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  6. <strong>Osteoporosis, aging, tissue renewal, and product science</strong>
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  9. The incidence of osteoporosis, like obesity, has been increasing in recent decades. The number of hip
  10. fractures in many countries has doubled in the last 30 or 40 years (Bergstrom, et al., 2009). An exception
  11. to that trend was Australia in the period between 2001 and 2006, where the annual incidence of hip fractures
  12. in women over 60 years old decreased by 28.3%. During those years, the number of prescriptions for "hormone
  13. replacement therapy" decreased by 54.6%, and the number of prescriptions for bisphosphonate increased by
  14. 245%. The publication of the Women's Health Initiative results in 2002 (showing that the Prem-Pro treatment
  15. caused breast cancer, heart attacks, and dementia), led to a great decrease in the use of estrogen
  16. treatments everywhere. After the FDA approved estrogen's use in 1972 for the prevention of osteoporosis the
  17. number of women using it increased greatly, and by 1994, 44% of women in the US had used it. After the WHI
  18. results were published, the number of prescriptions for "HRT" fell by more than half, and following that
  19. decrease in estrogen sales, the incidence of breast cancer decreased by 9% in women between the ages of 50
  20. and 54.With the incidence of hip fractures increasing while the percentage of women using estrogen was
  21. increasing, it seems likely that there is something wrong with the theory that osteoporosis is caused by an
  22. estrogen deficiency. That theory was derived from the theory that menopause was the consequence of ovarian
  23. failure, resulting from the failure to ovulate and produce estrogen when the supply of eggs was depleted.
  24. The theory was never more than an ideological preference, but the estrogen industry saw it as an opportunity
  25. to create a huge market.There are many studies that seem to imply that the greater incidence of osteoporotic
  26. fractures among women is the result of their exposure to estrogen during their reproductive years. This
  27. would be analogous to the understanding that it is the cumulative exposure to estrogen that ages the nerves
  28. in the hypothalamus that control the cyclic release of the gonadotropic hormones, causing the
  29. menopause.<strong>. . . the nature of science itself changed around the middle of the last century, becoming
  30. product and disease oriented, so that now relatively few people are continuing to study bones
  31. objectively.</strong>Animal studies show that estrogen stunts growth, including bone growth. The high
  32. estrogen levels in girls' teen years and early twenties accounts for the fact that women's bones are lighter
  33. than men's. In rat studies, treatment with estrogen was found to enlarge the space between the jawbone and
  34. the teeth, which is a factor in periodontal disease (Elzay, 1964). Teeth are very similar to bones, so it's
  35. interesting that treating male or female rats with estrogen increases their incidence of tooth decay, and
  36. removing their gonads was found to decrease the incidence (Muhler and Shafer, 1952). Supplementing them with
  37. thyroid hormone decreased the incidence of cavities in both males and females (Bixler, et al., 1957).One of
  38. the "estrogen receptors" appears to actively contribute to bone loss (Windahl, et al., 1999, 2001). Studies
  39. in dogs following the removal of their ovaries found that there was an increase of bone remodeling and bone
  40. formation rate in the first month, followed by a few months of slowed bone formation, but that by 10 months
  41. after the surgery the bones had returned to their normal remodeling rate, and that "at no time was a
  42. significant reduction in bone volume detected" (Boyce, et al., 1990). With the removal of the ovaries, the
  43. production of progesterone as well as estrogen is affected, but the adrenal glands and other tissues can
  44. produce those hormones.Until the influence of the estrogen industry overwhelmed it, ordinary science was
  45. studying bone development in comprehensive ways, understanding its biological roles and the influences of
  46. the environment on it. But the nature of science itself changed around the middle of the last century,
  47. becoming product and disease oriented, so that now relatively few people are continuing to study bones
  48. objectively.The outstanding physical-chemical property of bone is that it is a reservoir-buffer of carbon
  49. dioxide, able to bind huge amounts of the gas into its structure.When carbon dioxide increases in the
  50. bloodstream it is at first absorbed rapidly by the bones, and if the blood level of CO2 is kept high day
  51. after day, the rate of absorption gradually slows down, but in experiments that have continued for several
  52. weeks the bones were still slowly absorbing more carbon dioxide; the absorption curve seems to be
  53. asymptotic. When people move to or from high altitudes, their bones appear to continue adapting to the
  54. different gas pressures for years. A reduction of atmospheric pressure (which allows the tissues to retain
  55. more carbon dioxide) helps to reduce the calcium loss caused by immobility (Litovka and Berezovs'ka, 2003;
  56. Berezovs'kyi, et al., 2000), and promotes the healing of damaged bone (Bouletreau, et al., 2002). Ultrasound
  57. treatment, which accelerates bone healing, stimulates processes similar to reduced oxygen supply (Tang, et
  58. al., 2007). The mineral in newly formed bone is calcium carbonate, and this is gradually changed to include
  59. a large amount of calcium phosphate. Besides forming part of the mineral, carbon dioxide is also
  60. incorporated into a protein (in a process requiring vitamin K), in a process that causes this protein,
  61. osteocalcin, to bind calcium. The osteocalcin protein is firmly bonded to a collagen molecule. Collagen
  62. forms about 30% of the mass of bone; several percent of the bone consists of other organic molecules,
  63. including osteocalcin, and the rest of the mass of the bone consists of mineral.Thyroid hormone is essential
  64. for forming carbon dioxide. In the early 1940s, experimental rabbits were fed their standard diet, with the
  65. addition of 1% desiccated thyroid gland, which would be equivalent to about 150 grains of Armour thyroid for
  66. a person. They became extremely hypermetabolic, and couldn't eat enough to meet their nutritional needs for
  67. growth and tissue maintenance. When they died, all of their tissues weighed much less than those of animals
  68. that hadn't received the toxic dose of thyroid, except for their bones, which were larger than normal.
  69. Experiments with the thin skull bones of mice have shown that the active thyroid hormone, T3, increases the
  70. formation of bone. To increase cellular respiration and carbon dioxide production, T3 increases the activity
  71. of the enzyme cytochrome oxidase, which uses copper as a co-factor. Increased thyroid activity increases the
  72. absorption of copper from foods.There is an inherited condition in humans, called osteopetrosis or marble
  73. bone disease, caused by lack of a carbonic anhydrase enzyme, which causes them to retain a very high level
  74. of carbon dioxide in their tissues. Using a chemical that inhibits carbonic anhydrase, such as the diuretic
  75. acetazolamide, a similar condition can be produced in animals. Acetazolamide inhibits the bone resorbing
  76. actions of parathyroid hormone, including lactic acid formation and the release of the lysosomal enzyme,
  77. beta-glucuronidase (Hall and Kenny, 1987). While lactic acidosis causes bone loss, acidosis caused by
  78. increased carbonic acid doesn't; low bicarbonate in the body fluids seems to remove carbonate from the bone
  79. (Bushinsky, et al., 1993), and also mineral phosphates (Bushinsky, et al., 2003). The parathyroid hormone,
  80. which removes calcium from bone, causes lactic acid to be formed by bone cells (Nijweide, et al., 1981;
  81. Lafeber, et al., 1986). Lactic acid produced by intense exercise causes calcium loss from bone (Ashizawa, et
  82. al., 1997), and sodium bicarbonate increases calcium retention by bone. Vitamin K2 (Yamaguchi, et al., 2003)
  83. blocks the removal of calcium from bone caused by parathyroid hormone and prostaglandin E2, by completely
  84. blocking their stimulation of lactic acid production by bone tissues. Aspirin, which, like vitamin K,
  85. supports cell respiration and inhibits lactic acid formation, also favors bone calcification. Vitamin K2
  86. stimulates the formation of two important bone proteins, osteocalcin and osteonectin (Bunyaratavej, et al.,
  87. 2009), and reduces the activity of estrogen by oxidizing estradiol (Otsuka, et al, 2005).The formation of
  88. eggshell, which is mostly calcium carbonate, is analogous to the early stage of bone formation. In hot
  89. weather, when chickens pant and lower their carbon dioxide, they form thin shells. A sodium bicarbonate
  90. supplement improves the quality of the eggshell (Balnave and Muheereza, 1997; Makled and Charles, 1987).
  91. Chickens that habitually lay eggs with thinner shells have lower blood bicarbonate than those that lay thick
  92. shelled eggs (Wideman and Buss, 1985). One of the arguments for stopping the sale of DDT in the US was that
  93. it was threatening to cause extinction of various species of bird because it caused them to lay eggs with
  94. very weak shells. Several other synthetic estrogenic substances, ethynylestradiol, lindane, PCBs, cause
  95. eggshell thinning, partly by altering carbonic anhydrase activity (Holm, et al, 2006). Estrogen and
  96. serotonin activate carbonic anhydrase in some tissues, progesterone tends to inhibit it. DDE, a metabolite
  97. of DDT, reduces medullary bone formation in birds (Oestricher, et al., 1971) and bone mineral density in men
  98. (Glynn, et al., 2000). Among its estrogenic effects, DDE increases prolactin (Watson, et al., 2007); one
  99. form of DDT inhibits progesterone synthesis and increases estrogen (Wojtowics, et al., 2007)In youth, the
  100. mineralization of the collagen framework is slightly lower than in maturity, and the bones are more
  101. flexible. With aging, the mineralization increases progressively, and the proportion of collagen decreases
  102. slightly, and the bones become increasingly brittle. (Rogers, et al., 1952; Mbuyi-Muamba, et al., 1987).
  103. Collagen is a major part of the extracellular substance everywhere in the body, and its concentration
  104. increases with aging in the non-calcified tissues. There is considerable renewal and modification of
  105. collagen, as new molecules are formed and old molecules broken down, but its average structure changes with
  106. aging, becomes less soluble and more rigid, as the result of chemical cross-links formed between molecules.
  107. These cross-links are involved in regulating the differentiation of bone cells (Turecek, et al., 2008).
  108. Recently (August 2, 2011), Deasey et al., have published evidence showing that cross-linking is required for
  109. bone mineralization (2011).<strong>The outstanding physical-chemical property of bone is that it is a
  110. reservoir-buffer of carbon dioxide, able to bind huge amounts of the gas into its structure.</strong
  111. >Around 1950, Fritz Verzar began studying the changes of collagen that occur with aging, and his work led to
  112. the "collagen theory of aging." He showed that older, stiffer, less elastic tendons have a higher "melting"
  113. or contracting temperature than young tendons. (This effect is responsible for the curling of a piece of
  114. meat when it is frying.) Verzar and his colleagues investigated the effects of hormonal treatments on the
  115. aging of rat collagen, especially in their tail tendons. They found that estrogen treatment increased the
  116. stiffness and the melting temperature of collagenous tissues. While estrogen increased the cross-linking
  117. with aging, removing the pituitary gland was found to retard the aging. Later, the cross-linking enzymes
  118. transglutaminase and lysyl oxidase, which are induced by estrogen, were found to be a major factor in the
  119. cross-linking of collagen and other molecules.When estrogen was found to age the connective tissues, it was
  120. assumed that continual breeding during an animal's life-time, greatly increasing the total exposure of the
  121. tissues to estrogen, would increase the aged rigidity of the connective tissues, but these animals were
  122. found to have less rigid tissues. During pregnancy other hormones, especially progesterone, were also
  123. increased, and it was suggested that this reversed the effects of aging and estrogen. Since most people had
  124. believed that frequent pregnancies would cause a woman to age more rapidly, a large survey of records was
  125. done, to compare the longevity of women with the number of pregnancies. It was found, in the very extensive
  126. Hungarian records, that life-span was increased in proportion to the number of pregnancies.Despite these
  127. very interesting results in the 1950s and 1960s, the growing influence of the estrogen industry changed the
  128. direction of aging research, favoring the belief that decreasing estrogen accelerated the deterioration of
  129. tissues in aging, and the popularity of Denham Harman's "free radical theory of aging" led many people to
  130. assume that random reactions produced by lipid peroxidation were responsible for most of the cross-linking,
  131. and that theory was gradually replaced by the "glycation" theory of aging, in which sugar molecules break
  132. down and form the cross-links, by random, non-enzymic processes. Estrogen's role in aging was completely
  133. by-passed.The meat industry is interested in reducing the toughness of meat, by influencing the nature of
  134. the collagen in muscle. Castrated animals were found to produce meat that was tenderer than that of intact
  135. males. When castrated animals were treated with testosterone, the amount of collagen was increased, making
  136. the meat tougher. But when dihydrotestoserone, which can't be converted to estrogen was used, the meat
  137. didn't become tough. Treatment with estrogen produced the same increase of collagen as treatment with
  138. testosterone, showing that testosterone's effect was mainly the result of its conversion to estrogen
  139. (Miller, et al., 1990).In the 1960s and '70s the estrogen industry was looking for ways to build on the
  140. knowledge that in puberty estrogen is responsible for accelerating the calcification of the growth plate at
  141. the ends of the long bones, and to find a rationale for selling estrogen to all women concerned with the
  142. problems of aging. As bone metabolism was investigated, two kinds of cell were found to be active in
  143. constantly remodeling the bone structure: Osteoclasts (breaking it down), and osteoblasts (building new
  144. bone). Estrogen was found to slow the actions of the osteoclasts, so the idea that it would delay
  145. osteoporosis became the basis for a huge new marketing campaign. Slowing bone metabolism became the focus.
  146. Although estrogen was known to increase prolactin, and prolactin was known to accelerate bone loss, nearly
  147. all publications began to focus on substances in the blood or urine that corresponded to the rate of bone
  148. turnover, with the implication that increasing bone turnover would correspond to a net loss of bone.This was
  149. the context in which, during the 1980s, articles about thyroxine's role in causing osteoporosis began to
  150. appear. The thyroid hormone supports bone renewal, and increases indicators of bone breakdown in the blood
  151. and urine. If estrogen's use was to be justified by slowing bone turnover, then the effects of thyroid,
  152. accelerating bone turnover, should be interpreted as evidence of bone destruction.A basic problem with many
  153. of the publications on thyroid and bone loss was that they were talking about an unphysiological medical
  154. practice (prescribing the pre-hormone, thyroxine), which frequently failed to improve thyroid function, and
  155. could even make it worse, by lowering the amount of T3 in the tissues.Later, it was noticed that high TSH
  156. was associated with the signs of lower bone turnover. TSH rises when there is less thyroid hormone, but
  157. (after the recombinant TSH became available for medical use) a few publications argued that it was the TSH
  158. itself, rather than the absence of thyroid hormone, that was "protecting" the bones (lowering the evidence
  159. of bone turnover). The doctrine that had been developed to support estrogen therapy was now used to oppose
  160. thyroid therapy. Keeping the TSH high would slow bone turnover. Working in this cultural context, genetic
  161. engineers at Amgen identified a protein that inhibited the formation of osteoclast cells, and slowed bone
  162. metabolism. It was suggested that it was responsible for estrogen's suppression of the osteoclasts, and many
  163. publications appeared showing that it was increased by estrogen. It was named "osteoprotegerin," meaning
  164. "the bone protecting protein." Prolactin increases osteoprotegerin (OPG), reducing bone resorption just as
  165. estrogen does. Serotonin also increases OPG, and it turns out that OPG is elevated in all of the
  166. pathological conditions associated with high serotonin, including cancer, pulmonary artery hypertension,
  167. vascular calcification, and even bone loss.While Arthur Everitt, Verzar, and others were studying the
  168. effects of the rat's pituitary (and other glands) on collagen, W. D. Denckla investigated the effects of
  169. reproductive hormones and pituitary removal in a wide variety of animals, including fish and mollusks. He
  170. had noticed that reproduction in various species (e.g., salmon) was quickly followed by rapid aging and
  171. death. Removing the pituitary gland (or its equivalent) and providing thyroid hormone, he found that animals
  172. lacking the pituitary lived much longer than intact animals, and maintained a high metabolic rate. Making
  173. extracts of pituitary glands, he found a fraction (closely related to prolactin and growth hormone) that
  174. suppressed tissue oxygen consumption, and accelerated the degenerative changes of aging.Aging, estrogen,
  175. cortisol, and a variety of stresses, including radiation and lipid peroxidation, chemically alter collagen,
  176. producing cross-links that increase its rigidity, and affect the way it binds minerals. The cross-linking
  177. enzymes induced by estrogen are involved in the normal maturation of bone collagen, and at puberty when
  178. estrogen increases, bone growth is slowed, as the cross-linking and mineralization are accelerated. With
  179. aging and the accumulation of heavy metals and polyunsaturated fats, random oxidative processes increase the
  180. cross-linking. In bones, the relatively large masses of cartilage absorb oxygen and nutrients slowly, so
  181. internally the amount of oxygen is very limited, about 1/5 as much as at the surface, and this low oxygen
  182. tension is an important factor in regulating growth, differentiation, cross-linking, and calcification,
  183. maintaining bone integrity. But in blood vessels the connective tissues are abundantly supplied with oxygen
  184. and nutrients; this is normally a factor regulating the production of collagen and its cross-linking, and
  185. preventing calcification. When the factors promoting collagen synthesis and maturation are increased
  186. systemically, with aging and stress, the excess cross-linking slows the biological renewal process in bones,
  187. but in blood vessels the same processes creating excess cross-linking initiate a calcification process,
  188. involving the various factors that in youth are responsible for normal maturation of bone.Prolactin, like
  189. estrogen, interferes with thyroid function and oxygen consumption (Wade, et al., 1986; Strizhkov, 1991;
  190. Spatling, et al., 1982). Many years ago, repeated lactation was considered to cause osteoporosis and loss of
  191. teeth, and prolactin, which mobilizes calcium from bones for the production of milk, was recognized as an
  192. important factor in bone loss. Drugs that increase prolactin were found to cause osteoporosis. In the 40
  193. years since the drug industry began its intense promotion of estrogen to prevent and treat osteoporosis,
  194. there has been very little attention to the fact that estrogen increases prolactin, which contributes to
  195. osteoporosis, but some people (e.g., Horner, 2009) have noticed that oral contraceptives and menopausal
  196. hormone treatments have damaged the bones of the inner ear, causing otosclerosis and impaired hearing, and
  197. have suggested that prolactin mediates the effect.A few years ago, the "serotonin reuptake inhibitor"
  198. antidepressants, already known to increase prolactin by increasing the effects of serotonin, were found to
  199. be causing osteoporosis after prolonged use. Estrogen increases serotonin, which besides promoting the
  200. secretion of prolactin, also stimulates the production of parathyroid hormone and cortisol, both of which
  201. remove calcium from bone, and contribute to the calcification of blood vessels. The association between
  202. weakened bones and hardened arteries is now widely recognized, but researchers are being careful to avoid
  203. investigating any mechanisms that could affect sales of important drug products, especially estrogen and
  204. antidepressants.Following the recognition that the SSRI drugs were causing osteoporosis, it was discovered
  205. that the serotonin produced in the intestine causes bone loss, and that inhibiting intestinal serotonin
  206. synthesis would stop bone loss and produce a bone building anabolic effect (Inose, et al., 2011). One group
  207. that had been concentrating on the interactions of genes commented that, recognizing the effects of
  208. intestinal serotonin, they had suddenly become aware of "whole organism physiology" (Karsenty and Gershon,
  209. 2011).In previous newsletters I have talked about the ability of intestinal irritation and the associated
  210. increase of serotonin to cause headaches, asthma, coughing, heart and blood vessel disease, muscular
  211. dystrophy, flu-like symptoms, arthritis, inflammation of muscles and nerves, depression, and inflammatory
  212. brain diseases. With the new recognition that serotonin is a basic cause of osteoporosis, intestinal health
  213. becomes a major issue in aging research.The protein that inhibits intestinal formation of serotonin is the
  214. low density lipoprotein receptor-related protein. This seems likely to have something to do with the fact
  215. that "low" HDL is associated with better bones. A low level of LDL is associated with increased vertebral
  216. fractures (Kaji, et al., 2010).Cartilage synthesis and turnover are highest at night. It is inhibited by
  217. metabolic acidosis (increased lactic acid), but not by respiratory acidosis (CO2) (Bushinsky, 1995). Since
  218. most calcium is lost from bone during the night (Eastell, et al., 1992; even in children: DeSanto, et al.,
  219. 1988) in association with the nocturnal rise of the catabolic substances, such as free fatty acids,
  220. cortisol, prolactin, PTH, and adrenalin, things which minimize the nocturnal stress can decrease the bone
  221. turnover. These include calcium (Blumsohn, et al., 1994) and sugar. Catabolic substances and processes
  222. increase with aging, especially at night. Babies grow most during the night when bone turnover is high, and
  223. even a daytime nap accelerates collagen turnover (Lutchman, et al., 1998). Discussions about whether a
  224. certain person's osteoporosis is "menopausal osteoporosis" or "senile osteoporosis" have neglected the
  225. possibility that osteoporosis doesn't begin in either menopause or old age, but that it is the result of
  226. life-long developmental processes that interact with all the factors that are involved in aging. The fact
  227. that the collagen content of old bone is lower than in young bone (as a percentage of bone weight) shows
  228. that the problem in osteoporosis isn't a lack of calcification, it's a deficiency of tissue renewal,
  229. parallel to sarcopenia, the decrease of muscle mass with aging. Systemically decreased tissue renewal would
  230. account for the association of bone loss with other processes such as male baldness (Morton, et al., 2007)
  231. and Alzheimer's disease (Zhou, et al., 2011, Duthie, et al., 2011).A high level of respiratory energy
  232. production that characterizes young life is needed for tissue renewal. The accumulation of factors that
  233. impair mitochondrial respiration leads to increasing production of stress factors, that are needed for
  234. survival when the organism isn't able to simply produce energetic new tissue as needed. Continually
  235. resorting to these substances progressively reshapes the organism, but the investment in short-term
  236. survival, without eliminating the problematic factors, tends to exacerbate the basic energy problem. This
  237. seems to be the reason that Denckla's animals, deprived of their pituitary glands, but provided with thyroid
  238. hormone, lived so long: they weren't able to mobilize the multiple defenses that reduce the mitochondria's
  239. respiratory energy production. Several things that the geneticists would never be able to fit into their
  240. schemes of "bone regulatory molecules" such as OPG, growth hormone, parathyroid hormone, and estrogen, fit
  241. neatly with the idea that bone health is maintained by respiratory energy and tissue renewal, under the
  242. influence of thyroid hormone. For example, adrenaline, which is increased by stress, aging, and
  243. hypothyroidism (and in many cases by estrogen), causes bone loss. Even the bone loss caused by immobility
  244. can be blocked by an adrenaline blocker such as propranolol. (The stress of immobility also famously
  245. increases serotonin.) Adrenaline tends to decrease carbon dioxide and increase lactic acid, and it strongly
  246. increases parathyroid hormone (Ljunhgall S, et al., 1984). Calcium activates mitochondrial respiration, and
  247. lowers adrenaline (Luft, et al., 1988), parathyroid hormone (Ohgitani, et al., 1997), and prolactin (Kruse
  248. and Kracht, 1981). Copper, which is the co-factor for the cytochrome C oxidase enzyme, activated by thyroid,
  249. is essential for bone formation and maintenance, and is consistently deficient in osteoporosis. Thyroid
  250. hormone increases the body's ability to assimilate copper. Aspirin, which stimulates bone formation, has
  251. other thyroid-like actions, including activation of mitochondrial respiration and energy production, with an
  252. increase of cytochrome C oxidase (Cai, et al., 1996), and it lowers serotonin (Shen, et al., 2011). It also
  253. apparently protects against calcification of the soft tissues, (Vasudev, et al., 2000), though there has
  254. been surprisingly little investigation of that. "Aspirin can promote trabecular bone remodeling, improve
  255. three-dimensional structure of trabecular bone and increase bone density of cancellous in osteoporotic rats
  256. by stimulating bone formation. It may become a new drug for the treatment of osteoporosis" (Chen, et al.,
  257. 2011).A wide range of inflammatory mediators that accelerate inflammation and bone loss also inhibit thyroid
  258. function. People who ate more polyunsaturated fat, which inhibits thyroid and oxidative metabolism, were
  259. several times more likely to have osteoporotic fractures (that is, essentially spontaneous fractures) than
  260. people who ate the least (Martinez-Ramirez, et al., 2007). Arachidonic acid stimulates prolactin secretion,
  261. and prolactin acts on the thyroid gland to decrease its activity, and on other tissues to increase their
  262. glycolysis (with lactate production), while decreasing oxidative metabolism (Spatling, et al., 1982;
  263. Strizhkov, 1991). Living at high altitude, which strengthens bones, increases thyroid activity and decreases
  264. prolactin (Richalet, et al., 2010) and parathyroid hormone (Khan, et al., 1996). It lowers free fatty acids,
  265. which lower bone mass by reducing bone formation and increasing bone resorption (Chen, et al., 2010). In
  266. menopausal women, polyunsaturated fatty acids and even monounsaturated fats are associated with bone loss,
  267. fruit and vegetable consumption protects against bone loss (Macdonald, et al., 2004).While it's very
  268. interesting that the drug propranol which blocks adrenaline, and drugs that block serotonin formation, have
  269. bone protective and restorative effects, they also have undesirable side effects. Food choices that optimize
  270. oxidative metabolism are the safest, as well as the most economical, way to approach the problem of
  271. osteoporosis and other degenerative changes. A person can easily perceive changes in appetite, quality of
  272. sleep, changes in skin, hair, and mood, etc., but blood tests could be used to confirm that the right
  273. choices were being made. Tests for vitamin D, parathyroid hormone, free fatty acids, and CO2/bicarbonate, as
  274. well as the hormones, can be helpful, if a person isn't sure whether their diet, sunlight exposure, and
  275. thyroid supplementation is adequate. The popular medical understanding of the organism is based on a
  276. mechanistic view of causality, in which genes have a central role, causing things to develop and function in
  277. certain ways, and that hormones and drugs can cause genes to increase or decrease their activity. Genes that
  278. build bones can be activated by one substance, and genes that tear down bones can be inhibited by another
  279. substance. The "osteoprotegerin" story illustrates the problem with that kind of thinking. Vernadsky's
  280. description of an organism as a "whirlwind of atoms" is probably a better way to think of how "causality"
  281. works. The moving air in a whirlwind forms a self-intensifying system, with the motion reducing the
  282. pressure, causing more air to be drawn into the system. The atoms moving in coordination aren't acting as
  283. separate things, but as parts in a larger thing. The way in which increased metabolism in the bones acts
  284. favorably on the metabolism of kidneys, blood vessels, lungs, liver, digestive system, etc., which in turn
  285. favors the bones' renewal, is analogous to the tendency of a whirlwind to intensify as long as there is a
  286. source of energy. <strong>The intensity of oxidative metabolism is the basic factor that permits continuing
  287. coordination of activity, and the harmonious renewal of all the components of the organism.</strong>
  288. <strong><h3>REFERENCES</h3></strong>Ann Nutr Aliment. 1975;29(4):305-12. <strong>[Effects of administering
  289. diets with starch or sucrose basis on certain parameters of calcium metabolism in the young, growing
  290. rat].</strong> Artus M. (Sucrose maintains calcium homeostasis in vitamin D deficient bones.)J Appl
  291. Physiol. 1997 Oct;83(4):1159-63. <strong>A bout of resistance exercise increases urinary calcium
  292. independently of osteoclastic activation in men.</strong> Ashizawa N, Fujimura R, Tokuyama K, Suzuki
  293. M.Poult Sci. 1997 Apr;76(4):588-93. <strong>Improving eggshell quality at high temperatures with dietary
  294. sodium bicarbonate.</strong> Balnave D, Muheereza SK.Fiziol Zh. 2000;46(1):10-6. <strong>[The effect of
  295. measured hypoxia on the development of situational osteopenia].</strong> Berezovs'kyi VIa, Litovka IH,
  296. Chaka OH.Plast Reconstr Surg 109(7):2384-97, 2002. <strong>Hypoxia and VEGF up-regulate BMP-2 mRNA and
  297. protein expression in microvascular endothelial cells: implications for fracture healing.</strong
  298. >Bouletreau PJ, Warren SM, Spector JA, Peled ZM, Gerrets RP, Greenwald JA, Longaker MT.J Med Assoc Thai.
  299. 2009 Sep; 92 Suppl5:S1-3. <strong>The role of vitamin K2 on osteoblastic functions by using stem cell model.
  300. </strong>Bunyaratavej N, Sila-Asna M, Bunyaratavej A.J Med Assoc Thai. 2009 Sep;92 Suppl5:S4-6. <strong
  301. >Highly recommended dose of MK4 for osteoporosis.</strong> Bunyaratavej N, Kittimanon N, Jitivirai T,
  302. Tongthongthip B. The recommended dose of Menatretenone is 45 mg three times a day; however the compliant in
  303. daily practice is not convenient. This study shows the twice dose per day is inferior to the recommended
  304. dose. This study used the level of Gla protein in osteocalcin as a parameter for the comparison. The mean of
  305. three-time dose a day is 11.27 nanogram per milliliter while the mean of the other group is 6.07 nanogram
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