the fracture rate was higher in women than men). According to Pendergrass, this is the first study to show an increased fracture rate in men as well as women. Of note, however, an analysis that looked only at recent TZD prescriptions did not find an increased fracture risk in men, suggesting that men may need to be on the drugs for longer than 18 months before developing an increased risk of broken bones.

Both older women and older men (age 50 to 65 at study conclusion) had a significantly increased fracture risk, but in younger subjects (age 43 to 49) only women were at significantly increased risk. Of note, the study could not control for alcohol consumption and smoking, both of which are known risk factors for fractures. Older adults (age 65 and older) could not be included in the analysis, due to a lack of data, the authors note.

Odds Ratios for Fracture Risk Group Odds ratio 95% CI
All patients 1.43 1.35–1.50
All women 1.55 1.44–1.65
All men 1.26 1.16–1.38
New TZD Rx, women* 1.40 1.19–1.64
New TZD Rx, men* 1.09 0.88–1.35
Rosiglitazone vs pioglitazone 1.03 0.96–1.11
*<18 mo

Pendergrass has previously disclosed research grant support from Novo-Nordisk.

References
Aubert RE, Herrera V, Tully L, et al. Thiazolidinedione treatment increases the risk of fracture. American Diabetes Association 2009 Scientific Sessions; June 7, 2009; New Orleans, LA. 601-P. Authors and Disclosures
Shelley Wood is a journalist for theheart.org, part of the WebMD Professional Network. She has been with theheart.org since 2000, and specializes in interventional cardiology. She studied literature at McGill University and the University of Cape Town and received her graduate degree in journalism from the University of British Columbia, specializing in health reporting. She can be reached at SMWood@webmd.net.
Heartwire © 2009 Medscape, LLC