The Better Bones Blog

by Dr. Susan Brown, PhD.

Can prunes reverse bone loss?

My friend and fellow osteoporosis researcher Dr. Bahram Arjmandi says yes, the humble prune can reverse bone loss, and his research data is looking strong. For more than a decade Dr. Arjmandi of Florida State University in Tallahassee has tested a wide variety of “functional foods” for their potential impact on bone health. He has studied soy, blueberries, strawberries, raisins, dates, and finally prunes. No other natural substance, he reports, comes near to having the bone-building effect of prunes. Further, when I saw him at the ASBMR international bone meeting last fall, he reported he had never seen any natural substance produce such consistent beneficial bone-building results.

prunes-5b1-5dDr. Arjmandi’s several successful animal and human studies document that special phenolic compounds in dried plums up-regulate growth factors linked to bone formation (such as IGF-1) and counter the activity of factors that inhibit bone formation (such as TNF-alpha). It probably also helps that prunes are one of the foods highest in antioxidants and also contain generous amounts of various key bone nutrients including potassium, boron, and copper. While Dr. Arjmandi has found other natural substances capable of halting bone loss, prunes were the only food found to actually restore lost bone.

This summer Dr. Arjmandi and colleagues will complete a landmark, controlled human clinical trial on prunes and bone health. For this study, 120 post-menopausal women have been taking either 100 grams of prunes (9-10 a day) or an equivalent portion of dried apples for one year. While it will be a few more months before all the research data is in, thus far 30 women in the prune group have had at least a 6% increase in hip bone, and one woman had an exceptional 11% increase consuming prunes over the year. Preliminary data from a segment of research subjects found that all prune-eaters showed at least some improvement in bone mass by six months into the study. [update on this study can be found here]

For several years I have heard Dr. Arjmandi speak of his prune research and read many of his research articles. It makes sense: if you could limit factors that hinder bone formation, such as inflammation and oxidative stress, and at the same time up-regulate new bone formation growth factors, and provide key bone nutrients, you could well accomplish the unthinkable and stimulate new bone formation with a simple, wholesome food substance.

At the Center for Better Bones, a group of us (including myself) are doing our own “prune experiment.” If you are inclined to join us, take Dr. Arjmandi’s advice and start slowly with a few prunes a day, working up to the full 9-10 over time. I have found soaked or stewed prunes are easier to digest, and Dr. Arjmandi has found that prunes do not lead to either weight gain or increased blood sugar levels. Also they should help build new bone in men as well as women.

 

References:

Arjmandi, BH et al. 2002. Dried plums improve indices of bone formation in postmenopausal women. Journal of Women’s Health & Gender-Based Medicine, 11:61-68.

Hooshmand, S and Arjmandi, BH. 2009. Viewpoint: Dried plum, an emerging functional food that may effectively improve bone health. Ageing Res Rev, Apr 8:122-7.

 

How often should a low-risk individual get a bone density test? Canadian authorities say only every 5 years.

If you are thinking that you should have a bone mineral density retest every year or two, you should know that Canadian osteoporosis authorities might disagree. Summer 2008 findings from the large Canadian Multicentre Osteoporosis Study led researchers to suggest that bone density testing in middle-aged and older adults can be delayed for intervals of up to five years in the absence of risk factors for bone loss, unless a therapeutic intervention is being monitored.

As the researchers report, while current guidelines recommend that measurements of bone density be repeated once every two or three years, their data suggest that, at this rate of testing, the average person would exhibit changes well below the margin of error. “Consequently … repeat measurements of bone density could be safely delayed for intervals of up to 5 years unless a therapeutic intervention is being monitored or there are additional clinical risk factors for bone loss, such as corticosteroid use.”

The study included 4,433 women and 1,935 men, and interestingly enough, bone loss was found to begin earlier in men—between 25 and 39 years of age. Bone loss in women appeared to begin between ages 40 and 44, with the greatest rate of decline between ages 50 and 54, followed by a slower decline. Then from age 70 onwards both women and men experienced another phase of accelerated bone loss.

And what about those at high risk for excessive bone loss and/or fracture?

We at the Center for Better Bones monitor high-risk individuals on our natural bone-building programs with regular bone resorption tests every six months or so and bone density testing at 2 to 3 year intervals.

For details on testing the success of your bone building program using bone resorption markers see my articles, Bone testing – assessing bone breakdown and bone loss, and Bone density testing.

Finally, if you wonder whether you are at high risk for osteoporosis, check into our interactive Bone Fracture Risk Assessment Questionnaire.

 

Reference:
Berger, C. et al. 2008. Change in bone mineral density as a function of age in women and men and association with use of anti-resorptive agents. CMAJ, 178(13):1660-8.

 

Oral alendronate (Fosamax®) use seriously increases the risk of severe dental complications

For some time now we have been hearing reports of strange jaw bone decay (osteonecrosis) associated with the use of Fosamax® and other bisphosphonate osteoporosis drugs including Actonel® and Boniva®. We have been told, however, that the risk of this frightful side effect (1) was extremely low (on the order of 1/1000 of a percent) and (2) involved those taking the bone drugs intravenously. As the dust clears and non-commercially financed studies are surfacing however, we see a different story. As recently reported by the University of Southern California Dental School in Los Angeles, the risk of jaw bone damage from oral bisphosphonate use is both real and significant.

This 2008 study looked at Dental School patients who were on, or had taken, Fosamax and who also were being treated for active osteonecrosis of the jaw (a “rotting” or death of jaw bone tissue). The study identified 208 patients with a history of Fosamax use and found that 4% of these had active osteonecrosis of the jaw. All osteonecrosis cases occurred after either simple tooth extraction or denture trauma that resulted in jawbone exposure. In 4% of all cases, the jaw was simply not able to heal itself from the trauma of tooth extraction or other injury. This is not an insignificant number and it is a far cry from the 1/1000 of a percent risk previously suggested by medical authorities. On the other hand, of the University’s 13,522 patients without a history of Fosamax use, 4,384 underwent tooth extraction without a single development of post-surgery jaw osteonecrosis.

From the Better Bones Perspective, this is not at all surprising. There are likely many mechanisms by which these osteoporosis drugs damage the self-repair capacity of bone. For one, the drugs greatly reduce not only the unwanted bone breakdown, but they also equally reduce the desired new bone build-up. This curtailing of bone renewal limits the self-repair, self-renewal process of bone breakdown and build-up. The development of “jaw rotting” after jaw bone trauma is one manifestation of this severe repair deficit.

 

Reference:

Sedghizadeh, PP, et al. 2009. Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: An institutional inquiry. J Am Dent Assoc, 140(1):61-66.


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