Talk:Osteoporosis/Archive 1

What is osteophysis?

Not an accepted medical term, unless you count German. Google has been spammed by a German-language website, so I had great trouble determining whether this is actually a clinical entity. Unless you can provide some support, I have removed the link. At any rate, it redirected to this article! JFW | T@lk 18:05, 3 Nov 2004 (UTC)

History

This page needs a history section in line with other disease pages. I will try and research something - but others may know a lot more.

Benjaminstewart05 19:03, 2 May 2006 (UTC)

Strontium ranelate

This section seems to be somewhat biased and pro-strontium, which is a comparatively new treatment option. With regards to efficacy, this treatment has not been shown to be superior to PTH1-34, nor bisphosphonates. Also, no long term data is available for strontium, as compared with a drug such as Fosamax, which has 10 year data.

Also, as far as I'm aware, the mechanistic information on Strontium being pro-osteoblastic and anti-osteoclastic comes from some fairly weak cell culture studies. I'm always hesitant to jump to conclusions about in vivo mechanism based on in vitro data.

Note: I am a medical researcher and not a drug company spokesperson.

Above posted by User:[email protected] 09:29, 8 May 2006

When faced with perceived bias, please do not just insert a {{POV}} tag and then walk away. This is not constructive. You are obviously in possession of the studies that are relevant here. Could you share these with us? JFW | T@lk 11:40, 8 May 2006 (UTC)

---

REGARDING MECHANISM:

The in vitro studies I was referring to are:

Canalis E, Hott M, Deloffre P, Tsouderos Y, Marie PJ. The divalent strontium salt S12911 enhances bone cell replication and bone formation in vitro. Bone. 1996;18:517–523.

Takahashi N, Sasaki T, Tsouderos Y, Suda T. S12911-2 inhibits osteoclastic bone resorption in vitro. J Bone Miner Res. 2003;18: 1082–1087.

There is a publication in press (e-pub) that indicates that this may hold true in mice. I must admit that I haven't read this publication critically, as I only just noticed it while searching for the original references.

Marie PJ. Strontium ranelate: a physiological approach for optimizing bone formation and resorption. Bone. 2006 Feb;38(2 Suppl 1):S10-4. Epub 2006 Jan 24.

REGARDING EFFICACY:

This is a useful review discussing the current status of the clinical trials on Strontium. In summary, the SOTI and TROPOS studies showed significant increases in spine and hip fractures, even if these studies have minor criticisms in the following review regarding their study design.

Burlet N, Reginster JY. Strontium ranelate: the first dual acting treatment for postmenopausal osteoporosis. Clin Orthop Relat Res. 2006 Feb;443:55-60.

Compared to meta-analysis of bisphosphonates (of which there is a lot more data), you see that BPs give a similar if not better result (tests for statistical significance have been carried out).

Nguyen ND, Eisman JA, Nguyen TV. Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials. J Bone Miner Res. 2006 Feb;21(2):340-9.

Aaron 22:49, 8 May 2006 (UTC)

So how about choosing the most representative studies for citation in the article. I think the Nguyen cite is a fantastic choice when it comes to providing a WP:CITE for the efficacy of BPs. There is no problem with saying "strontium ranelate has been demostrated to both increase bone deposition and decrease bone turnover, but these results are from laboratory studies only". It would be better still if that statement could be traced to a recent systematic review, to round off the assessment of therapeutic modalities for osteoporosis.

Aaron, with your background it may be possible to massively improve the quality of this article. Do you think you could make such a commitment? I'll be available for help at any stage. JFW | T@lk 11:47, 9 May 2006 (UTC)

I think it was sad and shows ignorance about the latest findings in strontium research that the owner of this page choose to remove my wife's well-researched blog on strontium for osteoporosis. Her blog at http://strontiumforbones.blogspot.com was designed to inform visitors about strontium and to let patients know about the strontium citrate alternative. Her DexaScan result is approaching normal while she almost died taking Fosamax. It's time that physicians and patients get all the information and not your biased views. —Preceding unsigned comment added by Werewolfking (talk • contribs) 21:12, 23 April 2008 (UTC)

Perhaps it might be an idea to add Strontium based treatments to a section with Xylitol, as treatments which either require more research, or people to find further references? MrAnderson7 (talk) 03:58, 6 February 2009 (UTC)

factors

'Social pressure' is a factor which affects bone density. Also, a new technique is being marketed which is an adaptation of diabetes mellitus injection techniques. The mere suggestion that diabetes (social pressure from shunting) has similar causes to osteoporosis (social pressure from inclusion) has put the new injection technique into the hands of those affected. beadtot 6/6/2006 02:19, 7 June 2006 (UTC)

Risk factors of osteoporosis

Dino Hsu 13:52, 21 June 2006 (UTC) I am not an expert, but a fan of wiki, I wish wiki could provide an objective and balanced point of view, so please check John Robbins' arguments that high protein levels from animal and dairy diets is the major risk factor of osteoporosis, there are extensive discussion on newsgroup since 1996, but I will quote this one:

http://groups.google.com.tw/group/alt.support.thyroid/browse_thread/thread/2c921cd4a42cd818/331e1014de38829d?lnk=st&q=john+osteoporosis&rnum=3&hl=zh-TW#331e1014de38829d

"Osteoporosis is not first a disease of calcium deficiency. It is a disease of excess protein. Animal and dairy products are full of sulfur-rich proteins. Sulfur makes extra acid in the body; as acids wash through the bones, they dissolve calcium, which is then eliminated through the urine. This only happens with animal protein and it has a name: protein-induced hypercalciuria, which means too much calcium going out in the urine. There's no doubt that the findings reported by Drs. Lindsay Oddoye, and Margen in the American Journal of Clinical Nutrition are true: "High protein diets cause a negative calcium balance, even in the presence of more than adequate dietary calcium. Osteoporosis would seem to e an inevitable outcome of continued consumption of a high protein diet" ** Even calcium tablets and daily doses of milk cannot keep up with the calcium lost to excess protein ..."*** Dino Hsu 13:52, 21 June 2006 (UTC)

The evidence to support the idea of a link between high animal protein intake and osteoporosis is very tenuous. In fact, there is just as much epidemiological evidence to support the contrary view. Rather than trade contradictory studies, however, let's just look at whether this is a plausible theory. Osteoporosis results from an inbalance between osteoblast and osteoclast activity. These cells either create (osteoblasts) or break down (osteoclasts) the protein content of bone. They are normally in harmonic balance, allowing regular turnover of bone, without undermining its structure or function. In postmemopausal osteoporosis, osteoclast activity increases, resulting in a net bone loss. Without a protein matrix to cling to, calcium phosphate is lost and the bone strength decreases. Simply replacing calcium does very little, as there is no coherent structure for it to adhere to. Bisphosphonates partially block the osteoclast activity, allowing normal bone structure to be restored, at least in part. In steroid-induced osteoporosis, it is a reduction in osteoblast activity that is to blame, although the end result would be the same. These facts have been clearly demonstrated from bone biopsy studies.

If the problem was simply a reduction in availability of calcium - whether caused by dietary problems or a specific disease process - the result would be an inadequately calcified but otherwise normal protein structure in the bone. This is an entirely different condition called osteomalacia, which has only superficial resemblances to osteoporosis. The animal fat hypothesis is therefore a complete red herring in this context. Jbelsey 15:35, 6 October 2006 (UTC)

Why has no one mentioned the high risk of those who suffer from anorexia nervosa and bulemia nervosa

Dear Jbelsey, According to your explanation, osteoporosis results from an inbalance between osteoblast and osteoclast activities, this is quite comprehensive. However, you seem to imply the availability of calcium is not so relevant to osteoporosis, if at all? This is somewhat contrary to common understandings; even from the current wiki page, we can see 29 occurences of "calcium". Besides, you seem to negate both the pro side and the con side of the debate about whether "milk and dairy product is the main cause of osteoporosis" because calcium level is not relevant in the first place. Please clarify, thanks.

I've read around this issue a little bit and find it very plausible. I dont see why the arguement that the protien structure is also low says the animal protien theory is a red herring, because the body tends to catabolise any excesses in the body, so if the calcium were lower than the protien structures in the body, would the excess protien not be catabolised to show the normal protien/calcium ratio on biopsy anyway? Its not saying that calcium is not a factor in osteoperosis, it is merely saying that the compounds in animal protien do two things that decrease the rate that calcium can be layed down in the bone. The first is that increase animal protien decrease blood plasma pH. This lowered pH is picked up in the parathyroid gland which releases PTH (Parathyroid Hormone) which pull calcium out of the bone to buffer the blood and so raise the blood pH back to physiological normal (7.4?). The second is that the increase protien intake strains the kidneys and allows for greater electrolite loss in the urine (ie. Calcium). It makes sence, and explains why countries with low calcium intake often have a lower rate of bone fractures, because alot of these countries may have a lower intake of animal protiens, or protien in general. somebody implied that there is epidemiological research that says protien intake doesn't have an effect on bone density. If you, or anyone else knows of any references, I would love to see them, because osteoperosis is a subject that comes up often in my line of work. I'd like to clarify all this if possible. Its just so hard to believe that it could be so simple as lowering protien intake. If anyone wants any references, just shout and I'll put them up ...BlackDice572 (talk) 15:57, 18 November 2008 (UTC)

coeliacs

I have inserted reference to coeliacs in risk factors, as it seems to be such a key determinant, not least because of its prelevance (around one in a hundred) at least in the West, and possibly everywhere. wikwobble

prevention?

Can someone put up something on prevention of osteoporosis? I would do it myself, but I no virtually nothing on this subject aside from the fact that it isn't good XD. --Gotmesomepants 01:26, 29 July 2006 (UTC)

I agree, this article is lacking a prevention section. I'll add some stuff later when I have time. --Drenched 22:17, 15 March 2007 (UTC)

In the Prevention/Neutrition/Vitamin D paragraph, the percentage increases should be included, i.e., "... increae bone density by 1% ... increase formation of kidney stones by 17%." GetItRightAlready (talk) 19:14, 27 July 2009 (UTC)GetItRightAlready (talk) 19:19, 27 July 2009 (UTC)

BP and ONJ

I agree with Davidruben that ONJ and bisphosphosphonate discussion is best left to the BP page.Dr Aaron 09:49, 1 October 2006 (UTC)

Oral osteoporosis medications (specifically bisphosphonates) now appear to reduce the risk of jaw degredation Havard —Preceding unsigned comment added by Sgwiki92 (talk • contribs) 03:57, 13 January 2008 (UTC)

Cathepsin K blockers

Should there be a mention of cathepsin K blockers (AAE581, Balicatib - Novartis)? The phase II results appear to be positive, also for subjects not in the "postmenopausal women" category. A few references can be found at the bottom of: [1]

Sun

It was on the news today that exposure to sunlight boosts vitamin D and may help relieve osteoperosis, should this be included somewhere?

That is not news, see rickets and osteomalacia. JFW | T@lk 06:23, 26 June 2007 (UTC)

Drugs

PPAR ligands and now SSRIs[2] have been linked with reduced bone density. JFW | T@lk 06:23, 26 June 2007 (UTC)

high risk of falls or recurrent falls --> osteoporosis?

In the Risks-section of osteoporosis, this claim was included:

• high risk of falls or recurrent falls

I, perhaps, temporarily moved that claim to here, because I think it needs discussion. Fractures, when they've already occured, actually strengthen the bones, preventing a fracture to occur again. When a bone heals after a fracture, that connection is the strongest part of the bone. I agree that a lifestyle with a lot of bone-breaking can be irritable, but actually it prevents osteoporosis, so if that person would return to a normal lifestyle, fewer fractures would probably occur compared with other people. In short, high risk of falls or recurrent falls increase the risk of fracture, but decrease the risk of osteoporosis. Mikael Häggström 09:50, 3 July 2007 (UTC)

Solved! At another place at risk factors, this is seen:

Estrogen deficiency following menopause is correlated with a rapid reduction in BMD. This, plus the increased risk of falling associated with aging, leads to fractures of the wrist, spine and hip.

Thus, it wasn't refering to osteoporosis, but to the fractures following it.Mikael Häggström 10:17, 3 July 2007 (UTC)

Hip protectors are rubbish

JAMA JFW | T@lk 23:24, 24 July 2007 (UTC)

Formatting

There is some pretty non-standard formatting in this article. Some lists can be improved by removing the indented commentary, or turning them into prose. Use of the non-TOC header (prefixed with ";") should be encouraged for content more than 4 levels deep (====Header====), before the article turns into a quagmire. JFW | T@lk 07:17, 23 September 2007 (UTC)

Hypercortisolism

A new Ann Intern Med study (PMID 17938392) shows that in patients in whom secondary osteoporosis had been excluded by standard criteria, there was a substantial number (10%) in whom there was subtle hypercortisolism on dexamethasone suppression testing. This may warrant inclusion - I suspect some HMOs are going to insist on all patients with osteoporosis being screened for subclinical Cushing's due to its associated diabetes/obesity/hypertension/general mayhem risk. JFW | T@lk 17:15, 16 October 2007 (UTC)

Relative efficacy of drugs

Meta-analysis shows they're all pretty much the same, or at least superiority cannot be demonstrated. JFW | T@lk 14:09, 18 December 2007 (UTC)

Bone building

doi:10.1172/JCI33612 - review on anabolic treatments. JFW | T@lk 11:20, 3 February 2008 (UTC)

DOI doesn't work, try PMC 2214701 now. JFW | T@lk 20:02, 27 February 2008 (UTC)

Agenda for MCOTW

This article is now WP:MCOTW. It is already pretty comprehensive in terms of content, sources, and related articles. I think the aim of the collaboration should be to improve it to WP:GA status. I thought the following issues should be addressed:

• We need more sources for the numerous risk factors for osteoporosis, e.g. the numerous endocrinopathies, dietary/lifestyle issues.
• We need images, e.g. an X-ray of vertebral fracture, fractured neck of femur, a microphoto of porous bone vs normal bone.
• We need quality of life studies to emphasise the impact of chronic pain due to vertebral fracture.
• Which interventions are actually proven to attenuate fracture risk? There are numerous studies showing an increase in BMD, but does this translate to better bone that doesn't break? People want to know.
• I am sure there are other things.

I hope to do some work on this one. JFW | T@lk 20:07, 27 February 2008 (UTC)

Images

Well, my list of potential images isn't ideal, but it's a start:

• The images here can be "freely used for educational purposes," which I think reasonably includes Wikipedia.

• This link has some interesting images (1996), but STR out of Lawrence Livermore is technically a UC (state university) publication, instead of a US (federal) publication, which means that the copyright is complicated to figure out: May be free, may not be free, may be possible to get permission.

• JPL offers a "no copyright" paper with a pic of an AccuDEXA machine at this link.

• Also, it seems like this major report by the US Surgeon General should have useful images, but the couple that I looked at are reprinted-by-permission images. If we particularly like them, then perhaps we could get permission. (Or perhaps others will be found that are actually free.)

Hope this helps, WhatamIdoing (talk) 22:23, 27 February 2008 (UTC)

As a radiographer I may be able to get some images demonstrating Osteoporosis although it is more common to see the results of it on an x-ray (ie. a fracture). Is this suitable? Heather 15:50, 28 February 2008 (UTC)Glitzy_queen00

Yeah, give us #NOF, Colles', vertebral fractures! JFW | T@lk 15:30, 18 March 2008 (UTC)

T-score

I wonder whether the "T-score -2.5 or below is osteoporosis" qualification shouldn't be changed to "T-score -2.5 or above is osteoporosis". It fits into the logic "higher score=higher risk/probability/certainty of OP occurence" but being not a doctor, I leave the article as is for editing by people more knowledgeable on the subject. KG

No, the T score reflects the bone mineral density, and the lower the score the lower the bone mineral density and the higher the risk of fracture. The actual unit for both the T- and the Z-score is standard deviations, as BMD sits on a Gaussian curve. JFW | T@lk 15:30, 18 March 2008 (UTC)

LDL-related protein 5

We will need to mention LRP5 polymorphisms now: http://jama.ama-assn.org/cgi/content/abstract/299/11/1277 JFW | T@lk 15:30, 18 March 2008 (UTC)

Hyperbaric Oxygen Therapy?

Can any one tell me if there is any truth in the idea that Hyperbaric Oxygen Therapy can be beneficial? —Preceding unsigned comment added by 58.172.176.248 (talk) 10:20, 30 March 2008 (UTC)

Try Google. Osteoporosis is a chronic condition; are you suggesting people should live in a hyperbaric environment continuously? JFW | T@lk 16:17, 31 March 2008 (UTC)

Blaming Merck

John Broughton (talk · contribs) added a paragraph on Merck being to blame for the overdiagnosis and overtreatment of osteoporosis. The source is an opinion article by Sharon Brownlee, who has apparently written a book about this but does not exonerate her from citing sources for the allegation that Merck had a hand in setting the T-score cutoffs and doctors buying DEXA machines. To be sure, the T-score cutoffs were introduced before Fosamax was approved. JFW | T@lk 16:17, 31 March 2008 (UTC)

I have added the paragraph back to the article. As for the source: "Sharon Brownlee writes stories and essays about medicine, health and biotechnology for Atlantic Monthly, New York Times Magazine, New Republic, and Time. A senior fellow now at the New America Foundation ... [3].

Note that I am not citing her opinion about things - I'm simply citing facts that she included in what she wrote. As for Brownlee's failure to cite sources, this does not disqualify what she says - she is an expert, and nothing about WP:RS says that a reliable source must in turn cite its sources.

Jfdwolff said "T-score cutoffs were introduced before Fosamax was approved." I've reworded the article to make it clear that the panel that set the definition of osteoporosis did not act after Fosamax was approved. As many editors may know, the drug approval process is a long one; it is entirely consistent with that long process for a drug maker to be working on things that will improve sales once the drug is finally formally approved.

Also note that I did not in any way use the words "overdiagnosis" or "overtreatment", or discuss "blame" for these matters (if in fact they are the case).

I will certainly be agreeable to modification or removal of this information should anyone provide sourced information that contradicts it. At the moment, however, it fills a missing gap in the article (how and when osteoporosis was formally defined in terms of bone density), it is factual information provided by an expert; and it is published in a reputable newspaper. -- John Broughton (♫♫) 17:54, 31 March 2008 (UTC)

I am suggesting that Browlee's article is an opinion piece rather than a statement of fact. The entire tenor of that article is of malice by "big pharma" (or at least disease mongering, a neologism that describes the situating she writes of). Given that it is an opinion piece that merely alludes to the possibility of an industry-perpetuated scam, I am really not sure whether it constitutes a reliable source.

Thank you for adding the densitometry article. That is very helpful. JFW | T@lk 20:15, 31 March 2008 (UTC)

Densitometry was in routine clinical use well before 1995, see PMC 1663786 JFW | T@lk 20:32, 31 March 2008 (UTC)

You have not responded to the issue of whether Brownlee can be considered an expert or not, so I'm assuming that she can be. As such, I quote from WP:V: Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. However, caution should be exercised when using such sources: if the information in question is really worth reporting, someone else is likely to have done so.

I intend to revise the information I posted to include a number of other (clearly news) sources, but there are a few items in Brownlee's piece - facts - that I think are worth including, and which - while they may have been published elsewhere - I'm not inclined to do a long and exhaustive search for.

If there is a policy or guideline within Wikipedia that says that facts mentioned in opinion pieces cannot be used in articles, I would appreciate your pointing that out. -- John Broughton (♫♫) 22:55, 31 March 2008 (UTC)

Also, regarding Densitometry was in routine clinical use well before 1995, I certainly don't disagree - and I hope nothing I put in the article said otherwise. (If I did, I'd appreciate someone pointing it out.) Rather, the point is the volume of testing of bone density rose sharply after osteoporosis was redefined (in 1992) as a condition that could (and should) be measured prior to people falling and breaking a bone. That increased volume would clearly require more machines, and Brownlee is simply saying (as I read her) that Merck help finance those new machines. Or is there evidence that the number of bone density scanning machines did not change substantially between (say) 1992 and 2002? (I'd be astonished if that were so.) -- John Broughton (♫♫) 23:04, 31 March 2008 (UTC)

It's not that Brownlee can't be considered a reliable source in the ordinary sense; it's that extraordinary (or controversial) claims require extraordinary (and uncontroversial) sources. Additionally, I'm sure you will agree that we should normally use the best available source, and that this can't be considered the best possible source. WhatamIdoing (talk) 02:28, 1 April 2008 (UTC)

I don't find the "extraordinary claims" issue to be on point - I put nothing into the article that could be considered a "claim". As for "best sources", I also don't accept that proposal - Wikipedia requires acceptable sources (reliable sources), not "best" sources. If "best sources" were required, we could argue all day about whether better sources existed (somewhere), continuing to reject anything that didn't meet this hypothetical standard.

Having said that, I have in fact found better sources without much difficulty, and hope to have some time to add information to the article in the near future. -- John Broughton (♫♫) 12:54, 4 April 2008 (UTC)

You are essentially saying that there is a grand conspiracy of disease mongering which implicates the WHO, Merck and the health systems of several nations. For such a claim, one needs more than just speculation. JFW | T@lk 05:47, 6 May 2008 (UTC)

Men

NEJM clinical practice article http://content.nejm.org/cgi/content/short/358/14/1474 JFW | T@lk 14:44, 6 April 2008 (UTC)

doi:10.1056/NEJMoa0801197 - multiple genetic loci found. Three in known regions: RANKL, osteoprotegerin and estrogen receptor 1, and two novel ones in ZBTB40 and MHC. JFW | T@lk 08:16, 30 April 2008 (UTC)

Comparative efficacy of treatments for preventing non-vertebral fracture: http://www.annals.org/cgi/content/abstract/148/9/637 (how many reviews can the Annals publish about this?) JFW | T@lk 05:47, 6 May 2008 (UTC)

Physical activity and risk

In the risks section of the article. There is a paragraph explaining the effects of insufficient/excess activity. Both have no citations. From what I've looked at the there is evidence that physical activity is related with higher bone density. But I haven't found anything solid about the excess activity's effect.

If anyone has any sources of info related to this please tell me. Otherwise, i think we might have to cut down on (not eliminate) the paragraph on excess activity's effect. Ziphon (talk) 03:54, 11 May 2008 (UTC)

• I've found "In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%"

on [4] and [5].How reliable are these sources? Ziphon (talk) 04:27, 11 May 2008 (UTC)

The problem with excessive exercise is that it leads to amenorrhoea and hence markedly reduced oestrogen levels. This, coupled with the low body weight of many athletes, is probably at the basis of this risk. This distinction needs to be clarified in the article. JFW | T@lk 10:00, 11 May 2008 (UTC)

In the Treatment section there is a subsections Mechanical Stimulation with two headlines: Exercise and Low Level Mechanical Signals. The papers referenced in there show the benefits of exercise. I had actually entered a third headline, Whole Body Vibration Exercise, which is nothing else than Low Level Mechanical Signals performed at one order of magnitude higher intensity. It had its peer-reviewed referenced paper, but somebody took it out deciding there was not enough evidence.

Diseases associated with osteoperosis

There's a huge list of diseases associated with osteoperosis in the article most of them are uncited. I was wondering how the citation process is going to work. Do we add a intext citation after each disease?

Ziphon (talk) 05:08, 11 May 2008 (UTC)

Actually, I expanded that list based on reference 16 (Simonelli C, ICSI). That reference mentions all those conditions, so they are not uncited. We could add extra references in-line but I wouldn't add {{fact}} tags because that reference lists all of them. I found that reference while reading some review, I think. --Steven Fruitsmaak (Reply) 09:18, 11 May 2008 (UTC)

Thanks mate, for telling me that (saved me heaps of time looking for a source :) ). The next question is do we have to add a reference for each disease? Otherwise we can remove the "this section needs references etc." sign.

Ziphon (talk) 10:06, 11 May 2008 (UTC)

Lifestyle risk factors

Do we really need a citation to say that smoking cessation and moderation of alcohol intake are commonly recommended. We already have citations to highlight that it is a modifiable risk factor. I don't see how we can find a reference somehow showing doctors are commonly recommend this. Should we be perhaps citing guidelines(but this will vary from country to country) or is no reference required. Or am i just thinking too much. :P Ziphon (^ALL_ears) 13:14, 13 June 2008 (UTC)

Vibration Exercise vs Low Level Mechanical Signals

I had entered a subsection Vibration Exercise, with its own referenced study supporting it, but somebody immediately deleted it writing that it appears experimental. In reality it is the same type of treatment described in the next sub-section titled Low Level Mechanical Signals, with the only difference that Vibration Exercise employs stronger vibration amplitudes, and delivers stronger results. Why, if one subsections on the same theme is allowed, another one is not? I had referenced one research paper, and there are several more that have been published showing the same results. By eliminating the entry, one is sticking its head in the sand like an ostrich, doing a disservice to Wikipedia. It seems to me that this process of removal is somewhat arbitrary, or that there are double standards. —Preceding unsigned comment added by Gciriani (talk • contribs) 22:10, 17 June 2008 (UTC)

My concern was that there seems to be little evidence that it actually prevents fractures. JFW | T@lk 07:13, 18 June 2008 (UTC)

Have you read the peer-reviewed article about the study, which I referenced? It is published in one one of the most authoritative journals writing about bones. What is your qualification? Are you one of the peers who approved the article and now are having second thoughts? Or did you just arbitrarily decide that even though there was enough evidence for the peer-reviewer, there was not enough evidence for you? The study clearly shows an increase in BMD compared to a control group and a group performing resistance exercise. My entry only mentioned increased BMD. I do not understand why you would delete my entry and leave the following one, which refers the same type of treatment, only with different modalities.

Please let me know the criteria for inclusion (logical please and not arbitrary, and no double standards please), so that I may try to meet them. Gciriani (talk) 12:40, 18 June 2008 (UTC)

Incidence by Race

Aren't the reference populations used in bone densitometry different for black and non-black people? The document from WHO [6] cited as a reference states that being an asian or caucasian is an endogenous risk factor. It seems, therefore, that osteoporosis incidence among black people is much lower. Why isn't this mentioned in the article? —Preceding unsigned comment added by 194.65.5.235 (talk) 16:58, 22 August 2008 (UTC)

Sounds reasonable. Go ahead, WP:BOLD. JFW | T@lk 00:24, 26 August 2008 (UTC)

Bisphosphonates - Manufacturer-Supported Study

The manufacturer-supported study seems experimental, not confirmed and only a suggestion. I recommend deleting the paragraph.--Gciriani (talk) 13:33, 29 September 2008 (UTC)

Not sure which paragraph you are referring to, but if a study is cited in all national professional guidelines then clearly they have decided that whatever drawbacks there are, the data are useful for clinical practice.

The same cannot be said about the modalities you told us about previously. JFW | T@lk 16:06, 29 September 2008 (UTC)

I was referring to the section Treatment, subsection Medication, sub-subsection Bisphosphonates, second paragraph

A 2007 manufacturer-supported study suggested that in patients who had suffered a low-impact hip fracture, annual infusion of 5 mg zoledronic acid reduced risk of any fracture by 35% (from 13.9 to 8.6%), vertebral fracture risk from 3.8% to 1.7% and non-vertebral fracture risk from 10.7% to 7.6%. This study also found a mortality benefit: after 1.9 years, 9.6% of the study group (as opposed to 13.3% of the control group) had died of any cause, indicating a mortality benefit of 28%.

--Gciriani (talk) 18:21, 29 September 2008 (UTC)

I don't see why it should be removed. This was published in the New England Journal of Medicine, and I can assure you that it will be incorporated into clinical practice guidelines fairly switftly. This is the first time that bisphosphonate treatment has been shown to improve mortality, so the study is quite relevant to the reader. JFW | T@lk 21:21, 1 October 2008 (UTC)

Poorly Phrased

Several sentences are poorly phrased, making understanding difficult. For instance, what does the following mean?

• Osteoporosis can be prevented with lifestyle advice and sometimes medication, and in people with osteoporosis treatment may involve lifestyle advice, preventing falls and medication.

What does involve lifestyle advice mean? I don't think that the advice prevents osteoporosis. It is probably the lifestyle change that prevents it or treats it.

Another recent entry proposed lack of calcium as a statement at the end of the main section. It was deleted as Not adding to the entry. Well, if it is not correct I agree to deleted. But if it merely summarizes the disease, in a shorter sentence, it should propelled to the top, and not erased because it does not add to the article. I think that if something simplifies a subject should stay there. Again, I do not know if it is a correct statement, but who deleted it, implied that the sentence was correct. This is an encyclopedia and the lay user should be the first one served; more specialized communities should be served after.--Gciriani (talk) 19:18, 9 October 2008 (UTC)

Lifestyle advice in people with osteoporosis includes dietary advice to increase calcium and vitamin D intake, as well as possibly increasing sunlight exposure. Perhaps you could rephrase the sentence yourself; you may be correct in the sense that advice only prevents osteoporosis if implemented.

The problem with the "lack of calcium" comment was that it stated that lack of calcium was the "most important cause". I'm sure you agree that menopause, lack of weight-bearing exercise, genetics and vitamin D deficiency are probably more important, as the Western diet is pretty calcium replete. JFW | T@lk 21:28, 9 October 2008 (UTC)

Editing Etiquette

Hello fellas, replacing whole sections, with new sections in which only a few words have changed, makes it very difficult to understand what changed. One then has to compare both old and new section word by word. I understand it's easier for you to cut the whole section, make a few changes in your word processors, and then paste back the whole section. However, this is not about you, but about collaboration of many individuals. Correct only the words you need to correct please, it will be much easier for the rest of us.  :-) --Gciriani (talk) 01:46, 10 December 2008 (UTC)

See Help:Page history and Help:Diff. This will hopefully sort you out. JFW | T@lk 22:33, 10 December 2008 (UTC)

I failed to make myself clear. That's exactly what I'm talking about, doing the the Difference comparison between to subsequent edits, doesn't help much if the person who edited last has replaced the whole section by cutting the whole section, editing with a word processor a few words, and then pasting back the whole. Let me give you an example. Compare Jdwolff's editing 22:43, 8 December 2008 Jfdwolff, with the previous one. Although only a one-line sentence has been deleted, It looks like the whole sections has changed. Try it for yourself on the attached thumbnail image. If you are not the author of the change, you have to painstakingly compare each column word by word. To add insult to injury, in the example I gave, because of the length of the section, one has to keep scrolling up and down, finding out at the end that only a tiny part had been replaced.

Difficult to compare Editing

Eventually one realizes that the author needed to delete just one line, but to make it easier on him/herself elected to delete and replace the whole section. Unfortunately this makes revision by peers much more difficult. I hope this made it clear that the practice of cut and and paste makes it difficult for everybody else (except the author :-) ).--Gciriani (talk) 16:05, 13 December 2008 (UTC)

This is a problem that is not restricted to this article. I suggest you take this topic to the help desk. I understand the problem you are having. I use WikEd (can be activated through preferences for better diffs. JFW | T@lk 01:19, 14 December 2008 (UTC)

Thanks for letting me know about WikEd, it’s neat! Though, I do not understand what WikEd has to do with this issue. Well, I see it works even with Google reader which solves my problem I guess. :-) --Gciriani (talk) 00:21, 19 December 2008 (UTC)

Xylitol and osteoporosis

I removed a section on xylitol added by MrAnderson7 (talk · contribs). Although I'm known myself to add research articles, these studies in rats are primary sources and don't merit inclusion in a general article on osteoporosis, imho. Perhaps if we had Treatments under investigation for osteoporosis. --Steven Fruitsmaak (Reply) 13:05, 6 February 2009 (UTC) P.S.: See WP:MEDRS for a discussion on primary and secondary sources (basically, we prefer reviews over benchwork).

Sounds good to me. I didn't have enough time to find better references, so just put the edit in with the rat tests. I'm sure somebody out there has appropriate references for inclusion of the edit? MrAnderson7 (talk) 21:35, 8 February 2009 (UTC)

Basically, there are multiple papers by the Finnish group on xylitol in rats, but I found no studies in humans. I think it's too early to include this. --Steven Fruitsmaak (Reply) 21:57, 8 February 2009 (UTC)

Bananas cause osteoporosis?

This is the first time I've read of bananas causing osteoporosis (mentioned in the beginning of the article), but there's no citation to a journal or anything. A quick google search on the words osteoporosis bananas seems to indicate that bananas do the opposite due to the potassium content. Should that portion be removed if a citation cannot be produced?

201.198.113.130 (talk) 23:50, 31 March 2009 (UTC)

It was random vandalism. Potassium has very little impact on bone metabolism. JFW | T@lk 05:59, 1 April 2009 (UTC)

Genetics

Of the 150 candidate genes, only 9 are associated with BMD and of these only 4 with fracture. http://www.annals.org/cgi/content/abstract/151/8/528 JFW | T@lk 16:09, 20 October 2009 (UTC)

Biomarkers

Although the current information on this page regarding techniques and tools for diagnosis of osteoporosis is thorough and accurate, it lacks any information on chemical biomarkers as a means to detect osteoporosis in individuals. There is a wealth of peer-reviewed articles on the subject and biomarkers are being increasingly used as a way to diagnose osteoporosis, and so I added a small section with a couple of examples under "diagnosis." Hope y'all dig it! —Preceding unsigned comment added by Keithkal (talk • contribs) 12:41, 1 May 2011 (UTC)

I agree that these need to be mentioned, but I don't think any of the biomarkers have a ROC that is sufficient for them to come close to becoming a gold standard. In fact, neither the diagnostic criteria nor common risk calculators such as FRAX rely on biomarkers. JFW | T@lk 19:36, 1 May 2011 (UTC)

Reference list

Ref. No. 42 is cited with regard to Diabetes mellitus (type 1 and 11) being risk factors for osteoporosis. Having read that article in detail it makes no mention of any form of diabetes, so either than paragraph needs to be updated, or another source found. — Preceding unsigned comment added by 131.203.241.98 (talk) 01:59, 28 November 2014 (UTC)

Source for my bit about magnesium

I have just added a bit on magnesium as needed to prevent osteoporosis. Before any one says this is not cited, here is a source for this information:

http://nutritionalmagnesium.com/research/bone-health/159-magnesium-effective-in-treatment-of-osteoporosis.html

Any one good at in-line citations may wish to add this into the article. ACEOREVIVED (talk) 10:43, 9 May 2012 (UTC)

Are there any better refs. This one is a little old and unfortunate. I have removed the text until refs are found. --Doc James (talk · contribs ·

email) 14:34, 9 May 2012 (UTC)

How about this reference:

http://www.jacn.org/content/28/Supplement_1/82S.full

At least this one cites references, including three from the The_Lancet! ACEOREVIVED (talk) 19:57, 15 May 2012 (UTC)

You can see that this is a reference to a journal article in the "American Journal of Clinical Nutrition". A high Google search under "Scholarly articles" after one types in "bone health" and "Magnesium" is:

http://www.jacn.org/content/28/Supplement_1/82S.full

which, as you can see, is the same website address. ACEOREVIVED (talk) 21:09, 15 May 2012 (UTC)

Any advice about this website? It is fairly up-to-date, but I am not sure how scholarly it is:

http://www.naturalcalm.ca/osteoporosis-and-magnesium.html

The bottom line of that website appears to be that magnesium, as well as calcium, is vital for our bones. ACEOREVIVED (talk) 10:17, 16 May 2012 (UTC)

There is also this website, which emphasises how magnesium is important for good bones and teeth:

http://www.life123.com/health/nutrition/vitamins-minerals/essential-minerals.shtml

ACEOREVIVED (talk) 10:22, 16 May 2012 (UTC)

In the high-quality secondary source you provided (JACN 2009), the section on magnesium concludes with the sentence: "In any event, much more research on the relationship between magnesium and bone health is needed." I think that's pretty unambiguous. JFW | T@lk 20:55, 16 May 2012 (UTC)