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Friday, October 02, 2009

Osteoporosis drug Forteo linked with bone cancer

BLACK BOX WARNING FOR FORTEO, a gentically engineered pharmaceutical
POTENTIAL RISK OF OSTEOSARCOMA: In male and female rats, teriparatide caused an increase in the incidence of osteosarcoma (a malignant bone tumor) that was dependent on dose and treatment duration. The effect was observed at systemic exposures to teriparatide ranging from 3 to 60 times the exposure in humans given a 20-mcg dose. Because of the uncertain relevance of the rat osteosarcoma finding to humans, prescribe FORTEO® only for patients for whom the potential benefits are considered to outweigh the potential risk. FORTEO should not be prescribed for patients who are at increased baseline risk for osteosarcoma (including those with Paget's disease of bone or unexplained elevations of alkaline phosphatase, pediatric and young adult patients with open epiphyses, or prior external beam or implant radiation therapy involving the skeleton)

Forteo, the drug that was found to cause a rare, serious bone cancer (osteosarcoma) in rodents, but drug proponents suggested such cancers would not occur in humans. But this week, there have been three reported cases of this rare bone cancer developing in people taking Forteo.

The most recent case was detailed in an abstract (# SU0345) presented at the annual meeting of the American Society for Bone Mineral Research in Denver, from which I just returned. This is the third case in the recent literature. The first case of osteosarcoma associated with Forteo use was published in the Journal of Bone Mineral Research in 2007 (JBMR vol. 22, p. 334), and a second case was published on-line in Osteoporosis International on the 14th of July, 2009.

What you can do to protect your bones-
It is a myth that calcium is the cure for prevention. The best prevention is regular weight-bearing exercise, an increased intake of vitamin D-3 (at least 2,000 IU a day, more if you live in northern latitudes and are a person of color or someone who does not go in the sun), vitamins K and C, magnesium, and a high intake of vegetables (especially leafy green and yellow vegetables). A study reported in the American Journal of Clinical Nutrition found that the best preventative against osteoporosis is a high intake of vegetables, both because of the high potassium content and the fact that a number of flavonoids in vegetables directly prevent calcium loss. In addition, avoiding a high intake of red meats is also essential.

Bone Health Testing - Better than DEXA and no radiation exposure
Bone Density Measurements: Most people think of bone density studies as involving special x-ray machines. In fact, better measurements can be obtained from blood tests. One of the best involves measurements of pyridinium crosslinks and deoxypridinoline (DPD).

Pyridinium is a substance found in both bone and cartilage and deoxypyridinoline is found predominantly in bone. High levels of DPD indicate osteoporosis when other bone disorders are not present.

Pyridinium is elevated in a number of conditions including osteoporosis, rheumatoid arthritis, osteoarthritis and chronic alcohol abuse. These tests are very valuable in following responses to treatments.

And when getting annual physicals, make sure to request a Phosphorus level so you can determine the Calcium-Phosphorus ratio. Years ago Phosphorus was removed from the metabolic panel by Medicare because they believed it to be a cost cutting measure and an unnecessary test.

You might also consider testing for vitamin D (25 OH test) and parathyroid hormone.

Thank you to Susan Brown PhD and Russell Blaylock MD for sharing some of the information in this post.


Lani said...

A few points to consider - DpD only indicates current bone loss. There are so many factors regarding bone loss - including; those who never gained peak bone mass for multiple reasons - eating disorders or simply not eating well during formative years. On occasion I work with patients who have advanced bone loss (one patient was breaking a bone once a month) for which Forteo makes sense - sometimes the benefits outweigh the risks. I only order the DpD and PtH - intact when the DEXA warrants further investigation such as a -2.5 T score (30% less than the average 35 y/o). While DEXAs are not perfect I have been working with this technology for 15 years and feel that in the right hands, it is a good tool. Most importantly, the nutritional advise that you talk about is right on. I am also excited about whole body vibration and I am researching it now for myself and for my patients. There is a lot to sort out here too - right frequency, amplitude etc. In the near future I will offer a free webinar on the topic and will have one of the top researchers on with me.

Bone is quite complex - I also feel that digestive disorders are at the root of many cases involving active bone loss.

I could go on but.....

PS - I have borderline osteoporosis, am 60 years old and still roller-skate


Lani Simpson, DC

herbalYODA said...

Actually DEXA is not the most informative test for bone health and it exposes people to radiation.
I'm almost 67 and have no signs of even bone thinning. I am a long time user of "lymphology" developed by Dr Samuel West which began as rebounding and I also use one of Dan Dial's Molecular Enhancers, and have just started with whole body vibration using a piece of equipment I purchased from West's son, Karl who is continuing the work. I also look at the range of factors in bone health and have done so for decades.
The problem with Forteo is that it is a fluoride based pharmaceutical that does not promote healthy bones like natural medicine do.
GUT health is important especially in the large intestine, nutrition and supplementation make a major difference as does having healthy fat in your diet.
Thanks for reading, and your comments, keep skating...