apoe4 and osteoporosis.

[hairyfairy]

Iv`e been reading about the apoe4 gene and it`s relationship with low bone density. Does having this gene weaken bones?

[NF52]

Iv`e been reading about the apoe4 gene and it`s relationship with low bone density. Does having this gene weaken bones?

Although I found one study claiming a "relationship" between ApoE 4 and lower bone density in Brazilian women, it's important to remember that studies can find a "relationship" that is not "statistically significant" (and if they don't include those words, it usually means it didn't meet that test.) To use an extreme example, I can find a "relationship" between children who wear diapers and children who are not yet writing their names in cursive, but it doesn't mean diaper-wearing causes a delay in cursive skills, or that cursive writing speeds up toilet-training.
Just as importantly, even a statistically significant relationship doesn't mean that one thing causes the other; it may be a reverse relationship or both may be related to some other factor. For example, low Vitamin D may be linked to bone density, but low bone density doesn't cause low Vitamin D, and both may be caused by some other factor such as poor dietary options.

Here's some better news, from a large "meta-analysis"--when data from several studies are pooled to increase the likelihood that the conclusions are valid (with some caution that even in meta-analyses, combining several poorly designed small studies doesn't suddenly make a perfect study).
Associations of APOE Gene Polymorphisms with Bone Mineral Density and Fracture Risk: A Meta-Analysis

RESULTS:
In sex-pooled analyses, APOE4 carriers had a 0.018 g/cm(2) lower weighted mean trochanteric BMD [i.e. hip bone mineral density] than non carriers (p = 0.0002) with no evidence for between-study heterogeneity. A significant association was also detected with lumbar spine BMD (p = 0.006); however, inter-study heterogeneity was observed. Associations with lumbar spine and trochanteric BMD were observed predominantly in women and became less significant in meta-regression (p = 0.055 and 0.01, respectively). There were no consistent associations of APOE4 genotype with BMD at other skeletal sites or with fracture risk.

CONCLUSIONS:
Based on these findings, there is insufficient evidence to support a strong and consistent association of the APOE genotype with BMD and fracture incidence.

[TheBrain]

I guess I can’t blame my worsening osteoporosis on being E4/E4. My doctor wants me to start an osteoporosis Rx. I’ve read too many bad consequences from taking these meds. I have to find another way to improve my BMD. I’m wondering if my recently diagnosed (but long-standing) hydrogen sulfide small intestinal bacterial overgrowth (SIBO) is a contributing factor. So far, I’m not finding much information on that possibility.

[Anna]

I'm trying to figure out why one might think e4 would jeopardize bone density.

I guess I can’t blame my worsening osteoporosis on being E4/E4. My doctor wants me to start an osteoporosis Rx. I’ve read too many bad consequences from taking these meds. I have to find another way to improve my BMD. I’m wondering if my recently diagnosed (but long-standing) hydrogen sulfide small intestinal bacterial overgrowth (SIBO) is a contributing factor. So far, I’m not finding much information on that possibility.

Well this caught my attention, as I can relate! I'm pretty sure my osteoporosis is a consequence of low digestive enzymes and chronic bacterial and yeast overgrowth. Resolving SIBO and candida is beyond difficult! I have not started on osteoporosis meds either, except for HRT. Anyway, if you find another way to improve bone density, let us know! (I'm too tired now to find the literature pertaining to SIBO causing low bone density, but I have seen it. I believe it's primarily a matter of poor nutrient absorption -- especially minerals -- just like with celiac disease.)

[TheBrain]

Well this caught my attention, as I can relate! I'm pretty sure my osteoporosis is a consequence of low digestive enzymes and chronic bacterial and yeast overgrowth. Resolving SIBO and candida is beyond difficult! I have not started on osteoporosis meds either, except for HRT. Anyway, if you find another way to improve bone density, let us know! (I'm too tired now to find the literature pertaining to SIBO causing low bone density, but I have seen it. I believe it's primarily a matter of poor nutrient absorption -- especially minerals -- just like with celiac disease.)

Hi Anna,

I'm sorry to hear you also have osteoporosis. I'm early in the research phase and haven't decided what to do (beyond continuing my bHRT). The difficult thing about knowing if what I try improves my bone density is that I have to wait two years before my insurance will cover another bone density test!

But here are some things I've found. Of course, contradictions abound.

Small intestinal bacterial overgrowth: a possible risk factor for metabolic bone disease (Unfortunately, I don't have the full text.)

Abstract
Small intestinal bacterial overgrowth (SIBO) is one of the causes of malabsorption syndromes. The prevalence of metabolic bone disease in patients with SIBO is unknown, but a recent prospective case-control study indicated significant contribution of SIBO to the development of metabolic bone disease. We review this and other reports in the literature and discuss the possible mechanisms causing metabolic bone disease in patients with SIBO.

Comprehensive Review Shows No Higher Rates of Celiac Disease in Osteoporosis Patients



My FM PA suggested I check out Dr. Morley Robbins' work. I found the following article written by him. I was tired when I read it and need to re-read it. He has a protocol that I haven't checked out yet. He's very focused on iron overload.
Iron Toxicity Post #70: The IRON-ic TRUTH of Osteoporosis and it’s Origin… - The Root Cause Protocol

What do we know happens in the 40’s and 50’s for women? Menopause.

Osteoporosis and menopause – what’s the link?

What does this mean in the context of metabolism in the body? Suddenly women are accruing iron, not bleeding every month… the iron building up in their body is causing changes in the osteoblasts which prevents them from maintaining density. What does excess unbound iron cause in the body? Oxidative Stress.

Winding back a bit further, Reactive Oxidative Species (ROS) such as superoxide and that pesky ‘oxidative problem child’ H2O2 (Hydrogen Peroxide) SHOULD be neutralized by our natural antioxidant enzyme systems – however in mineral dysregulated bodies, which are HIGH in unbound iron, LOW in bioavailable copper and magnesium, and with LITTLE antioxidant support in the body (let’s think of our ever-busy Ferroxidase, and Superoxide Dismutase (SOD))…..if we do not have enough of the components in our antioxidant systems, we cannot neutralize these “Accidents,” that are called “Oxidants” that are ALSO called, Reactive Oxidative Species.

Cellular changes start to happen… let’s say… osteoblasts cannot keep up with recycling of the bones, and our Bones get weaker and less able to stay in balance.

Using Functional Medicine to Treat Osteoporosis - Kara Fitzgerald ND Naturopathic Doctor

An avid athlete and Iron Man competitor, Dr. McCormick was training hard one day when he felt a sharp pain in his hip. The pain didn’t stop for several days, so he went in for testing and learned he was riddled with microfractures in his hip caused by severe osteoporosis.

He’s not alone. Globally, one in five men over the age of 50 will get osteoporosis, according to the International Osteoporosis Foundation. (One in three women over 50 will, too.) For a “women’s disease,” one in five is a high ratio.

Every doctor he saw wanted to put him on bisphosphonates and send him on his way. But he didn’t want to take medication for the rest of his life—and he refused to believe that bone loss had a single cause that required a single pharmaceutical solution. A doctor of chiropractic and a former Olympic athlete, he immersed himself in the study of osteoporosis to help himself and his patients.

Today he’s arguably the world leader in nutritional management of patients with bone fragility. He’s the author of The Whole-Body Approach to Osteoporosis; a go-to reference for me and my patients suffering with bone loss; written for the lay audience, it’s meaty enough for clinicians wanting a good jumping-off point for a functional approach to bone health. Keith consults with osteoporosis patients all over the world. But perhaps the greatest testament to his accomplishments? He’s back to competing in Iron Mans.

In today’s blog, I’m going to highlight some of the key takeaways from my conversation with Dr. McCormick on the New Frontiers in Functional Medicine podcast. I’ve pulled out insights on the whole-body causes of osteoporosis—and a bunch of clinical pearls for working with patients. And if this post leaves you hungry for more, be sure to listen to our interview.

The Root Cause of Osteoporosis | Alternative Medicine Blog | Vitamin C Expert

A large body of scientific evidence shows that reversing the focal scurvy improves bone density, reduces fracture risk, and greatly lowers all causes of mortality. The remedy is inexpensive, wildly effective, and totally safe. And yet, hardly anyone in mainstream medicine talks about it or is even aware of it. Quite simply, scurvy (severe vitamin C deficiency), whether general or localized (focal), can be prevented, cured, and reversed with appropriate dosing and administration of vitamin C and other important nutrients.

This last approach also requires B vitamins, vitamins D and K2, as well as magnesium.

[JML]

I have to find another way to improve my BMD. I’m wondering if my recently diagnosed (but long-standing) hydrogen sulfide small intestinal bacterial overgrowth (SIBO) is a contributing factor.

I read the book "The Whole Body Approach to Osteoporosis" by Keith McCormick (referenced by Dr. Kara Fitzgerald), and was pretty overwhelmed. Poor absorption seems to be a root cause for many (my doc says SIBO can cause that).

The one thing that I read everywhere is that strength training (upper and lower body muscles) and weight bearing exercise with heel strikes (walking is better than being on an elliptical trainer) are important. So, as much as I hate it, I am trying to increase my resistance training. I probably won't be retested for awhile, but I'm very curious if this has worked for anyone else out there?

[donbob]

...The one thing that I read everywhere is that strength training (upper and lower body muscles) and weight bearing exercise with heel strikes (walking is better than being on an elliptical trainer) are important. So, as much as I hate it, I am trying to increase my resistance training. I probably won't be retested for awhile, but I'm very curious if this has worked for anyone else out there?

Progressive loading in a prudent manner, using weight training, is often encouraged as bone strength enhancing. Somewhere I read the following: “If you think weight training is dangerous, try being weak. Weakness is dangerous.” Weight training may also improve connective tissue, balance, muscle mass, and cardio fitness. Personally, I am stronger, but have not had a second bone scan to know if bone density has improved.

[TheBrain]

I read the book "The Whole Body Approach to Osteoporosis" by Keith McCormick (referenced by Dr. Kara Fitzgerald), and was pretty overwhelmed. Poor absorption seems to be a root cause for many (my doc says SIBO can cause that).

The one thing that I read everywhere is that strength training (upper and lower body muscles) and weight bearing exercise with heel strikes (walking is better than being on an elliptical trainer) are important. So, as much as I hate it, I am trying to increase my resistance training. I probably won't be retested for awhile, but I'm very curious if this has worked for anyone else out there?

By overwhelming, do you mean that McCormick's advice contained many moving parts (like Dr. Bredesen's protocol)? Or something else? Would you not recommend his book?

Thanks for mentioning that walking is better than using an elliptical trainer due to the heel strikes. That gives me incentive to do more walking, even more treadmill walking if it's icky outside.

I've been doing resistance training for years, but I must admit I've been in maintenance mode. I've not been doing what I believe donbob is recommending: "progressive loading in a prudent manner." I'm assuming that means safely increasing the weights being lifted over time.

[rrmolo]

I am osteoporotic but it is because my ovaries were removed at age 41. I am 78 now. I have had scans every 2 years and always refused meds. My last scan showed no change. I go to strength training exercise classes 2-3 times/ week, hike regularly, play raquetball , play pickleball, golf in season and generally just keep active. I am considering donating blood now and thought the blood comment re excess unbound iron very interesting. My T score hips is minus 2.9 and for spine minus 2.2

[TheBrain]

I am osteoporotic but it is because my ovaries were removed at age 41. I am 78 now. I have had scans every 2 years and always refused meds. My last scan showed no change. I go to strength training exercise classes 2-3 times/ week, hike regularly, play raquetball , play pickleball, golf in season and generally just keep active. I am considering donating blood now and thought the blood comment re excess unbound iron very interesting. My T score hips is minus 2.9 and for spine minus 2.2

You're an inspiration! For many reasons, I need to be more active. I'm 58, and my numbers are significantly worse than yours.

Did your numbers improve over time, or is it more that you've held steady?