The Bone Resorption Assay Test for Osteoporosis
Are you breaking down bone faster than you are building it? A simple urine test will tell you.
Bone is living, active tissue. The body is constantly breaking down old bone and rebuilding new bone. The process is called remodeling. When bone is built faster than it is removed, bone mass increases and bones get stronger. When bone is broken down faster than new bone is made, you are losing bone mass. Optimum bone density is a dynamic balance between bone removal and the deposit of new tissue.
Osteoporosis is caused by more bone cells being resorbed than being deposited. This imbalance results in a progressive loss of bone density and a thinning of bone tissue. Osteoporotic bones are more porous and therefore more vulnerable to fracture.
Approximately 20 percent of bone tissue in the body is replaced each year by this process on a cyclical basis throughout the skeleton.
The Bone Resorption Assay detects biochemical markers, called collagen cross links, which reflect the amount of bone turn-over. Collagen is a fibrous protein which provides the bone with strength and flexibility. When the urinary level of collagen cross links is high, this indicates that bone is being removed faster than it is replaced. This indicates osteoporosis in the making.
The Bone Resorption Assay is a simple urine test that lets you know where you stand. We provide you with the test kit, and schedule a review of the results 2-3 weeks later.
OSTEOPOROSIS IS PREVENTABLE
In many people today, the total amount of bone that is grown peaks around age 30. The rate in which bone mass is lost increases during the first five to ten years when women become postmenopausal.
Osteoporosis affects more women than it does men, but men are not immune to it. The National Osteoporosis Foundation says that despite the large number of men affected, osteoporosis in men remains underdiagnosed and underreported.
Knowing what causes osteoporosis can mean all the difference in helping protect yourself from it.
Osteoporosis is not a calcium deficiency
Osteoporosis is due in greater measure to a proportional decrease in a range of minerals. Bones are made of at least 12 minerals, including calcium.
Dr. Robert Thompson's book, The Calcium Lie, draws attention to the misleading focus on just one mineral:
"Most consumers and, surprisingly, most doctors, believe that bones are made of calcium. Yet any basic biochemistry textbook will tell you the truth: Bones are made of at least a dozen minerals and we need all of them in perfect proportions in order to have healthy bones and healthy bodies.
Thompson makes the case for supplementation with trace minerals to make up for what we do not get from food grown in today's mineral depleted soils.
"Expecting to keep bones strong by giving someone calcium supplements is like expecting that you can make a loaf of bread from yeast alone. It simply won't work and, in the case of calcium supplements, it can do great harm as crystallized excess calcium concretions make their way into arteries and joints and force the adrenals to compensate for calcium excess to their own detriment.
"If you get too much calcium, through food sources or by taking supplements, you set yourself up for an array of negative health consequences, including obesity, Type 2 diabetes, Type 2 hypothyroidism, hypertension, depression, problem pregnancies and more."
Amino acids are part of the bone matrix
Amino acids are the building blocks of protein. So eating high quality protein like eggs and grass-fed beef is good. What? You've read that eating meat and a high-protein diet weakens bones?
The protein theory was first presented in 1968 and followed up in 1972 with a study comparing bone density of vegetarians and meat eaters. But the studies were not well done. Dr. Herta Spencer, of the Veterans Administration Hospital in Hines, Illinois, notes that the studies used isolated, fractionated amino acids from milk or eggs. Her follow up studies show that when protein is given as natural meat, subjects do not show any increase in calcium excreted, or any significant change in serum calcium, even over a long period.
The textbooks tell us that the body needs vitamin D for calcium utilization, and vitamin A for both calcium and protein assimilation. Protein powders usually lack these fat-soluble co-factors that the body can use to build and maintain healthy bones. The "acid-ash" of meat is given as the reason high meat diets cause bone loss. But meats also supply phosphorus, which counteracts this acidity. Phosphorus is needed for the phosphate component of bone matter. Meats are also excellent sources of vitamin B12, which plays a little understood role in maintaining the integrity of the bones.
The type of saturated fats found in tropical oils, butter and other animal fats, plays an important role in bone modeling. This may explain why population groups in tropical areas, where coconut and palm oils form a major component of the diet, have very little osteoporosis.
Omega-3 fatty acids
Omega-3 fats prevent excessive bone turnover. Many studies show that adding omega-3 fatty acids to the diet preserves bone density. The phenomenon of losing bone density in older people, or at the beginning of menopause for women, is thought to be related to inflammation. Omega-3 oils have an anti-inflammatory effect.
The standard American diet is too low in omega-3s, and too high in omega-6s. Investigators at Purdue University found that high levels of free radicals from omega-6 linoleic acid (found principally in corn, soy and safflower oils) interfered with bone formation.
Vitamin K is best known for its role in blood clotting. However, vitamin K is also absolutely essential to build strong bones and prevent heart disease. It acts as the biological "glue" that helps plug calcium into the bone matrix.
It also functions as a cofactor in the process that replaces old bone.
Vitamin K is commonly found in fermented foods, like natto (Japanese fermented soybeans), and dark green leafy vegetables like collard greens and spinach.
It is well established that calcium needs 1,25-dihydroxy-vitamin D - for transport. Insufficient vitamin D leads to less calcium absorption, elevated blood concentrations of parathyroid hormone, and increased rates of bone resorption, which may eventually lead to osteoporosis and bone fracture. Several studies found that older people who experience a hip fracture have lower serum concentrations of 25-hydroxyvitamin D than do those without a fracture.
Some 25 percent to 50 percent of the elderly are thought to have vitamin D deficiency, which can lead to loss of muscle strength and an increased likelihood of falling that, in turn, increases the risk of hip fracture. Very often when people "fall and break a hip," the bone in the hip actually gives way first, then the person falls down.
Synthetic vitamin D, however, can cause hypercalcemia, a disturbance of calcium equilibrium leading to excessive blood calcium and calcification of soft tissues. Synthetic vitamin D added to commercial milk does not have the same beneficial effect as vitamin D from sunshine or old fashioned cod liver oil in preventing rickets and strengthening the bones.
Forget the milk moustache
Milk is often thought to decrease osteoporotic bone loss and fracture risk since it is promoted as a primary source of calcium and vitamin D. But the form of vitamin D that is typically added to grocery store milk is not natural. And pasteurization makes insoluble the major part of the calcium found in raw milk.
A 2003 Harvard Medical School study found that neither milk nor calcium supplementation reduces the risk of osteoporotic hip fractures in postmenopausal women. Researchers found no association in other groups of people between calcium intake and fracture risk.
Celiac disease decreases bone density
People with osteoporosis are more likely than the general population to also have celiac disease, an intestinal disorder caused by intolerance to wheat flour – gluten. Celiac disease renders people unable to absorb certain nutrients, including calcium and vitamin D.
A classic 1998 study found that children and adolescents with low bone mineral density due to celiac disease, who follow a gluten free diet, experience a rapid increase of bone mineral density that leads to a complete recovery of bone mineralization. But in adults, however, no spontaneous recovery has been documented.
Fluoride and Iodine
Sodium fluoride added to municipal drinking water is one of a number of substances that is harmful to our bones. It causes an apparent increase in bone mass, but the bone structure is abnormal and weak. As fluoride accumulates in your bones, they become more brittle and prone to fracture. Recent studies indicate that hip fractures are more common in areas where water is fluoridated.
Iodine found in natural sea salt, sea foods and butter helps maintain healthy ovaries and thyroid gland, both of which play a role in maintaining bone integrity.
Sugar, caffeine, soda, alcohol
The renowned dentist Dr. Melvin Page demonstrated that sugar consumption upsets the natural homeostasis of calcium and phosphorus in the blood. Normally, these minerals exist in a precise ratio of ten to four. Sugar consumption causes serum phosphorus to decrease and calcium to rise. The excess serum calcium, which comes from the bones and teeth, cannot be fully utilized because phosphorus levels are too low. It is excreted in the urine or stored in abnormal deposits such as kidney stones and gallstones.
Caffeine also upsets the natural balance of calcium and phosphorus, and causes increased calcium to be excreted in the urine. Phosphoric acid in soft drinks is a major cause of calcium deficiency in children and osteoporosis in adults. Aluminum from antacids, cans, and pollution also contributes to bone loss.
Osteoporosis is often associated with excess consumption of alcohol. This is the likely explanation of bone loss in Eskimos, who are highly prone to alcoholism. In a healthy person, the tearing down and building up of bone is in balance so there is no net loss of bone. However, chronic and heavy drinking can disrupt the balance by suppressing new bone formation. The empty space created by normal bone-removing activity is inadequately filled by newly formed bone. This process continues at other skeletal sites during the next remodeling cycle. The cumulative effect of this process during several remodeling cycles is manifested as measurable bone loss over a period of just a few years.
TAKE A PILL FOR OSTEOPOROSIS?
The Food and Drug Administration (FDA) has approved several antiresorptive medications to treat osteoporosis including alendronate (Fosamax®), risedronate (Actonel®) and zoledronic acid (Reclast®). These medications are in a class of drugs called bisphosphonates.
Bisfosphonate drugs kill the osteoclasts in your bones - these are the cells which destroy bone as part of the natural bone regeneration process. Osteoclasts replace old bone by releasing acids and enzymes to remove minerals and collagen. Once the osteoclasts have done their job, protein-secreting cells called osteoblasts deposit new tissue, thus building bone. When the osteoclasts are destroyed, the osteoblasts do indeed continue to function. So you get thicker bone that is denser, but not necessarily stronger, because they have not undergone the normal remodeling process. Your bones can become denser but more brittle, increasing your long-term risk of developing a fracture.
The constant remodeling of bone requires both osteoblasts and osteclasts to remove old bone and rebuild new bone.
You have choices. You could assess the state of your bones with a standard dual energy X-ray absorptiometry, or DEXA, the most common method to measure bone mass density. The DEXA bone scan involves ionizing radiation at two different frequencies to get an idea of the amount of calcium contained in a bone. The scan can roughly measure bone density, but cannot tell you if you are headed in the right direction – if you are gaining or losing density.
The process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood.
Bone resorption can also be the result of disuse and the lack of stimulus for bone maintenance. Astronauts, for example, undergo a certain amount of bone resorption due to the lack of gravity providing the proper stimulus for bone maintenance.
At the Arizona Center for Advanced Medicine, we assess the state of your bone health with the Bone Resorption Assay, a simple urine test that detects biochemical markers which reflect present remodeling activity.
Type I bone collagen contains unique cross linked protein structures that give greater stability. Active bone resorption requires a breakdown of this protein structure; the peptide fragments from this breakdown are excreted in urine. Since bone resorption is a relatively constant process, the amount of specific peptides found in the urine provides an accurate measure of the rate of bone loss.
The Bone Resorption Assay measures the deoxypyridinoline fragment of Type I collagen breakdown from a single urine specimen. This is the fragment that contains the cross linking point and has been demonstrated to be more specific to bone resorption than breakdown fragments measured in some earlier assays.
We will give you the test kit, and when the results come back, you will know where you stand. If your bone density is declining, we will work with you to reverse that because the good news is: osteoporosis is a preventable condition.