Osteoporosis / Osteomalacia sharron fuchs dc

[Guest guest]

In a message dated 10/18/2004 11:23:25 AM US Mountain Standard Time, sharronf@... writes:

Definition of osteoporosis and osteomalacia from Stedman's Medical Dictionary : see attachment

Sharron, I appreciate your concern and continued assertions but you need to reread your own material. Quoting from your Dorlands sources that you provide :

=========================

osteomalacia

osctT-b-m^-lQcshT-^

A disease characterized by a gradual softening and bending of the bones with varying severity of pain; softening occurs because the bones contain osteoid tissue that has failed to calcify .....

=============

- Again as I mentioned previously in both private emails to you and public ones to the board, osteomalacia is poor calcification of the bone.

Now to qoute your Dorlands source about osteoporosis :

===========================

osteoporosis

osctT-b-pb-rbcsis

Reduction in the quantity of bone or atrophy of skeletal tissue; an age-related disorder characterized by decreased bone mass

========================================

- Dorlands is correct in saying it is the loss of "bone mass", and is correct by not saying it is the loss of calcium. Most of bone mass is collagen not calcium.

Sharron after reading this second round of information you sent me I am even more than 100% certain now that I was correct, Previously I was only 100% correct

osteoporosis is the loss of bone matrix (collagen) and osteomalacia is the loss of calcium - so again calcium supplements is a waste of time for osteoporosis.

Definition from Guytons Textbook of Medical Physiology, 5th edition, page 988, and I qoute :

"Osteomalacia is rickets in adults and is frequently called "adult rickets". Normal adults rarely have dietary lack of vitamin D or calcium because large quantities of calcium are not needed for bone growth as in children. owever , lack of vitamin D and calcium occassionally occur as a result of steatorrhea. Under these conditions an adult occassionally has such poor calcium intake that adult rickets can occur.

Osteoporosis, the most common of all bone diseases in adults and especially uin old age, is a different disease than osteomalacia and rickets, for it results from diminished organic matrix rather than abnormal bone calcification."

You need to re-read the definitions you sent me. But let me cut and paste from definitions you sent me on October 15. Regarding the information on osteoporosis what you sent me on Oct 15 reads :

===================================

Osteoporosis Overview 

Osteoporosis, or porous bone, is a disease characterized by low bone mass .............

What is Bone? Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework,....

==================================

So we see that osteoporosis is the loss of bone mass (not calcium) and that bone is mostly made of collagen. Collagen makes bones flexible and calcium makes them hard. When bones lose calcium they bend (rickets) since collagen/protein is flexible, when they collagen (osteoporosis) all that is left is calcium and they become like a stick of chalk - brittle. As mentioned in the osteoporiosis information you sent me, it says collagen provides a soft network - this allows flexibility, and if you take out the calcium bones bend. Bones don't bend in osteoporosis - the snap in two, they become brittle.

Now when I cut and paste from the information you provided on Oct 15 regarding osteomalacia we read :

=======================================

osteomalacia

insufficient mineralization of osteoid etiology:

dietary deficiency of vitamin D3, lack of solar irradiation

deficiency of metabolism of vitamin D

chronic renal tubular disease

phenobarbitol, diphenylhydantoin

decreased absorption of vitamin D (malabsorption, gastrectomy)

diphosphonates (decrease calcium deposition; rx. for Paget's)

==================================================

If you read it carefully you will see that it is insufficient mineralization - this means primarily calcium. In fact in the last sentence it reads - "decrease calcium".

Sharron, reread the information you sent me closely, and read Guytons. Osteoporosis is the loss of collagen from the bone primarily - the loss of matrix - so again I contend Vitamin C is more important than calcium since vitamin C drives the production of hydroxyproline from which all collagen is made. Collagen in bone is type 1 collagen.

Anglen

[Guest guest]

My mistake - I meant to say I cut and pasted quotes from Stedmans medical dictionary that Sharron sent me, but I mistakenly attributed the quotes to Dorlands dictionary - but nonetheless the point is still the same.

Anglen

[Guest guest]

I am including this letter since I feel it is an important issue for our profession, and health care in general. It was a private email and hopefully Sharron does not mind me posting it publicly - she is intelligent and determined, both of which I admire, but I feel there is a certain myth of osteoporosis that is being perpetuated. -

=======================================

In a message dated 10/18/2004 4:48:49 PM US Mountain Standard Time, Sharronf@... writes:

in osteoporosis it too is multifactorial ie low calcium intake, hypovitaminosis d and decreased estrogen. but to me it appears that the end result is diminished calcium in the bones , which ultimately seems the same end point as in osteomalacia.

so they are similar to me yet they are different.

They are different and they are different. Exactly different, exactly opposite. I am not sure how you can even read into it that they are the same in any way??????

The definition you sent today of osteomalacia reads : "osteomalacia  

osctT-b-m^-lQcshT-^  

A disease characterized by a gradual softening and bending of the bones with varying severity of pain; softening occurs because the bones contain osteoid tissue that has failed to calcify "

your source mentions nothing about matrix in this, and clearly states it is because it does not calcify - period. As well it states, exactly as I did that when calcium is removed the bones soften - making them bend. Never has a bone bent in osteoporosis - they snap because they get brittle - EXACTLY the opposite of osteomalacia. Regarding osteoporosis, the material you sent me says:

Osteoporosis Overview 

Osteoporosis, or porous bone, is a disease characterized by low bone mass .............

What is Bone? Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework,....

It is clear that collagen is soft - again it bends. Bones never bend in osteoporosis - they break. This is why kids get bowed legs with osteomalacia.

Again the definition you sent me today on osteomalacia reads :

osteomalacia

insufficient mineralization of osteoid etiology:

I am not taking this from anywhere or making it up, it is the definition you provided from stedman's (not dorlands). It clearly says it is a mineralization problem, and has NOTHING to do with collagen defects. Osteomalacia is not a primary defect in matrix.

You mention that osteoporosis is multifactorial and list "hypervitaminosis D, low calcium intake, low estrogen ..." - It is multifactorial but estrogen is the only factor you list that is correct. Guytons lists 7 causes of osteoporosis and they include : " 1) lack of use of the bones 2) malnutrition to the extent that sufficient protien matrix cannot be formed. 3) Lack of vitamin C 4) Postmenopausal lack of estrogen. 5) old age 6) Cushings disease 7) Acromegaly." - page 988, Guytons, edition 6. Again as is clearly stated in Guytons on the same page " Osteoporosis, the most common of all bone diseases in adults and especially in old age, is a different disease from osteomalacia and rickets, for it results from diminished organic matrix rather than abnormal calcification."

You also mentioned : "in reading what i sent and in reading harrison's which i rely on heavily, osteomalacia has several causes which include hypovitaminosis d which does effect calicum and bone formation but osteomalacia can also be a primary defect in the matrix which can't be adequately mineralized. "

So I want to go to ons since it is a source you rely heavily on. When I myself read ons Prinicples of Internal Medicine, edition 15 page 2201 I read " Rickets and osteomalacia are disorders in which mineralization of the organic bone matrix is defective..." This does not say that there is a disorder with matrix, but that mineralization is defective.

However I must take large exception to what on wrotes about osteoporosis. On page 2227 in ons they state "Osteoporosis is defined as a reduction of bone mass...". In Harrions and elsehwere, such as the other sources I cut and pasted above that you sent me, we know that bone is primarily composed of collagen - so when "bone mass" is lost it has to be primarily collagen. If there is calcium loss in osteoporosis, it is because there is inadequate matrix to hold it - that is all. So when ons goes on to spout the same trype ...maybe "crap" is a better word.... ons goes on on page 2229 and others to recommend calcium. I am not against medicine, but this is just such a bunch of crap. They are suggesting replacing the loss of "bone mass" (which by definition HAS to be primarily collagen) with simple calcium. However what is lost is primarily collagen. Bone is mostly collagen, this makes up most of its mass - and osteoporosis by ons definition is the loss of bone mass - it is wise not to try and suggest it is the loss of calcium - but I have to say that ons suggestion to try and fix the problem by adding some calcium is just more medical hypnotic suggestion, hoping that nobody thinks about it too much and notices the fallacy in this thought.

This is a recent peer reviewed medical study showing the realtionship of vitamin C, collagen and osteoporosis :

Calcif Tissue Int. 1998 Sep;63(3):183-9.

 

The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study.

Hall SL, Greendale GA.

Loma University School of Medicine, Loma , California, USA.

Ascorbic acid is a required cofactor in the hydroxylations of lysine and proline necessary for collagen formation; its role in bone cell differentiation and formation is less well characterized. This study examines the cross-sectional relation between dietary vitamin C intake and bone mineral density (BMD) in women from the Postmenopausal Estrogen/Progestin Interventions Trial. BMD (spine and hip) was measured using dual energy X-ray absorptiometry (DXA). ........ each 100 mg increment in dietary vitamin C intake, was associated with a 0. 017 g/cm2 increment in BMD (P = 0.002 femoral neck; P = 0.005 total hip). ........ These data are consistent with a positive association of vitamin C with BMD in postmenopausal women with dietary calcium intakes of at least 500 mg.

I am pretty sure I am the first doctor to suggest in a published format that vitamin C is more important than calcium for osteoporosis. I wrote about it sometime in the 1990's in the INTERNIST magazine, which is the official publication for the CDID. Since then my opinion has not changed much except to include my understanding of it now as an inflammatory condition as well - therefore benifitted by omega 3 fish oils (I can produce studies on this if desired).

Thanks for letting me share my thoughts on this subject. I feel it is vital that as chiropractors, we should have the most thorough understanding of these bone problems, on top of a thorough neurologic understanding. This is not meant as a personal attack, so please don't take it that way. I know you are very educated and smart. However it sickens me that this simple problem is treated from the medical paradigm with calcium - how ironic that a profession (medicine) that has attacked the use of vitamin supplements for decades recommends calcium - of course it is not suprise that they recommend it incorrectly for the wrong condition. I am not anti-medicine, hopefully as evidenced by my continuing efforts to earn my MD at this time - but medicine has ALOT to learn.

Collagen and minerals are delicately intertwined - affecting one does affect the other. But every source I have read, including the ones you have sent me from Harrions, Stedmans, medical college of wisconsin and the osteoporosis organization all state osteomalacia is a problem with mineralization - so treat with minerals. And all of them define osteoporosis as either a defect in matrix or a loss of "bone mass" - and of course most of the mass of bone is collagen - if the collagen is lost, calcium must be lost - but only because there is no collagen to hold on to it.

We need to understand this thoroughly, we need to be the ones to educate the world - including the medical world.

Anglen

[Guest guest]

,

I don't mind being taken to task. And I too feel it is important for us as a profession to look at things critically, with an open mind, and to reach for new insights. I remind you however, that two reasonable people can look at the same thing and reach different conclusions. I will look at what you have posted and see where it leads.

sharron fuchs dc

-----Original Message-----From: ANG320@... [mailto:ANG320@...]Sent: Monday, October 18, 2004 7:48 PMSharronf@...; Subject: Re: Osteoporosis / Osteomalacia sharron fuchs dc

I am including this letter since I feel it is an important issue for our profession, and health care in general. It was a private email and hopefully Sharron does not mind me posting it publicly - she is intelligent and determined, both of which I admire, but I feel there is a certain myth of osteoporosis that is being perpetuated. - =======================================In a message dated 10/18/2004 4:48:49 PM US Mountain Standard Time, Sharronf@... writes:

in osteoporosis it too is multifactorial ie low calcium intake, hypovitaminosis d and decreased estrogen. but to me it appears that the end result is diminished calcium in the bones , which ultimately seems the same end point as in osteomalacia. so they are similar to me yet they are different. They are different and they are different. Exactly different, exactly opposite. I am not sure how you can even read into it that they are the same in any way??????The definition you sent today of osteomalacia reads : "osteomalacia osctT-b-m^-lQcshT-^ A disease characterized by a gradual softening and bending of the bones with varying severity of pain; softening occurs because the bones contain osteoid tissue that has failed to calcify "your source mentions nothing about matrix in this, and clearly states it is because it does not calcify - period. As well it states, exactly as I did that when calcium is removed the bones soften - making them bend. Never has a bone bent in osteoporosis - they snap because they get brittle - EXACTLY the opposite of osteomalacia. Regarding osteoporosis, the material you sent me says: Osteoporosis Overview Osteoporosis, or porous bone, is a disease characterized by low bone mass ............. What is Bone? Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework,.... It is clear that collagen is soft - again it bends. Bones never bend in osteoporosis - they break. This is why kids get bowed legs with osteomalacia.

Again the definition you sent me today on osteomalacia reads : osteomalacia

insufficient mineralization of osteoid etiology: I am not taking this from anywhere or making it up, it is the definition you provided from stedman's (not dorlands). It clearly says it is a mineralization problem, and has NOTHING to do with collagen defects. Osteomalacia is not a primary defect in matrix. You mention that osteoporosis is multifactorial and list "hypervitaminosis D, low calcium intake, low estrogen ..." - It is multifactorial but estrogen is the only factor you list that is correct. Guytons lists 7 causes of osteoporosis and they include : " 1) lack of use of the bones 2) malnutrition to the extent that sufficient protien matrix cannot be formed. 3) Lack of vitamin C 4) Postmenopausal lack of estrogen. 5) old age 6) Cushings disease 7) Acromegaly." - page 988, Guytons, edition 6. Again as is clearly stated in Guytons on the same page " Osteoporosis, the most common of all bone diseases in adults and especially in old age, is a different disease from osteomalacia and rickets, for it results from diminished organic matrix rather than abnormal calcification." You also mentioned : "in reading what i sent and in reading harrison's which i rely on heavily, osteomalacia has several causes which include hypovitaminosis d which does effect calicum and bone formation but osteomalacia can also be a primary defect in the matrix which can't be adequately mineralized. "So I want to go to ons since it is a source you rely heavily on. When I myself read ons Prinicples of Internal Medicine, edition 15 page 2201 I read " Rickets and osteomalacia are disorders in which mineralization of the organic bone matrix is defective..." This does not say that there is a disorder with matrix, but that mineralization is defective. However I must take large exception to what on wrotes about osteoporosis. On page 2227 in ons they state "Osteoporosis is defined as a reduction of bone mass...". In Harrions and elsehwere, such as the other sources I cut and pasted above that you sent me, we know that bone is primarily composed of collagen - so when "bone mass" is lost it has to be primarily collagen. If there is calcium loss in osteoporosis, it is because there is inadequate matrix to hold it - that is all. So when ons goes on to spout the same trype ...maybe "crap" is a better word.... ons goes on on page 2229 and others to recommend calcium. I am not against medicine, but this is just such a bunch of crap. They are suggesting replacing the loss of "bone mass" (which by definition HAS to be primarily collagen) with simple calcium. However what is lost is primarily collagen. Bone is mostly collagen, this makes up most of its mass - and osteoporosis by ons definition is the loss of bone mass - it is wise not to try and suggest it is the loss of calcium - but I have to say that ons suggestion to try and fix the problem by adding some calcium is just more medical hypnotic suggestion, hoping that nobody thinks about it too much and notices the fallacy in this thought.This is a recent peer reviewed medical study showing the realtionship of vitamin C, collagen and osteoporosis : Calcif Tissue Int. 1998 Sep;63(3):183-9. The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study.Hall SL, Greendale GA.Loma University School of Medicine, Loma , California, USA.Ascorbic acid is a required cofactor in the hydroxylations of lysine and proline necessary for collagen formation; its role in bone cell differentiation and formation is less well characterized. This study examines the cross-sectional relation between dietary vitamin C intake and bone mineral density (BMD) in women from the Postmenopausal Estrogen/Progestin Interventions Trial. BMD (spine and hip) was measured using dual energy X-ray absorptiometry (DXA). ........ each 100 mg increment in dietary vitamin C intake, was associated with a 0. 017 g/cm2 increment in BMD (P = 0.002 femoral neck; P = 0.005 total hip). ........ These data are consistent with a positive association of vitamin C with BMD in postmenopausal women with dietary calcium intakes of at least 500 mg. I am pretty sure I am the first doctor to suggest in a published format that vitamin C is more important than calcium for osteoporosis. I wrote about it sometime in the 1990's in the INTERNIST magazine, which is the official publication for the CDID. Since then my opinion has not changed much except to include my understanding of it now as an inflammatory condition as well - therefore benifitted by omega 3 fish oils (I can produce studies on this if desired).Thanks for letting me share my thoughts on this subject. I feel it is vital that as chiropractors, we should have the most thorough understanding of these bone problems, on top of a thorough neurologic understanding. This is not meant as a personal attack, so please don't take it that way. I know you are very educated and smart. However it sickens me that this simple problem is treated from the medical paradigm with calcium - how ironic that a profession (medicine) that has attacked the use of vitamin supplements for decades recommends calcium - of course it is not suprise that they recommend it incorrectly for the wrong condition. I am not anti-medicine, hopefully as evidenced by my continuing efforts to earn my MD at this time - but medicine has ALOT to learn.Collagen and minerals are delicately intertwined - affecting one does affect the other. But every source I have read, including the ones you have sent me from Harrions, Stedmans, medical college of wisconsin and the osteoporosis organization all state osteomalacia is a problem with mineralization - so treat with minerals. And all of them define osteoporosis as either a defect in matrix or a loss of "bone mass" - and of course most of the mass of bone is collagen - if the collagen is lost, calcium must be lost - but only because there is no collagen to hold on to it.We need to understand this thoroughly, we need to be the ones to educate the world - including the medical world. Anglen

[Guest guest]

Bravo!

Willard Bertrand, D.C.

Re:

Osteoporosis / Osteomalacia sharron fuchs dc

I am including this letter since I

feel it is an important issue for our profession, and health care in general.

It was a private email and hopefully Sharron does not mind me posting it

publicly - she is intelligent and determined, both of which I admire, but I

feel there is a certain myth of osteoporosis that is being perpetuated. -

=======================================

In a message dated 10/18/2004 4:48:49 PM US Mountain Standard Time,

Sharronf@... writes:

in osteoporosis it too is

multifactorial ie low calcium intake, hypovitaminosis d and decreased estrogen.

but to me it appears that the end result is diminished calcium in the bones ,

which ultimately seems the same end point as in osteomalacia.

so they are similar to me yet they are different.

They are different and they are different. Exactly different, exactly

opposite. I am not sure how you can even read into it that they are the

same in any way??????

The definition you sent today of osteomalacia reads : " osteomalacia

osctT-b-m^-lQcshT-^

A disease characterized by a gradual softening and bending of the bones with

varying severity of pain; softening occurs because the bones contain osteoid

tissue that has failed to calcify "

your source mentions nothing about matrix in this, and

clearly states it is because it does not calcify - period. As well it states,

exactly as I did that when calcium is removed the bones soften - making them

bend. Never has a bone bent in osteoporosis - they snap because they get

brittle - EXACTLY the opposite of osteomalacia. Regarding osteoporosis,

the material you sent me says:

Osteoporosis Overview

Osteoporosis, or porous bone, is a disease characterized by low bone mass

..............

What is Bone? Bone is

living, growing tissue. It is made mostly of collagen, a protein that provides

a soft framework,....

It is clear that collagen is soft - again it bends. Bones

never bend in osteoporosis - they break. This is why kids get bowed legs with

osteomalacia.

Again the definition you sent me today on

osteomalacia reads :

osteomalacia

insufficient

mineralization of osteoid etiology:

I am not taking this

from anywhere or making it up, it is the definition you provided from stedman's

(not dorlands). It clearly says it is a mineralization problem, and has NOTHING

to do with collagen defects. Osteomalacia is not a primary defect in matrix.

You mention that osteoporosis is multifactorial and list " hypervitaminosis

D, low calcium intake, low estrogen ... " - It is multifactorial but

estrogen is the only factor you list that is correct. Guytons lists 7 causes of

osteoporosis and they include : " 1) lack of use of the bones 2)

malnutrition to the extent that sufficient protien matrix cannot be formed. 3)

Lack of vitamin C 4) Postmenopausal lack of estrogen. 5) old age 6)

Cushings disease 7) Acromegaly. " - page 988, Guytons, edition

6. Again as is clearly stated in Guytons on the same page "

Osteoporosis, the most common of all bone diseases in adults and especially in

old age, is a different disease from osteomalacia and rickets, for it results

from diminished organic matrix rather than abnormal calcification. "

You also mentioned : " in reading what i sent

and in reading harrison's which i rely on heavily, osteomalacia

has several causes which include hypovitaminosis d which does effect

calicum and bone formation but osteomalacia can also be a

primary defect in the matrix which can't be adequately

mineralized. "

So I want to go to ons since it is a source you rely

heavily on. When I myself read ons Prinicples of Internal Medicine,

edition 15 page 2201 I read " Rickets and osteomalacia are disorders in

which mineralization of the organic bone matrix is defective... "

This does not say that there is a disorder with matrix, but that mineralization

is defective.

However I must take large exception to what on wrotes about osteoporosis.

On page 2227 in ons they state " Osteoporosis is defined as a

reduction of bone mass... " . In Harrions and elsehwere, such as the

other sources I cut and pasted above that you sent me, we know that bone is

primarily composed of collagen - so when " bone mass " is lost it has

to be primarily collagen. If there is calcium loss in osteoporosis, it is

because there is inadequate matrix to hold it - that is all. So when ons

goes on to spout the same trype ...maybe " crap " is a better word....

ons goes on on page 2229 and others to recommend calcium. I am not

against medicine, but this is just such a bunch of crap. They are suggesting

replacing the loss of " bone mass " (which by definition HAS to be

primarily collagen) with simple calcium. However what is lost is primarily

collagen. Bone is mostly collagen, this makes up most of its mass - and

osteoporosis by ons definition is the loss of bone mass - it is wise not

to try and suggest it is the loss of calcium - but I have to say that ons

suggestion to try and fix the problem by adding some calcium is just more

medical hypnotic suggestion, hoping that nobody thinks about it too much and

notices the fallacy in this thought.

This is a recent peer reviewed medical study showing the realtionship of

vitamin C, collagen and osteoporosis :

Calcif Tissue Int. 1998 Sep;63(3):183-9.

The relation of dietary vitamin C intake to bone mineral density: results from

the PEPI study.

Hall SL, Greendale GA.

Loma University School of Medicine, Loma , California, USA.

Ascorbic acid is a required cofactor in the hydroxylations of lysine and

proline necessary for collagen formation; its role in bone cell differentiation

and formation is less well characterized. This study examines the

cross-sectional relation between dietary vitamin C intake and bone mineral

density (BMD) in women from the Postmenopausal Estrogen/Progestin Interventions

Trial. BMD (spine and hip) was measured using dual energy X-ray absorptiometry

(DXA). ........ each 100 mg increment in dietary vitamin C intake, was

associated with a 0. 017 g/cm2 increment in BMD (P = 0.002 femoral neck; P =

0.005 total hip). ........ These data are consistent with a positive

association of vitamin C with BMD in postmenopausal women with dietary calcium

intakes of at least 500 mg.

I am pretty sure I am the first doctor to suggest in a

published format that vitamin C is more important than calcium for

osteoporosis. I wrote about it sometime in the 1990's in the INTERNIST

magazine, which is the official publication for the CDID. Since then my opinion

has not changed much except to include my understanding of it now as an

inflammatory condition as well - therefore benifitted by omega 3 fish oils (I

can produce studies on this if desired).

Thanks for letting me share my thoughts on this subject. I

feel it is vital that as chiropractors, we should have the most thorough

understanding of these bone problems, on top of a thorough neurologic

understanding. This is not meant as a personal attack, so please don't take it

that way. I know you are very educated and smart. However it sickens me that

this simple problem is treated from the medical paradigm with calcium - how

ironic that a profession (medicine) that has attacked the use of vitamin supplements

for decades recommends calcium - of course it is not suprise that they

recommend it incorrectly for the wrong condition. I am not anti-medicine,

hopefully as evidenced by my continuing efforts to earn my MD at this time -

but medicine has ALOT to learn.

Collagen and minerals are delicately intertwined - affecting one does affect

the other. But every source I have read, including the ones you have sent me

from Harrions, Stedmans, medical college of wisconsin and the osteoporosis

organization all state osteomalacia is a problem with mineralization - so treat

with minerals. And all of them define osteoporosis as either a defect in matrix

or a loss of " bone mass " - and of course most of the mass of bone is

collagen - if the collagen is lost, calcium must be lost - but only because

there is no collagen to hold on to it.

We need to understand this thoroughly, we need to be the ones to educate the

world - including the medical world.

Anglen

OregonDCs

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