Natural Bone Builders

March 12, 2010 Written by JP       [Font too small?]

Some alt-med experts are suspicious of mainstream medical publications such as the The New England Journal of Medicine (NEJM). They generally believe that such periodicals are firmly in the camp or even in the pocket of allopathic medicine. While there may be some truth to that, it’s also accurate to say that unbiased articles do occasionally appear in these same journals that are often criticized. Read the following quote and tell me if it sounds like it belongs in a publication whose primary purpose is to support the existing medical and pharmaceutical paradigm: “The current drug-labeling practice for adverse events is based on the implicit assumption that an accurate portrait of patients’ subjective experiences can be provided by clinicians’ documentation alone. Yet a substantial body of evidence contradicts this assumption, showing that clinicians systematically downgrade the severity of patients’ symptoms, that patients’ self-reports frequently capture side effects that clinicians miss, and that clinicians’ failure to note these symptoms results in the occurrence of preventable adverse events”. That quote is taken directly from a current analysis entitled, “The Missing Voice of Patients in Drug-Safety Reporting” which is presented in the March 10th online edition of the NEJM.

A rather alarming presentation was also recently given at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Researchers from Columbia University Medical Center provided data based on two new studies that the most commonly used “bone building drugs” (bisphosphonates) may actually lead to poorer bone integrity in the long term. The cause for concern involves a noted suppression of bone remodeling that appears to result in more brittle bones when these medications are used for four years or more. (1,2)

Most holistic and integrative physicians prefer to look at natural factors that may influence the organic growth and integrity of bone architecture. A recent review provided by the USDA Human Nutrition Research Center on Aging at Tufts University mentions a number of dietary components that are vital for supporting bone mineral density at all stages of life. Specifically, they encourage optimal intakes of B Vitamins, calcium, carotenoids (plant-based antioxidants), magnesium, potassium and Vitamins C, D, K. Ensuring adequate protein and reducing the consumption of cola beverages are also mentioned. (3)

According to some nutritionists, Vitamin K needs to play a more prominent role in the management of skeletal health. This is particularly important because this micronutrient is often deficient in populations that need it the most. An evaluation from earlier this year determined that older men and women were likely to have deficient levels of plasma MK-7, a biologically active form of Vitamin K. This is a pressing cause for concern because the two most common forms of K, phylloquinone (K1) and meanquinones (K2), are known to enhance bone formation, protect against bone resorption and support collagen cross-links that further strengthen the skeletal system. (4,5,6,7)

In December 2009, scientists from the Keio University School of Medicine in Japan examined the current state of evidence regarding Vitamin K interventions in relation to fracture risk. Seven randomized controlled studies were included in the evaluation. The researchers reported that despite “only a modest increase in bone density, high-dose Vitamin K supplementation improved indices of bone strength in the femoral neck and reduced the incidence of clinical fractures”. The most recent data available in the medical literature tends to support this observation. (8)

  • Supplementing with 180 mcg of the MK-7 form of Vitamin K2 results in statistically relevant changes in lumbar spine bone mineral density. So says a newly published, placebo-controlled study that followed 94 heart and lung transplant patients over the course of one year. Transplantation recipients are at a greater risk for osteoporosis. An important detail was also discovered in the course of this trial: the participants with the highest plasma K2 levels were more likely to have poorer Vitamin D status. This suggests that supplementation with Vitamin K may necessitate greater Vitamin D intake as well. (9)
  • A different form of Vitamin K2 (menatetrenone) was the focus of a current experiment involving rats who were undergoing glucocorticoid (GC) treatment. These powerful steroid medications are typically used to manage asthma, auto-immune and inflammatory conditions. They’re also notorious for negatively impacting bone density. The addition of K2 to an 8 week steroid treatment regime was shown to prevent “bone resorption while maintaining bone formation” in GC treated rats. (10)
  • *If* you decide to use a bisphosphonate medication, you may want to consider adding Vitamin K2 to your daily routine as well. A recent animal study presented in the Journal of Bone Mineral Metabolism concluded that “the combination treatment was more effective than ALN (alendronate – a bisphosphonate drug) alone for improving bone strength in OVX mice”. OVX stands for overariectomized and represents a model suggestive of menopause. (11)
Patient vs. Physician Reported Drug Side Effects
Source: NEJM – March 10th, 2010 (link)

I’m often asked about the relative importance of supplementing with calcium and Vitamin D. Some people believe that they don’t need to take additional amounts of these nutrients because they eat plenty of calcium-rich foods and spend at least some time in the sunshine. In most cases, it’s still a good idea to add supplemental calcium and D to your daily routine if you’d like to support stronger bones. Here’s why:

The results of The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study (OSTPRE-FPS) was just released. This was a 3 year trial that involved 593 postmenopausal women. Roughly half consumed 1,000 mg of supplemental calcium and 800 IUs of Vitamin D per day. The others served as a control group and received only a placebo. Post trial bone density testing indicates that the participants who used the supplements had a greater total body bone mineral density at the completion of the 3 year period. Furthermore, the supplement users who were highly compliant (>80% supplement use) exhibited even greater gains in skeletal strength. The concluding remarks of the study state that “Daily Vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake”. (12)

Osteopenia and Osteoporosis are serious health concerns for all senior men and women and those who hope to one day achieve seniority. But what’s equally important is the prevention of fractures. A fracture late in life can not only be debilitating but can also dramatically increase the likelihood of serious complications and worse. The same dosage of 1,000 mg of calcium and 800 IUs of Vitamin D was recently shown to reduce total fracture risk by 17% in a group of 3,195 women aged 65-71 as compared to those using a placebo. Some areas of the body were protected to an even great extent – “distal forearm fractures” (<30%) and “upper extremity fractures” (<25%). (13)

Medications are inherently foreign to the body. There is no chemical receptor or dietary requirement for the synthetic creations contained in prescription drugs. Even medicines that try to emulate natural hormones are often problematic because they’re not identical to the hormones produced in the body. This is not to say that there aren’t instances when pharmaceutical care is advisable. I know I would certainly accept this form of treatment in situations where it was absolutely necessary. But drugs are unlikely to ever replace the natural building blocks that we all need to survive and thrive. This is why I believe that we should first examine diet and lifestyle before opting to use bone building or other medications that may have unexpected, long-term consequences.

Warning: People taking certain “blood thinning” medications should consult with their health care providers prior to increasing vitamin K consumption through diet or supplementation. (14)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Bone and Joint Health, Nutritional Supplements

13 Comments & Updates to “Natural Bone Builders”

  1. Nina K. Says:

    Morning JP :-)

    ..i’m late: wish you both an funny relaxing weekend :-)

    Nina K.

  2. JP Says:

    Thanks, Nina! :)

    I hope you and your hubby had a great weekend as well!

    We’ve had a very busy weekend – at the Natural Products Expo West. More of that in the coming days!

    Be well!


  3. Nina K. Says:

    Morning JP :-)

    thank you! Sounds very interesting Im excited looking for the news this week… :-)

    Nina K.

  4. JP Says:

    Update 06/08/15:

    J Pineal Res. 2015 Jun 3.

    Melatonin improves bone mineral density (BMD) at the femoral neck in post-menopausal women with osteopenia: A randomized controlled trial.

    Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment with melatonin could improve bone mass and integrity in humans. In a double-blind RCT, we randomized 81 post-menopausal osteopenic women to one-year daily treatment with melatonin 1mg (N=20), or 3mg (N=20), or placebo (N=41). At baseline and after one-year treatment, we measured BMD by DXA, quantitative computed tomography (QCT), and high resolution peripheral QCT (HR-pQCT), and determined calcitropic hormones and bone markers. Mean age of the study subjects was 63 (range 56-73) years. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin (p<0.05) in a dose-dependent manner (p<0.01), as BMD increased by 0.5% in the 1mg/d group (p=0.55) and by 2.3% (p<0.01) in the 3mg/d group. In the melatonin group, trabecular thickness in tibia increased by 2.2% (p=0.04), and vBMD in the spine by 3.6% (p=0.04) in the 3mg/d. Treatment did not significantly affect BMD at other sites or levels of bone turnover markers, however, 24h urinary calcium was decreased in response to melatonin by 12.2% (p=0.02). In conclusion, one-year treatment with melatonin increased BMD at femoral neck in a dose-dependent manner, while high dose melatonin increased vBMD in the spine. Further studies are needed to assess the mechanisms of action and whether the positive effect of night-time melatonin will protect against fractures.

    Be well!


  5. JP Says:

    Updated 08/17/15:

    Updated 08/17/15:

    Evid Based Complement Alternat Med. 2015;2015:689138.

    Intake of Novel Red Clover Supplementation for 12 Weeks Improves Bone Status in Healthy Menopausal Women.

    Objective. To investigate the effect by which daily consumption of a novel red clover (RC) extract influences bone health, inflammatory status, and cardiovascular health in healthy menopausal women. Design. A 12-week randomized, double-blinded, placebo-controlled trial involving 60 menopausal women receiving a daily dose of 150 mL RC extract containing 37.1 mg isoflavones (33.8 mg as aglycones) or placebo. Methods. Bone parameters were changes in bone mineral density (BMD), bone mineral content (BMC), and T-score at the lumbar spine and femoral neck. Bone turnover (CTx) and inflammatory markers were measured in plasma and finally blood pressure (BP) was evaluated. Results. RC extract had positive effect on bone health, and only the women receiving the placebo experienced a decline in BMD (p < 0.01) at the lumbar spine. T-score at the lumbar spine only decreased in the placebo group (p < 0.01). CTx decreased in the RC group with -9.94 (±4.93)%, although not significant. Conclusion. Daily consumption of RC extract over a 12-week period was found to have a beneficial effect on bone health in menopausal women based on BMD and T-score at the lumbar spine and plasma CTx levels. No changes in BP or inflammation markers were found and no side effects were observed.

    Be well!


  6. JP Says:

    Updated 09/19/15:

    Am J Clin Nutr. 2015 Sep 16.

    No increase in risk of hip fracture at high serum retinol concentrations in community-dwelling older Norwegians: the Norwegian Epidemiologic Osteoporosis Studies.

    BACKGROUND: Norway has the highest hip fracture rates worldwide and a relatively high vitamin A intake. Increased fracture risk at high intakes and serum concentrations of retinol (s-retinol) have been observed in epidemiologic studies.

    OBJECTIVE: We aimed to study the association between s-retinol and hip fracture and whether high s-retinol may counteract a preventive effect of vitamin D.

    DESIGN: We conducted the largest prospective analysis of serum retinol and hip fracture to date in 21,774 men and women aged 65-79 y (mean age 72 y) who attended 4 community-based health studies during 1994-2001. Incident hip fractures occurring up to 10.7 y after baseline were retrieved from electronic hospital discharge registers. Retinol determined by high-pressure liquid chromatography with ultraviolet detection in stored serum was available in 1154 incident hip fracture cases with valid body mass index (BMI) data and in a subcohort defined as a sex-stratified random sample (n = 1418). Cox proportional hazards regression weighted according to the stratified case-cohort design was performed.

    RESULTS: There was a modest increased risk of hip fracture in the lowest compared with the middle quintile of s-retinol (HR: 1.41; 95% CI: 1.09, 1.82) adjusted for sex and study center. The association was attenuated after adjustment for BMI and serum concentrations of α-tocopherol (HR: 1.16; 95% CI: 0.88, 1.51). We found no increased risk in the upper compared with the middle quintile. No significant interaction between serum concentrations of 25-hydroxyvitamin D and s-retinol on hip fracture was observed (P = 0.68).

    CONCLUSIONS: We found no evidence of an adverse effect of high serum retinol on hip fracture or any interaction between retinol and 25-hydroxyvitamin D. If anything, there tended to be an increased risk at low retinol concentrations, which was attenuated after control for confounders. We propose that cod liver oil, a commonly used food supplement in Norway, should not be discouraged as a natural source of vitamin D for fracture prevention.

    Be well!


  7. JP Says:

    Updated 12/23/15:!divAbstract

    Food Funct. 2015 Dec 21. [Epub ahead of print]

    Consumption of onion juice modulates oxidative stress and attenuates the risk of bone disorders in middle-aged and post-menopausal healthy subjects.

    Osteoporosis is a chronic inflammatory condition that is characterized by the loss of bone mineral density (BMD). The current study was undertaken to evaluate the impact of onion juice intake on the bone mineral density (BMD) and bone loss in corroboration with antioxidant effects in human (in vivo) as well as inhibitory effects on the differentiation of osteoclasts in the cell line (in vitro). For in vitro studies, the RAW 264.7 (osteoclast progenitor) cells were used to examine the anti-osteoclastogenic effect of onion. In the case of in vivo studies, twenty-four subjects were divided into two groups and advised to intake 100 mL of onion juice or placebo for 8 weeks. Anthropometric measurements and blood samples were collected at the initial, 2nd, 6th, 8th and 10th week. The result of in vitro studies indicated that onion extract would effectively inhibit the osteoclastogenesis and its differentiation. Significant changes in the levels of alkaline phosphatase (ALP), free radicals, total antioxidant capacity (TEAC) and various antioxidants were observed in onion administered subjects. The BMD of three postmenopausal women was also found to be mildly improved on supplementation with onion juice. Onion juice consumption showed a positive modulatory effect on the bone loss and BMD by improving antioxidant activities and thus can be recommended for treating various bone-related disorders, especially osteoporosis.

    Be well!


  8. JP Says:

    Updated 1/14/16:

    Osteoporos Int. 2016 Jan 11.

    Greater serum carotenoid concentration associated with higher bone mineral density in Chinese adults.

    This cross-sectional study has been performed to investigate the relationship between serum carotenoids and bone mineral density (BMD) in Chinese population. We found that women with higher serum β-cryptoxanthin, lycopene, or α-carotene exhibited higher BMD at various bone sites. Similar association was observed between α-carotene and BMD in men.

    INTRODUCTION: Carotenoids may positively regulate bone metabolism through their antioxidant properties; however, few studies have examined the relation between serum carotenoids and bone health. We aimed to determine the associations between the serum concentration of several carotenoid subclasses and BMD in a Chinese population.

    METHODS: This study was a community-based cross-sectional study. We measured 1898 women and 933 men aged 59.6 years who completed serum β-cryptoxanthin, zeaxanthin + lutein, lycopene, and α-carotene concentration analyses and BMD assessments. Serum individual carotenoids were assessed by the methods of reverse-phase high-performance liquid chromatography. Dual-energy X-ray absorptiometry was applied to determine BMD at whole body, lumbar spine, total hip, femur neck, and trochanter. ANCOVA was used to examine the correlations between categorized individual carotenoids and BMD at measured sites.

    RESULTS: After adjusting for potential covariates, a monotonic dose-response positive correlation between circulating levels of β-cryptoxanthin, lycopene, and α-carotene and BMD at various skeletal sites was observed in women. Women in the top (vs. bottom) quartiles of serum β-cryptoxanthin, lycopene, or α-carotene exhibited 1.8-2.3, 1.5-2.0, or 1.3-2.7 % higher BMD at the bone sites with significant results (P-trend <0.05), respectively. For men, the corresponding values were 2.6-4.0 % for α-carotene at the whole body and hip regions (P-trend <0.001-0.023).

    CONCLUSION: These results suggest that serum carotenoids have a favorable association with bone health in the study population, especially in women.

    Be well!


  9. JP Says:

    Updated 08/06/16:

    Int J Environ Res Public Health. 2016 Jul 26;13(8).

    Olives and Bone: A Green Osteoporosis Prevention Option.

    Skeletal degeneration due to aging, also known as osteoporosis, is a major health problem worldwide. Certain dietary components confer protection to our skeletal system against osteoporosis. Consumption of olives, olive oil and olive polyphenols has been shown to improve bone health. This review aims to summarize the current evidence from cellular, animal and human studies on the skeletal protective effects of olives, olive oil and olive polyphenols. Animal studies showed that supplementation of olives, olive oil or olive polyphenols could improve skeletal health assessed via bone mineral density, bone biomechanical strength and bone turnover markers in ovariectomized rats, especially those with inflammation. The beneficial effects of olive oil and olive polyphenols could be attributed to their ability to reduce oxidative stress and inflammation. However, variations in the bone protective, antioxidant and anti-inflammatory effects between studies were noted. Cellular studies demonstrated that olive polyphenols enhanced proliferation of pre-osteoblasts, differentiation of osteoblasts and decreased the formation of osteoclast-like cells. However, the exact molecular pathways for its bone health promoting effects are yet to be clearly elucidated. Human studies revealed that daily consumption of olive oil could prevent the decline in bone mineral density and improve bone turnover markers. As a conclusion, olives, olive oil and its polyphenols are potential dietary interventions to prevent osteoporosis among the elderly.

    Be well!


  10. JP Says:

    Updated 08/30/16:

    Eur J Nutr. 2016 Aug 24.

    Dietary patterns in an elderly population and their relation with bone mineral density: the Rotterdam Study.

    PURPOSE: Our aim was to identify dietary patterns that are associated with bone mineral density (BMD) against a background of relatively high dairy intake in elderly Dutch subjects.

    METHODS: Participants were 55 years of age and older (n = 5144) who were enrolled in The Rotterdam Study, a population-based prospective cohort study. Baseline intake of 28 pre-defined food groups was determined using a validated food frequency questionnaire. Dietary patterns were identified using principal component analysis. BMD was measured using dual-energy X-ray absorptiometry at baseline and at three subsequent visits (between 1993 and 2004). Linear mixed modelling was used to longitudinally analyse associations of adherence to each pattern with repeatedly measured BMD (both in Z scores).

    RESULTS: After adjustment for confounders, two dietary patterns were associated with high BMD: a “Traditional” pattern, characterized by high intake of potatoes, meat and fat (β = 0.06; 95 % CI 0.03, 0.09) and a “Health conscious” pattern, characterized by high intake of fruits, vegetables, poultry and fish (β = 0.06; 95 % CI 0.04, 0.08). The “Processed” pattern, characterized by high intake of processed meat and alcohol, was associated with low BMD (β = -0.03; 95 % CI -0.06, -0.01). Associations of adherence to the “Health conscious” and “Processed” pattern with BMD were independent of body weight and height, whereas the association between adherence to the “Traditional” pattern with BMD was not.

    CONCLUSIONS: Against a background of high dairy intake and independent of anthropometrics, a “Health conscious” dietary pattern may have benefits for BMD, whereas a “Processed” dietary pattern may pose a risk for low BMD.

    Be well!


  11. JP Says:

    Updated 03/08/17:

    Inflamm Bowel Dis. 2017 Mar 6.

    Supplementation with 2000 IU of Cholecalciferol Is Associated with Improvement of Trabecular Bone Mineral Density and Muscle Power in Pediatric Patients with IBD.

    BACKGROUND: Inflammatory bowel diseases (IBD) are associated with altered bone health and increased risk for fractures. Vitamin D deficiency is frequently found in IBD; however, the effect of vitamin D supplementation on bone health of children with IBD is poorly understood. We aimed to observe the changes in volumetric bone density and dynamic muscle functions after vitamin D substitution in a cohort of pediatric patients with IBD.

    METHODS: This was a prospective observational study of 55 patients (aged 5-19 years) with IBD. Bone quality was assessed using peripheral quantitative computed tomography and muscle functions by jumping mechanography at baseline and after a median of 13.8 (interquartile range, 12.0-16.0) months of daily substitution of 2000 IU of cholecalciferol.

    RESULTS: Median serum levels of 25-hydroxyvitamin D increased from 58 nmol/L at the baseline visit to 85 nmol/L at the last follow-up visit (P < 0.001); no signs of overdose were reported. The Z-scores of trabecular bone mineral density, cortical bone cross-sectional area, and maximal muscle power improved significantly during the follow-up period (+0.5, P = 0.001, +0.3, P = 0.002 and +0.5, P = 0.002, respectively). Cholecalciferol substitution was positively associated with trabecular bone mineral density and maximal muscle power (estimates 0.26, 95% confidence interval 0.14-0.37, P < 0.0001 and 0.60, 95% confidence interval 0.32-0.85, P < 0.0001, respectively) but not with the Strength-Strain Index or maximal muscle force (Fmax).

    CONCLUSIONS: We observed an improvement in bone and muscle parameters after cholecalciferol substitution in pediatric patients with IBD. Therefore, vitamin D substitution can be considered in such patients.

    Be well!


  12. JP Says:

    Updated 03/25/17:

    Medicine (Baltimore). 2017 Mar;96(12):e6437.

    Updated association of tea consumption and bone mineral density: A meta-analysis.

    BACKGROUND: Current studies evaluating the association of tea consumption and bone mineral density (BMD) have yielded inconsistent findings. Therefore, we conducted a meta-analysis to assess the relationship between tea consumption and BMD.

    METHODS: The PubMed, Embase, and Cochrane Library databases were comprehensively searched, and a meta-analysis performed of all observational studies assessing the association of tea consumption and BMD. Forest plots were used to illustrate the results graphically. The Q-test and I statistic were employed to evaluate between-study heterogeneity. Potential publication bias was assessed by the funnel plot.

    RESULTS: Four cohort, 1 case-control, and 8 cross-sectional studies including a total of 12,635 cases were included. Tea consumption was shown to prevent bone loss [odds ratio (OR): 0.66; 95% confidence interval (CI), 0.47-0.94; P = 0.02], yielding higher mineral densities in several bones, including the lumbar spine [standardized mean difference (SMD): 0.19; 95% CI, 0.08-0.31; P = 0.001], hip (SMD: 0.19; 95% CI, 0.05-0.34; P = 0.01), femoral neck [mean difference (MD): 0.01; 95% CI, 0.00-0.02; P = 0.04], Ward triangle (MD: 0.02; 95% CI, 0.01-0.04; P = 0.001), and greater trochanter (MD: 0.03; 95% CI, 0.02-0.04; P < 0.00001), than the non-tea consumption group.

    CONCLUSION: This meta-analysis provided a potential trend that tea consumption might be beneficial for BMD, especially in the lumbar spine, hip, femoral neck, Ward triangle, and greater trochanter, which might help prevent bone loss.

    Be well!


  13. JP Says:

    Updated 05/08/17:

    J Transl Med. 2017 Apr 24;15(1):81.

    Preliminary results demonstrating the impact of Mediterranean diet on bone health.

    BACKGROUND: Nutrition is an environmental factor affecting bone health. Nutrition is considered essential to achieve and maintain optimal bone mass. Mediterranean diet (MD) has shown to prevent bone disease. Aim of this study is to investigate the relationship between bone health status and adherence the MD.

    METHODS: Four-hundred eighteen healthy people (105 males and 313 females, age 50 ± 14 years) were recruited in the outdoor hospital of the “Campus Salute Onlus” held in Piazza del Plebiscito in Naples, October 17-20th 2013 and 09-11th October 2014. All subjects underwent clinical assessment, calcaneal quantitative ultrasound (QUS) scanner and PREvención con DIeta MEDiterránea (PREDIMED) questionnaire.

    RESULTS: Globally, prevalence of osteoporosis and osteopenia were 7.7 and 46.0%, respectively. The majority of subjects (60.5%) had an average score (score 6-9) of adherence to MD. The T-score showed positive correlation with PREDIMED score (r = 0.250, p < 0.001). The higher T-scores were positively associated with a higher consumption of extra-virgin olive oil (EVOO), vegetables, fruits, legumes, and fish and negatively associated with consumption of red meat. The higher T-scores were positively associated with the highest odds of PREDIMED scores (higher adherence) (OR 6.91, IC 6.27-7.61, p < 0.001). Multiple regression analysis models indicated that, among the single food items investigated, high T-score can be predicted by consumption of EVOO (p < 0.001), fish (p < 0.001) and fruit (p = 0.002) intake. A PREDIMED score of 3 was found to be predictive for a low T-score (α = 0.05, R-squared index = 0.417).

    CONCLUSIONS: The results demonstrate a positive correlation between bone health status and adherence to MD, suggesting that a high adherence to MD promotes bone health. The observations here reported confirmed that a specific dietary approach, such as MD, can represent a modifiable environmental factor for osteoporosis’ prevention.

    Be well!


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