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Gabriel treats osteoporosis as REVERSIBLE in many cases, not inevitable bone loss requiring bisphosphonates.
Gabriel treats osteoporosis as REVERSIBLE in many cases, not inevitable bone loss requiring bisphosphonates. Bone is LIVING tissue, constantly remodeling (osteoblasts build, osteoclasts break down—balance determines density). Bisphosphonates (Fosamax, Boniva) STOP bone remodeling (poison osteoclasts—old bone stays but becomes brittle, serious side effects—jaw osteonecrosis, atypical fractures). Protocol: 1) Optimize bone-building nutrients (calcium WITH vitamin D3, K2, magnesium, boron—SYNERGY matters, not just calcium alone), 2) Weight-bearing exercise (CRITICAL—mechanical stress stimulates bone formation, more effective than supplements), 3) Balance hormones (estrogen, testosterone, thyroid—critical for bone), 4) Reduce inflammation (chronic inflammation breaks down bone), 5) Improve gut health (nutrient absorption), 6) Eliminate bone-robbers (excess caffeine, alcohol, soda, smoking, acid-forming diet without vegetables), 7) Bioidentical hormone replacement if appropriate (estrogen protects bones in women post-menopause). Goal: increase BMD, prevent fractures, avoid bisphosphonates if possible.
Standard Treatment
Bisphosphonates (most common—prevent bone breakdown): Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Zoledronic acid (Reclast—IV yearly), Denosumab (Prolia—injection every 6 months, RANK ligand inhibitor), Raloxifene (Evista—SERM, selective estrogen receptor modulator), Teriparatide (Forteo—parathyroid hormone analog, BUILDS bone, daily injection, expensive), Romosozumab (Evenity—newest, sclerostin inhibitor, builds bone, monthly injection, very expensive), Calcitonin (nasal spray—older, less effective), Hormone replacement (estrogen—protects bones in post-menopausal women, but cardiovascular/cancer concerns with synthetic HRT), Calcium and vitamin D supplements (recommended but often inadequate alone)
The Problem
Bisphosphonates (Fosamax, Boniva, Reclast): Reduce fractures modestly (30-50% vertebral fracture reduction, hip fractures less—NNT high, need to treat many to prevent one fracture), DON'T build bone (stop breakdown by poisoning osteoclasts—old bone stays but becomes BRITTLE, bones appear denser on DEXA but quality poor, "frozen bone"), Serious side effects: Osteonecrosis of jaw (ONJ—bone death in jaw, 1-10% with IV bisphosphonates, devastating, requires jaw surgery, avoid dental work while on bisphosphonates), Atypical femur fractures (rare but serious—femur breaks with minimal trauma after years of bisphosphonates, ironic—drug to prevent fractures CAUSES fractures), Esophageal irritation (must take on empty stomach, sit upright 30 min—reflux, ulcers, esophageal cancer concern), GI upset (nausea, abdominal pain), Muscle/bone/joint pain (some patients severe), Rebound bone loss (after stopping—rapid bone loss, fracture risk increases), Duration limit (FDA recommends 3-5 years then "drug holiday"—but rebound occurs), Prolia (Denosumab): Similar efficacy to bisphosphonates, injection every 6 months, SEVERE rebound bone loss after stopping (must continue indefinitely or switch to bisphosphonate—trapped on medication), Serious infections (suppresses immune system), Hypocalcemia (low calcium—must supplement), Osteonecrosis of jaw, Atypical fractures, Forteo (Teriparatide): BUILDS bone (only anabolic drug—stimulates osteoblasts), Effective (increases BMD more than bisphosphonates), BUT: Daily injection (painful, inconvenient), Very expensive ($2000+/month), 2-year limit (black box warning—bone cancer in rats, though not seen in humans), After stopping—need bisphosphonate or lose gains, Conventional approach: Prescribes bisphosphonates based on T-score alone (<-2.5 or fracture—automatic prescription), Doesn't: Optimize nutrition FIRST (vitamin D, K2, magnesium, boron—many patients deficient, correcting may be sufficient), Emphasize exercise (MORE effective than drugs for building bone, proven to increase BMD, free, no side effects), Address root causes (inflammation, hormonal imbalances, gut malabsorption, medications causing bone loss), Test bone turnover markers (CTX, P1NP—guide treatment, faster feedback than DEXA every 2 years), Consider BHRT (bioidentical hormone replacement—estrogen protects bones, safer than synthetic), Offer natural alternatives (Strontium, Ipriflavone, comprehensive nutrition + exercise protocol), Calcium + vitamin D alone inadequate (standard recommendation "take calcium and vitamin D"—without K2, magnesium, boron—insufficient, many still lose bone), Doesn't educate on bone-building vs bone-stopping (bisphosphonates STOP remodeling, don't build—patients think they're "building bone"), Many patients could improve BMD with: Comprehensive nutrition (calcium, D3, K2, magnesium, boron, collagen), Weight-bearing exercise (resistance training, high-impact if appropriate), Hormone optimization (BHRT if post-menopausal), Lifestyle (quit smoking, limit alcohol, fall prevention), Treat underlying causes, Some need medications (severe osteoporosis, fracture history—but try natural approach first, use meds as last resort, consider Forteo if must use medication—only one that builds bone)
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What's Included
Available through Fullscript
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What's Included
Whole food supplements by Standard Process
What's Included
Standard Process + Matter peptides
Calcium-rich foods (BETTER than supplements—1200mg/day total): Dairy (if tolerated—yogurt, kefir, cheese, milk—full-fat better), Sardines with bones 3oz = 325mg calcium, Canned salmon with bones, Collard greens 1 cup cooked = 268mg, Spinach (high calcium but oxalates reduce absorption), Kale, Bok choy, Broccoli, Almonds 1oz = 75mg, Sesame seeds/tahini (very high calcium), Fortified non-dairy milk (if avoiding dairy—almond, soy, oat with added calcium), Blackstrap molasses, Vitamin D foods (enhance calcium absorption): Fatty fish (salmon, mackerel, sardines—also omega-3), Egg yolks, Mushrooms (UV-exposed), Vitamin K2 foods (directs calcium to bones): Natto (fermented soy—highest K2 source, 1000mcg per serving, but acquired taste), Grass-fed butter, Gouda cheese, Other aged cheeses, Egg yolks (pastured), Liver, Fermented vegetables, Magnesium foods: Dark leafy greens (spinach, Swiss chard), Pumpkin seeds, Almonds, Avocado, Dark chocolate, Black beans, Boron foods: Prunes, Raisins, Avocado, Nuts, Legumes, Alkalizing vegetables (prevent bone calcium loss to buffer acid): Dark leafy greens, Broccoli, Cucumber, Celery, Peppers, Onions, Garlic, Adequate protein (bones are 50% protein—collagen matrix, need 0.8-1g/kg body weight, but balance with vegetables), Omega-3 foods (anti-inflammatory—wild fish, grass-fed meat), LIMIT bone-robbers: Soda (phosphoric acid leaches calcium from bones), Excess caffeine (>3 cups coffee/day—increases urinary calcium loss, okay with adequate calcium intake), Excess salt (increases urinary calcium loss—<2300mg sodium/day), Excess animal protein without vegetables (acid-forming—body buffers by pulling calcium from bones, eat protein WITH abundant vegetables), Avoid: Trans fats, Excess alcohol (>2 drinks/day—toxic to osteoblasts), Refined sugar (inflammatory, nutrient-depleting)
Weight-bearing exercise CRITICAL (MORE important than supplements—mechanical stress stimulates bone formation, studies show exercise increases BMD): Resistance training 2-3x/week minimum (lifting weights, resistance bands, body weight exercises—squats, lunges, push-ups, planks—targets spine, hips where fractures occur), Progressive overload (gradually increase weight/resistance—bones adapt to stress), High-impact activities (if appropriate—jumping, jogging, tennis, dancing—creates bone-building stress, but avoid if severe osteoporosis or fracture risk), Weight-bearing aerobic (walking, hiking, stair climbing—better than swimming/cycling which don't stress bones), Balance exercises (prevent falls—Tai Chi proven to reduce fracture risk, yoga, single-leg stands), Flexibility (maintain mobility—yoga, stretching), Avoid prolonged sitting (sedentary lifestyle weakens bones), Quit smoking (MAJOR bone loss—reduces blood flow, increases fracture risk, impairs healing), Limit alcohol (<2 drinks/day—excess toxic to bone cells), Fall prevention (critical for fracture prevention): Remove trip hazards (rugs, clutter), Adequate lighting, Grab bars in bathroom, Non-slip mats, Vision check (poor vision increases falls), Medication review (sedatives, BP meds increase fall risk), Balance training, Appropriate footwear, Adequate sleep (7-9 hours—bone remodeling happens during sleep, growth hormone peak), Stress management (chronic cortisol breaks down bone—meditation, yoga), Sunlight exposure (vitamin D production—15-30 min sun on arms/legs daily without sunscreen, more if dark skin or winter), Maintain healthy weight (underweight increases fracture risk—bones need mechanical load, overweight increases fall risk and inflammation), Bioidentical hormone replacement if appropriate (post-menopausal women—estrogen protects bones, BHRT preserves BMD, discuss risks/benefits with doctor, NOT synthetic HRT like Premarin), Avoid medications that cause bone loss: Chronic steroids (prednisone—if must take, calcium/D3/K2, bisphosphonate may be needed), PPIs (reduce calcium absorption—if must take, ensure adequate calcium/D3, consider H2 blocker or fix root cause of reflux), SSRIs (associated with increased fractures—if possible, address depression with other methods), Some diabetes meds (thiazolidinediones—rosiglitazone, pioglitazone), Anticonvulsants, Excess thyroid hormone (if overtreated hypothyroidism—check levels)
Mind, Body & Spirit
True healing requires addressing all dimensions of health. These evidence-based practices complement physical treatment protocols.
Daily meditation practice to reduce stress, lower inflammation, and support healing.
Developing healthy coping strategies to reduce cortisol and support immune function.
Conscious breathing techniques to regulate nervous system and reduce symptoms.
Time in nature to reduce stress, improve mood, and support physical healing.
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