The calcium phosphate imbalance – hyperphosphatemia and hypocalcemia and acidosis – of chronic renal failure causes havoc on bones and circulation, and can be considerably mitigated by supplements with dolomite (CalMag) – (NOT aluminium)- and vigorous vitamin D3, and timely dialysis and transplantation. .
But apart from rickets and renal failure, IATROGENIC PHOSPHATE DEPLETION by antacids is a perhaps-forgotten hazard of chronic antacid ingestion : dozens of papers on Pubmed since the early 1970s to the 1990s attest to the common problem even in adults outside hospital. The authoritative University of Oregon website sums up the need: the recommended daily phosphate allowance RDA for adults is about 700mg (up to 1200mg in pregnancy) – but the safe upper limit is at least 3000mg/day.
The common causes of adult chronic phosphate deficiency include (apart from food- soil phosphate depletion that blights crops; anorexia nervosa; diuretics[ thiazide, Diamox); in perhaps descending order of prevalence: fructose (now used as profuse sugar substitute in the cooldrink and fast food industry); vitamin D3 deficiency; poorly controlled diabetes and insulin excess; alcoholism; starvation and diarrhoea- malabsorption:- but especially chronic ingestion of phosphate-free antacids of sodium, calcium, magnesium and especially aluminium. Given the accumulating toxicity of aluminium in bone and dementing diseases, there is no longer place for aluminium antacids, which should be banned.
A recent review of Medication-induced Hypophosphatemia from Greece stresses that diuretic and bisphosphonates (eg Elisaf ea 1998) are the chief causes. A 40year old article in the BMJ lists thiazides as a cause, although Massry ea showed a decade later that thiazides blunt the hypercalciuria of phosphate depletion..
And this week a 3year study from Germany of 4000 women on oral bisphosphonate shows a median oral bisphosphonate treatment duration of 145.5 days. Persistence rates after 1 and 2 years were 27.9% and 12.9%, respectively. These abysmally poor medium-term compliance figures tell us how badly patients tolerate and view bisphosphonates.
Hence, dont use bisphosphonates for osteoporosis. There is no need for them with their major risks. Use appropriate harmless calcium-magnesium phosphate and vitamin D. There has never been convincing evidence to justify prescription of biSphosphonate for osteoporosis.
It is symptomatic of the pernicious influence of Big Pharma that the Wiki section on osteoporosis devotes dozens of lines to designer commercial drugs heavily promoted and prescribed by the Disease Industry, that have never been proven to be necessary let alone safe; but only a few lines to the score of natural essentials that reverse both osteoporosis and all other common degenerative diseases of aging. It doesnt even mention phosphate supplementation, though it mentions phosphate depletion as one of the many causative factors in osteoporosis- ignoring the fact that bisphosphonates actuallly worsen phosphate depletion in some studies. .
February 10, 2011 In today’s NEJM N Engl J Med Bisphosphonates for Osteoporosis, Vis Dijkman and Lems at the hallowed VU Amsterdam bewail that a 67year old woman with osteoporosis was not treated with a bisphosphonate..
This is precisely the reflex response that marketeers of such synthetic drugs spend millions to obtain by doctored trials, massive advertising, ghosted papers in leading journals that crave such marketing adspend, and employment of spin doctors and lobbyists… to promote $billion sales.. . .
Although bisphosphonates and other modern designer drugs like strontium halve fracture rates, they cost a fortune, and have deadly albeit arguably rare risks; and have negligible need or indication except profiteering.
It is indeed medical malpractice when such patients are not placed on the economic safe multisystem protective supplements freely available in any democracy .
So where is the indication for such heavily advertized contentious patented designer drugs when they do nothing for multisystem health -especially frailty and falls, the chief risk factor for fractures – and all-cause morbidity and mortality?
When osteoporosis and all the other associated chronic major degenerative diseases of aging are at least halved, adding health to years, by the sensible combination of at least 20 micronutrients- fish oil, appropriate balanced human hormone replacement and a sensible powder blend of the vitamins, minerals and biologicals-that have each been shown to strengthen all-system health at little cost and no significant risk?
update 29 Jan 2011 Prof Heaney’s team showed in a 12 month trial published last year that while women on a potent anabolic agent “with phosphate intake less than 1000mg/day, phosphate and carbonate salts of calcium appear to be approximately equally effective in supporting vigorous bone building in osteoporosis ; but phosphate salt may be preferable in patients with restricted phosphorus intakes”. Combined Vitamin D and balanced sex hormones , the other minerals and vitamins, are potent anabolic agents.
Hence it becomes clearer from Heaney’s and White’s respective recent trials that since so many older women have relative calcium and phosphate deficiency- without obsessively checking the plasma calcium-phosphate product too regularly- modest supplementary tricalcium phosphate eg eg 1 gram a day can be given with eg modest calcium carbonate a gram a day to provide about 700mg calcium and 200mg phosphate a day, safely combined with the score of other natural bone-and muscle-anabolic supplements mentioned below and in previous reviews on this website. If the plasma calcium and phosphate levels and product do not rise to the mid-upper range of healthy people despite all the other supplemments, if desireable the dose of calcium phosphate can be titrated upwards and the calcium carb dose downwards .
It is intriguing that, predictable hypocalcemic hyperphosphatemia from chronic renal failure and hypoparathyroidism aside, on Pubmed and Google, phosphate overdose has rarely been reported in adults , and then in bizarre circumstances.with gross overdose of eg sodium phosphate for purgation. Search for “calcium phosphate overdose” on Pubmed and Google reveals no case reports. Such is evidence-based medicine- there is no report and thus no evidence of serious risk from appropriate use of oral calcium phosphate supplements.
By contrast, already by 1976 Heaney and Saville showed that bisphosphonate elevated blood phosphate and calcium, but reduced both bone resorption and mineralization by about 50%.
Hence there is no place for bisphosphonates in the treatment of osteoporosis, when it is calcium-magnesium phosphate that is needed.
23 January 2011 Regulators, Administrators, medical schemes, Academics, specialists and family practitioners must produce evidence for patients to support why they (the Healthcare Industry) promote patent synthetics like Fosamax – bisphosphonates BPN- and Pro(el)os – strontium ranelate- ahead of solidly evidence-based century-recognized and balanced physiological safe low-cost natural multisupplements like vitamins, minerals and the past century, appropriate human steroids.
The accumulating evidence against synthetic designer drugs which target solely bone, and for well-proven combined safe approriate natural supplements that benefit all bodily systems –has been updated regularly for bisphosphonates eg alendronate- the Fosamaxes – and strontium ranelate– Prot(e)os. .
In PHOSPHATE NUTRITION AND TREATMENT OF OSTEOPOROSIS Professor Robert Heaney in 2004 anaylses the crucial role of adequate phosphate in the elderly. As we had hardwired into our brains in organic chemistry at med school 50 years ago, the main cation mineral elements in bone are calcium and phosphorus in the ratio of 2:1 in the matrix hydroxyapatite- [Ca3(PO4)2]3 Ca(OH)2; whereas potassium and magnesium are the main and thus most vital cellular ie intramuscular cations; and sodium (chloride) extracellularly. Thus while overall cationic mineral balance including sodium is crucial, calcium, magnesium, phosphorus and potassium are the main locomotion- strength – cations. . Heaney and Chris Nordin have for almost 50 years urged dietary balance of calcium and phosphorus to optimize bone – why do doctors and Regulators continue to ignore this basic truth?
The association of calcium and phosphorus balance in senile osteoporosis goes back on Pubmed to at least 1953 if not to the 1930s.
But Pubmed and Wiki are only small windows on history. It is salutory that on Pubmed osteoporosis was already reported by Wherry in a fulltext report dated 1894 ! It was already a scourge in Egyptian women 4000 years ago. My thick Lancet volume for 1839-40 does not list osteoporosis, nor does my bulky 2 volume 1959 Oxford Universal Dictionary.
Nor does my facimile Sir William Osler’s Principles and Practice of Medicine 1892- but under rickets, for the frail child it warmly recommends milk as the chief food; phosphorus dissolved in olive oil; cod liver oil; and iron iodide given with the oil. And on the next page under scurvy, Osler discussed Dr James Lind’s as yet unidentified antiscorbutic factor which some felt might be due to the alkaline salts in fruit; with in children fracturing scurvy very much like rickets The Google layout of the 1901 edition is of course longer, but the section on rickets treatment was identical.
By WW2 Fuller Albright recognized one extra major osteoporosis link- menopause- and began treating such women successfully with estrogen replacement HRT.
So by WW2, decades before bisphosphonates for profit were thought of, mainstream medicine already knew about the chief nutrrients for healing bone- cow’s milk for its calcium, potassium, protein and vitamin D; cod liver oil for its abundant vitamin D3; iron, iodine, phosphates, lemon juice for its vitamin C, and estrogen.
Thus it is unsurprising that, apart from the major food components- protein (nitrogen) and energy (starch and fats) , strength and upright posture and locomotion depends on maintenance of optimal micronutrients- calcium magnesium potassium phosphate, vitamins especially C and D, and acid-base balance in the blood, ie in the diet.
It is common knowledge that as kidney function fails, with unrestricted diet, acid and phosphate accumulate and calcium falls with calcification of vessels and tissues and weakening of muscles and bones.
But in average aging women (who mostly undergo loss of crucial anabolic steroid hormones in early midlife, decades younger than men), as Heaney says, dietary phosphate deficiency becomes another major risk factor for osteoporosis- which is aggravated by increasingly earlier menopause, vegetarianism, regression to tea and sandwiches diet, and increasing intolerance for dairy products and darker climate, let alone in devout muslim women applying cultural avoidance of all sun exposure; and
- the idiotic marketing and preaching of pills like B-D-cal- which provide harmful unopposed daily 1500mg calcium as citrate or carbonate with a trivial vitamin D3 dose of perhaps 400iu a day
- aggravating the increasing calciferol deficiency from decreasing dairy intake; urban work indoors and no-longer compulsory sport at schools; and the idiotic omission of meaningful supplements of all the other essentials that become deficient with diet and aging- bone-and-muscle trophic minerals and vitamins especially magnesium, boron, selenium, manganese, zinc, iodine, even strontium, fluoride; and vitamins B, C, K;
- and the modern irrational and adverse denial of appropriate balanced physiological gonadal hormone replacement after age 60yrs.
- This is in turn worsened by the liberal use of purgatives; calcium-magnesium-wasting furosemide, SSRI antidepressants, corticosteroids and ethanol; and aluminium and synthetic antacids and deodorants rather than calcium magnesium salt.
And as Heaney says, confusing the phosphate retention of kidney failure with people with normal kidney function- who in fact have phosphorus depletion worsened by high calcium intake.
As he says, supplement with Calc (tri)phosphate works best, to provide a positive phosphate balance of perhaps 90mg/day to maintain serum phosphate well within the healthy range of 1.5 to 2mmol/L. Calcium triphosphate provides some 400mg calcium and 200mg phosphorus per gram, thus 400mg a day of this salt will provide only 160mg calcium but perhaps adequate 80 mg phosphorus a day – dose to be adjusted simply on the blood calcium and phosphate levels if not just on progress in bone density restoration. The remaining adequate supplement of calcium- ~500mg/d – is provided by eg calcium carbonate 1500mg a day, and of magnesium eg 300mg/day as mag -ox 500mg/day. There is no reason why females should be far more vulnerable to fractures because of targeting merely the mediocre peak bone density of average women at 30yrs instead of that of young men.
If everyone were encouraged to take safe vigorous combined appropriate supplements, premature aging diseases would fall greatly, cutting need for hospitalization, prescription modern drugs and acute-care specialists by far more than half ie putting thousand of health workers out of work other than to care for the increasing numbers of old survivors- pensioners. .
So it is now clear that Bisphosphonates and ranelate- Proteos/Protos- are unnecessary for osteoporosis when the latter is so easily healed and prevented by all the natural supplements discussed above, and when these patented synthetics designed solely for Big Pharma profit have rare but deadly adverse effects eg lethal DRESS syndrome, oesopageal ulceration-stenosis and cancer, and devastating teeth and jaw loss let alone collapse of the femur.
NEW TRIAL SHOWS NATURAL PHOSPHATE IS BETTER THAN BISPHOSPHONATE : Now a new paper from Liverpool University UK by White ea confirms that natural phoshate supplement does better than bisphosphonate- alendronate, BNP- in restoring bone density in patients..
This expose of the redundancy of potentially crippling BNPs comes just 10 years after Rogers et al in Scotland noted that ” After more than 30 years of clinical use, bisphosphonates’ molecular mechanisms of action are only just becoming clear”- they reduce bone resorption necessary for bone remodelling. .
But the BNP deception goes back a lot longer. Already in 1990 Prof Reid ea in New Zealand showed that BNP produces a gradual rise in serum phosphate- BUT ” an acute and sustained inhibition of bone resorption followed by a more gradual reduction in bone formation… over the 12 month period. “. This explains clearly why BNPsreduce fracture rate in the shortterm, but can produce disasterous osteonecrosis and long bone fractures.
COMBINATION SUPPLEMENTS: In 1999 Reginster ea reported ia randomized controlled trial showing that lowdose monofluorophosphate MPF (20mg fluoride) in osteoporotic women for 4 years decreased fracture rate as much as calcium supplement alone. In 2009 Castel-Branco ea showed in a metaanalysis that hyroxyapatite was significanlty more protective than calcium alone.
By 1999 the world’s leading osteoporosis research team – Christiansen and Riis, still active after 26 years together – showed in a similar 2year trial that the same dose MPF plus 50ug estradiol and NETA produced an exciting 11.8% increase in spinal bonemass density compared to 4% on the HRT alone, and only 2.4% on the MPF alone. The same team in 1996 showed that in 15year followup, postmenopausal women fall into two groups: as opposed to the 70% majority slow bone losers, the 49 fast losers “had at all sites significantly less bone mass than the normal bone losers (p < 0.001). 23 women had experienced a peripheral (Colles’) fracture and 25 a spinal fracture. The fracture groups had generally significantly (p < 0.05) less bone mass than the group without fracture, both in the forearm, spine, and hip and they also had the highest rate of bone loss after menopause (p < 0.05). Baseline bone mass and rate of loss predisposed to the same extent to fractures with ODD’s ratios of about 2. If both low bone mass and rate of loss were present, the ODD’s ratio increased to about 3.” For three decades they have promoted appropriate estradiol and modern progestin replacement, withdrawal of which leads again to steady bone loss.
So why are BNPs- and increasingly strontium ranelate – – trumpeted as the most-prescribed drugs for osteoporosis? Quite simply- because health workers do what academics and professional bodies, Regulators and osteoporosis associations, politicians and Magnagement dictate- and thus what Big Pharma dictates since Big Pharma with its $multibillion a year raincheck synthetic (but long term never tested ) drugs pays such lobbyists well to research and register and promote their ever-new modern drugs before they go out of patent or are cancelled due to major adverse effects- or proof that they are actually useless. .
No matter how superior and safe combined supplements have been abundantly proven to be against fractures and all other common degenerative diseases of aging, no Big Pharma company is going to massmarket any supplements or combination of these when they are not patentable. So the AntiOsteoporosis Big Pharma lobbyists- the FDA and academic researchers, are well rewarded to denigrate effective natural supplement combinations since these are not patentable. It is obvious that no western ie allopathic Medical School can resist ie function without the massive research funding from Big Pharma.
Balanced natural supplements (which we evolved on and from in available diet over aeons – which protect all systems in the body- reduce all diseases and mortality drastically. Their free availability as foodstuffs (and human HRT as prescription supplements) is thus increasingly suppressed by eg the FDA, NHS , European Medicines Authority and medical schemes at the behest of their paymaster Big Pharma, for whom Only Disease Pays.
Hence BNP promotion and prescription for common osteoporosis is longstanding criminal fraud when simple supplements including phosphate heal bone without any of the horrendous risks of BNPs. We dont need reminding that BNP were developed to treat cancer bone pain ie terminal disease. Their use for common osteoporosis has never been remotely justified.
One may thus well ask again- since natural phosphate and the other essential supplement micronutrients are abundant, low cost, and so safe (like everything else in life- in appropriate balanced dose)- and so well known to become deficient with ageing and restricted diet- why did and do Authorities and Regulators allow heavily marketed synthetics phosphate salts- BNPs – and synthetic strontium salt- to be launched and continued to saturate the market before there was good proof of both need for them and evidence of long term safety, lack of major adverse effects?
It is trite to repeat that Regulators are there to protect the public- in this case consumers, patients- not promote reckless profiteering by ruthless corporates.
The essential role of abundant phosphate in diet was already exquisitely described by Harmon ea from Illinois in 1974 in pigs, (whose physiology so closely resembles humans) where paralysis and bone loss were prevented simply by adequate phosphate diet supplement to improve the calcium:phosphate balance in diet from about 2:1 to 1.4:1. The paper details references going back decades- so the benefits of adequate phosphates were already long and well known to science.
In the face of such simple nutritional benefit of natural microsupplements, why else except for commercial gain would research on BNPs already be reported since 1958? and their use against osteoporosis since 1971? Guanabens already reported BNP -associated long bone fracture in 1994 ; and he reviews the problem of vitamin D and phosphate deficiency related osteomalacia in a study a few months ago.
It is painfully obvious that synthetic drugs like BNPs that produce low bone turnover will cause brittle bones- osteomalacia, as Whyte reviewed in 2009. So why use such drugs, when all that patients need – if they cant take abundant sunshine and milk- is some balanced lowcost multisupplements. So it becomes increasingly negligent to promote, prescribe the synthetic drugs BNPs and SrRanelate, and high calcium-low vitamin D pills; and withhold balanced proven multisupplements.
Why do Regulators and so-called Expert Committees allow BNPs, SrRan and high calcium-low vitamin D pills (followed by expensive patents like synthetic designer HRT – xenohormones, and calcitonin and terapeptide ), to be the “most popular prescriptions” for osteoporosis (dictated largely by Big Pharma, and surgeons- gynecologists and orthopaedists – not metabolic nutrition-physiology-based endocrinologists and dieticians) – unless such authorities are in commercial cartel collusion with Big Pharma and the fracture industries against patients’ interests? Why are payors and the most vulnerable older women- patients and others- allowed to be fleeced, preyed on like this for profiteering by poor health?