Tightening control of one metabolic disease (Diabetes Mellitus) may result in predisposition to another (Osteoporosis). You can’t win.
Since the publication of the Women’s Health Initiative in 2002, Hormone Replacement Therapy (HRT) has taken the rap for increasing the risk for heart disease, thromboembolism, stroke and breast cancer, even if it may prevent osteoporosis and ameliorate menopausal symptoms.
However, for those brave souls who kept faith with HRT (usually those with low cardiovascular risk, or suffer intolerable hot flashes), the benefit on bone mass and bone architecture is real, and appears to continue to pay dividends even after its discontinuation.
When news broke in 2010 that a metaanalysis showed a link between calcium supplementation (without Vitamin D) and heart attack, osteoporosis prevention suddenly became that much more “difficult”. We found ourselves once again in a “damned if you do, damned if you don’t” dilemma. So much time and energy was wasted in consultation on “good old calcium” instead of discussing the merits-risks-costs of the various osteoporosis treatments available.
With this large prospective study, the controversy should FINALLY be put to rest. It seems to me almost reprehensible that metaanalyses trawling retrospective data for illogical and inexplicable associations should be allowed to be sensationalised and promulgated to a gullible and panicky public.
Prior Bisphosphonate (anti-resorptive) use is associated with an initial response lag to treatment with Teriparatide (bone former). This may be due to the prolonged persistence of Bisphosphonates in bone matrix inhibiting the bone-resorbing osteoclasts (and indirectly through paracrine and other modes of signalling, the bone-forming osteoblasts), thereby retarding bone turnover.
By the same token, this lag is not apparent with Denosumab, an anti-resorptive with a short half-life. Hence the logic and effectiveness of combining Tereparatide with Denosumab and not a Bisphosphonate in treating the more severely osteoporotic.
Conceivably, androgen deficiency can predispose to erectile dysfunction and male osteoporosis. Also, atherosclerosis is linked to osteoporosis and peripheral vascular disease, with the latter linked to ED and falls.
Consensus Guideline on Drug Therapy After Osteoporotic Fractures
