Talk:Osteoporosis

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[edit] What is osteophysis?

Not an accepted medical term, unless you count German. Google has been spammed by a German-language website, so I had great trouble determining whether this is actually a clinical entity. Unless you can provide some support, I have removed the link. At any rate, it redirected to this article! JFW | T@lk 18:05, 3 Nov 2004 (UTC)

[edit] History

This page needs a history section in line with other disease pages. I will try and research something - but others may know a lot more.

Benjaminstewart05 19:03, 2 May 2006 (UTC)

[edit] Strontium ranelate

This section seems to be somewhat biased and pro-strontium, which is a comparatively new treatment option. With regards to efficacy, this treatment has not been shown to be superior to PTH1-34, nor bisphosphonates. Also, no long term data is available for strontium, as compared with a drug such as Fosamax, which has 10 year data.

Also, as far as I'm aware, the mechanistic information on Strontium being pro-osteoblastic and anti-osteoclastic comes from some fairly weak cell culture studies. I'm always hesitant to jump to conclusions about in vivo mechanism based on in vitro data.

Note: I am a medical researcher and not a drug company spokesperson.

Above posted by User:Aarons@chw.edu.au 09:29, 8 May 2006
When faced with perceived bias, please do not just insert a {{POV}} tag and then walk away. This is not constructive. You are obviously in possession of the studies that are relevant here. Could you share these with us? JFW | T@lk 11:40, 8 May 2006 (UTC)


REGARDING MECHANISM:

The in vitro studies I was referring to are:

Canalis E, Hott M, Deloffre P, Tsouderos Y, Marie PJ. The divalent strontium salt S12911 enhances bone cell replication and bone formation in vitro. Bone. 1996;18:517–523.

Takahashi N, Sasaki T, Tsouderos Y, Suda T. S12911-2 inhibits osteoclastic bone resorption in vitro. J Bone Miner Res. 2003;18: 1082–1087.

There is a publication in press (e-pub) that indicates that this may hold true in mice. I must admit that I haven't read this publication critically, as I only just noticed it while searching for the original references.

Marie PJ. Strontium ranelate: a physiological approach for optimizing bone formation and resorption. Bone. 2006 Feb;38(2 Suppl 1):S10-4. Epub 2006 Jan 24.

REGARDING EFFICACY:

This is a useful review discussing the current status of the clinical trials on Strontium. In summary, the SOTI and TROPOS studies showed significant increases in spine and hip fractures, even if these studies have minor criticisms in the following review regarding their study design.

Burlet N, Reginster JY. Strontium ranelate: the first dual acting treatment for postmenopausal osteoporosis. Clin Orthop Relat Res. 2006 Feb;443:55-60.

Compared to meta-analysis of bisphosphonates (of which there is a lot more data), you see that BPs give a similar if not better result (tests for statistical significance have been carried out).

Nguyen ND, Eisman JA, Nguyen TV. Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials. J Bone Miner Res. 2006 Feb;21(2):340-9.

Aaron 22:49, 8 May 2006 (UTC)

So how about choosing the most representative studies for citation in the article. I think the Nguyen cite is a fantastic choice when it comes to providing a WP:CITE for the efficacy of BPs. There is no problem with saying "strontium ranelate has been demostrated to both increase bone deposition and decrease bone turnover, but these results are from laboratory studies only". It would be better still if that statement could be traced to a recent systematic review, to round off the assessment of therapeutic modalities for osteoporosis.
Aaron, with your background it may be possible to massively improve the quality of this article. Do you think you could make such a commitment? I'll be available for help at any stage. JFW | T@lk 11:47, 9 May 2006 (UTC)

I think it was sad and shows ignorance about the latest findings in strontium research that the owner of this page choose to remove my wife's well-researched blog on strontium for osteoporosis. Her blog at http://strontiumforbones.blogspot.com was designed to inform visitors about strontium and to let patients know about the strontium citrate alternative. Her DexaScan result is approaching normal while she almost died taking Fosamax. It's time that physicians and patients get all the information and not your biased views. —Preceding unsigned comment added by Werewolfking (talk • contribs) 21:12, 23 April 2008 (UTC)

[edit] factors

'Social pressure' is a factor which affects bone density. Also, a new technique is being marketed which is an adaptation of diabetes mellitus injection techniques. The mere suggestion that diabetes (social pressure from shunting) has similar causes to osteoporosis (social pressure from inclusion) has put the new injection technique into the hands of those affected. beadtot 6/6/2006 02:19, 7 June 2006 (UTC)

[edit] Risk factors of osteoporosis

Dino Hsu 13:52, 21 June 2006 (UTC) I am not an expert, but a fan of wiki, I wish wiki could provide an objective and balanced point of view, so please check John Robbins' arguments that high protein levels from animal and dairy diets is the major risk factor of osteoporosis, there are extensive discussion on newsgroup since 1996, but I will quote this one:

http://groups.google.com.tw/group/alt.support.thyroid/browse_thread/thread/2c921cd4a42cd818/331e1014de38829d?lnk=st&q=john+osteoporosis&rnum=3&hl=zh-TW#331e1014de38829d

"Osteoporosis is not first a disease of calcium deficiency. It is a disease of excess protein. Animal and dairy products are full of sulfur-rich proteins. Sulfur makes extra acid in the body; as acids wash through the bones, they dissolve calcium, which is then eliminated through the urine. This only happens with animal protein and it has a name: protein-induced hypercalciuria, which means too much calcium going out in the urine. There's no doubt that the findings reported by Drs. Lindsay Oddoye, and Margen in the American Journal of Clinical Nutrition are true: "High protein diets cause a negative calcium balance, even in the presence of more than adequate dietary calcium. Osteoporosis would seem to e an inevitable outcome of continued consumption of a high protein diet" ** Even calcium tablets and daily doses of milk cannot keep up with the calcium lost to excess protein ..."*** Dino Hsu 13:52, 21 June 2006 (UTC)

The evidence to support the idea of a link between high animal protein intake and osteoporosis is very tenuous. In fact, there is just as much epidemiological evidence to support the contrary view. Rather than trade contradictory studies, however, let's just look at whether this is a plausible theory. Osteoporosis results from an inbalance between osteoblast and osteoclast activity. These cells either create (osteoblasts) or break down (osteoclasts) the protein content of bone. They are normally in harmonic balance, allowing regular turnover of bone, without undermining its structure or function. In postmemopausal osteoporosis, osteoclast activity increases, resulting in a net bone loss. Without a protein matrix to cling to, calcium phosphate is lost and the bone strength decreases. Simply replacing calcium does very little, as there is no coherent structure for it to adhere to. Bisphosphonates partially block the osteoclast activity, allowing normal bone structure to be restored, at least in part. In steroid-induced osteoporosis, it is a reduction in osteoblast activity that is to blame, although the end result would be the same. These facts have been clearly demonstrated from bone biopsy studies.

If the problem was simply a reduction in availability of calcium - whether caused by dietary problems or a specific disease process - the result would be an inadequately calcified but otherwise normal protein structure in the bone. This is an entirely different condition called osteomalacia, which has only superficial resemblances to osteoporosis. The animal fat hypothesis is therefore a complete red herring in this context. Jbelsey 15:35, 6 October 2006 (UTC)

Why has no one mentioned the high risk of those who suffer from anorexia nervosa and bulemia nervosa

Dear Jbelsey, According to your explanation, osteoporosis results from an inbalance between osteoblast and osteoclast activities, this is quite comprehensive. However, you seem to imply the availability of calcium is not so relevant to osteoporosis, if at all? This is somewhat contrary to common understandings; even from the current wiki page, we can see 29 occurences of "calcium". Besides, you seem to negate both the pro side and the con side of the debate about whether "milk and dairy product is the main cause of osteoporosis" because calcium level is not relevant in the first place. Please clarify, thanks.

[edit] coeliacs

I have inserted reference to coeliacs in risk factors, as it seems to be such a key determinant, not least because of its prelevance (around one in a hundred) at least in the West, and possibly everywhere. wikwobble

[edit] prevention?

Can someone put up something on prevention of osteoporosis? I would do it myself, but I no virtually nothing on this subject aside from the fact that it isn't good XD. --Gotmesomepants 01:26, 29 July 2006 (UTC)

I agree, this article is lacking a prevention section. I'll add some stuff later when I have time. --Drenched 22:17, 15 March 2007 (UTC)

[edit] BP and ONJ

I agree with Davidruben that ONJ and bisphosphosphonate discussion is best left to the BP page.Dr Aaron 09:49, 1 October 2006 (UTC)

Oral osteoporosis medications (specifically bisphosphonates) now appear to reduce the risk of jaw degredation Havard —Preceding unsigned comment added by Sgwiki92 (talk • contribs) 03:57, 13 January 2008 (UTC)

[edit] Cathepsin K blockers

Should there be a mention of cathepsin K blockers (AAE581, Balicatib - Novartis)? The phase II results appear to be positive, also for subjects not in the "postmenopausal women" category. A few references can be found at the bottom of: [1]

[edit] Sun

It was on the news today that exposure to sunlight boosts vitamin D and may help relieve osteoperosis, should this be included somewhere?

That is not news, see rickets and osteomalacia. JFW | T@lk 06:23, 26 June 2007 (UTC)

[edit] Drugs

PPAR ligands and now SSRIs[2] have been linked with reduced bone density. JFW | T@lk 06:23, 26 June 2007 (UTC)

[edit] high risk of falls or recurrent falls --> osteoporosis?

In the Risks-section of osteoporosis, this claim was included:

  • high risk of falls or recurrent falls

I, perhaps, temporarily moved that claim to here, because I think it needs discussion. Fractures, when they've already occured, actually strengthen the bones, preventing a fracture to occur again. When a bone heals after a fracture, that connection is the strongest part of the bone. I agree that a lifestyle with a lot of bone-breaking can be irritable, but actually it prevents osteoporosis, so if that person would return to a normal lifestyle, fewer fractures would probably occur compared with other people. In short, high risk of falls or recurrent falls increase the risk of fracture, but decrease the risk of osteoporosis. Mikael Häggström 09:50, 3 July 2007 (UTC)

Solved! At another place at risk factors, this is seen:

Estrogen deficiency following menopause is correlated with a rapid reduction in BMD. This, plus the increased risk of falling associated with aging, leads to fractures of the wrist, spine and hip.

Thus, it wasn't refering to osteoporosis, but to the fractures following it.Mikael Häggström 10:17, 3 July 2007 (UTC)

[edit] Hip protectors are rubbish

JAMA JFW | T@lk 23:24, 24 July 2007 (UTC)

[edit] Formatting

There is some pretty non-standard formatting in this article. Some lists can be improved by removing the indented commentary, or turning them into prose. Use of the non-TOC header (prefixed with ";") should be encouraged for content more than 4 levels deep (====Header====), before the article turns into a quagmire. JFW | T@lk 07:17, 23 September 2007 (UTC)

[edit] Hypercortisolism

A new Ann Intern Med study (PMID 17938392) shows that in patients in whom secondary osteoporosis had been excluded by standard criteria, there was a substantial number (10%) in whom there was subtle hypercortisolism on dexamethasone suppression testing. This may warrant inclusion - I suspect some HMOs are going to insist on all patients with osteoporosis being screened for subclinical Cushing's due to its associated diabetes/obesity/hypertension/general mayhem risk. JFW | T@lk 17:15, 16 October 2007 (UTC)

[edit] Relative efficacy of drugs

Meta-analysis shows they're all pretty much the same, or at least superiority cannot be demonstrated. JFW | T@lk 14:09, 18 December 2007 (UTC)

[edit] Bone building

doi:10.1172/JCI33612 - review on anabolic treatments. JFW | T@lk 11:20, 3 February 2008 (UTC)

DOI doesn't work, try Full text at PMC: 2214701 now. JFW | T@lk 20:02, 27 February 2008 (UTC)

[edit] Agenda for MCOTW

This article is now WP:MCOTW. It is already pretty comprehensive in terms of content, sources, and related articles. I think the aim of the collaboration should be to improve it to WP:GA status. I thought the following issues should be addressed:

  • We need more sources for the numerous risk factors for osteoporosis, e.g. the numerous endocrinopathies, dietary/lifestyle issues.
  • We need images, e.g. an X-ray of vertebral fracture, fractured neck of femur, a microphoto of porous bone vs normal bone.
  • We need quality of life studies to emphasise the impact of chronic pain due to vertebral fracture.
  • Which interventions are actually proven to attenuate fracture risk? There are numerous studies showing an increase in BMD, but does this translate to better bone that doesn't break? People want to know.
  • I am sure there are other things.

I hope to do some work on this one. JFW | T@lk 20:07, 27 February 2008 (UTC)

[edit] Images

Well, my list of potential images isn't ideal, but it's a start:

  • The images here can be "freely used for educational purposes," which I think reasonably includes Wikipedia.
  • This link has some interesting images (1996), but STR out of Lawrence Livermore is technically a UC (state university) publication, instead of a US (federal) publication, which means that the copyright is complicated to figure out: May be free, may not be free, may be possible to get permission.
  • Also, it seems like this major report by the US Surgeon General should have useful images, but the couple that I looked at are reprinted-by-permission images. If we particularly like them, then perhaps we could get permission. (Or perhaps others will be found that are actually free.)

Hope this helps, WhatamIdoing (talk) 22:23, 27 February 2008 (UTC)

As a radiographer I may be able to get some images demonstrating Osteoporosis although it is more common to see the results of it on an x-ray (ie. a fracture). Is this suitable? Heather 15:50, 28 February 2008 (UTC)Glitzy_queen00

Yeah, give us #NOF, Colles', vertebral fractures! JFW | T@lk 15:30, 18 March 2008 (UTC)

[edit] T-score

I wonder whether the "T-score -2.5 or below is osteoporosis" qualification shouldn't be changed to "T-score -2.5 or above is osteoporosis". It fits into the logic "higher score=higher risk/probability/certainty of OP occurence" but being not a doctor, I leave the article as is for editing by people more knowledgeable on the subject. KG

No, the T score reflects the bone mineral density, and the lower the score the lower the bone mineral density and the higher the risk of fracture. The actual unit for both the T- and the Z-score is standard deviations, as BMD sits on a Gaussian curve. JFW | T@lk 15:30, 18 March 2008 (UTC)

[edit] LDL-related protein 5

We will need to mention LRP5 polymorphisms now: http://jama.ama-assn.org/cgi/content/abstract/299/11/1277 JFW | T@lk 15:30, 18 March 2008 (UTC)

[edit] Hyperbaric Oxygen Therapy?

Can any one tell me if there is any truth in the idea that Hyperbaric Oxygen Therapy can be beneficial? —Preceding unsigned comment added by 58.172.176.248 (talk) 10:20, 30 March 2008 (UTC)

Try Google. Osteoporosis is a chronic condition; are you suggesting people should live in a hyperbaric environment continuously? JFW | T@lk 16:17, 31 March 2008 (UTC)

[edit] Blaming Merck

John Broughton (talk · contribs) added a paragraph on Merck being to blame for the overdiagnosis and overtreatment of osteoporosis. The source is an opinion article by Sharon Brownlee, who has apparently written a book about this but does not exonerate her from citing sources for the allegation that Merck had a hand in setting the T-score cutoffs and doctors buying DEXA machines. To be sure, the T-score cutoffs were introduced before Fosamax was approved. JFW | T@lk 16:17, 31 March 2008 (UTC)

I have added the paragraph back to the article. As for the source: "Sharon Brownlee writes stories and essays about medicine, health and biotechnology for Atlantic Monthly, New York Times Magazine, New Republic, and Time. A senior fellow now at the New America Foundation ... [3].
Note that I am not citing her opinion about things - I'm simply citing facts that she included in what she wrote. As for Brownlee's failure to cite sources, this does not disqualify what she says - she is an expert, and nothing about WP:RS says that a reliable source must in turn cite its sources.
Jfdwolff said "T-score cutoffs were introduced before Fosamax was approved." I've reworded the article to make it clear that the panel that set the definition of osteoporosis did not act after Fosamax was approved. As many editors may know, the drug approval process is a long one; it is entirely consistent with that long process for a drug maker to be working on things that will improve sales once the drug is finally formally approved.
Also note that I did not in any way use the words "overdiagnosis" or "overtreatment", or discuss "blame" for these matters (if in fact they are the case).
I will certainly be agreeable to modification or removal of this information should anyone provide sourced information that contradicts it. At the moment, however, it fills a missing gap in the article (how and when osteoporosis was formally defined in terms of bone density), it is factual information provided by an expert; and it is published in a reputable newspaper. -- John Broughton (♫♫) 17:54, 31 March 2008 (UTC)

I am suggesting that Browlee's article is an opinion piece rather than a statement of fact. The entire tenor of that article is of malice by "big pharma" (or at least disease mongering, a neologism that describes the situating she writes of). Given that it is an opinion piece that merely alludes to the possibility of an industry-perpetuated scam, I am really not sure whether it constitutes a reliable source.

Thank you for adding the densitometry article. That is very helpful. JFW | T@lk 20:15, 31 March 2008 (UTC)

Densitometry was in routine clinical use well before 1995, see Full text at PMC: 1663786 JFW | T@lk 20:32, 31 March 2008 (UTC)
You have not responded to the issue of whether Brownlee can be considered an expert or not, so I'm assuming that she can be. As such, I quote from WP:V: Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. However, caution should be exercised when using such sources: if the information in question is really worth reporting, someone else is likely to have done so.
I intend to revise the information I posted to include a number of other (clearly news) sources, but there are a few items in Brownlee's piece - facts - that I think are worth including, and which - while they may have been published elsewhere - I'm not inclined to do a long and exhaustive search for.
If there is a policy or guideline within Wikipedia that says that facts mentioned in opinion pieces cannot be used in articles, I would appreciate your pointing that out. -- John Broughton (♫♫) 22:55, 31 March 2008 (UTC)
Also, regarding Densitometry was in routine clinical use well before 1995, I certainly don't disagree - and I hope nothing I put in the article said otherwise. (If I did, I'd appreciate someone pointing it out.) Rather, the point is the volume of testing of bone density rose sharply after osteoporosis was redefined (in 1992) as a condition that could (and should) be measured prior to people falling and breaking a bone. That increased volume would clearly require more machines, and Brownlee is simply saying (as I read her) that Merck help finance those new machines. Or is there evidence that the number of bone density scanning machines did not change substantially between (say) 1992 and 2002? (I'd be astonished if that were so.) -- John Broughton (♫♫) 23:04, 31 March 2008 (UTC)
It's not that Brownlee can't be considered a reliable source in the ordinary sense; it's that extraordinary (or controversial) claims require extraordinary (and uncontroversial) sources. Additionally, I'm sure you will agree that we should normally use the best available source, and that this can't be considered the best possible source. WhatamIdoing (talk) 02:28, 1 April 2008 (UTC)
I don't find the "extraordinary claims" issue to be on point - I put nothing into the article that could be considered a "claim". As for "best sources", I also don't accept that proposal - Wikipedia requires acceptable sources (reliable sources), not "best" sources. If "best sources" were required, we could argue all day about whether better sources existed (somewhere), continuing to reject anything that didn't meet this hypothetical standard.
Having said that, I have in fact found better sources without much difficulty, and hope to have some time to add information to the article in the near future. -- John Broughton (♫♫) 12:54, 4 April 2008 (UTC)
You are essentially saying that there is a grand conspiracy of disease mongering which implicates the WHO, Merck and the health systems of several nations. For such a claim, one needs more than just speculation. JFW | T@lk 05:47, 6 May 2008 (UTC)

[edit] Men

NEJM clinical practice article http://content.nejm.org/cgi/content/short/358/14/1474 JFW | T@lk 14:44, 6 April 2008 (UTC)

doi:10.1056/NEJMoa0801197 - multiple genetic loci found. Three in known regions: RANKL, osteoprotegerin and estrogen receptor 1, and two novel ones in ZBTB40 and MHC. JFW | T@lk 08:16, 30 April 2008 (UTC)

Comparative efficacy of treatments for preventing non-vertebral fracture: http://www.annals.org/cgi/content/abstract/148/9/637 (how many reviews can the Annals publish about this?) JFW | T@lk 05:47, 6 May 2008 (UTC)

[edit] Physical activity and risk

In the risks section of the article. Theres a paragraph explaining the effects of insufficient/excess activity. Both have no citations. From what I've looked at the there is evidence that physical activity is related with higher bone density. But I haven't found anything solid about the excess activity's effect.

If anyone has any sources of info related to this please tell me. Otherwise, i think we might have to cut down on (not eliminate) the paragraph on excess activity's effect. Ziphon (talk) 03:54, 11 May 2008 (UTC)

  • I've found "In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%"

on [4] and [5].How reliable are these sources? Ziphon (talk) 04:27, 11 May 2008 (UTC)

The problem with excessive exercise is that it leads to amenorrhoea and hence markedly reduced oestrogen levels. This, coupled with the low body weight of many athletes, is probably at the basis of this risk. This distinction needs to be clarified in the article. JFW | T@lk 10:00, 11 May 2008 (UTC)

[edit] Diseases associated with osteoperosis

There's a huge list of diseases associated with osteoperosis in the article most of them are uncited. I was wondering how the citation process is going to work. Do we add a intext citation after each disease?

Ziphon (talk) 05:08, 11 May 2008 (UTC)

Actually, I expanded that list based on reference 16 (Simonelli C, ICSI). That reference mentions all those conditions, so they are not uncited. We could add extra references in-line but I wouldn't add {{fact}} tags because that reference lists all of them. I found that reference while reading some review, I think. --Steven Fruitsmaak (Reply) 09:18, 11 May 2008 (UTC)
Thanks mate, for telling me that (saved me heaps of time looking for a source :) ). The next question is do we have to add a reference for each disease? Otherwise we can remove the "this section needs references etc." sign.

Ziphon (talk) 10:06, 11 May 2008 (UTC)