Osteoporosis ( I )

Osteoporosis ( I )

The Relationship between BMD(Bone Mineral Density) and Osteoporosis

Osteoporosis is a skeletal system disorder associated with endangered bone strength, which is defined by low bone density and quality, consequently increasing the risk of fractures of the hip, spine, wrist, ribs, and shoulder. (Cooper, 1999) Thus it is characterized by low bone mass and deterioration of bone tissue, which leads to decreased bone strength, increased bone fragility, and risk of fracture. (Liberman et al., 1995; Kanis, 2008; Baron & Hesse, 2012; Szulc et al., 2010) Osteoporosis incites a critical public health issue, causing substantial morbidity and mortality.

Globally, more than 200 million women are suffering from osteoporosis, and most of these women are aged 45 years and older and have experienced postmenopause. (IOF, 2018) Moreover, nearly 8.9 million people are suffering fractures that are caused by osteoporosis. (IOF, 2018) In Europe, osteoporosis is a substantial economic burden because the disability caused by osteoporosis is higher than that produced by cancer (except lung cancer) and other chronic noncommunicable diseases such as asthma, rheumatoid arthritis, and cardiovascular diseases. (IOF, 2018)

WHO has defined osteoporosis as a level of Bone Mineral Density (BMD). (Kanis et al., 1994) When patients are diagnosed with osteoporosis, they measure the Bone Mineral Density (BMD) which comes with T-score value. If the result is lower than -2.5, they are diagnosed with osteoporosis, and if the T-score value is in between -2.5 and -1.0, they are diagnosed with osteopenia. If the value is greater than -1.0, they are considered normal.

Although many scientists have researched to find a way to increase Bone Mineral Density (BMD), current treatment options conducted in the medical setting have not yet made any significant increase to BMD. Bisphosphonates, SERMS, Teriparatide, Calcitonin and Thiazide Diuretics are currently prescribed to treat osteoporosis. Moreover, some physicians recommend taking calcium supplements with Vitamin D, since an increase in calcium level in plasma would trigger the pituitary gland. By stimulating the thyroid gland, thyroid hormone (TH) is secreted, which initiates osteoblasts. However, it was painful to influx calcium ion in intracellular membrane because the regular calcium that is sold in the market is not the physiologically active form of calcium as it is bound to protein. Moreover, Paziana & Paziana (2015) have mentioned in their research that an excessive calcium intake could have adverse effects on the cardiovascular system because a sudden increase of calcium ion in the blood may cause calcification in blood vessels. Also, as Kim et al. (2017) discovered through their research, an excessive calcium intake can elevate the risk of metabolic syndrome for men. Therefore, due to the adverse effects of calcium intake, calcium supplements could not be the primary source for treating osteoporosis.

Despite the various treatment options for osteoporosis, the prevalence rate of osteoporosis is increasing because these treatments are yet to be proved for any significant efficacy. Bisphosphonate is the most frequently prescribed medication for patients with osteoporosis. Bisphosphonate mimics the structure of pyrophosphate and the activates the enzymes that are triggered by pyrophosphate. Therefore, it coordinates calcium and causes it to become accumulated in bones to increase BMD. However, it is still questionable if the BMD also improves the quality of bone. Even though bisphosphonates are the most prevalently used medication for osteoporosis, it is still unknown whether it is the best treatment option, since it only increases the density of bone and not the quality of bone. Furthermore, IOF (2018) has found out that bisphosphonate has many adverse side effects such as Hyperparathyroidism, Paget’s Disease of Bone, Osteomalacia, Renal Failure, and Nephrolithiasis. For such reasons, it has been controversial whether patients with osteoporosis should continue to be prescribed bisphosphonates as their first line of medication.

SAC can be introduced as a new treatment option for osteoporosis because as shown by Choi et al. (2011), SAC proved its medical efficacy in their research. Through their study, they wanted to investigate if SAC increases BMD and prevents bone turnover when ovariectomized rats are orally ingested 0.0012% of SAC solution (83/μg/kg) for 12 weeks. As a result, the ovariectomized group treated with SAC had higher BMD (0.2276±0.012 mg/cm2) rates as compared to the group that was not treated with SAC (0.1965±0.012 mg/cm2). Moreover, the ovariectomized group treated with SAC had higher 17β-estradiol, lower osteocalcin, and Type I Collagen C-terminal Telopeptides (CTx), which result in a n increase in bone turnover.

As SAC solution is verified as a dietary supplement in Canada, the United States, Republic of Korea, Indonesia and Japan, more than 100,000 patients with osteoporosis have been trialing it since 2012 and showing a significant improvement in laboratory BMD tests. In referring to one of the postmenopausal osteoporotic patient’s data, after treating 5 to 15 mg of SAC orally every day for six months, her T-score increased to -0.8 from -3.4 which was profoundly osteoporotic. While there are no significant treatments available for patients with osteoporosis, the SAC solution can be seen as an innovative one, since it directly increases the serum calcium level as well as the intracellular calcium level, and decreases parathyroid hormone (PTH) secretion, which prevents unnecessary bone resorption. Moreover, as it has no adverse effect due to only a small amount of calcium being ingested to trigger calcium ion concentration in the intracellular membrane, it can be an active form of treatment for osteoporosis in the future.

Osteoporosis is classified into two different types: Type I osteoporosis and Type II osteoporosis. Type I osteoporosis is mostly seen among women who have experienced postmenopause and Type II osteoporosis is mainly observed among men with hypogonadism. According to Funaro et al. (2013), hypogonadism is “one of the main risk factors for osteopenia and osteoporosis, which can be found in 8% of hypogonadal men younger than 50 years of age.” (p. 19) As Chou et al., (2016) investigated in their article, “older age (> 55 years), and low ERα mRNA levels in PBLs (≦ 250.39 copies/μg DNA) were associated with an approximately 9.188-, and 31.25- fold risk of osteoporosis.” (p. 124) Whilst many scientists have assumed that osteoporosis is related to the alteration of sex steroids, the exact cause of the disease is still unknown. Moreover, a large number of scientists have aggressively researched the pharmaceutical medication for osteoporosis. However, none of the pharmaceutical options have shown significant efficacy for treating osteoporosis, and while the global population is getting older, the global economic burden of osteoporosis and osteoporotic fractures is increasing immensely.