Transcript Integrative Biophysics and Pulsed Electromagnetic Field

Keith R. Holden, M.D.
Ponte Vedra Beach, FL
www.Dr-Holden.com
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Guidelines for prevention and tx vary
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Bone quality versus bone quantity
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Same BMD can have different fx risk (age)
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Cumbersome dosing requirements
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Drug side effects
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Esophagitis
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Esophageal stricture
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Esophageal cancer
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Osteonecrosis of jaw
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Atypical Femur Fracture
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Bisphosphonates ↓ osteoclast fxn & induce
osteoclast apoptosis
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Suppress bone resorption = hard, brittle bone
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Path: ↓ bone heterogeneity = ↓ bone quality
 Complete lack of TCN labeling = severe ↓ bone formation
 Stress injury-like cortical hypertrophy in other femur with
unilateral AFF
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↑ BMD does not always = ↑ bone strength
T-score not consistent predictor of
osteoporosis outside of elderly
postmenopausal white♀
Other populations, Z score may be better
predictor of low bone density
www.shef.ac.uk/FRAX/tool.jsp
FRAX estimates 10-yr. fx risk based on
BMD femoral neck + osteo risk factors
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Bone quality = bone strength (cortical bone
structure/quality of collagen) + rate of
remodeling
Bone densitometry measures BMD
(quantity), helps assess fx risk, aids in dx of
osteo, but does NOT measure bone quality
Healthy bone requires a balance of:
Bone building by osteoblasts
Resorption by osteoclasts
90% collagen (majority Type 1)
Osteoclast degradation & osteoblast
synthesis create circulating peptides of Type
1 collagen
Type I collagen is cross-linked by
deoxypyridinoline (DPD)
DPD provides rigidity and strength (quality)
to bone
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Reflects bone remodeling yrs. before BMD ∆
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↑ T score + ↑ biomarker → fx risk (odds 4.1)
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Allow tracking of response to therapy
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May improve adherence to therapy
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Cross-link Type IC (relatively selective)
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Measure of bone resorption - ↑ urine level > bone loss
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Unaffected by diet
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Easy to measure spot AM urine
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Recheck within 30-90 days after initiating therapy
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Covered by Medicare
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Calcium
Vitamin D
Magnesium
Boron
Strontium ranelate
Ipriflavone
Vitamin K
Choline stabilized orthosilicic acid (ch-OSA)
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Ch-OSA = bioavailable silicon
RDBPC trial: added to calcium and D3 showing
improved bone biomarkers and BMD ↑ 2%
RDBPC trial: ↑ tensile strength of hair
RDBPC trial: + effects of skin surface changes,
mechanical properties, ↓ brittleness hair/nails
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Pulsed Electromagnetic Field (PEMF) therapy
has shown promise in clinical trials for tx and
prevention of osteoporosis
Mediates process via cell signaling proteins –
growth factors, cytokines, and prostaglandins
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PEMF 72Hz 10 hrs daily for 12 wks to radius
of “osteoporosis prone” ♀
BMD showed sig. inc. in exposed areas 36
wks
Similar but weaker response in non-treated
arm
(Tabrah, et. al., 1990)
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Evaluated rats with surgically induced DOP
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After 8 wks, PEMF sig. ↑BMD, ↑ TGF-beta 1,
↓IL-6 in proximal femur
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Conclusion: PEMF efficiently suppresses bone
loss in DOP via local factors
(Shen, et al., 2010)
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Evaluated CR with PEMF in ovariectomyinduced osteoporosis in rats
12 weeks, (OVX-DPEMF) group had better
prevention against OVX-induced bone loss
↑BMD, ↑osteoblast activity, ↑ trabecular health
markers; ↓bone markers of resorption (uDPD)
(Jing, et. al., 2010)
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Rats with streptozotocin-induced DM bone loss
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PEMF daily 8 hrs x 8 wks
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PEMF improved biomechanical bone quality DM bone
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PEMF partially reversed DM-induced bone deterioration
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Conclusion: PEMF might become an additive method for
inhibiting DM osteoporosis
(Jing, et al., 2011)
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Study on in-vitro osteoblastic cell culture
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PEMF ↑osteoblastic growth, ↑ TGF-beta 1
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PEMF ↓ prostaglandin E2
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Conclusion: Study sheds light on mechanism of
action of PEMF in non-union fx & prevention of
osteoporosis
(Li, et al., 2007)
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Studied rats subjected to bil ovariectomy
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PEMF augmented/restored trabecular bone
mass/architecture in PEMF groups
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PEMF attenuated higher serum PGE(2) of OVX rats
and restored levels to that of controls
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Conclusion: PEMF may be useful in prevention of
osteoporosis resulting from ovariectomy
(Chang, et al., 2003)
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PTH used to tx osteoporosis; Insulin & IGF-1
anabolic roles in osteogenesis
Cell signaling proteins IRS-1, S6 RSK, & eNOS
were phosphorylated by PTH, Insulin, & PEMF to
the same extent in osteoblast-like cells
Conclusion: Anabolic affects of PEMF may be
mediated through these proteins
(Schnoke, et. al., 2007)
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↑ BMD
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↑ TGF-beta 1
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↓ IL-6
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↓ PGE(2)
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↑ osteoblast growth
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Phosphorylation of IRS-1, S6 RSK, eNOS
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Alkalinizing plant based diet
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Address food sensitivities
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Mineral rich foods
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Remove
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Replace
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Reinnoculate
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Repair
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Rebalance
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Foci of interference (ANS)
Stress
Inflammation
Toxins
Allergy
Infection (occult, dysbiosis, dental)
Heavy metals
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Resistance training
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Nutritional supplementation
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Hormonal balance
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PEMF
66 y.o ♀ with osteoporosis (T-score -3.1)
 Baseline: mostly plant based diet, resistance
training, Ca, Mg, and D
 (1/27/11) uDPD 9.7 nM/mM Cr (NL < 6.5)
 Weekly 1 hr PEMF sessions x 2 mos
 (3/16/11) uDPD 4.5 (53% drop!)
 Maintenance: Monthly 1 hr PEMF
 (7/21/11) uDPD 5.5
 (10/24/11) uDPD 4.5
63 y.o. ♀ osteoporosis (‘09 T-score LS -3.9;
‘11 T-score LS -4.1)
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Hx FMG, CFS, IBS, MCS & hx multiple fxs
Baseline: BHRT, Ca, Mg, D
Added ch-OSA + tx gut dysbiosis
Started PEMF (3/26/11) monthly; (7/26/11) inc.
freq. to weekly; (9/12/11) 2-3 X week
(4/13/11) uDPD 9.7; (10/4/11) uDPD 5.0
(48.45% drop!)
Keith R. Holden, M.D.
822 A1A North, Suite 310
Ponte Vedra Beach, FL 32082
(904) 473-4954
[email protected]
www.Dr-Holden.com