Heavy Metals, Bone Turnover, Osteopenia and Osteoporosis Assessment and Treatment
You will see data showing LOWER levels of metals (blood or urine) associated with LOWER levels of osteopenia and or osteoporosis. This is because the people with MORE bone turnover have MORE dumping of metals from bone.
An important issue is if you JUST chelate you will have HIGH metals on the testing probably as long as the patient is alive as you are speeding metal elimination from the bone. Unless you STOP the turnover you will never “chelate” them appropriately.
A counterpoint to this clinically is that if you do not support the elimination of the bone-turnover triggered metals WHILE you support bone density repair the patient will have other negative effects from the circulating metals. This then requires bone turnover assessment, potentially supportive detox, and bone support to slow turnover and clean up metals as they move out of the bone.
BONE SUPPORT IDEAS:
Strontium 500-700 mg BID, Boron 3-6 mg QD
Vitamin C, Ca/Mg/Zn etc. (And any nutrients as clinically indicated).
Vitamin D Sufficient to keep 25(OH) and 1,25(OH) in upper 50 – 75% of normal range [See the webinar “Natural Immunologic Agents for a deep discussion of 25 / 1,25 Vitamin D metabolism.]
Vitamin K (MK-4) 45 – 90 mg / day [PMID: 24841104] or MK-7 180 – 250 mcg / day [PMID: 23525894]
Physical support “Osteostrong” or “Perfect Workout” [aka ‘Super Heavy / Super Slow’ work out programs]
Bisphosphonates if indicated
MONITORING:
You will ALWAYS have high Pb and other metals if bone is turning over regardless of how long you chelate. This has created trouble for practitioners who “chelated for months” only to find the Pb and other metals never drop. I recommend using the NTx which is available as a urine test from any reference lab as a serial marker, and especially as a baseline. I recommend using this even if you are doing DEXA.
NTx – N-Telopeptide Cross-links (NTx), Urine (Serial Monitor) LabCorp or others
Subsequent specimens for comparison should be collected at approximately the same time of day as the baseline specimen.
| Baseline NTx | Probability of Decrease in BMD |
|---|---|
| 18- 38 | 1.4 |
| 38- 51 | 2.5 |
| 51- 67 | 3.8 |
| 67-188 | 17.3 |
In anyone (male or female) with suspected bone turnover obtain an NTx and if greater than 25 – 30 start bone health support and re-test every 6 months.
THERAPEUTICS:
If bone turnover is minimal consent the patient that you are initiating detoxification and chelation as usual but you are going to add bone health support to your protocol. Also they need to know that you have done the baseline NTx and will repeat that at your first re check of the Urine Toxic Metals (UTM) (Pre and Post challenge). All follow-up UTM are Pre and Post challenge (until pre-shows non-acute exposure) AND all unchallenged are normed to NHANES.
If bone turnover is significant you can follow the above but must consent the patient that they need to do aggressive bone support while chelating and that follow up NTx and UTM (Per and Post UTM) are required for safety. Also they should be consented that their UTM levels will likely stay high until the bone turnover is under control.
If bone turnover is significant it is often more appropriate to explain the dynamics of bone dumping of heavy metals and that you prefer to do baseline NTx and Pre/Post UTM and then treat the bone health aggressively for 3 months while you support gentle detox. This can include glutathione, fiber and bowel regularity and low weelkly doses of oral DMSA to “mop up” metals that are circulating. I normally give 250 – 500 mg DMSA QHS two nights a week for this purpose.
Also, regardless of the choice above know that the MOST EFFICIENT chelation involves a triple therapy including EDTA, a dithiol (DMPS/DMSA) and Glutathione. This includes oral or IV protocols. (Most common question is source for oral EDTA that works. I use Quicksilver Liposomal EDTA / ALA as first choice or Allergy Research as second choice **No affiliation.) Generally if oral the EDTA is 10 mg/Kg 3 days on and 4 days off taken with DMSA 20-30 mg / Kg on the same days as the EDTA. The Glutathione is liposomal or Acetyl form and 100 – 200 mg QD 7 days a week. If oral more information can be found in the “Oral Chelation” course on ConsultDrA. If IV then use the doses and strategies in Dr’s Crinnion, Osborne and My online chelation course (available from ivnutritionaltherapy . com – *not a part of ConsultDrA but I wrote and taught that course).
Most critical are notifying the patient of the dynamics, and that they can not expect metal levels on the UTM to decrease until bone turnover stabilizes. On the clinical side your testing and monitoring is most critical.
REFERENCES:
https://flore.unifi.it/retrieve/handle/2158/1053178/154642/Heavy%20metals%20accumulation%202016.pdf
https://journals.sagepub.com/doi/10.1177/0960327117705425