Bone- and Heart-Healthy Yogurt Dip

Below is a recipe for a simple, tasty yogurt dip that my husband came up with. It has only three ingredients, four, if you like more salt than is provided by the cheese. Unlike most dips, this one is healthy for our bones and hearts. Plus, it is delicious. You can play around with the amounts of ingredients, leave out the garlic, or add dried onion or another ingredient of your choice. The possibilities are endless. 

1/2 cup fat-free Greek yogurt

2 tbsp. shredded parmesan cheese

1 tsp. dried minced garlic

pinch of salt, if desired

TBS, Strontium, and Prof. Didier Hans

Prof. Didier Hans, PhD, MBA co-founded Med-Imaps SA in 2006 and became CEO of Medimaps Group in 2012. He currently drives the company’s global strategy, orientation and business objectives, and oversees its Quality Management framework and policies.He holds a PhD in Medical Physics and an Executive MBA from HEC Geneva. https://www.medimapsgroup.com/team/didier-hans/

One of Medimaps Group's products, TBS iNsight™ (Osteo), is an advanced imaging software application for bone densitometers (DXA). It provides a way to better predict a patient’s risk for bone fracture, to fine-tune therapy decisions, and to improve patient management.

TBS iNsight™ is a Medical Device that is CE 2797 marked & has been cleared to be sold in the US.

https://www.medimapsgroup.com/tbs-osteo/

I recently had the opportunity to ask Prof. Hans a question by email. He graciously answered. 

My question:

Will a TBS score be affected by the bone strontium effect, as the BMD by DXA scan is?

His answer, paraphrased and confirmed: 

In our study of TBS and strontium ranelate, TBS was less affected by the larger atomic number of strontium than the BMD was affected. So, the study showed that strontium improved bone microarchitecture. 

Beneficial Effects of Strontium Ranelate vs. Alendronate on TBS and Bone Architecture

The following abstract was published on Osteoporosis International (2012) 23: (Supplement 2):S85–S386. 

Abstract P471, Pages S266-S267

Didier Hans1, Marc-Antoine Krieg1, Olivier Lamy1, Dieter Felsenberg2
1Lausanne University Hospital Center of Bone Diseases, Bone and Joints Department, Lausanne, Switzerland, 2Charité Campus Benjamin Franklin, Klinik und Poliklinik für Radiologue und Muklearmedizin, Berlin, Germany

Objective(s): Trabecular Bone Score (TBS, Med-Imaps, France) is an index of bone architecture independent of BMD calculated by quantifying local variations in grey level from anteroposterior spine DXA scan and reported to be associated with fracture in prior case-control and prospective studies1. We compared the effects of strontium ranelate (SrRan) and alendronate (ALN) on spine architecture patterns as assessed by TBS in women with postmenopausal osteoporosis.

Material & Methods: A post hoc analysis was performed on DXAs (Hologic and GE Lunar Devices) from 79 women out of 189 included in a double blind, double dummy study and randomized to SrRan 2 g/day or ALN 70 mg/week during 2 years2. Spine TBS parameters were assessed by TBS iNsight (v1.9) at the spine after 12 and 24 months of treatment. We applied ISCD rules for individual vertebrae exclusion independently for BMD and TBS, respectively. Since duplicate measurements were performed at baseline, precision were calculated as CV%.

Results: Baseline characteristics (mean ± SD) were similar between groups in term of age, 69.2 ± 4.4 years; BMI, 23.8±4.4 kg/m2; L1-L4 T-score, -2.9±0.9 and TBS 1.230 ± 0.09. As expected, the correlation between Spine BMD and TBS was very low with r2 = 0.12. Precision errors were 1.1% and 1.6% for spine BMD and TBS, respectively. Over 1 and 2 years, L1-L4 BMD increased significantly by 5.6% and 9% in SrRan group and by 5.2% and 7.6%, respectively in ALN group. Similarly, spine TBS increased by 2.3% (p < 0.001) and 3.1% (p < 0.001) in SrRan group and by 0.5% (ns) and 1.0% (ns) respectively in ALN group with a significant between-group difference in favor of SrRan (p = 0.04 and p = 0.03). There were no correlation between delta BMD and TBS at 1 year or at 2 years. The two treatments were well tolerated. 

Conclusion(s): SrRan has greater effects on bone architecture index at the spine compared to alendronate in women with postmenopausal osteoporosis after 2-year treatment. These results consolidate previous studies supporting a benefit of SrRan on bone architecture.

References: 1. Hans D. et al. J Bone Miner Res 2011;26:2762. 

2. Felsenberg D. et al. Osteoporos Int 2011;22(suppl. 1):S102.

https://sci-hub.se/https://doi.org/10.1007/s00198-012-1928-7

Trabecular Bone Score (TBS)

I will be asking that a Trabecular Bone Score (TBS) be included with my next DXA scan. The doctor who read my latest scan wrote, "Follow up with DEXA and TBS: As needed." 

I found a review of TBS. The review includes a section on "Changes in TBS with Treatment of Osteoporosis." Below is the paragraph comparing the effects of strontium ranelate and alendronate (Fosamax) on TBS. 

"The effects of strontium ranelate (SrRan) and alendronate on TBS were evaluated in a post hoc analysis performed in 79 women with postmenopausal osteoporosis of 189 included in a double‐blind, double‐dummy, randomized study. Women were randomized to either SrRan 2 g/day or alendronate 70 mg/week for 2 years. TBS and BMD parameters were assessed in the LS after 12 and 24 months of treatment. Over 1 and 2 years, LS BMD increased significantly by 5.6% and 9.0% in the SrRan group and by 5.2% and 7.6%, respectively, in the alendronate group. LS TBS increased by 2.3% (p < 0.001) and 3.1% (p < 0.001) in the SrRan group, but the change in the alendronate group was not significant (0.5% and 1.0%, respectively). There was a significant between‐group difference with SrRan showing larger TBS increases than alendronate."

Let me reiterate: Over one and two years, Lumbar Spine (LS) BMD increased in both the SrRan (5.6%, 9.0%) and alendronate groups (5.2%, 7.6%). You will note that the SrRan BMD numbers are higher, especially after the second year, than the alendronate numbers. The results are as expected because strontium results in an overestimation of BMD.  

HERE IS THE KICKER: LS TBS increased by 2.3% and 3.1% in the SrRan group, but the change in the alendronate group was not significant (0.5% and 1.0%, respectively). There was a significant between‐group difference with SrRan showing larger TBS increases than alendronate.

Keep in mind that TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard BMD measurement. TBS may be a better predictor of fracture risk than BMD alone. 
https://www.panoramaortho.com/wp-content/uploads/2019/03/TBS-Rev...

 

DXA Scan of 18 August 2022 Showing Normal Density

Below is my recent axial DXA performed on a Horizon Prologic Wi DXA scanner and showing NORMAL BONE DENSITY! Even if my scores are lower by half due to strontium use, the changes are phenomenal. Fifteen years ago, I was diagnosed with osteoporosis. My scans have gotten progressively better since I began taking strontium citrate 14 years ago. For my next DXA scan, I will ask that a Trebecular Bone Score (TBS) be included.Trabecular bone score (TBS) uses standard lumbar spine DXA imaging to assess bone texture inhomogeneity (that is, the number of filled versus unfilled voxels) in order to gauge bone quality and fracture risk. Strontium will not affect TBS as it does DXA. 

EXAM:  DXA AXIAL 8/18/2022

 INDICATION:  Postmenopausal.

 COMPARISON: 1/8/2018

 

FINDINGS:

 

Spine:  Total BMD of the spine L1-4 is 1.030 g/cm2, with a T-score of -0.2 and a Z-score of 2.2.

Left Femoral Neck: BMD is 0.741 g/cm2, with a T-score of -1.0  and a Z-score of 1.1.

 

Left Total Hip: BMD is 0.856 g/cm2, with a T-score of -0.7 and a Z-score of 1.0.

 

Right Femoral Neck: BMD is 0.752 g/cm2, with a T-score of -0.9 and a Z-score of 1.2.

Right Total Hip: BMD is 0.907 g/cm2, with a T-score of -0.3 and a Z-score of 1.5.

Spine density increased 5.2%. Left hip density decreased 1%. Right hip density increased 0.9%. These percent change findings may be inaccurate as exam was performed with different technique.

FRAX evaluation calculates 10-year probability of fracture:

 Major Osteoporotic: 7.9%%

 Hip: 1.3%%

IMPRESSION:

 Based on BMD, diagnosis is consistent with normal density.

 Follow up with DEXA and TBS: As needed.

WHO CRITERIA FOR T-SCORES:

 < or = -2.5 = osteoporosis

 < -1.0 and -2.5 = osteopenia

 > or = -1.0 = normal density

Calcium Intake and BMD

The following report is a systematic review and meta-analysis (the highest level of scientific proof) on calcium intake and bone mineral density. 

Abstract

Objective To determine whether increasing calcium intake from dietary sources affects bone mineral density (BMD) and, if so, whether the effects are similar to those of calcium supplements.

Design Random effects meta-analysis of randomised controlled trials.

Data sources Ovid Medline, Embase, Pubmed, and references from relevant systematic reviews. Initial searches were undertaken in July 2013 and updated in September 2014.

Eligibility criteria for selecting studies Randomised controlled trials of dietary sources of calcium or calcium supplements (with or without vitamin D) in participants aged over 50 with BMD at the lumbar spine, total hip, femoral neck, total body, or forearm as an outcome.

Results We identified 59 eligible randomised controlled trials: 15 studied dietary sources of calcium (n=1533) and 51 studied calcium supplements (n=12 257). Increasing calcium intake from dietary sources increased BMD by 0.6-1.0% at the total hip and total body at one year and by 0.7-1.8% at these sites and the lumbar spine and femoral neck at two years. There was no effect on BMD in the forearm. Calcium supplements increased BMD by 0.7-1.8% at all five skeletal sites at one, two, and over two and a half years, but the size of the increase in BMD at later time points was similar to the increase at one year. Increases in BMD were similar in trials of dietary sources of calcium and calcium supplements (except at the forearm), in trials of calcium monotherapy versus co-administered calcium and vitamin D, in trials with calcium doses of ≥1000 versus <1000 mg/day and ≤500 versus >500 mg/day, and in trials where the baseline dietary calcium intake was <800 versus ≥800 mg/day.

Conclusions Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture.

Conclusions

In summary, increasing calcium intake from dietary sources increases BMD by a similar amount to increases in BMD from calcium supplements. In each case, the increases are small (1-2%) and non-progressive, with little further effect on BMD after a year. Subgroup analyses do not suggest greater benefits of increasing calcium intake on BMD in any subpopulation based on clinically relevant baseline characteristics. The small effects on BMD are unlikely to translate into clinically meaningful reductions in fractures. Therefore, for most individuals concerned about their bone density, increasing calcium intake is unlikely to be beneficial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784773/

My Current Supplements

My bone protocol consists of the following supplements. The dosage for each is  one capsule or tablet per day unless otherwise stated. 

AOR Strontium Support II, 341 mg strontium (from citrate) per capsule (two capsules daily)

Country Life, Gluten Free, Calcium Magnesium with Vitamin D Complex (250 mg Ca, 125 mg Mg, 100 I.U. Vitamin D per capsule) (two capsules daily)

Innate Vitality Magnesium Glycinate, 500 mg/capsule 

Nature Made Multi Men's 50+, No Iron (OK for men and women; contains 1000 IU vitamin D3 and 21 other nutrients) 

Nature Made D3, 1000 IU (one capsule three times/week)

I also take the following supplements for general health. The dosage for each is one capsule or tablet per day unless otherwise stated.

Solgar Citrus Bioflavonoid Complex, 1000 mg per tablet (Bioflavonoids are antioxidants.)

Solary Selenium, 100 mcg

Vitacost Chelated Zinc (zinc glycinate chelate), 30 mg

Doctor’s Best Lutein with Optilut (20 mg lutein, 4 mg zeaxanthin in two capsules)(2 capsules/day)

Nature Made Vitamin C, 500 mg

Solgar Natural Vitamin E (as d-Alpha Tocopherol plus d-Beta, d-Delta and d-Gamma Tocopherols), 400 IU

Horbaach Sublingual Methylcobalamin (Vitamin B12), 5000 mcg

I also take a couple of digestive aids: 

A probiotic (I am trying different brands.)

A multi-enzyme digestive (I am trying different brands.) 

Theories on How Strontium Prevents Fractures

Physiochemical Mechanisms/Sacrificial Bonds 
Physiochemical mechanisms describe "how Sr (strontium) is able to affect the intrinsic tissue quality of bone by directly incorporating into bone at multiple levels, including the organic matrix and the hydrated layer surrounding hydroxyapatite (HA) crystals, forming sacrificial bonds and stabilizing hydration shells." 

Cellular Mechanisms/Ca-sensing Receptor (CaSR) 
"The cellular mechanisms are centered mainly around the Ca-sensing receptor (CaSR) and its ability to mediate bone cell function and respond to Sr, providing evidence for the dual-acting mechanism."

"Osteoclast precursors and mature osteoclasts express the CaSR on their cell membrane..."

Enhanced Bone Microarchitecture 
"Microarchitecture is an important aspect of bone strength and increased fracture risk in patients with osteoporosis is associated with trabecular thinning and increased cortical porosity."

"Clinical studies have shown SR treatment increased cortical thickness and trabecular number and decreased trabecular spacing from baseline, determined using high-resolution peripheral quantitative computed tomography (HR-pQCT)." 

https://www.sciencedirect.com/science/article/pii/S2352187220300334

Vegetable Magnesium Stearate in Strontium Citrate Products

Magnesium stearate, also known as vegetable stearate, is used as a "flow agent" in supplement tablets and capsules to prevent different supplement ingredients from sticking to each other and to the blending and punching equipment. The flow agent ensures a homogenous blend of ingredients and a consistent dosage in each and every capsule or tablet. It is a common ingredient in many supplements, including strontium citrate products. I have never had a problem with it, but some people might have. 

"Magnesium stearate is generally safe to consume, but too much of it can have a laxative effect. In large amounts, it can irritate the mucus lining of the bowels. This may trigger a bowel movement or diarrhea."

"Allergic reactions to magnesium stearate are rare, but you should avoid it and talk to your doctor if it affects you."

https://www.webmd.com/vitamins-and-supplements/what-is-magnesium-stearate

Below is a list of strontium citrate products with and without magnesium stearate. It is not an exhaustive list. If your product is not listed here, check the label. 

Strontium Citrate Products with Magnesium Stearate

Life Extension Strontium has microcrystalline cellulose, vegetable cellulose (capsule), vegetable stearate, and silica, in addition to strontium citrate. 

Nova Nutritions Strontium Citrate has a gelatin capsule, rice powder, and vegetable magnesium stearate.

Vitacost Strontium has hydroxypropyl methylcellulose, microcrystalline cellulose, vegetable stearic acid and vegetable magnesium stearate in addition to strontium citrate. 

Strontium Citrate Products without Magnesium Stearate but with Other Additives

Swanson Strontium Citrate has gelatin, rice flower, calcium laurate, and silica.

Pure Encapsulations Strontium (Citrate) has a vegetarian capsule (cellulose, water) and contains hypoallergenic plant fiber (cellulose) and ascorbyl palmitate. 

Strontium Citrate Products with No Additives

AOR Strontium Support II, which I take, is in a capsule composed of hypromellose and purified water and contains no additives.

AlgaeCal Strontium Boost is in a vegetable cellulose (vegetarian capsule) and contains no additives.

Strontium Chloride

I just became aware of a strontium chloride product for bone health,
Eniva Strontium Mineral Liquid Concentrate. One fluid ounce (30 mL) contains 250 mg strontium. The ingredients are purified water, strontium (from strontium chloride), natural flavors, citric acid, sorbic and/or benzoic acid(s) [protects freshness], stevia leaf extract. A liquid may offer quicker absorption than tablets or capsules that must first dissolve in the digestive tract before being absorbed. 

https://eniva.com/strontium-mineral-liquid-concentrate-32-oz/?sk...