BONE HEALTH INNOVATION

Transcription

1 BONE HEALTH INNOVATION A revolutionary approach to joint health Esther Mills-Roberts, Nutritional Biochemist Not to be reproduced, either in full or part, without prior permission

2 SO WHY THE NEED? There are, on average, 206 bones in our body. Joints are a dynamic resource of minerals and vitamins, a nutritional back-up system in times of need, to support a pregnancy, and to literally prop us up. It gives us a backbone, a structure supporting muscles and ligaments, allowing movement and height and, well, the essence of who we are as people. So important is our joint system that it s made our way into common phrases; we walk tall, hold our head up high and can feel it in our bones. We owe it to our bodies to keep our joints as healthy as possible at every stage of life.

3 BUT WHERE ARE WE? For joint pain (knee, hip, hand and foot), a pharmacological approach is still dominant (poor uptake of lifestyle solutions; diet, exercise). BMC Musculoskeletal Disorders; London Vol. 19, (2018). Interesting findings: Age 45-54: 4.6% did aerobic exercise, 14.7% did muscle strengthening exercises, 7.1% dieted to lose weight, 34.2% used opioid pain killers. Age 65-74: 4.5% did aerobic exercise, 12.2% did muscle strengthening exercise, 11.4% dieted to lose weight, 43% used opioid pain killers.

4 BUT WHERE ARE WE? UK National Osteoporosis Guideline Group (NOGG), data from 2008, and reported in 2017 found that: 536,000 new fragility fractures occur each year: hip fractures, vertebral fractures, forearm fractures and fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures. More than one third of adult women and one in five men will sustain one or more fragility fractures in their lifetime.

5 NATIONAL LIFESTYLE GUIDELINES NOGG National guidelines for Osteoporosis: Increasing the level of physical activity, stopping smoking, reducing alcohol intake to 2 units/day, reducing the risk of falls and ensuring adequate dietary calcium intake and vitamin D status. Calcium: recommendation - between 700 and 1200 mg, through dietary intake. Supplementation for those whose dietary intakes are less than 700mg. Postmenopausal women and men 50 years who are at increased risk of fracture, a daily dose of 800 IU of Vitamin D cholecalciferol should be advised (Grade A recommendation).

6 HIDDEN CONSIDERATIONS Glucocorticoid medications Bone loss and increased fracture risk occur rapidly after initiation of glucocorticoid therapy and increase with the dose and duration of therapy. Adequate calcium intake should be achieved through dietary intake if possible, with the use of supplements if necessary. An adequate vitamin D status should be maintained, using supplements if required. Archives of Osteoporosis, 2017, vol. 12, no. 1, pp Alendronate/Alendronic acid side effect is gut disturbance. A nutritional approach, bearing in mind new research?

7 HIDDEN CONSIDERATIONS Alcohol: More than 3 units/day increases osteoporosis/fracture risk. Nutritional deficiencies: calcium, vitamin D, magnesium, protein (note that vitamin D deficiency may contribute to fracture risk through undermineralisation of bone.

8 Magnesium? EMERGING ADVICE Dietary magnesium has relevance for population prevention strategies for sarcopenia, osteoporosis, and fractures. Biobank Cohort: Middle aged men and women, Nutrients, vol. 9, no. 11, pp For sarcopenia: Protection from cytokine stimulation of osteoclast activity, or reduction of loss of muscle mass and strength. For osteoporosis, Mg can influence: osteoblast activity and calcium homeostasis through interactions between PTH and vitamin D. For skeletal muscle: maintenance of protein synthesis and turnover. Performance, though energy metabolism (production of ATP), transmembrane transport and muscle contraction/relaxation.

9 SUPPLEMENTARY APPROACHES Fish Oil s Glucosamine Sulphate MSM Turmeric Isoflavones/hormonal balancers Anti-inflammatory herbs Circulatory herbs Muscle supporters Connective tissue/collagen supporters Pain managers (CBD)

10 The microbiome: EMERGING ADVICE Intestinal microorganisms can disrupt the balance between bone formation and resorption by indirectly stimulating or inhibiting osteoblasts and osteoclasts. Intestinal microorganisms affect bone metabolism by regulating growth factors or altering bone immune status and can also alter the metabolism of serotonin, cortisol and sex hormones (affecting bone mass). The composition of the intestinal microbial flora, thus affecting bone health and also potentially helping to treat bone disease. Studying the relationship between intestinal flora and osteoblasts, osteoclasts, and bone marrow mesenchymal stem cells may provide a basis for preventing and treating bone diseases. Intractable & Rare Diseases Research, 2018, vol. 7, no. 3, pp

11 COLLAGEN Collagen fibrils in the joint caps of the knee. The collagen scaffold

12 THE SCIENCE BIT Type II collagen is the principal protein found in cartilage, and its small fibrils disposed in the proteoglycan matrix give strength and compressibility that allows absorption of impacts. The percentage of collagen found in the superficial layers of the articular cartilage reaches 80%. Deeper layers have around 65% of that protein in their structure.

13 PROVE IT! Autologous Collagen-induced Chondrogenesis

14 HOW? 2007 research. Oral hydrolysed collagen peptide supplementation. Proves efficacy via the oral route (ie, it is absorbed and gets to target cells). Shows regrowth of cartilage. Showed promising results for management of joint conditions using collagen.

15 FOR THOSE WHO PLAY SPORTS Osteochondral lesions caused by repetitive micro-trauma, acute trauma, especially to the knee year old salesman playing indoor football and running x 2/week with a sprained ankle 2 30 year old civil engineer and yachting athlete with knee pain.

16 CASE STUDY 1 43 year old salesman playing indoor football and running x 2/week with a sprained ankle Soft tissue oedema and ankle pain 10g/day bioactive collagen peptides No high impact sport Usual physio 16 months Pain free No further tissue damage Return to running and football

17 CASE STUDY 2 30 year old civil engineer and yachting athlete with knee pain. Patellar chondropathy 10g/day bioactive collagen peptides 1 month Usual physio Reduced exercise Lower knee pain At two months, symptomfree, painfree and yachting again