Building Bones without Drugs

Beth: I’m Beth Bennett, and this is How On Earth, the KGNU Science Show. Today is Tuesday, November 9th, 2021. Today is Tuesday, November 9th, 2021.

Beth: Coming up, we hear from Dr. John Jaquish, a biomechanical engineer who developed a mechanical system for loading bones to prevent and reverse osteoporosis, inspired by his mother’s diagnosis.

Beth: We begin with a look at some of the recent news in science. Sponges are some of our distant animal relatives. Our last common ancestor lived over 600 million years ago. Sponges have a simple body that’s specialized for filter feeding, meaning they trap food particles from water currents that flow through their tissues. They manage to coordinate feeding and reproduction, despite lacking a nervous system.

Beth: Remarkably, many genes known to be important in communication among nerve cells in more complex organisms, such as ourselves, are active in the digestive tissue cells in sponges.

Beth: Now, if genes characteristic of a nervous system are present, this is kind of a smoking gun indicating that there’s more to the story. Researchers followed up, and recently found some of the cellular structures that are typical of nerve cells in the sponge digestive cells.

Beth: The sponge cells are called collar cells, named for their rings of beating for jelly that create the water currents that transport suspended food particles through the body of the sponge.

Beth: In our nerve cells, there are structures in the cell membranes, that allow the cells to transmit and receive messages. Our nervous systems rely on this messaging to control voluntary muscles, and also involuntary processes such as heartbeat and breathing, as well as thinking and even writing these headlines. Finding these structures in sponge collar cells, as well as other cells that connect the entire sponge body, suggests that internal communication among different tissues appeared early in animal evolution.

Beth: It makes sense that if your lifestyle relies on coordinating internal water movement with eating, you would have a system of communication between your disparate parts to regulate their interactions. So, even though sponges are not particularly brainy, they are an important early step in the evolution of nervous systems. This research was reported last week in the journal Science.

Beth: The Denver Museum of Nature and Science has a full calendar of virtual events. On Wednesday, November 17th, Ka Chun Yu, curator of space science, and Bob Reynolds, research associate, present digital images from space to illustrate the changing face of our state. From hustling cities and mountain peaks to a vast ancient sea, Colorado has seen dramatic changes in its landscape and climate. You can sign up for this virtual presentation to look back in time to the Cretaceous, explore what we see today, and ponder what changes may be on the horizon. How will recent challenges like access to water and devastating fires affect what Colorado looks like in the future? Visit the museum website at dmns.com for more information.

Beth: Osteoporosis is a major health risk for older adults. Currently, there are a few pharmaceutical treatments, but all of them have significant side effects and potential risks. Dr. John Jaquish was inspired by his mother’s diagnosis of osteoporosis to develop a medical device to load bones, to improve bone strength without the risk of injury effects. He holds numerous patents on this and other biomedical devices. I spoke with him last week about this system. Welcome to the show, John, and thanks for talking today about your OsteoStrong system.

Dr. John Jaquish: Yeah. Hey, thanks for having me, Beth.

Beth: Yeah. It’s a pleasure to get to talk to you, finally, because I’ve been using the system for a while now, and I think it’s an intriguing idea and pretty effective. But before we start talking about how it works, and osteoporosis in general, we should talk about bone metabolism in general. And this might be an unusual thought to some of the listeners, that bones are a pretty metabolically active substrate. So, do you feel like talking a little bit about that?

Dr. John Jaquish: Yeah. So, our bones have a metabolic rate. Our bones are made of cells, and those cells, the old ones, die. They fall apart, just sort of dissolve, and new ones come from the middle of the bone. And as a bone cell begins its life, it starts in the middle, in the trabecular bone, and then it works its way to the outside, to the outer cortex. So, an older bone cell gets to the outside of the bone, and those layers, when you get towards the outer cortex, they become more compact.

Dr. John Jaquish: And most of the structural rigidity of bone is based on how much material is in the outer cortex. Now, that’s a part of the story, but that’s not the whole story because sometimes a bisphosphonate drug will keep somebody from losing old bone. So, they’ll have what looks like a healthy outer layer, but they have nothing going on on the inside.

Dr. John Jaquish: So, once that layer does shed, and eventually, it will, then they have no new bone to replace that. So, you can sort of artificially make your bone seem like it’s denser with the pharmaceuticals that are out there, but as soon as you cycle off, which you’re supposed to after five years, you lose that bone mass, and now you’re even worse off.

Beth: Right. Because if you don’t replace some of the softer bones in the interior of the structure, then you don’t have elasticity.

Dr. John Jaquish: Right.

Beth: I remember I really interesting thing from when I was an undergraduate. I worked in a biophysics lab, and we measured the elasticity of bone, which just blew my mind. I didn’t even ever think of bones as being elastic structures, but they can deform about 5%, and that keeps us from breaking our bones when we do all kinds of stuff.

Dr. John Jaquish: Yeah. Bones are, in a way, like a shock absorbers when it comes to impact. And that, coincidentally, is the only thing that stimulates them to grow. I had an orthopedic surgeon do rapid stop-motion photography on me as I did the lower extremity compressive movement with OsteoStrong, and you could see five centimeters of my leg completely disappear.

Beth: Wow. That’s amazing.

Dr. John Jaquish: I was under 4,000 pounds of compression. I know that sounds like a lot, but a lot of people can do that. Usually, that’s athletic male levels.

Beth: Right.

Dr. John Jaquish: Thousands of pounds. And then, after five seconds, when you stop the contraction, the bone springs right back into position. So it is, in essence, like a spring.

Beth: Right. And think of, in my simple-minded way, I think of bone metabolism as being like these people that we all know that is constantly remodeling their homes, which would drive me crazy. But there’s always something to be done.

Dr. John Jaquish: Yeah, I know people like that.

Beth: Yeah. Some people are… One room gets finished, and then they move on to the next one, and then a few years later they’re back to the first room. And that’s what our bones are doing, interestingly enough. They’re always-

Dr. John Jaquish: Always remodeling. Right.

Beth: Yeah. Always remodeling.

Dr. John Jaquish: And it’s only based on the activity. And you have to consider the nutrients you’re giving your body. You have to give it the building blocks. You have to have the proper amount of protein. And that’s part of the reason why 20 out of 20 different studies, all combined in a meta-analysis which was published in 2018, showed that vegan nutrition rapidly destroys bone.

Beth: Right. Not enough protein. Yeah.

Dr. John Jaquish: Yeah. They’re not getting the proper amount of protein. And once you realize you need to take in one gram per pound of bodyweight?

Beth: Yeah.

Dr. John Jaquish: You can’t be vegan. And most vegan sources of protein are 9% or less usable by the body.

Beth: Right.

Dr. John Jaquish: Right. So, 91% of the protein you take in via vegetable sources becomes nitrogen and goes through you in form of waste, because it’s the wrong amino acids.

Beth: Rght. And interestingly, clinical trials that have been done on some other nutrients that people popularly think of as supporting bone health, like calcium and vitamin D, give pretty mixed results in terms of-

Dr. John Jaquish: Right. That’s right. Well, I can explain that. It’s because the more calcium you take in, the more your body lets go of the older calcium that it’s been hanging on to, so you start to shed bone faster.

Dr. John Jaquish: But here’s the problem. Calcium comes into your system, and if you stimulate the body to build more bone cells within the trabecular bone, in the soft… in the middle of the bone, then it’s a good trade-off. You’re trading new bone for old bone.

Dr. John Jaquish: But here’s the problem. People, when they stop doing high-impact activity… And the high impact, let me just give people some perspective, the minimum amount of impact is 4.2 multiples of body weight. That’s the minimum. You’re doing nothing if you’re not exceeding 4.2 multiples of body weight. So, anyone who’s postmenopausal is not loading their body with 4.2 multiples of body weight.

Beth: Right. In general, as people get older, they quit exercising as much.

Dr. John Jaquish: Right. And then they take calcium, which makes the problem even worse.

Beth: Right. Yeah.

Dr. John Jaquish: Right.

Beth: Yeah. Double it.

Dr. John Jaquish: And calcium is great if you’re doing something to build bone, and going for a brisk walk around the neighborhood with your dog might be good for your circulation, it might be good for your dog, but it’s not doing anything for your bone.

Beth: Right. So, let’s talk a little bit about the mechanics. What is it about loading the bone that stimulates it to add new bone mass?

Dr. John Jaquish: So, I’m the inventor of OsteoStrong and I’m the chief science officer. Nobody at OsteoStrong likes it when I explain it this way, but I like this explanation. All stimuli that change the body, like heavyweights when you’re weightlifting, or whatever you’re doing to load muscle, or whether it’s sunlight to build a suntan, or abrasion to build a callus, all of these things, there’s a certain threshold that they require of stimuli. And so, it’s not like everything you touch builds you a callus. You’ve got to have some serious disruption in subcutaneous layers to stimulate that.

Beth: Right.

Dr. John Jaquish: And the same thing with the sunlight. It could be Christmas day in the United States, and we could stand in the sun all day long, and we’re not going to get a sunburn.

Beth: Right.

Dr. John Jaquish: But on the 4th of July in the United States? Oh, yeah. You can get a sunburn in 15 minutes. So, it’s stimuli. That’s solely what it’s based on, the relevant level of stimulus so that the adaptation can happen. And here’s what I like saying that nobody likes when I say it. All stimuli to the body is an irritation.

Beth: Right.

Dr. John Jaquish: When I work out, and anybody’s read my book or seen pictures of me online, very muscular guy. When I exercise, it’s an irritation.

Beth: Right. You’re breaking-

Dr. John Jaquish: The body responds to that irritation and builds muscle.

Beth: Yeah. You’re breaking those muscles down a little bit.

Dr. John Jaquish: Say it again?

Beth: You’re breaking those muscles down a little bit. You’re damaging the muscles when you work out, and then they respond.

Dr. John Jaquish: That’s a myth. No. Muscles do not get damaged when… Only if you do it wrong.

Beth: Well, the inflammation is what I’m trying to get at. There is that irritation.

Dr. John Jaquish: Oh, yeah. There’s inflammation for sure. Yeah. Exactly. Inflammation is different than damage.

Dr. John Jaquish: So, there was a theory a long time ago that micro-tears in the muscle create… the tissue grows back stronger. That’s wrong. That’s an oversimplification, and oversimplification is another word for wrong.

Beth: Good point.

Dr. John Jaquish: Do you like that? When it comes to bone, it needs to be taken to a point of relevant fatigue, and then it needs to be given the time to adapt. So you need to load it with a significant amount of load so that the bone matrix, all those little walls inside the bone, become distorted. You need distortion within the bone matrix. So, like you were saying, you didn’t realize that the bone was flexible.

Beth: Right.

Dr. John Jaquish: You have to enact this, otherwise, you’ll never change anything. Once that happens, the bones say to themselves something like, “Oh, okay. We need to be able to tolerate this amount of load, so what we’re going to do is remodel. We’re going to build more little walls inside of the bone, and we’re going to use the minerals that are floating by in our bloodstream to do so. We’re going to take these minerals and build structures within the bone,” which ends up making the bone denser and more powerful.

Beth: Right. Okay. Got it. So, earlier you mentioned postmenopausal women. And one reason that postmenopausal women are more at risk for osteoporosis, which is bone loss, is that they don’t have circulating estrogen, and estrogen inhibits bone loss.

Dr. John Jaquish: Right.

Beth: But there are plenty of older men that get osteoporosis, too.

Dr. John Jaquish: One in five men, and I think it’s three in five women.

Beth: Right. And you fall and break a hip when you’re 70, 75, 80, and your life just goes downhill, and that’s a leading cause of death for a lot of people. They break a hip and then they just never get back to an active lifestyle.

Dr. John Jaquish: Osteoporotic fractures have the same death rate as breast cancer.

Beth: Right.

Dr. John Jaquish: People aren’t all that aware. We have a great sort of marketing vehicle behind breast cancer awareness, but other things hurt people just as much or more. And I don’t know, for one reason or another… I mean, maybe just because it involves breasts, people pay attention.

Beth: Yeah. There have been a lot of celebrities that have jumped onto that bandwagon, and not so many with osteoporosis. But I think like you’re saying, people don’t just realize the link between a fracture. They think, “Oh, general from a fracture,” but that’s not true.

Dr. John Jaquish: Listen to this statistic. If you get a fracture over the age of 50, a hip fracture, you have a 50% chance of death in one year-

Beth: Right.

Dr. John Jaquish: … if you’re over 50 years old.

Beth: Yeah. It’s horrifying. It’s horrifying. So, then that leads us into a discussion of your method because I was blown away when I read some of the clinical trials. The data is remarkable. So, why don’t you describe the OsteoStrong system, and then we can talk about some of the data that’s supported.

Dr. John Jaquish: Yeah. So, when I developed the OsteoStrong system, the intention was high impact. So, we want the benefit of high impact without the risks of high impact. So, for example, gymnasts, when they do a dismount from the uneven bars, and they usually flip in the air and then land, they can get 10 times their body weight through their lower extremities and their hips. So, incredible loading. By the way, nobody can lift a weight that’s 10 times their body weight. Not even close. So, when we look at what the body’s doing and the forces that need to be absorbed, it was like, “Okay.” So, I designed this entire system to treat my mother’s osteoporosis.

Beth: Right.

Dr. John Jaquish: So, yeah. And I looked at the problem from a very different perspective. I hadn’t finished my Ph.D. yet when I invented it. And my Ph.D. advisor, once he saw what I was doing, he said, “If you had done your Ph.D. and then had this idea, you would have talked yourself out of it because of our education…” His then comment further was, “Our education system is such that we’re told what you can do and what you can’t, and we focus a lot on what you can’t do. And this is one of those things where you would’ve believed in pharmacology, and you would have not believed in physical medicine, which is the category that this falls into. Because most physical medicine interventions are just not taken seriously.”

Beth: Yeah. Right.

Dr. John Jaquish: Usually, because they don’t work.

Beth: Yeah.

Dr. John Jaquish: Whereas, in this case, this works better than any drug that’s ever been trialed, and there are no side effects. I mean, I suppose the side effect is better posture and increased strength.

Beth: Right.

Dr. John Jaquish: Which shouldn’t upset anybody.

Beth: Yeah. I think that’s a big plus of the system, is that you don’t have those drug-related side effects, which are pretty scary, I think.

Dr. John Jaquish: Yes, they are.

Beth: So, your system loads different parts of the skeleton, and people can-

Dr. John Jaquish: Yeah. It emulates high impact. So, it puts a body into the four positions you naturally absorb impact. Upper extremities, lower extremities, core, and spine. Now, how would you protect yourself from a high-impact event? And so, you get in those positions, and your body is capable of so much more than it is in a standard fitness environment.

Dr. John Jaquish: I then continued and developed a system for fitness, which makes weightlifting look pretty stupid. And weightlifting is stupid, by the way. My best-selling book is called Weightlifting Is a Waste Of Time.

Beth: Oh, I’ll have to look for that because I read your book on the osteogenic loading system.

Dr. John Jaquish: Okay. Yeah. Yep. That’s called Osteogenic Loading. Wait, did you get through that whole thing?

Beth: Yes, I did.

Dr. John Jaquish: Wow.

Beth: And I got to tell you that I thought that biologists were dense writers, but I have since revised my opinion to think that engineers are even more dense writers than biologists.

Dr. John Jaquish: Yeah. That book was not written to be exciting. It was written to just document what was.

Beth: But it does a good job of documenting it, and there are good figures. But for the people that have never seen this system, to me, you feel like you’re in an isometric situation when you’re on one of these machines. You’re pushing, you’re pulling hard-

Dr. John Jaquish: Yeah. That’s not what it is. You’re moving.

Beth: … and you’re not moving.

Dr. John Jaquish: You are moving.

Beth: Right. You just don’t detect that much movement.

Dr. John Jaquish: Yeah. If you watch yourself do it, it looks like you’re moving. If you ask the person who’s doing it, “Did you move?” They’ll say no.

Beth: Right. But here’s a question for you. I know a lot of… When you’re on the machines, you always start by compressing your core. Does that stimulate bones, too? Is that a deformation of some of the skeletal structures when you engage your core?

Dr. John Jaquish: Oh, yeah. The ribs. I mean, your abdominals are attached to your ribs.

Beth: Right.

Dr. John Jaquish: And you need distortion in the rib bones to build the bone density in that. Yeah.

Beth: Yeah. Okay. Okay. Good. So, then, you did some clinical trials with… I think it was mostly with women, as I recall. And you found some good-

Dr. John Jaquish: Yeah. They have more life-threatening issues, so the research is always biased toward women.

Beth: Right. So, what did you find with… And it was over a pretty short period of six months, as I recall, that you got some positive results.

Dr. John Jaquish: That’s right. Yeah. It doesn’t take very long. I prefer when physicians are a little more up-to-date on analytics, because the blood tests for bone turnover, looking at anabolic and catabolic activity, are so much more accurate than DEXA scans. A DEXA scan is a picture, and everybody who’s taken a picture of themselves knows that at some angles you look better than others.

Beth: Right.

Dr. John Jaquish: From some angles, you look sleepy. From some angles, you look fat. Some angles, you just don’t like your smile, or whatever. Well, DEXA scans are the same in that almost no two are alike. The x-ray tech has to manually point. They have to define where the bounding box is on your hip bone. But if you’ve lost or gained weight, your hip might sit a little differently-

Beth: Sure.

Dr. John Jaquish: … between your DEXA scans. So, there’s nothing you can do. Your reading’s going to be different in one direction or the other, and you won’t know. You’ll just get an error.

Beth: Okay.

Dr. John Jaquish: And it won’t tell you it’s an error. It’ll say, “You either lost or gained bone density.” And the truth is, you might not have.

Beth: Okay. Yeah. So, the first papers that I saw that you had done used DEXA. So, are you now using the blood markers?

Dr. John Jaquish: I’m trying to encourage researchers to do both because they don’t want to not do DEXA.

Beth: Right.

Dr. John Jaquish: See, DEXA became the favored measurement, because what does DEXA look at? It looks at the outside of the bone, right? It’s a picture.

Beth: Right.

Dr. John Jaquish: An X-ray.

Beth: Yeah.

Dr. John Jaquish: But an x-ray that doesn’t go through your bone. So, I mean, you’re looking at the outside of the bone. And when you have a category of drug that protects the outside of the bone only, boy does that DXA scan makes those drug patients look good.

Beth: Right.

Dr. John Jaquish: So, the test made the drug look like it was a success. So, no wonder it was the favored method.

Beth: Sure. Yeah.

Dr. John Jaquish: But now that those patents have expired, nobody’s pushing DEXA anymore. There are a lot of companies that used to make DEXA tables that just don’t even make them anymore.

Beth: Oh, interesting. Okay.

Dr. John Jaquish: Right. And I understand perfectly why. Pharma companies aren’t pushing DEXA scans anymore, because their patents ran out. Beth: Right. Dr. John Jaquish: So, now all of a sudden, it seems harder to get a DEXA. Yeah. It’s harder to get a DEXA because there’s no marketing vehicle behind it anymore. And it also was a crummy test. Beth: Yeah. Well, that’s interesting. Dr. John Jaquish: It’s inaccurate. So, the blood test is the way. It should be less expensive, though certain lab companies will gouge you, as lab companies tend to do. You got to make them aware. When they give you a $2,000 bill, you’re like, “Yeah, this is supposed to cost about $40.” Beth: Right. Well, that’s interesting to know. Well, we are just about out of time, John. I want to thank you for talking, and I will put a link to your website, and also links in our show notes about those blood markers because I think a lot of people aren’t familiar with those. Dr. John Jaquish: Yeah. Beth: But I think- Dr. John Jaquish: It’s what you want from one test to the next test to the next test. You want to occur there are you know that the test is inaccurate, why bother with it? Beth: Right. Especially when it’s pricey, like the DEXAs are. Dr. John Jaquish: Yeah. Now, insurance will cover either one. Beth: Okay. Well, that’s been great talking to you, John. Thank you so much. Dr. John Jaquish: Yes. Beth: And, yeah, keep up the good work. Dr. John Jaquish: All right, Beth. Thanks so much. This was fun. Beth: I was speaking with Dr. John Jaquish, developer of the Osteostrong system for treating osteoporosis. I’ll put links in the show notes to his website and publications.