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Osteoporosis Section: Ask the Expert

Osteoporosis Ask the Expert

Question answered by Barry L. Gruber, M.D.

The relationship between osteoporosis and high protein diets.

Question:
Could you discuss the relationship between high protein diets and osteoporosis, including how this link has been studied? What daily intake of protein is considered high enough to cause bone loss? Does it apply to men and women equally, and to all ages equally? I am interested because I've had great success with a low carbohydrate diet, which, by default, has high protein levels. I don't want to increase my risk of osteoporosis, however. Thanks for sharing your knowledge.

The exact reason that high protein diets might be associated with low bone mass is unknown, although researchers postulate alterations in pH and calcium urinary losses, among other considerations. The link has been an epidemiologic one by surveys. You can find out more by perusing any of these medical citations in a medical library, although I think that specific answers to all your questions may be elusive:

    Lewis RD; Modlesky CM
    Nutrition, physical activity, and bone health in women.
    Department of Foods and Nutrition, The University of Georgia, Athens 30602, USA. Language: Eng
    Source: Int J Sport Nutr 1998 Sep;8(3):250-84

    Lau EM; Woo J
    Nutrition and osteoporosis.
    Department of Community & Family Medicine, Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Language: Eng
    Source: Curr Opin Rheumatol 1998 Jul;10(4):368-72

    Bonjour JP; Schurch MA; Chevalley T; Ammann P; Rizzoli R
    Protein intake, IGF-1 and osteoporosis.
    Division of Bone Diseases, WHO Collaborating Center for Osteoporosis and Bone Diseases, University Hospital, Geneva, Switzerland.
    bonjour@cmu.unige.ch
    Language: Eng
    Source: Osteoporos Int 1997;7 Suppl 3:S36-42

    Reid DM; New SA
    Nutritional influences on bone mass.
    Department of Medicine and Therapeutics, University of Aberdeen.
    Language: Eng
    Source: Proc Nutr Soc 1997 Nov;56(3):977-87

    Feskanich D; Willett WC; Stampfer MJ; Colditz GA
    Protein consumption and bone fractures in women.
    Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
    Language: Eng
    Source: Am J Epidemiol 1996 Mar 1;143(5):472-9

Antiphospholipid Antibody Syndrome, Heparin and osteoporosis.

Question:
Nine months ago I delivered my second child. My first pregnancy (age 24) went smoothly -- I had a normal pregnancy and delivery. After 3 first trimester miscarriages, I went to a specialist who diagnosed me with Antiphospholipid Antibody Syndrome. As soon I determined I was pregnant he started me on heparin shots and a low dose of aspirin to keep my blood from clotting. I continued this throughout my pregnancy until 48 hours before he induced me.

About 6 weeks before delivery I was having horrible back pain. He eventually prescribed mild muscle relaxers which did not begin to touch the pain. After crying from the pain in his office and nearly falling trying to get off of the examining table he admitted me and requested an orthopedic see me. The hospital refused to allow x-rays for obvious reasons - risk to the baby. The pain was unbearable -- I slept on the sofa - had to walk with a walker - my husband had to dress me, etc. After I delivered I saw my primary care doctor - an internist. He saw on the xray two places that looked like strained areas and vertebral compression and osteopenia (the radiologist's report said that the bone loss was extremely severe for a person of my age). He immediately stopped the heparin shots and told me that was a side effect of heparin.

I now take Fosamax, OsCal, Synthroid. The perinatologist that I saw told me that I should not take estrogen - due to the Antiphospholipid Antibody Syndrome. I'm at a loss as to birth control, hormones, aspirin, long term effects of bone loss, compression, etc. I lost 4 inches in height and suffer from back pain. (It's been 9 months since I delivered.) Will I always have back pain? Can bone loss be completely corrected? Do I need other hormones? Please give me some direction. Thanks!

Your case is quite complicated and it is probably in your best interest to seek the advice of a rheumatologist with particular interest in osteoporosis. It would not be of any service to you to try to give you specific medical advice by the internet.

Osteo sonography as a screening method.

Question:
I would like to know if the osteo sonogram is a good method for screening in osteoporosis because of it`s low cost and harmfulness and the correlation with the DEXA densitometry. I'll would like to know also where can I get some Bibliography about it.

Thanks, yours sincerely,

Dr. Juan A. ALves
Gynaecology & Obstetrics
Montevideo
Uruguay
South America

The sonography of the heel is a good technique for screening purposes. The limitation of this technique at present is to utilize the data for comparison purposes should an individual go on therapy and require a follow-up measurement to monitor the response to therapy. The correlation with DEXA is adequate however for screening purposes (and more important for predicting future fractures). One citation which is often referred to:

    Baran DT; Faulkner KG; Genant HK; Miller PD; Pacifici R
    Diagnosis and management of osteoporosis: guidelines for the utilization of bone densitometry.
    Department of Orthopedics, University of Massachusetts Medical Center, Worcester, Maine, USA.
    Language: Eng
    Source: Calcif Tissue Int 1997 Dec;61(6):433-40

Is Miacalcin the right drug for me?

Question:
I am a 53 year old going through menopause. I took Fosamax for 6 months but stopped taking it because it made me tired. I know that is not a listed side effect, but that is how it affected me especially if I would forget to take a calcium pill. I am now on Miacalcin Nasal Spray. But since I am not 5 years past menopause and I have been taking Prempro for 4 months is Miacalcin the right drug for me? Please reply. Thanks

Without Bone density results, it's difficult to comment on therapy, but it is accepted that Miacalcin shows it benefit most after 5 years of menopause and is more active in treating osteoporosis of the spine and has limited benefit on the hip in relation to other therapies. Estrogen (with or without progesterone) will help build bone in about 80% of women. About 18-20% of women are genetically incapable of building significant bone with estrogen and require alternative therapies. A urinary or serum NTx (discussed in many previous posts) would be helpful in patients who had one done prior to therapy (baseline) and again, three months after initiation of therapy (to evaluate reduction in breakdown products of bone and thereby determine if less bone is being "lost").

**Note: Opinions expressed here are for educational purposes only and, as such, do not constitute a physician patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

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