A PHYSICIAN’S PERSPECTIVE ON BONE-BUILDING
Dr. Carolyn DeMarco, M.D., a general practitioner who specializes in women’s health and alternative medicines, has kindly written Chapters 12, 13 and 14.
PUT YOUR BONES TO THE TEST – WHO IS AT RISK FOR WEAK BONES?
A Foreword By Dr. Carolyn DeMarco
There are hundreds of research studies in the medical literature that illustrate the effectiveness of diet, nutritional supplementation and core strengthening exercise programs, to halt and even reverse poor posture, misaligned biomechanical movement and osteoporosis. The groundbreaking research findings on the exciting impact of both nutrition and exercise on superior bone structure and function are quite dramatic.
You can regenerate bone mineral density and bone health naturally!
- In April 2006, the journal Surgical Neurology reported that omega-3 fatty acid supplements from fish oils, rich in EPA and DHA were effective for 70 percent of people using them to reduce neck or back pain.
- Dr. Bruce Ovbiagele, a professor of neurology at the Stroke Center, University of California, Los Angeles published research in April 2006, showing that people with the highest blood levels of calcium were also 50-70 percent less likely to experience a stroke—and people who suffered a stroke recovered more quickly when their blood calcium levels tested high.
- In the May 2004 edition of BMC Women’s Health, University of Connecticut researchers proved that bone loss and cognitive decline are co-occurring conditions. If you increase your bone mineral density (BMD) and bone strength through diet, exercise and a bone-building supplement—you simultaneously boost your good moods, memory and brainpower.
- Dr. Pamela Marcovitz, a leading women’s cardiology specialist who directs the Ministrelli Women’s Heart Center in Beaumont Hospital in Royal Oak, Michigan, stated in March 2006, that “80 percent of heart disease is preventable,” using supplements, exercise and a nutritious diet. Heart disease is the number one killer of women in North America.
- Dr. Walter Willett, of Harvard Medical School writing in the journal Science states, “Milk and other dairy products may not be directly equivalent to calcium from supplements.”
- Recent research cautions us from consuming more than 1,000 to 1,500 mg of calcium daily. Use a food-based, bone-building supplement with no more than 500 mg of elemental calcium, combined with many super-critical cofactors to boost bone-repair and bone-building functions daily.
- In a 2002 editorial in the Journal of the American Medical Association, Harvard researchers recommended that all North Americans should take a multivitamin every day—as the potential protection against chronic illness like osteoporosis clearly outweighs the minimal cost. Harvard School of Public Health website states that a daily multivitamin is “the least expensive insurance policy you can buy.”
As a physician, my main objective is to guide patients in maintaining optimum bone health or rebuilding bone health through a comprehensive program of nutritional supplementation and lifestyle interventions. I would like to illustrate the bone-building benefits of such an approach, of natural bone density regeneration, with this story.
Move Out Of The High Bone Fracture Risk Zone — Naturally
Sally, at 45 years of age, came to see me with a 20 percent reduction in vertebral trabecular bone mineral density expressed as a T-Score of –2. This spinal density score was low enough to put her at high risk for osteoporotic bone fracture. After 18 months on a “cell friendly” nutritious diet that emphasized alkalinizing salads, vegetables, fruit, berries, spices and herbs, a food-based bone-building supplement, weight resistant core exercise for strength and balance, and a lifestyle tune-up, she gained almost 20 percent more bone mineral density. This increase raised her vertebral density as a T-Score of almost 0, which took her out of the high bone fracture risk threshold.
While many fractures such as a wrist, finger or forearm fracture, are painful and inconvenient, others may be outright life threatening. A hip fracture, for example, not only involves six or more months of physical rehabilitation and lifestyle chaos, but also is frequently complicated by blood clots that may travel to the lungs, kidneys, brain, liver, or intestines, or involve other serious surgical complications. More than 310,000 hip fractures were reported in North America in 2005 and each case cost at least $45,000 and involved considerable pain.
Dr. Robert Josse, Associate Physician-in-Chief, St. Michael’s Hospital and Professor of Medicine, University of Toronto, says that 20 percent of older patients die within three months of a fracture and 15 to 20 percent will not be able to regain their former independence and must be admitted to a nursing home. This crisis situation shows no signs of improving despite the millions of dollars being poured into pharmaceutical research and promotion. Perhaps what is needed is a fresh new approach.
The Other Side Of The Story
In the course of researching for this book, I found that every type of drug therapy has serious side effects. Some drugs work to protect the hip or the spine, but not for both of them. Medications for osteoporosis have been studied for anywhere from one year to ten years, and none have been studied for longer than ten years. Long-term effects of medications after that time period are simply unknown. No expert in the field knows how long the drugs should be taken and when they should be stopped. In addition, medication cannot be used for children, and younger adults, as they have not been studied in this age group.
I also found out that loss of bone density with age is normal and does not automatically mean an increase in fracture risk. New Zealand researcher and author, Gillian Sanson says in her landmark book, The Myth of Osteoporosis, “Osteoporosis is thought of as a disease when in most cases, it is just a condition than can be remedied by a smart lifestyle makeover.”
Furthermore, she states, “People are diagnosed with osteoporosis because they have low bone density, not because they have bone fractures. This occurs routinely despite the fact that BMD (bone mineral density) does not accurately identify men or women who will experience a bone fracture. A person with high bone density may go on to fracture, and another with low bone density may never fracture. Low BMD is but one of many risk factors of a disease that can be truly diagnosed only when there is a “fragility fracture”—a bone fracture resulting from low impact due to trauma. Calling low BMD osteoporosis is like calling elevated cholesterol heart diseases or calling high blood pressure a stroke.”
Moreover, hip fractures in those aged 80 or over are a marker of accelerated wear-and-tear, of overall poor or frail health. In addition healthy women and men rarely die from hip fractures. In women who were mobile before a hip or pelvic fracture it is estimated that as few as 14 percent of their deaths were caused or hastened by the fractures. Most factors that cause fractures in those 80 years of age or older are unrelated to low bone density, but due to severe falls after years of suboptimal nutrient intake.
In Chapter 2, we note that science and technology have magnified the destructive impact of acidification of our air, oceans, soils and upon humans themselves. If we look more deeply into medical research we will find that underneath the many surface differences of diseases such as cancer, cardiovascular disease, stroke and osteoporosis is this question of both inflammation and maintaining an alkaline pH.
There are six core insights that I believe we must focus on to be able to avoid or reverse major illness including heart disease, mental decline and osteoporosis:
- eat a color coded “cell friendly” alkaline diet, emphasizing fresh salads, vegetables, herbs, spices, “green drinks”, berries and brightly colored fruit
- exercise for core strength and balance
- reduce stress with meditation, yoga, prayer, Tai Chi, deep breathing or quiet time
- get 8 hours of deep, rejuvenating sleep a night in a darkened environment
- daily, use a food-based, comprehensive bone-building supplement
- eat more lean vegetable protein and ensure you have adequate omega-3, -6, -7 and -9 essential fats daily in your menu makeover, which provide many health benefits
The good news is that by following the well-documented recommendations and step-by-step self-help action plan, outlined in Chapters 1 to 11 of this groundbreaking book, you can experience lifelong bone health naturally. It is only through major changes to our lifestyle including diet, exercise and stress reduction that we can truly hope to prevent and reverse osteoporosis. Even if you have the condition and experience a fragility fracture, lifestyle changes are the major preventative tactic and are at least as important, if not more important, than medication in any treatment management protocol.
This book offers insight and hope that will allow you to actually prevent needless fractures, “dowager’s hump”, and loss of mobility or independence—and—even regain enough bone mass to take you out of the high-risk zone. Both bone health development and maintenance is natural and spontaneous when you follow this book’s simple but comprehensive program. I personally follow it!
And perhaps most importantly, the life-saving information and guidelines provided in The Bone-Building Solution will keep your bones strong and even reverse bone-breakdown or osteoporosis, so that the need for prescription drugs may be eliminated.
Naturally, people in their later years may need a medication to assist them, but the vast majority of us can naturally prevent, treat and reverse osteoporosis.
I present Chapters 12, 13 and 14 to you so you can fully understand the traditional medical approach that most physicians utilize, and see the promising alternative approaches doctors like me are utilizing with great results in people of all ages.
No matter what positive changes or fine-tuning you decide to make in your diet, exercise, supplement and lifestyle, be sure not to pass an early judgement until you give yourself 6 full weeks to truly adapt and assimilate the changes. Remember, you are removing layers and years of eating habits and a lifestyle that may not have been good for your health. You are also acquiring new tastes, new foods and a better way of living. I have never met anyone who regretted trying the 6 well-publicized lifestyle makeover changes I have presented.
I know, as a physician, osteoporosis is preventable. I also know that it has reversal potential. This book represents an invitation to take care of your own optimum well-being and to give you real hope that you can have healthier bones, a stronger stature, better posture and more fluid biomechanical movement naturally, all-life-long.
The Proof Is In The Pudding
I thoroughly enjoyed Chapter 5 about the acid-alkaline effect our food choices have on the health of our brain, heart, bones, teeth and nails. To further emphasize the virtues of a natural food diet I would like to present the latest research showing the need to eat more vegetables, salads, berries, fruit, herbs, spices and “green drinks” to experience an alkaline biochemical functioning.
While an internal alkaline balance is optimal, our biochemical functioning, daily stress of living, exposure to toxins and even the metabolism of food, produce a great deal of acidic by-products. For example, when we exercise or move we produce lactic acid and carbonic acid. Lactic acid and carbonic acid in turn are broken down—carbonic acid to carbon dioxide which we exhale and water which we excrete. Phosphoric acid and sulphuric acid are likewise produced from the metabolism of the phosphorus and sulfur contained in many foods such as meats rich in sulfa-amino acids. To regain the life-supporting alkaline state, acids from all sources must be buffered or neutralized through combination with alkaline minerals. Acid-forming elements in our food include phosphorus, sulfur, chlorine, iron and iodine. Foods in which these elements predominate leave an acidic residue when metabolized. The alkaline minerals are calcium, potassium, sodium and magnesium that can form bicarbonates to neutralize excess acids by acting as “acid sponges”.
Dr. Anthony Sebastian and colleagues at the University of California in San Francisco, recently presented evidence of the need for alkaline/acid rebalancing. In a groundbreaking study reported in the Journal of Clinical Endocrinology Volume 90, in February 2005, they looked precisely at postmenopausal bone loss and its relation to alkaline/acid balance.
Their first observation was that postmenopausal women in North America generally exhibit a low level acidic state, rather than the ideal low level alkaline state, due to acids
produced in metabolizing our typical high fat, sugar, processed grains and animal protein diet. Then they speculated that a lifetime mobilization of alkaline minerals from bone, to neutralize this acute acidic condition, would contribute to a decrease in bone mass. This bone loss, they suggested, could be reduced and bone formation enhanced by neutralization of these acids and subsequent sparing of the body’s alkaline minerals. Research shows, as you eat more animal protein (meat), your acid load increases.
Their research findings validated these speculations. Women who daily consume the Standard American Diet (SAD), containing some 80 grams of acidifying animal protein, were given an alkali in the form of potassium bicarbonate. This alkalinizing “acid sponge” neutralized internal, excessive acid production, which led to a decrease in calcium and phosphorus excretion, and stimulated new bone formation, and a reduction in the rate of bone-breakdown. Facilitating a return to the normal alkaline state spared bone-building minerals and enhanced bone health and bone mineral density (BMD).
Important Note On Protein Consumption And Calcium Elimination
In your body, calcium and protein have a see-saw relationship. As acidifying animal protein levels rise, the calcium content of your bones goes down. Excess animal protein above 60 grams a day for the average woman and 90 grams a day for the average man, raise acid levels that can lead to kidney stones, kidney injury and accelerated bone-breakdown. John McDougall, M.D., author of The McDougall Program for Women, says that eating excess animal protein is the human body’s “equivalent of acid rain”. You need to include some vegetable protein in your daily diet and lots of brightly colored produce, to buffer the acids from eating animal protein.
Stages Of Life And Weak Bone Prevention
The decade between 20 to 30 is the age of maximum bone-building and developing peak bone mass. A healthy lifestyle is essential, with core exercise and a comprehensive food-based, bone-building supplement.
30 to 40 is the “green light” decade. This is a pivotal age, since the average age at which you begin to lose bone is age 34. After that, you lose one percent bone mass per year. It is important to maintain a good exercise regimen and to improve nutrition and take a good food-based, bone-building nutritional supplement. This is a critical decade for maintaining maximum bone mass, bone strength and bone structure.
From 40 to 50 is the “orange light” decade of vulnerability in which you can have more stress and at the same time let exercise and nutritional regimens slide. Vigilance is critical at this time to pay attention to diet, stress reduction, a bone-building supplement and core exercise for both strength and balance—these are all vitally important for your future posture and structure.
50 to 60 is the “red light” decade of caution. This is the wakeup call decade. You have to work consciously on weight training, core exercise, eating an alkaline diet and taking a high quality bone-building supplement each and every day. Stress reduction and deep sleep are important.
The decade of 60 to 70 is a time when you want to retain your maximum bone strength and function. The same program that will stop bone loss will also help lower your high risk of stroke, cancer and heart disease. Optimal health programs are essential to longevity.
70 to 80+, primary attention must be given to fall prevention, building strong muscles and maintaining bones. It is imperative that you fall-proof your home to ensure that there are no obstacles that could cause a fall. Daily, walk as much as possible and use a food-based, bone-building supplement. Believe it or not, bones are much like your muscles. The more you use them, the stronger they become. The opposite is also true. If you do not walk enough, but sit around to rest your weary bones, they become weaker and much more prone to fracture.
PUT YOUR BONES TO THE TEST
Who Is At Risk For Weak Bones?
If you have a family history of osteoporosis, then, as with so many conditions, your risk of experiencing it is greater. If your mother or father had a broken hip, this suggests that your risk factor would double. It is estimated that if someone in your immediate family has primary osteoporosis, you have between a 60 to 80 percent chance of developing the disease yourself. Why is it important to assess your family history? Because when you understand that your risk factor is high, you know how important it is to get a BMD test and stay wisely on top of your optimum bone health, long before you have any signs of trouble. According to the American and Canadian Medical Associations, between 20 and 30 percent of women who have gone through menopause have osteoporosis, and another 3 percent have low bone density.
Why do women get more osteoporosis? In part, the risk is due to normally thinner bones, and partly because the loss of estrogen at menopause accelerates bone loss, especially for the first five to seven years after menopause begins. However, it must be emphasized that lower bone density is a normal part of aging and by itself does not lead to fracture. That is why improving your diet, maintaining core exercise levels for strength and balance, and daily using a “molecular targeted” bone-building supplement, as we age, is so critical to bone health mobility and independence.
Looking at the statistics in a different way allows more hope for men and women. Eighty-five percent of people aged 50, with a life expectancy of 80 years, will not suffer a hip fracture. Furthermore, as mentioned previously, for those in good health prior to a hip fracture, the injury rarely leads to death.
In a nutshell, living the “cell friendly” lifestyle detailed so well in this book and following the ancient rules of color coded eating that Sam Graci emphasized in Chapter 4, will preserve and maintain bone health, even if a weak bone related fracture should occur in your lifetime.
Men And Children Are Also At Risk—Many Do Not Know It
Although many osteoporosis sufferers are women, men and children are also at risk of osteoporosis or weak bones. In fact, 4 million men in North America have osteoporosis, and one in two men older than age 50 will have an osteoporotic-related fracture in his lifetime. It is called a “silent epidemic” that actually begins in our 20s and for some even earlier in their teens.
Osteoporosis begins to affect men about ten years later than it affects women. And because both men and women are living longer, researchers and doctors anticipate more people will have hip fractures in the future. In fact, by the year 2020 researchers project that men will have one half of all hip fractures in North America. Men must become bone wise.
Because osteoporosis apparently becomes an equal opportunity disease as you age, you may be curious as to when men should start having bone mineral density scans. All men older than 70 need a baseline scan, as well as men under age 60 who have risk factors, such as long-term corticosteroid use or use of drugs to treat prostate cancer.
Lost In Translation
Your bone density potential is partially determined by hereditary factors, and partially by lifestyle and environmental factors. Many bone experts are especially concerned that today’s children are going to suffer from osteoporosis at alarming and increasing numbers, due to a number of factors. Remember—children, preadolescents and teens are at the most critical age for building healthy bones. Why are today’s children putting themselves at a higher risk level for future osteoporosis?
- Children spend more time sitting, talking on cell phones, playing computer games or watching television 4-6 hours a day and less time exercising, walking and moving
- Children spend more time indoors and therefore receive less exposure to sunlight-forming vitamin D, a vitamin necessary for strong bones later in life
- Teenage girls usually have to deal with peer pressure to stay as thin as possible and may not eat enough calcium-rich fruit, vegetables and colorful salads
- Children are substituting acidifying soft drinks for milk, averaging 2 soft drinks a day
- More teens are smoking
- Parents are unaware of the crucial need for a bone-building supplement
- Children, preadolescents and teens eat far too many processed, sweet, acidifying foods that prevent them from maximizing their lifelong bone-building capacity
Prevent A Future Shock In Your Children’s Lives
The 2006 television series, Honey We’re Killing the Kids, counsels young preadolescents and their parents who are very sedentary and living almost exclusively on processed, acidifying fast foods. A computer program projects what the children will look like at the ages of 15, 25, 30, 35, 40 and 50. In every case the children and parents were shocked to see that their skin quality, hair quality, physical appearance and overall health would deteriorate to such a degree if their poor lifestyle habits continued. Obviously, there are some risk factors you cannot do much about, but there are others that you can. I’m not suggesting that it is easy to change the lifestyle patterns of a lifetime, or that you can simply stop taking necessary medications because they enhance your risk of developing osteoporosis. It is important to be aware of these critical factors so that you can intelligently deal with them as effectively as possible. Here is a list of some of the most important risk factors you can change with simple, effective, and safe lifestyle adjustments, proper exercise and a smart supplement action plan, regardless of your age.
11 Risk Factors You Can Change
- Not going for your BMD testing
- Lack of exercise
- Low calcium and vitamin D3 intake
- Low body weight
- Certain medications
- High table salt intake
- High sugar intake
Bone-density tests are non-invasive procedures that can tell you whether or not osteoporosis is affecting any of your 206 bones. There is no substitute for taking early preventive measures if you are even at the slightest risk of developing osteoporosis. Talk to your doctor. See what he or she recommends. With my patients I generally recommend testing for:
- All women, forty or older who have had a low impact bone fracture
- All postmenopausal women under sixty-five who have one or more additional risk factors besides menopause, including a history of fracture as an adult, being Caucasian, having impaired eyesight despite correction, having a history of alcoholism, smoking, or low dietary intake of calcium, or taking certain medications
- All women sixty-five or older regardless of risk factors
- All men seventy or older (under sixty if you have the risk factors previously mentioned)
- All men, women, and children who have known risks of osteoporosis from other medical conditions or medications, referred to as secondary causes
Lack Of Exercise
I am a big believer in exercise, not only as a safeguard against osteoporosis but also as a good way to stay happier and healthier as long as possible. Without weight-bearing activity, bones become thin, porous and weak. This is often seen in patients who are confined to prolonged bed rest. Sometimes it takes months for them to recover their strength. Even plaster casts that are worn to stabilize broken bones and help them heal, can ironically promote bone loss. One study found that when a patient wore a wrist cast for as little as three weeks, 6 to 7 percent of the bone in that area was lost. Weight-bearing exercises, according to the National Osteoporosis Foundation, are those in which your bones and muscles work against gravity. This is any exercise in which your feet and legs are bearing your weight. Jogging, walking, stair climbing, dancing and sports are examples of weight-bearing exercise with different degrees of impact. Swimming and bicycling are not primarily weight-bearing but are more of an aerobic exercise.
Equally important I believe for building strong, healthy bones and muscles is weight training three times a week or more. Weight training has a multitude of good effects besides building bone and muscle, including improving almost all the biomarkers of aging, thus providing a tremendous anti-aging effect. Weight-bearing exercise, including walking, causes your bones to break down and rebuild themselves in a denser, stronger form. Exercise physiologists state that it takes about six months of regular weight-training exercises to significantly rebuild your bone mass and strength.
For now just remember that even walking as exercise, combined with a modest amount of weight training, can go a long way toward saving your beautiful bones. Please see Chapter 6 of this book, Ramp Up Bone-Building Metabolic Exercise, for suggestions and ideas.
Smoking is a real problem when it comes to osteoporosis. Estrogen helps prevent osteoporosis by inhibiting the action of osteoclasts, the cells that break down and clear away old bone. Smoking has the effect of inactivating estrogen, leaving the smoker with what amounts to an estrogen deficiency. Men and women who smoke usually reach andropause or menopause before men and women who don’t. Not only that, smokers are often less physically active than non-smokers, which again increases the risk of developing osteoporosis.
Here’s what we know about the effects of alcohol on healthy bone structure and function:
- Alcohol upsets our body’s sensitive calcium balance. Parathyroid hormone (PTH) and vitamin D3 regulate the balance of calcium in our systems. Alcohol elevates our PTH levels, causing a strain on our calcium reserves. Chronic alcohol abuse, which causes continuous elevation in PTH, can cause a secondary condition known as hyperparathyroidism, the effects of which further deplete the calcium we have stored in our bones. Alcohol also inhibits the production of enzymes found in the kidneys and liver that convert the inactive form of vitamin D into its active form, thus interfering with the absorption of calcium from the intestines. Excessive alcohol also increases magnesium excretion in the urine, which in turn makes calcium absorption difficult and this alone is enough to cause accelerated bone-breakdown. Research shows that a glass of dry red wine daily may actually be beneficial to bone health. There is no evidence that moderate drinking is beneficial to bone density.
- Suboptimal nutrition. People who drink excessively do not eat a well-balanced diet, and this can lead to multiple nutrient deficiencies including calcium, magnesium, B vitamins, trace minerals and protein. If you drink beyond moderation, you should geta bone density test as soon as possible and use a food-based, bone-building supplement daily.
- Alcohol has a toxic effect on osteoblast bone-building cells. Osteoclasts are bone-breakdown cells, responsible for bone resorption or remodelling, and may be over-stimulated by exposure to alcohol.
- Alcohol increases the risk of bone fracture due to loss of balance and falls. Intoxicated people often have impaired balance and fall frequently, breaking wrists, hips, even vertebrae—that is why people suspected of drunk driving are asked to walk a straight line. The older we get, the greater the risk of fractures resulting from excessive drinking and falling.
- Excessive alcohol increases the level of cortisol. Cortisol is a glucocorticosteroid that, at high levels, leads to decreased bone formation and increased bone-breakdown.
Since caffeine is a diuretic to the kidneys, it may increase the amount of calcium excreted in urine. It is a stimulant to the brain and heart, as so many of us know from experience when we find that we can’t really get going until after we’ve had our first cup of coffee in the morning. Caffeine is most often found in tea leaves and coffee beans, and as with alcohol, it is fine when used in moderation, but can have a negative effect on our bones when we overdo it. Two cups daily of black, organic coffee is the maximum acceptable. Make sure that if you are drinking decaffeinated coffee that it is a water based decaffeination process rather than one using chemicals.
Every day, we lose between 100 and 250 mg of calcium through the kidneys into the urine. My feeling is that anything that increases calcium loss in the urine, which caffeine does, simply leads to increased calcium deficiency, and so should be limited as much as possible.
Dr. Robert Heaney, an osteoporosis specialist, and his associates at Creighton University in Nebraska reported the results of a study in which sixteen people were given four 100 mg caffeine tablets a day for nineteen days. All of the people had calcium intakes of at least 600 mg per day. They also took a bone-building supplement.. They concluded that 400 mg of caffeine per day was very helpful, if the people were also getting at least 600 mg of calcium in their diets each day.
They also suggested that the increased loss of calcium in the urine from drinking caffeinated coffee may have occurred only in the first three hours after drinking the coffee, and did not persist for the rest of the day. Dr. Robert Heaney reported in 2002 in the journal Food and Chemical Toxicology that there is no evidence of a detrimental effect on bone health—from coffee and tea—as long as an individual meets daily calcium, vitamin D and micronutrient requirements.
Limit your coffee consumption to two cups a day—that’s cups (5 ounces), not mugs (10 ounces). Eliminate pop from your diet and that of your children’s. Remember that every can of acidifying pop contains 8 teaspoons of sugar in addition to caffeine. The phosphoric acid in soft drinks harm the micro-architecture of your bones, and have especially negative consequences for children’s health and their future bone development.
Low Levels Of Calcium And Vitamin D
It should be pretty clear by now that it is important to eat lots of green, leafy vegetables, “green drinks” and fat-free dairy products like organic yogurt every day, so you can get a jump start on overcoming the calcium deficiency that more than 50 percent of all North American men and women have. To maintain optimum calcium levels easily, use a food-based, bone-building supplement containing calcium, magnesium, vitamin K1, probiotic cultures and vitamin D3.
Low Body Weight
If you are a small-boned, lightweight person, then your risk of developing osteoporosis is particularly high. Several studies suggest that if you weigh less than 130 pounds for women or 150 pounds for men, you are especially susceptible to developing osteoporosis. The point is that you can be too thin, which for the majority of women are somewhat of a relief. In fact, a risk factor for osteoporosis is that you weigh the same as you did when you were 25.
Appropriate body weight, as well as weight-bearing exercise, goes a long way toward protecting our bones. If you are underweight for your height and frame, I’d suggest you start doing something about that now. Healthy, calcium rich diet; a bone-building supplement and exercise are just what the doctor ordered.
Some medications interfere with calcium absorption, or bone formation and remodelling, thereby leaving you more susceptible to developing osteoporosis. This can create a tricky situation, since these medications can be vitally important to your health. If you are taking one of these medications or are planning to do so, be sure to let your doctor know about your concerns relating to their impact on osteoporosis. Here are some medications to be aware of:
- Antacids with aluminum– These medications are used to treat heartburn, indigestion, excess stomach acid, ulcers, and gastric reflux disease. Some of these antacids are salts derived from mineral sources, including aluminum. The aluminum is the problem when it comes to the healthy structure and function of your bones. When you take an aluminum-based antacid, your body is unable to absorb from the intestines, the calcium and phosphorus it needs, and so you increase your risk factor for osteoporosis. Taking an occasional aluminum-based antacid may be fine, but if you use them every day they can weaken the microenvironment of your 206 bones and 143 joints. Non-aluminum-based antacids do not deplete bone. Let me list a few of the more popular aluminum-based antacids on the market: Aludros, Amphojel, Gaviscon, Gelusil, Kolantyl, Maalox, Mylanta, Riopan. Here are some non-aluminum-based antacids: Alka-Seltzer, Bisodol, Mylicon, Rolaids*, Titralac*, and Tums*. The antacids with an asterisk (*) contain calcium carbonate, which helps bones to a small degree. This is because calcium carbonate is absorbed at such a low rate and requires strong stomach acids to make it soluble—for easy absorption into the bloodstream and distribution to your bones.
- Antibiotics – Frequent or prolonged use of antibiotics, especially tetracycline, can impair healthy bone structure and function. Be sure to bring this up with your doctor if you have been on one or more antibiotics for an extended period of time. If you are using antibiotics you should be taking probiotics while you are on them and for at least one month afterwards. Ensure your bone-building supplement contains a variety of probiotic cultures.
- Anticonvulsants – Anticonvulsant medication prevents seizures by inhibiting the repetitive spread of electrical impulses along nerve pathways. It also has an effect on the liver’s ability to metabolize vitamin D3 effectively as 1,25-dihydroxyvitamin D3. When vitamin D3 is not properly metabolized, the body is unable to absorb calcium very well from the intestines. Phenytoin (trade name Dilantin) is the most commonly used anticonvulsant. Phenobarbital is used less often but has the same effect. Since these drugs must be taken for a lifetime, it is important for those who use them to take a food-based, broad spectrum, bone-building supplement with all the necessary cofactors.
- Diuretics – Diuretics or water pills increase the volume of urine. They are used to treat high blood pressure and congestive heart failure by decreasing the blood volume and thereby lightening the workload on the heart. There are several classes of diuretics. The class that is a problem for bone health includes those that are called loop diuretics, because they work in an area of the kidney called Henle’s loop. Loop diuretics cause the kidneys to excrete excess calcium. They are so good at doing this; they are often prescribed for people who have too much calcium in their systems. The most popular forms of this drug are Lasix, Aldactone, Dyazide, Bumes, Diamox, and Edecrin. If you take one of these, you need to drink lots of water and add a food-based, bone-building supplement to your diet. The other class of diuretics called thiazide diuretics actually help you to preserve calcium. They have the opposite effect of loop diuretics because of their ability to decrease the urinary excretion of calcium. Hyrodiuril and hyrodthiazide are diuretics of this class commonly prescribed for mild high blood pressure, for water retention and sometimes along with other high blood pressure medications.
- Heparin and Coumadin (Warfarin) – These are blood-thinners or anticoagulants. Many men and women over the age of sixty are on these medications, typically for treatment of a heart problem. If you take them for a long period of time, pay close attention to your bone health, get whatever exercise your doctor feels is safe for you, and make sure there is lots of absorbable calcium in your diet, such as fat-free, organic plain yogurt and a bone-building supplement.
- Lithium -Lithium is used to treat patients with a serious type of depression known as bipolar disorder, a condition often marked by periods of euphoria and high energy alternating with depression. One of its side effects is the increased production of parathyroid hormone, which in turn increases the breakdown of bone. If you are taking lithium, make sure you keep physically active and get adequate calcium in your diet through food and a bone-building supplement.
- Methotrexate – The medication methotrexate is sometimes used to treat rheumatoid arthritis, cancer, psoriasis, and other immune disorders. It can also cause bone-breakdown, so ask your doctor what precautions you should take to protect damage to your beautiful bones.
- Steroids or Corticosteroids – These medications are the most common drug-related cause of osteoporosis. This group of medications is similar to the natural corticosteroid hormone cortisol, produced by the cortex of the adrenal glands. These drugs are used for a wide variety of conditions, including treatment of inflammatory intestinal illness, asthma and rheumatoid arthritis as well as to suppress the immune system after a transplant. These drugs may be prescribed as a pill, injection, a spray or a skin cream. When used for a short time or injected into a joint or swollen area there is no effect on bone health, but when used for long periods of time, 3 months or more, they begin to destroy the bone-building process and initiate the process of bone break-down. Some of the more frequently prescribed steroid drugs are prednisone, prednisolone, Medrol, Deltasone, Decadron, cortisone, Cortel, Celestone, and Aristocort. Studies show that within the first year after starting corticosteroid therapy, patients lose an average 14 percent of their bone mineral content and according to Gillian Sanson’s research, up to 50 percent may fracture, especially postmenopausal women. Anyone on long-term steroids should have a bone density scan, start using a food-based, bone-building supplement, join an exercise class that includes weight training and possibly be started on a medication to prevent the inevitable bone loss.
- Thyroid Medication – The thyroid is a powerful gland located on the front lower part of the neck. Among other things, it regulates metabolism. When the thyroid is over-stimulated, we develop what is called hyperthyroidism. When it is under-stimulated, we develop hypothyroidism. Long-term use of medications to control the activity of your thyroid can seriously interfere with both bone-repair and bone-building health. You need to be aware that prolonged use of the medication can put your bones at risk, so you should discuss this with your doctor and arrange to get a bone scan. Follow his or her advice, keep moving, eat calcium-rich foods, daily use a food-based, bone-building supplement, and you can do a lot to keep your bones healthy, strong, and beautiful—naturally—all-life-long.
A High Salt Intake Destroys Bone Integrity
Sodium, as found in salt, is a mineral of great importance to overall health. Yet, as with sugar and phosphorus, we consume far too much of it. Today North Americans consume much more salt than is desirable. Even though the U.S. and Canadian governments since 1977 have been recommending limiting salt intake to 2,000 mg per day, our consumption still averages over 8,000 mg per day. Don’t be deceived into thinking your salt intake is low just because you do not use a saltshaker. The salt in our diet comes mostly from processed foods—and lots of it.
Salt is second only to sugar as the most popular food additive. A three piece fast food fried chicken dinner alone may contain 2,000 to 2,500 mg of sodium; one can of soup could have 3,000 mg of sodium; and one cup of canned tomato juice has as much as 500 mg of sodium chloride. Remember, restaurants use a lot of table salt in their food preparation.
Highly processed table salt, sodium chloride, causes the body, through the kidneys, to lose calcium in the urine, contributing greatly to osteoporosis. Osteoporosis means “porous bones.”
Sugar, High-Fructose Corn Syrup And Artificial Sweeteners Are Harmful For Your Bones
Sugar, sweet treats, alcohol and stimulants are ultimately counterproductive to your physical and bone-building well-being. While they initially cause you to feel stimulated, shortly afterwards you are drained and start to crave more sugar. Sugar contributes to acidifying the system, overproduction of insulin (which can eventually lead to diabetes) and hormonal imbalance. So there is a short-term gain for a long-term price.
Sugar has always been available in natural sources from fruit, with its slow-releasing fructose balanced by fiber content that gives our bodies small, constant spurts of glucose, the primary fuel in our bloodstream.
Terry Grossman, M.D., an anti-aging physician and co-author of Fantastic Voyage, states, “The two chemicals that will age you quicker than anything else are cortisol, a by-product of stress, and elevated insulin, which peaks with sugar consumption.” Sugar promotes growth of a broad variety of pathological cells, including the yeast candida albicans and fungal infections. Sugar is a “naked carbohydrate”, that was introduced to North America by Christopher Columbus in 1493. It has many names, most of which end in -ose, e.g. fructose, glucose, maltose and sucrose. Do not use suspect, manufactured fructose added as a sweetener to foods, even healthy foods, since it may appear to support the initiation of cancer. Healthy sweeteners include stevia and agave syrup.
One Study Links Sugar to Increased Risk Of Cancer
Findings from the Korean Cancer Prevention Study, published in the January 12, 2005 issue of the Journal of the American Medical Association, finally revealed a direct correlation between elevated blood sugar levels and diabetes and the risk of developing and dying from cancer. Sugar and sweeteners are acidifying.
Tumors are primarily obligate glucose (sugar) metabolizers, meaning they require sugar for survival. Even though the brain normally uses high amounts of glucose, a hepatoma (a tumor of the liver), as an example, consumes roughly as much glucose as the brain.
Many North Americans continuously satisfy cancer’s appetite by ingesting as much as 295 pounds of sugar a year. Nobel Laureate Otto Warburg, Ph.D., discovered in 1955 that cancer cells use glucose for fuel. But, acidifying glucose accomplishes another strategic manoeuvre that favors cancer growth: it immobilizes and depresses the abilities of the immune system; it can also cause bones to lose calcium rapidly.
A lifestyle and diet that diligently eliminates all food with added sugars or synthetic sweeteners, deprives cancer of its primary energy supply and boosts the reliability of the immune system and maximizes bone-building functions.
Good Balance And Core Strength—Can Prevent Falling
Osteoporosis can make bones vulnerable—falls can break them. Almost 90 percent of osteoporosis-related hip fractures, and more than 90 percent of pelvic and hipbone fractures, and 50 percent of spinal fractures, result from falls.
Surprisingly so, good balance depends on your vision. Therefore, do some walking or balancing exercises each day with your eyes closed, to train your brain to keep you upright and steady. People who are physically fit and active have better balance and far fewer bone fracturing falls in their later years. Have your vision and hearing tested annually.
Fall prevention techniques may be better than medications at reducing the death rate from hip fracture. Research shows that a fall to the side, as opposed to forward or backward increases the risk of hip fracture by about six times, and is considered a much greater risk than lower bone density for hip fracture.
Mary Tinetti, M.D., of Yale University took a group of 300 women and men aged 70 or older. Half the group, the control group, received no special care. The other half learned exercises to improve their strength, balance and coordination—which resulted in 48 percent fewer falls—a very significant reduction for a group at such high risk.
Western medical researchers are beginning to appreciate what Eastern medical researchers have known for many years—that Tai Chi, Qigong and hatha yoga can dramatically improve your balance. Poor balance is not only a concern for us in our senior years, but an issue for us in our younger years because we are all vulnerable to falls.
It is estimated that 50 to 60 percent of falls happen in the home and 85 percent of those are caused by common “domestic hazards” like throw rugs, extension cords, slippery floors, dim lights or clutter on the floor. Give your home a serious safety check-up and immediately correct any problems you find.
Follow the core strengthening program in Chapter 6, Ramp Up Bone-Building Metabolic Exercise, to feel more secure and steady on your feet, improve your muscle and bone strength, enhance balance and significantly increase your fluid range of motion for a lifetime.
Osteoporosis Is Not An Isolated Disease
Osteoporosis is not a dreadful disease that randomly strikes some of us. Weak bone structure does not happen without a cause and that cause is often associated with many other health related problems like a poor diet, a lack of proper exercise, pop and sodas, acidifying junk food, excessive stress, smoking, some medication use, alcohol abuse and toxic exposure. I collectively call them—bone-depleting factors. Osteoporosis is a very complicated problem which Western medicine has tried to make very simple. Our unhealthy lifestyle habits deplete our bones of their precious stores of life-supportive minerals. The ultimate price we pay for excesses in these destructive modern day, “grab-and-feed” habits—is osteoporosis.
In reviewing the available anthropological data from around the world, I discovered that osteoporosis occurs in some countries more than it does in others. Canada and the United States have some of the highest osteoporosis rates in the world. The Proceedings of the Society of Experimental Biology & Medicine in 1992 printed research that showed the incidence of hip fractures, even in the elderly, of the Japanese, is almost 60 percent less than in North America.
Our fast-paced, stressful lifestyle leaves us too exhausted to exercise or even prepare healthy food. Our lack of healthy food and eating patterns, exercise, stress reduction, deep natural sleep and bone-building supplementation cause a lifelong pattern of bone destruction for ourselves and our children.
PUT YOUR BONES TO THE TEST
—MEASURING BONE MASS—
When Should You Have A Bone Density Test?
All women, forty or older who have had a low impact bone fracture should have a bone density test. This means a fracture without trauma or an injury. It usually takes considerable force to break a bone. Only 25 percent of people with low impact fractures actually receive treatment, says osteoporosis expert, Dr. Susan Ott. Dr. Ott states that, in nearly 50 percent of these cases, radiologists didn’t spot the fractures or note them in their reports.
- All postmenopausal women under sixty-five who have one major risk factor such as low impact trauma, low trauma spinal compression fracture, family history of osteoporosis (especially maternal hip fracture), taking steroids continuously for three or more months, premature menopause before age 45, malabsorption syndrome, overa ctivity of the parathyroid gland; or two minor factors such as taking medications such as coumadin, anticonvulsants or heparin, low intake of calcium through the diet, smoking, excessive caffeine intake (more than 4 cups a day). Weight of less than 57 kg, rheumatoid arthritis history and underweight (10 percent less than at age 25).
- Any situation where the bone density measurement would make a difference in whether or not treatment was started.
- All women sixty-five or older regardless of risk factors.
- All men seventy or older (under sixty if you have the risk factors previously mentioned).
- All men, women and children who have known secondary causes of osteoporosis. This means other medical conditions; diseases or the medications used to treat these illnesses are the real cause of the osteoporosis and the increased risk of fracture.
There are several types of BMD tests. All the tests are simple and painless.
Bone Testing Options—What Type Of Test Should You Have?
Once it has been determined that a bone density test is needed, your doctor must figure out what test to use. There are several types of bone density measuring devices. It’s important to understand the advantages and disadvantages of the different measurement techniques.
What Bone Testing Measures
Bone density tests only tell you one risk factor for osteoporosis—that is a decreased bone density. The larger the amount of mineral content in the bone, the higher is the bone density. It is the combination of mineral deposits and the micro-architectural structure that give bones their overall strength. There is currently no test that can measure bone strength and give you information about the microstructure of your bone.
Dual X-Ray Absorptiometry (DXA)
The most common method for determining your bone density is the central dual X-ray absorptiometry technique (central DXA). This machine is most often located in hospitals and radiology centers. Anyone living in an urban or suburban area will have access to one of these machines. You lie comfortably on a scanning table. When your spine is measured, as shown above, your legs are positioned on a firm pad to help flatten out your spine. For measurement of your hipbone, you lay your legs flat on the table. During the test, the scanner moves back and forth over your body. It can measure bone density in the hip, spine and forearm. They are important sites where fractures have the most serious consequences.
The current test of choice is dual X-ray absorptiometry (called DXA or DEXA for dual energy X-ray absorptiometry), and it is widely available. The hip and spine measurements are the most common procedures. The greater your risk for osteoporosis, the more important this information is for you. The small amount of radiation involved in a bone density scan is one tenth of a chest X-ray.
A smaller version of the DXA can measure bone density in the hands and the heel. The test takes two minutes, and the small machine can be used in doctors’ offices, which makes it more convenient for many people.
It is very important to have your bone density scans repeated on the same machine if you are comparing them. Various machines are not standardized; so comparing a reading obtained on one manufacturer’s machine to that obtained on another, is not accurate.
Another commonly available testing option is ultrasound. This technique involves no radiation. Ultrasound testing is already available in many doctors’ offices. The ultrasound assesses bone in the heel, tibia, patella or other peripheral sites where the bones are relatively close to the surface of the skin.
It is a much underutilized screening technique. According to the National Osteoporosis Foundation’s Physicians Guide, although the measurements are not as accurate as DXA or SXA (single X-ray absorptiometry), they appear to predict fracture risk as well as other measures of bone density.
A study of 149,524 postmenopausal women suggested that ultrasound and peripheral BMD are accurate in predicting fracture. Those with low bone density in the heel, forearm, or finger had a twofold increased risk of fracture within one year.
You must still be cautious, since this method of measuring bone density includes the same standard deviation problems as those of the DXA scan. It can classify a large number of people at high risk with too many false positive readings.
Unfortunately, ultrasound can’t check bone density in the spine and hip. The site most commonly measured is the heel; other bones in the lower leg and hand can be checked too. The results reflect not only density but also properties of collagen in the bone. While this information is helpful because the results are strongly correlated with fracture risk, it’s not a substitute for direct measurement of hip or spine bone density with DXA. However, it is a quick and inexpensive way to check for bone loss and will let you know if you are in a high-risk category and need to get a DXA scan.
How The Tests Work
DXA uses a technique called densitometry or X-ray absorptiometry; the machine passes an X-ray beam through an area of bone. Ultrasound testing uses sound waves instead of X-rays. Radiation (or sound waves) are absorbed by the bone—the denser the bone, the more it absorbs. The machine’s detectors translate absorption information into a measure of bone density.
The “dual” in dual X-ray absorptiometry (DXA) refers to the use of two different X-ray beams, which enables the machine to distinguish between bone and the soft tissue (e.g., muscle, fat) covering it. That’s why DXA can measure density of the hip and spine bones, even though they lie deep inside the body. Tests that use just a single beam can only measure bones that are just under the skin, such as the bones in the hand, wrist, and heel.
Single X-Ray Absorptiometry (SXA)
Now that DXA is available, SXA—which can’t check spine and hipbones—has been phased out. SXA measures bone density in the fingers, wrist and heel. Those results correlate strongly with hip and spine density, so the test remains a good general indicator of bone health.
Radiographic Absorptiometry (RA)
Radiographic absorptiometry (RA) is a special type of X-ray. It measures bone density in the hand, which is closely correlated with hip and spine density. The chief advantage of RA is low cost. Also, nearly any X-ray machine can be adapted for RA. This makes it a valuable screening tool for people without easy access to DXA, such as those who live in remote rural areas.
Computerized Axial Tomography (CT or CAT Scan)
CT scans are used mainly in research. But they can be helpful when other tests aren’t available, or in special situations. DXA, SXA, X-ray and RA all produce a two-dimensional image of the bone. CT also uses an X-ray beam, but it can create a three-dimensional image that can be important when a man or woman appears to be losing significantly more trabecular (the spongy inner part of the bone) than cortical bone (the hard outer part of the bone). In such a case, a CT scan would allow separate examination of the trabecular bone in the center of his or her spine. Please see Chapter 2 of this book for the radiation levels involved in CT scans.
How To Interpret Your Test Results
The results of a bone density test can be confusing at first. But once you know how to interpret the numbers and graphs, you’ll find the results very informative. Following is a guide to the terminology:
Bone-Mineral Density (BMD)
All of the tests measure the amount of mineral in a specific area of bone. The more mineral content, the denser is the bone. The mineral density is measured in grams or milligrams; area is measured in square centimetres—and BMD is described as grams or milligrams per square centimetre, g/cm2 or mg per cc.
We need to understand the way bone density results are reported, as well as explaining T-and Z-Scores and how osteoporosis and osteopenia are defined by T-Scores. I will also touch on differences in bone density related to gender and race.
Results from hip and spine DXA measurements are actually first calculated as grams of mineral per area of bone. Each bone normally has a different bone density. In order to standardize results across different sites and technologies, bone density measures are usually reported as T-Scores and Z-Scores. These scores have caused much confusion and misinterpretation among doctors, as well as patients.
What Is A T-Score?
T-Scores are calculated from an individual’s bone density results, the variation in bone density measurement, and the average bone density of a young normal reference population at peak bone mass. The age of the young normal reference population used to determine T-Scores differs slightly among different manufacturers of bone density measurement devices, but is usually between twenty and thirty-five years. This is the age when bone density is at its peak and osteoporosis-related fracture risk is at its lowest. Results are expressed as standard deviation (SD) scores above or below the average measurement for the young normal. A T-Score of –2 indicates that the person’s score is 2 standard deviations below average for a young normal person of the same gender. On average, every T-Score above or below 0 represents about 10 to 15 percent reduction (or increase) in bone mass. A T-Score of –2 in the spine means that the person’s bone mass is about 20 percent lower in the spine than the average for a young normal person of the same gender.
Osteoporosis is defined by the T-Score, as originally decided by the World Health Organization (WHO) in 1992. A T-Score of –2.5 or lower indicates the presence of osteoporosis. An intermediate condition, called osteopenia or low bone mass, is defined as a T-Score between –1 and –2.5. The WHO criteria were designed as descriptive terms in order to determine the prevalence of bone mass at different levels in different populations. These cut-off points were never intended as treatment or diagnostic cut-off points. It turns out that the osteoporosis cut-off point actually makes some biologic sense; the risk of fracture is substantially increased at –2.5, and the majority of people do not reach this level until they are in their eighties. Furthermore, –2.5 seems to be the T-Score at which treatment, at least with bisphosphonates, the most commonly prescribed drugs, consistently work.
For example, in the alendronate (Fosamax) clinical trials, alendronate reduced the risk of hip fractures in women who had T-Scores of –2.5 or lower but not in women with higher T-Scores. Similarly, in the risedronate (Actonel) clinical trial, risedronate only worked against hip fracture in those women who had documented osteoporosis. In contrast to osteoporosis, though, osteopenia is not as useful a term in determining who should be treated and who should not. In fact some experts maintain that comparing bone density, which normally and naturally decreases with age, without necessarily leading to an increase in fracture rate, is creating a falsely elevated rate of osteopenia, thus causing much unnecessary anxiety.
“Using the WHO standards” says the British Columbia Office of Health Technology Assessment, “22 percent of all women over age 50 will be defined as having osteoporosis and 52 percent as having osteopenia. Therefore the resulting epidemic observed in the last few years is more apparent than real.” It would therefore make more sense to compare your bone density to that of your own age group, which is what the Z-Score is all about.
What Is A Z-Score?
It is useful to know how your bone density compares with others of your age. The Z-Score compares a person’s results to those of an average reference population of the same age and gender (as opposed to the T-Score, which compares the patient’s measurement to that of a young population at peak bone mass). Just as for the T-Score, the Z-Score also takes into account the variability in the normal age-matched population. The results are expressed as positive or negative scores, referring to measurements above or below the average for the reference population. A score between –2 and +2 includes 95 percent of the population. Therefore, if you have a –2, you are in the lower 5th percentile for your age. If you have a Z-Score of +2, you are in the highest 95th percentile for your age. A score of 0 means that the person’s bone density is exactly average for age and gender. A score of –1 means that the individual’s bone density is two SDs below the average, usually about 20 percent lower than the average spine BMD. In the hip region, the variability is a bit higher, so a score of –1 usually indicates a reduction of about 13 percent compared to the average, or 26 percent compared to the average when the Z-Score is reported as –2.
For every reduction in Z-Score, the risk of fracture increases approximately twofold. That is, if the person’s Z-Score is –1, his or her risk of fracture is twice that of the average person at his or her age; for a score of –2, the person’s risk of fracture is four times higher than the average person’s; for a score of –3, the person’s risk of fracture is eight times higher than the average. These differences are called relative risk; we ascertain one person’s risk compared to the average person’s.
Because almost everyone loses some bone with increasing age, it is difficult to avoid falling into the osteoporosis category if you live long enough. While only 13 percent of women between ages fifty and fifty-nine have osteoporosis, 27 percent of those between sixty and sixty-nine have osteoporosis, 47 percent of women between the ages of seventy and seventy-nine have osteoporosis, and 67 percent between eighty and eighty-nine have osteoporosis.
Only 8 percent of men between the ages of fifty and fifty-nine have osteoporosis, 13 percent of men between sixty and sixty-nine have osteoporosis, 30 percent of men seventy to seventy-nine have osteoporosis, and 50 percent of men between eighty and eighty-nine have osteoporosis.
The T-Score compares your bone density with that of the average healthy young adult. T-Scores are based on a statistical measure called the standard deviation, which reflects differences from the average score.
We usually lose bone, as we age. So our T-Scores normally drop. The Z-Score presents our BMD in a different way, as a comparison with people our own age. A low Z-Score is a warning that we’re losing bone more rapidly than our peers, so we need to be monitored more closely by our doctor.
X-Ray and Radiographs
An X-ray based technique in which the hands are measured alongside an aluminum wedge can also be used to measure density. Results are sent to a central processing center for computer determination of bone density. This technique does require central processing, so results may not be available as soon as the X-ray is completed.
Many people become distressed to learn they have osteopenia, but it should just be considered as a warning sign, a kind of biological “wakeup call.”
Osteopenia implies that the bone mass is slightly low, but very much within the normal range. Osteopenia is not a disease. In fact, all men and women would be labelled with osteopenia, if they lived long enough.
Although 60 percent of all men and women in their fifties have BMD levels above the osteopenic range, 40 percent have BMD levels in the osteopenic range or below. Among those in their sixties, the majority of women have bone density values in the osteopenic range or below; only 40 percent have normal BMD levels. When women reach their seventies, less than 20 percent have normal BMD levels, and in their eighties, it’s only 10 percent who have BMD measurements above the osteopenic levels.
Osteopenia means that your bone density could fall anywhere between the lower fifth to sixteenth percentile compared to the average young normal BMD. Even in people who are twenty-five or thirty, this is still normal. We consider the fifth percentile to be normal with respect to height. Furthermore, the osteopenia determination does not take into account body size.
We know that smaller people probably have lower apparent BMD the way we measure it because we don’t correct for the small third bone dimension. So, many of the women whose measurements fall in the osteopenic range may be there in part due to small body size and small bone size. Osteoporosis-related fracture risk is extremely low in men and women who have bone mass in this range in contrast to fracture risk in men and women with osteoporosis.
So osteopenia is a problematical term that induces fear unnecessarily and probably should be abandoned.
The Limitations Of Bone Density Testing
According to many experts, including Dr. S. Pors Nielsen, the following are some of the limits of bone density testing:
- BMD measurement is not an ideal measure of true bone density and it gives no information at all regarding bone strength and micro-architecture.
- It should be used after correction for body size and/or bone size, age, sex and local variations in average bone mineral density.
- It should not be considered the sole indicator of present and future fracture risk—but only one risk factor that should be measured in terms of the whole picture of your lifestyle and environmental risks.
The Advisory Committee for Guidelines and Protocols for Bone Density Measurement in Women put it this way: “Low density is only one of many factors that can increase the risk of fracture. Factors such as inactivity, balance problems, poor vision, inappropriate footwear, the use of certain drugs and household hazards can all increase the risk of falling and fracturing bone. Some people believe that bone density testing and medical treatment of osteoporosis are examples of “medicalization” of natural processes such as menopause and aging. “Medicalization” means treating natural processes like diseases and relying too heavily on highly technological medical treatments, when less invasive approaches could be just as beneficial. However, bone density testing can provide valuable information and help women decide when hormone or drug treatment may be beneficial.”
Other Important Tests
Bone density tests determine if you have osteopenia or osteoporosis. But these tests cannot tell you why, how or how fast you’re losing bone. Nor can they evaluate suspected broken bones or spine fractures. Your doctor may suggest one or more additional tests. Here are some additional tests we use.
Blood tests can check levels of hormones important to bone, including:
This is the most potent form of estrogen. If you’re under age 45 and experiencing menstrual irregularities, your doctor may check your estradiol and other estrogens. If
levels are abnormally low, birth control pills might be suggested to boost your supply of estrogen, thereby protecting your bones. Also, I test for progesterone, free testosterone, DHEA-Sulfate and cortisol which also influence bone health.
Follicle-stimulating hormone (FSH)
FSH is a pituitary hormone that stimulates the ovaries, indirectly affecting estrogen supplies. As a woman approaches menopause, her FSH levels normally rise. Checking FSH helps your doctor determine if you’re entering menopause. This narrows down possible causes of no menses and other menstrual irregularities.
Thyroid and parathyroid
Problems with the thyroid and parathyroid glands can lead to bone loss. Thyroid or parathyroid hormone tests are the first diagnostic step when these issues are suspected.
Calcium Metabolism Tests
Abnormalities in blood calcium levels don’t necessarily mean that you have osteoporosis, but they can help clarify your medical situation. For example, some parathyroid problems cause an increase in blood calcium.
How Often Should You Be Tested?
Bones change slowly, so you don’t need to check them very often. The results could be misleading if you repeat a test too soon. The changes you might expect to see in your bones are small too. That’s why very frequent testing is not advised.
Follow-up bone scans are not considered necessary before 2 years are up unless you have existing fractures or very low bone density, states a bulletin sent to all doctor by the British Columbia Health Service. “The response to many of the drugs used to treat osteoporosis are more characterized by a reduction in fracture incidence than by an increase in bone density. Follow-up measurements of bone density should be interpreted with this fact in mind.” The rate of change in response to treatment is usually small and will not usually be detectable in less than 2 years. If you wish to have an accurate follow-up scan, you must use the same machine, in the same facility, at the same time of year, to have a consistence in calibration.
Better Ways For Doctors To Measure Up To Osteoporosis
The Limitations Of Bone Density Measurements
Bone mineral density testing has many limitations. The sites most commonly measured are the spine and the hip. But, your bone density can vary throughout the 206 bones in your skeleton. It is hard for me to conclude a patient has osteoporosis when one bone, for instance your hip, records low bone density, when the spine may be normal, or vice versa.
The National Women’s Health Network publication, Osteoporosis Fact Sheet, suggests that a better evaluation of bone density is obtained by comparing a person’s bone density to that of other fracture-free, healthy people your age. Worrisome for me, is that half of all people are shown to have low bone density on a dual X-ray absorptiometry test (DEXA), the preferred medical procedure for osteoporosis testing.
These scans can detect if your bone density is lower than that of other people your same age and sex, but they cannot predict if you will suffer a fracture. Bone density measurements compare you to “normal individuals” and I feel the results can be needlessly frightening.
Using bone density measurements may be very misleading because the “normal individuals” you are compared to have been established by the DEXA manufacturers. There is no agreed upon international reference standard and each manufacturer establishes their own data, resulting in completely different standards, between various DEXA machines, measuring the same bone.
Not surprisingly, I and many other physicians are beginning to question the relevance and accuracy of DXA and DEXA scanning measurements. Accuracy of diagnosis is fundamental and crucial for diagnosing osteoporosis and re-evaluating the effectiveness and safety of a treatment protocol over the years.
The medical journal Osteoporosis International in 2000 printed results of The Canadian Multicentre Osteoporosis Study (CaMos), a government-funded epidemiological study of 10,000 people. Their results caused great concern. Astonishingly so, they found that the prevalence of osteoporosis was only 16 percent in women and 5 percent in men, as opposed to the DXA and DEXA estimates of 50 percent in women and 12 percent in men. Overall, many people are being diagnosed with osteoporosis and prescribed medications—when they may not be necessary—because the machines may calculate too many false positive readings for osteoporosis.
The British Columbia (Canada) Office of Health Technology Assessment concluded that BMD testing does not result in a reduction of fractures and is not a cost-effective public health strategy.
Dr. Steven Cummings at the University of California, San Francisco, in The New England Journal of Medicine in 1995, explained that low bone density combined with a high number of known osteoporosis risk factors is the very best predictor of osteoporotic fracture. They found nearly 24 factors important for predicting the risk of hip fracture. A full 17 of these risk factors are independent of bone density.
In this very sophisticated study, Dr. Cummings discovered that bone density and 17 other risk factors are especially meaningful indicators of osteoporosis hip fracture risk and increase the chance of breaking a hip by 50 to 100 percent.
The 17 Independent Risk Factors For Hip Fracture
According to Dr. Steven Cummings, the people with the lowest bone density in their age group and the greatest number of the 17 risk factors are at greatest risk. Doctors need to interpret bone density measurements, hand in hand, equally with each patient’s personal risk factors.
The 17 risk factors are:
- Advancing age
- Low bone density
- Being taller at age 25
- Current caffeine intake
- Previous hyperthyroidism
- Any fracture since age 50
- Poor overall self-rated health
- Poor distance depth perception
- Weighing less than you did at age 25
- Current use of anticonvulsant drugs
- Lack of exercise, as in not walking daily for exercise
- Low-frequency hearing sensitivity and impaired vision
- A resting pulse of 80 beats or more per minute
- Tendency to stand on feet less than four hours a day
- The inability to rise from a chair without using your arms
- A history of maternal hip fracture (especially if your mother fractured a hip before age 80)
- Current use of long-acting benzodiazepines (tranquilizers, sleeping medications and anti-anxiety drugs)
The New Urine And Blood Tests For Bone Resorption
Currently, there are several urine tests aimed at detection of excess bone-breakdown. These urine tests help to address the future risk of osteoporosis. Also, these non-invasive urine tests can help determine the success of your prevention or treatment program.
The Type 1 collagen test examines the excretion of protein fragments from bone, in the urine. Bone breakdown requires a breakdown of this protein. The more protein fragments in the urine, the more rapid the systemic bone breakdown and a clue that bone quality is suboptimal. Bone changes slowly over years, but bone turnover can vary over a few days or weeks.
- The first test is called the n-telopeptide (NTX) or the c-telopeptides (CTX) Osteomark Test for Telopeptides of Type 1 Collagen, which measures the levels of bone resorption. The NTX levels can also be measured in the blood.
- The second test involves the measurement of the collagen crosslinks, pyridinium and deoxypyridinium (PYD or DPD). As bone breaks down they are released in the urine. Higher than normal levels of pyridinium and deoxypyridinium crosslinks in the urine indicates an increased rate of bone-breakdown.
- We also look at the deoxypyridinium to creatinine ratio because it is very specific to bone-breakdown. The pyridinium to creatinine ratio reflects both cartilage breakdown as well as bone-breakdown.
These urine tests are accurate and inexpensive for uncovering rapid bone loss. But, just like bone density measurements, what “normal values” the laboratories choose to use is important. Recent studies have helped to classify that the “normal values” being used are reasonable. These tests do not take the place of bone density testing, but they add information that bone density cannot provide.
Physicians and researchers continue to emphasize solely the single risk factor—low bone density. The causes of bone fractures are complex and blaming them on low bone density alone is not scientifically valid, sufficient or credible.
The U.S. National Institutes of Health acknowledge this same conclusion in a report issued in 2000 titled Osteoporosis Prevention, Diagnosis, and Therapy. The authors state, “It is important to acknowledge a common misperception that osteoporosis is always the result of bone loss.”
There are blood tests that measure the rate of bone-building called osteocalcin and bone-specific alkaline phosphatase. Sometimes urine and blood tests are useful in determining the degree of bone turnover in an individual patient.
Bone turnover marker levels can also be used to determine whether bone-building supplements and/or medical treatments are working. Also, it is ideal to have each sample obtained at approximately the same time of day—since the average levels fluctuate over the course of a day or night. These markers can help determine the dynamic, living status of your 206 bones, and help confirm that the treatment is working. High levels of some biochemical markers of bone turnover are associated with increased risk of osteoporotic fracture in postmenopausal women, independently of BMD, according to research by Patrick Garnero, Ph.D. and associates printed in the August 2000 Journal of Bone Mineral Research.
Many doctors who recommend bone scanning for their patients are unaware of this controversy. They make recommendations and medication decisions on the sole basis of the outcome of the DXA or DEXA bone density scan, even though there are huge discrepancies in the diagnosis of osteoporosis from manufacturers of various scanning machines, because there is no agreed upon international reference standard between various DXA machine manufacturers. DXA machines have “normal” reference standards set by measuring the peak bone mass of healthy, younger men and women. We must accept that a wide biological variation in bone density exists among adults who are healthy and fit. Low bone density may not be such a “red alert” if our bone strength and micro-architectural structure is sound.
Bone quality is not only determined by bone mass, but also by the micro-architecture of the bone. The porosity, brittleness, the crystal size and shape, the scaffolding structure of the collagen proteins, the ability to rapidly repair micro-fractures, the connectivity and shape of the trabecular (interior honeycomb) bone and the vasculature network of blood vessels’ ability to carry sufficient supplies of bone-building micronutrients—all influence the quality and the quantity of our 206 bones. The quality of our bones dictates our stature, posture and biomechanical movement.
My research into osteoporosis raises questions about the accuracy of a diagnosis only based on a bone scan—and the effectiveness and safety of various drug treatments, based on the results of just a bone scan. My self-discovery reaffirms my position that by making wise lifestyle, exercise, diet and bone-building supplement choices—you can successfully prevent, treat and reverse most cases of weak bones and osteoporosis naturally.
The miracle and marvel of the human body is that many, if not all, of these conditions can be turned around—literally reversed. Your superior bone health and biomechanical movement can be restored.
We can cool the fires of accelerated bone loss simply by eliminating its causes and adding bone “cell friendly” foods, as well as a bone-building supplement to our menu makeover. In this book, we have tried to provide a clear formula for the significant reduction of osteoporosis, loss of stature, poor posture and a loss of fluid biomechanical movement—and the recovery of your overall good health. Adopt the comprehensive step-by-step action plan in this book and watch your life change.
All this flows from simple, brightly colored foods, proper core strengthening exercise and the smart use of a bone-building supplement.
What began as a “thinking about” osteoporosis project on my part turned into an in-depth, comprehensive “rethinking” of the nature and causes of excessive bone breakdown and loss of fluid biomechanical movement. My rethinking is now calling for a new, fresh, “open
window” approach that will allow you to keep your bone structure and function healthy and strong for a lifetime.
THE PROS & CONS OF MEDICATION
Meeting Your Bones’ Nutritional Needs Is A Priority
There is evidence that some osteoporotic drugs reduce vertebrae fractures in older patients with previous vertebral fracture—but—there are no long-term, double blind, placebo studies that demonstrate what the overall benefits or risks might be after five years of use. This lack of long-term safety data, plus the way in which bisphosphonates suppress bone turnover, are sending a “red alert” to many experts who stress that we must use caution when prescribing them.
You are now aware that your 206 bones and 143 joints are alive and maintain a complex and dynamic process of growth that requires daily, high quality nutrition. It is startling that the daily nutritional needs of our bones are almost totally ignored by those at risk for osteoporosis. It is even more puzzling that men and women are regularly advised to supplement with calcium alone or at best, calcium with vitamin D3 which is not sufficient for a bone-building supplement. Furthermore, there is a lack of understanding on the part of some physicians of the benefits in reducing acidifying foods in patients’ diets or ramping up metabolic exercise to stimulate healthy new bone tissue growth—at any or every age!
Dr. Randall Stafford, M.D., PhD., of Stanford Prevention Research Center commented, “Physicians and patients may be so enamored with the new drugs available today that they are neglecting—calcium—this very important component of osteoporosis treatment.”
Dr. Stafford continues, “Greater attention to osteoporosis is critical and this includes vitamin D3, calcium and cofactors, and physical activity.”
Using a medical label to explain away the severe distress of osteoporosis, then simply medicating it, runs the risk of masking the underlying cause.
Bone Medications—Fraught With Uncertainties
Over the past decade, exciting advances have been made in drugs targeted at increasing bone density and reducing fractures. New drugs continue to be developed, and current drugs are being reformulated to improve effectiveness, cut down on the dose and minimize side effects. Some drugs are more effective than others, some protect the spine and not the hip or vice versa. And some protect both.
Some drugs have serious side effects. It is best to use your doctor as a resource and a guide to help you decide whether to go on medication and what medication to use.
When you are diagnosed with osteoporosis, your physician will likely recommend medication to reduce your risk of fracture. If you are diagnosed with the more imprecise condition of osteopenia, which is a grey zone with less clear cut answers your doctor will certainly recommend a bone-building supplement and an exercise program to reduce your risk of developing osteoporosis. If you have osteopenia, the decision on whether to start medication, will depend on your age and current bone density, how your bone density has changed over time (if the information is available), and your risk factor profile. If these three elements indicate that your risk of developing osteoporosis is high, then taking a drug plus lifestyle intervention may be an option. If on the other hand, you have few risk factors, you could consider lifestyle changes including diet, exercise and a food-based, bone-building supplement without prescription medication.
I’ll discuss the drugs that are currently approved for the prevention or treatment of osteoporosis, for whom and for what conditions they are approved, how well they work, and their side effects. You should be aware, however, that although many of these drugs can effectively reduce fracture rates by up to 50 percent, none are 100 percent effective. Thus, you need to consider all of the factors that contribute to fracture risk and ensure that you follow a comprehensive program that includes a food-based, bone-building supplement and may include drug management. The information contained in this chapter and throughout the book will help you create such a program.
MEDICATED TREATMENTS FOR OSTEOPOROSIS
All of the currently approved drugs reduce fracture rates by increasing bone density and reducing rates of bone turnover. Osteoporosis results from either increased bone loss or decreased bone formation. All but one of the currently approved drugs work by reducing the amount of bone lost such that a net gain in bone density occurs over time. The drugs that reduce bone loss render ineffective the bone cells that break down bone. The one drug that forms new bone is thought to stimulate bone-forming cells, but the precise action of this drug is still unknown. The currently approved classes of drugs are categorized as bisphosphonates, estrogen replacement or hormone replacement therapies, selective estrogen receptor modulators (SERMs), and synthetic calcium-regulating hormones. We’ll discuss each class of drugs in the following sections.
Currently, because of their potential fracture-reducing ability, bisphosphonates are the most widely prescribed drugs for treating osteoporosis.
The class of drugs called bisphosphonates is currently considered the most effective at reducing osteoporotic fractures in both the spine and the hip. Bisphosphonates work by being absorbed onto the bone crystals. When these bisphosphonate bone crystals are taken up by the bone cells that break down bone (the osteoclasts) these cells stop breaking down bone, bone mass is thus preserved. Two forms of bisphosphonates are currently available: alendronate (brand name Fosamax) and risedronate (brand name Actonel). On average, these drugs cause bone density to increase by approximately 4 to 8 percent at the spine and 1 to 3 percent at the hip over the first three to four years of treatment.
Increases in bone density generally plateau at around the fourth year of use, so that continued use of the drug then maintains a higher level of bone density. Most importantly, both drugs reduce the incidence of fractures at both the hip and the spine.
Alendronate (Fosamax) reduces the incidence of spine, hip and wrist fractures by about 50 percent over three years in patients with a prior spine fracture. It reduces the incidence of spine fractures by 48 percent in people who had low bone density but no prior fracture. But, those taking Actonel apparently had fewer fractures. Both had similar side effects. Risedronate reduces spine fractures by 41 to 49 percent and hip fractures by 36 percent over three years in patients with a prior spinal fracture. One large trial comparing the two drugs’ effect showed that alendronate increased bone density to a greater extent than risedronate did and also showed a greater decrease in bone turnover. But those taking Actonel apparently had fewer fractures. Both had similar side effects.
A new bisphosphonate known as ibandronate (trade name Boniva) was recently approved by the FDA for prevention and treatment of postmenopausal osteoporosis. It can be given either orally or intravenously. Other bisphosphonates have been developed that are not yet approved but are in the same drug class. These include etidronate, pamidronate, tiludronate and zoledronic acid. Research is now in progress on a combination of alendronate combined with vitamin D.
Who Are Bisphosphonates Intended For?
- women with high risk of bone loss after menopause to prevent bone loss
- women who have proven bone loss after menopause
- men who have proven bone loss
- bone loss caused by taking steroid drugs
- should not be used in children or young adults
- should not be used in people with ulcer, reflux or gastrointestinal problems
- should not be used in pregnant women
How long should you take this drug for? It has been proven to be safe for 5 to 10 years. If bone density has improved, go off after 10 years and reassess and monitor on a regular basis. This is a decision best made with your doctor. Experts disagree on the answer on how long to take this drug.
- make sure you are taking a high quality bone-building supplement that includes calcium, boron, silica, copper, zinc, magnesium and vitamin D3
- make sure you have a bone-building exercise program in place
- a healthy colorful alkaline diet as outlined in Chapter 5 of this book is essential
- after taking alendronate or risedronate, stay upright for 30 minutes
- take on an empty stomach with 6 to 8 ounces of water
- do not take anything else with the drug
- do not take at bedtime
- do not chew or suck on the tablet, it must be swallowed whole
- do not do any exercise involving bending over for 30 minutes
- do not take with other anti-inflammatory drugs such as ibuprofen, and naproxen
- do not take calcium, vitamin D3, or antacids within two hours of taking these drugs
- if on a weekly dosage take on the same day every week
- Ibandronate should be taken on the same day each month, 60 minutes before their first food or drink other than water or medication of the day; it must also be taken on an empty stomach first thing in the morning, with 6 ounces of water
- after taking ibandronate you have to remain upright for 60 minutes
- do not have dental surgery while on intravenous ibandronate and let your dentist know you are on any of these drugs prior to any procedure.
Side Effects To Consider
Reported side effects of both alendronate and risedronate include an increased incidence of upper gastrointestinal distress, heartburn, indigestion, chest discomfort, and pain with swallowing, although risedronate may have a lower rate of these problems.
Studies have shown that as many as 56 percent of patients do not take the drug as recommended. When combined with naproxen (a non-steroidal anti-inflammatory drug), Fosamax produced ulcers in 38 percent of volunteers and significant side effects in 69 percent.
A newly recognized side effect being discovered by users is that they are experiencing chronic, often severe joint and bone pain, swelling of ankles and feet, muscles, cramping and stiffness and difficulty walking. Most of the reports had to do with Fosamax. According to a 2005 Adverse Events Report from the FDA, pain was often described as severe, extreme, disabling or incapacitating and that many patients were unable to walk, climb stairs, or perform usual activities. Under-reporting of pain is probably considerable because of its subjective nature and because physicians may attribute pain to osteoporosis.
It goes on to recommend that you tell your doctor immediately if you develop severe bone, joint or muscle pain shortly after taking bisphosphonates. A serious long-term concern with bisphosphonates has to do with the shutting down of osteoclast cells that remove old weakened bone so the osteoblasts can build new bone.
Gillian Sanson in her book, The Myth of Osteoporosis, warns that bisphosphonates, like alendronate, stay in the bone for more than 10 years, and accumulate with use. “Stopping treatment does not remove them from the body, and their influence would continue for better or worse.” She continues to say, “Furthermore, there is no known method of removing the medication from the bones.” But osteoblasts require the activity of osteoclasts and the resorption of old bone to trigger their activity. In the absence of osteoclasts, osteoblasts are eventually immobilized. This may not be healthy for bone.
This suppression of bone remodeling may reduce bone toughness and increase micro fractures, which could in turn increase bone fragility. Although it is not known whether this effect reduces bone strength, there are concerns that long-term use of bisphosphonates will produce an older skeleton with more crystallized bone that will have less tensile strength in places like the hip.
Dr. Susan Ott, Associate Professor of Medicine at the University of Washington will only use bisphosphonates for five years. Bone biopsies from patients taking bisphosphonates show 95 percent reduction in the bone formation rate (after five years). The bisphosphonates get deposited in the bone and will accumulate for years. It is possible that many years of continuous medicine would make bone more brittle or impair the ability to repair damage. Bisphosphonates do reduce fracture and improve measurement of bone density for the first five years. After five years, the fracture rates are as high in women who keep taking alendronate as in the women who quit. More research is also being carried out, but to date, two-year studies of weekly therapy have not been large enough to determine the effect on fracture reduction.
After interviewing osteoporosis experts around the world, Sanson has strong confirmation for her assertion that vertebral fracture benefit with the bisphosphonates is very low. For example, she says that 22 women who have had a previous fracture would need to take Fosamax for three years to prevent one spinal fracture detectable by X-Ray in any one of them. She says there is very little benefit of these drugs on hip fracture rate.
Alendronate has also been linked to hypocalcemia (abnormally low blood calcium concentration), increased parathyroid hormone, and skin rash. A most grave side effect of bisphosphonates is jawbone death, which is very painful and difficult to treat. This complication mainly occurs in persons who are taking intravenous bisphosphonates but can occur in 1 to 10 percent of Fosamax users.
Bisphosphonate And Young People
Dr. Ott says that animal studies show bisphosphonates cause fetal and maternal abnormalities in bones and calcium metabolism, so she says that it is unethical to study this medication in pregnant women or women who might become pregnant while the bisphosphonates are still in their bones. Basically there are no studies on the use of bisphosphonates in children and young adults. A diagnosis of low bone density in a young person is not necessarily a cause for concern unless it occurs in the presence of other risk factors such as fragility fracture, abnormal thyroid and parathyroid function. Little is known about osteoporosis in young people, and attention to good nutrition, lifestyle and exercise, is of primary importance.
BOTTOM LINE: Bisphosphonates are the only drugs that both increase bone density and decrease fractures at both the hip and spine. As such they are the first line choice for many physicians. Both Fosamax and Actonel have been shown to reduce spine fractures by as much as 40 to 50 percent and hip fractures by as much as 30 to 50 percent. However, there are still many unanswered questions about long-term effects and the possibility of rare but disabling side effects.
ESTROGEN REPLACEMENT OR HORMONE REPLACEMENT THERAPIES
Estrogen or hormone replacement therapy is no longer the first line treatment of osteoporosis, but it still has a useful role to play in osteoporosis prevention.
Estrogen is thought to play a key role in bone health. Bone has special receptors for estrogen. Estrogen slows down the action of the osteoclasts. In addition it stimulates the production of vitamin D3, promotes the conservation of calcium by the kidneys and stimulates the relapse of growth hormone by the pituitary gland, which stimulates bone formation and increases absorption of calcium in the intestines.
- Women who might become pregnant, have breast cancer or other estrogen-dependent cancers, or have a risk of thromboembolic disease (blood clots in the legs) should not take hormone replacement therapies
- Women with a history of phlebitis or liver disease should not use it.
Increased risk of breast and uterine cancer; increased risk of blood clotting and gallbladder disease; and increased risk of heart attack and stroke.
A positive side effect is that it helps relieve the symptoms of the menopause. It reduces hot flashes and helps thinning of the vagina and increases good cholesterol in the blood.
- Always take with a comprehensive food-based bone-building supplement
- Have a good core exercise program in place
- Exercise will increase the effectiveness of the hormones
- Women who take ERT or HRT and exercise may experience greater gains in bone density than women taking either ERT or HRT or exercising only, suggesting some sort of positive interaction between estrogen and exercise on bone
- For prevention of osteoporosis, ERT or HRT is best started soon after menopause and continued for seven or more years.
Estrogen’s Effect On Bone Loss
For many women, estrogen (ERT) or estrogen and progesterone replacement therapies (HRT) have been prescribed specifically to reduce menopause-related bone loss. They offset the estrogen-related bone loss associated with menopause and even cause a slight increase in hip and spine bone density that plateaus after three years of use. Studies show that hormone replacement therapies reduce the incidence of fractures of the hip and spine by 30 to 50 percent.
When ERT or HRT are discontinued, however, bone density is lost in a manner similar to what occurs in menopause. Stopping estrogen therapy even after four years or more of treatment may cause a rapid acceleration of bone loss. Dr. David Felson and his colleagues at the Boston Arthritic Hospital examined the data on 212 women who had taken estrogen replacement therapy. He commented that: “Unfortunately the effect of estrogen replacement therapy does not persist long after the discontinuation of treatment. In women over 75, even 10 years of past estrogen use did not have a significant effect on bone density.” Dr. Ott recommends that after 10 to 15 years of estrogen therapy for bone loss, her patients switch to raloxifene.
Taking estrogen by itself is usually only recommended for women who have their uterus and tubes removed surgically. If you have your uterus, progesterone must be prescribed as well to offset the risk of uterine cancer caused by taking estrogen. Personally I feel that if progesterone is used, it must be bio-identical progesterone in the form of the prescription drug known as prometrium or in the form of a specially compounded skin cream.
Hormone Therapy And Your Heart
Hormone therapy was thought to be helpful in preventing heart disease, but this has been recently disproved in several landmark studies.
The first study to question the heart benefits of hormone replacement was the Heart and Estrogen/Progestin Replacement Study (HERS). This was a study of 2,763 women with known heart disease of whom half received hormone replacement therapy and half received a placebo. Both groups of women, whose average age was 66.7, had the same number of heart attacks. But the hormone group had a higher rate of gallbladder disease and inflammation of the veins. Exercise, diet and supplements are the most important strategies to maximize and maintain superior bone-building health, all-life-long.
The Women’s Health Initiative (WHI), a large clinical research study, was in part designed to specifically examine the health benefits of hormone replacement therapies in women. The study confirmed that HRT increased bone density in postmenopausal women and effectively lowered the incidence of fractures. However, the study also reported an increase in the number of heart attacks and strokes even in women taking hormone replacement compared to those who were not.
The sponsor of the WHI study, the National Institutes of Health (NIH), was concerned enough by the information that they stopped the trial and released the study findings to the public. The NIH currently sponsors a website that addresses questions and concerns about the use of ERT or HRT based on the latest research findings (www.nhlbi.nih.gov/health/ women/pht_facts.html). Recent studies are investigating the use of very low dose estrogen to preserve bone yet minimize the risk of stroke and breast cancer.
Bio-identical Hormones Offer Great Hope
There are two types of HRT available to women today. The first and most commonly prescribed type relies on synthetic drugs, which are really patented chemicals foreign to the human body. These include chemically altered or foreign estrogen, the most common form of which is Premarin, and chemically altered progesterone, which isn’t really progesterone at all but is made of chemicals called progestins such as Provera. These altered chemical structures are not readily recognized by the body.
Premarin, contains forms of estrogen completely foreign to the human body. Premarin is actually made from pregnant mare’s urine, and in the medical literature is often referred to by its generic name, conjugated equine estrogen (CEE). CEE has a totally different composition of estrogens than those found naturally in the human body. The three estrogens found normally in women are estriol (90 percent), estradiol (7 percent), and estrone (3 percent). CEE contains almost no estriol, but lots of estrone (75 percent) and estradiol (5 to 15 percent). In addition, horses have a number of estrogens unique to their species, most notably equilin (6 to 15 percent).
The second and less well known type of hormones are the bio-identical hormones which are hormones that are identical in structure to the hormones found in our own body. These hormones are made in a lab, but unlike the first class of hormones their structure is not altered and is one that the body recognizes. There are bio-identical estrogens, progesterones and testosterone available. All of these hormones are helpful for bone health and may be prescribed by medical doctors and naturopathic doctors familiar with their use. Several large studies involving tens of thousands of women on Premarin and Provera have become available in the past few years and have led to disturbing results. Based on these studies, it is now the consensus of many mainstream physicians that chemically altered or foreign estrogens like Premarin and chemically altered progesterones like Provera are not as beneficial as once thought.
It is remarkable that there is virtually no discussion in the mainstream health press about the fact that so-called estrogen replacement therapy did not use human estrogen at all. Yet we know that very slight changes in the chemical structure of a substance can have dramatic effects. For example, by altering only one chemical group in estrogen, it turns into testosterone. Altering a few carbon hydrogen bonds can turn a healthy omega-3 fat into an unhealthy trans fatty acid.
Bio-identical Hormones And Your Bones
Many patients and their physicians turned to safer and more natural bio-identical ERT or HRT, as an option during menopause. But can a woman really receive the benefits without the risk found with artificial, chemically altered hormones when taking bio-identical estrogen and progesterone?
Unfortunately, we don’t have large, drug company-sponsored studies to prove this beyond a shadow of a doubt, but a number of small studies suggest this may be so. In one study, bio-identical hormones appear to have the same beneficial effects as the conventional HRT with less risk. Another study in 1991 showed that bio-identical estradiol resulted in the same blood levels of circulating estrogen and the same health benefits as Premarin, but without some of the side effects of Premarin. In a study in the year 2005 from the University of Connecticut, the benefits of osteoporosis prevention were seen, with minimal side effects when low dose natural estrogens were given to women over 65. Natural estrogens may also provide some protection against Alzheimer’s and also help maintain the skin’s youthfulness. According to naturopathic doctor, Tori Hudson, estradiol has been shown in three small studies to have a beneficial effect on bone: however, other studies with estriol have not shown any protection from bone loss. Bio-identical hormones are now widely available from compounding pharmacies (pharmacists who create or compound their patients’ prescriptions from the original active drugs as opposed to simply counting pre-made pills out of bottles). The ratio of estrone (E1) to estradiol (E2) to estriol (E3) is compounded to closely mimic the ratio found naturally in the body. Typical doses of 2.5 to 5 milligrams per day of “Tri-Est” (E1, E2, and E3) or “Bi-Est” (E2 and E3) are given in combination with bio-identical progesterone and, if needed, bio-identical testosterone. Side effects associated with bio-identical HRT are typically much less than those seen with the synthetic drugs.
Natural Estrogens Are Preferred
Several small studies show that bio-identical estrogen does not increase cardiac risk and has beneficial effects on blood lipids. Natural progesterone also raises the good cholesterol and decreases cardiac artery spasm. A recent heart catheterization study showed the natural estrogen did not lead to progression of coronary artery disease in postmenopausal women already known to have heart disease.
BOTTOM LINE: Estrogen reduces vertebral and spinal fractures. However, because of an increased risk of heart disease, stroke and cancer, the FDA recommends other non-estrogen therapies be tried first. Its recommended use is strictly for prevention of osteoporosis. However, it is also used for postmenopausal women with a low trauma fracture and menopausal symptoms along with a bisphosphonate. There are small studies showing that natural estrogens and progesterones may be beneficial for the heart as well as for the bones.
Drug researchers have been searching for the perfect hormonal substitute that would produce the benefits of sex hormones such as estrogen and testosterone, but without side effects or danger.
One avenue for new drug research centers on a group of drugs known as selective hormone receptor modulators, or SERMS. It is hoped that these drugs would produce the good effects of estrogen on the bone without the bad cancer causing and blood clotting side effects.
The first SERM to undergo extensive evaluation was tamoxifen, which is still widely used to prevent reoccurrence of breast cancer. However, when proper long-term studies were done, it was found that tamoxifen’s protective effect only lasted about five years. After five years, the breast tissue appeared to become resistant to tamoxifen and tamoxifen may have actually caused more cancer. Meanwhile, it was found that tamoxifen increases bone loss in women taking it before menopause and helps prevent bone loss in women taking it after menopause. But because tamoxifen can cause hot flashes, nausea, and vomiting in 25 percent of women and less frequently depression, skin rashes, irregular bleeding, visual problems, liver enzyme changes and a slightly increased risk of uterine cancer and blood clots, tamoxifen is unsuitable as a routine therapy for bone loss. There has also been a disturbing question raised as to whether tamoxifen and other drugs in this class may remove the protective effect of estrogen on the brain and lead to an increased incidence of Alzheimer’s.
A newer SERM that comes closer to the goals of helping to control menopausal symptoms, preventing osteoporosis and breast cancer, is raloxifene (brand name Evista). Raloxifene has many beneficial effects, working like estrogen to prevent osteoporosis while also lowering harmful LDL-cholesterol levels. But even raloxifene is not ideal; preliminary results have shown that it does not relieve hot flashes—in fact, it seems to cause them—and, like tamoxifen, it is associated with an increased risk of blood clots. Researchers around the world are working to develop “the perfect SERM”, and numerous drugs of this class are currently under investigation. As with all new drugs, it is important to wait for long term studies to understand the true side effect picture, especially with respect to cancer.
On the other side of the genetic fence, research is also intense to discover the perfect SARM (selective androgen receptor modulator). SARMs have potential application to treat osteoporosis in men, age-related loss of muscle mass, and prostate enlargement. Although there are still no SARMs available for commercial use, GTx, a bio-pharmaceutical company that specializes in developing drugs related to men’s health, has developed more than 250 potentially useful SARMs to date. Just like SERMs, SARMs can either mimic or oppose the action of the natural hormone—in this case, testosterone.
The goal is to develop a drug that can produce the beneficial effects of testosterone, such as maintaining libido and bone and muscle mass, while avoiding the side effects or toxicities of testosterone replacement, such as prostate enlargement and male-pattern baldness.
Selective Estrogen Receptor Modulators
Raloxifene (brand name Evista), has been approved for reducing bone loss in postmenopausal women because it acts like estrogen on bone. Raloxifene has been developed as treatment specifically for osteoporosis. It has been approved for prevention of postmenopausal bone loss. It is believed that it may produce some of the beneficial effects of HRT, without the adverse effects. But at this time, treatment with raloxifene has not been shown to decrease the risk of either breast cancer or cardiovascular disease in early postmenopausal women.
Recent studies have shown that raloxifene modestly increases spine and hipbone density and reduces bone turnover in post menopausal women. It reduces spine fractures by up to 50 percent but thus far has shown no ability to reduce hip or other non-spine fractures.
Who Is This Drug Intended For?
Women with postmenopausal osteoporosis and for preventing bone loss in recently menopausal women.
Raloxifene does not have the same alleviating effect on menopausal symptoms as estrogen therapy. In experimental trials, women on raloxifene experienced more hot flashes, vaginal bleeding, leg cramps, and leg swelling and had a greater incidence of venous thromboembolic disease compared to women on placebo. However, raloxifene also reduced the incidence of breast cancer in women at low risk for the disease and reduced levels of harmful cholesterol. Unlike tamoxifen, raloxifene does not appear to stimulate the lining of the uterus, and is therefore less likely to be associated with an increased risk of cancer of the uterus.
The longest-running study of raloxifene has been slightly more than three years, so its safety and ability to continue to reduce spine fractures after three years of use is uncertain.
BOTTOM LINE: Raloxifene helps prevent vertebral fractures, but there is no evidence it prevents fractures of the hip. Its effects on the risk of breast cancer and heart disease are still being studied. It increases hot flashes and may cause life-threatening blood clots. Dr. Felicia Cosman says it is the best second line option if bisphosphonates cannot be taken.
Calcitonin is a natural hormone found in our bodies. It is made by the thyroid gland and controls the activity of osteoclasts, the cells that reabsorb (break down) bone. Calcitonin is also found in certain fish, including salmon, and has been extracted for use as a drug to treat the bone disease known as Paget’s Disease, and also osteoporosis. Salmon calcitonin was first approved for the treatment of osteoporosis in 1984. It appears to have few risks associated with use.
Perhaps one of the longest-standing drugs on the market for bone loss is Calcitonin (brand names Miacalcin, Calcimar). Calcitonin is a hormone that causes calcium to be taken up from the blood and deposited in the skeleton. Calcitonin is actually a hormone that the body makes naturally, and its purpose is to prevent excessively high levels of blood calcium. The idea behind using calcitonin as a drug is that if it is given in large amounts with a food-based, bone-building supplement, it may cause the extra ingested bone-building minerals to go straight to the skeleton. Calcitonin used to be given intravenously but resulted in too many side effects. A nasal spray form was developed and is the most commonly prescribed form, although users may experience some nasal discomfort.
Who Is This Drug Intended For?
- men with osteoporosis
- men and women who have osteoporosis from taking steroids
- for men and women for painful spinal fractures
- women who are five years postmenopausal and who have osteoporosis
A placebo-controlled trial of 1,255 postmenopausal women with low bone density and one or more previous vertebral fractures found that calcitonin treatment slowed bone density loss and reduced new vertebral fractures over a five-year period. There is no evidence of hip fracture prevention. Calcitonin has been found to have analgesic qualities in the management of severe pain due to vertebral crush fractures. On a personal note, I have found calcitonin very useful for relieving pain in older people with crush fractures. It can also be used along with bisphosphonates like Fosamax or Actonel.
When osteoporosis has occurred as a result of treatment from corticosteroids, calcitonin may be an effective treatment. A recent study showed that calcitonin appears to preserve bone mass in the first year of glucocorticoid therapy at the lumbar spine by about 3 percent compared to placebo, but not at the femoral neck (hip).
Nasal dryness and irritation, back and joint pain, and headache. It is advised that the drug should be administered with calcium and vitamin D3. The longest-running study of calcitonin has been five years, so its safety and ability to continue to reduce spine fractures after five years of use is uncertain.
BOTTOM LINE: Calcitonin is a safe drug taken as a nasal spray that is useful for the treatment of osteoporosis in women who are five years postmenopausal, and already have spinal fractures and can be added to bisphosphonates for the treatment of pain from vertebral fractures. It can also be used to prevent osteoporosis induced by steroid use in both men and women.
Parathyroid Hormone (PTH)
In November 2002, Forteo, a synthetic form of parathyroid hormone, was approved as the newest treatment for osteoporosis. The action of parathyroid hormone treatment (PTH) is different from other osteoporosis drugs that are classified as “anti-restorative” treatments that affect bone loss. PTH treatment stimulates bone formation, and for reasons that are not fully understood, daily injected low-doses of PTH appear to stimulate bone formation more than resorption, and may even rebuild trabecular bone. When PTH is given at regular intervals, bone is actually gained! Studies show that on the average, bone density at the spine can increase up to 10 percent in some people. Unfortunately, PTH is not as effective at building hipbone density and in fact results in no change at all.
It has not yet been evaluated for its ability to reduce fractures, but the increases in bone density suggest that it is likely effective at reducing spine fractures.
Who Is This Drug Intended For?
- men and women with severe osteoporosis or who have already had fractures
- men and women on long term steroids
- men and women who continue to have fractures despite being on other medications
- cannot be taken by persons who have had bone cancer, or radiation therapy involving the bones
- cannot be taken by those with active gout or high levels of calcium
Nausea, headache, dizziness and leg cramps, hypercalcemia and uric acid increased by 13 percent. Fifty percent of rats treated with high doses of intermittent PTH developed bone cancer.
Currently treatment lasts for two years. It can be given in three-month cycles, three months on, three months off, for 15 months. There are potentially serious risks associated with use, and there is no long-term safety data at this time.
Patients are required to give themselves daily injections using needles, much like those used by diabetics.
BOTTOM LINE: It is a new and expensive drug approved for both men and women with severe or difficult to treat osteoporosis, which currently can be taken for only two years.
Exercise And Drug Therapy Combined
Since exercise is known to have a positive effect on bone, combining exercise with drug therapy could result in an even greater reduction in fracture risk than just drug therapy alone.
Few studies of the combined effects of exercise and drug therapy have been done. Some studies have evaluated the combined effects of ERT (estrogen replacement therapy) or HRT (hormone replacement therapy which includes both estrogen and progesterone) plus exercise as well as alendronate plus exercise on bone health in women. Women who take ERT or HRT and exercise may experience greater gains in bone density than women taking either ERT or HRT or exercising only suggesting some kind of positive interaction between estrogen and exercise on bone. Only a handful of studies on alendronate plus exercise have been done and suggest little additional benefit of exercise to the potent effect of alendronate; however, the number of trials is too few to reach a solid conclusion.
Furthermore, exercise influences several aspects of your health in addition to bone and falls, so drug therapy should never be considered a substitute or replacement for exercise; rather, drug and exercise therapy combined should be considered part of a comprehensive program for reducing fracture and chronic disease.
Falls are an important risk factor for fractures, but no drug therapy has been shown to independently reduce the risk of falls. Since all wrist fractures, nearly all hip fractures, and about half of all spine fractures are associated with a fall, taking measures to reduce fall risk will decrease your risk of fracture beyond the effects of drug therapy. An easy to follow weight training program described in Chapter 6 of this book also includes exercises to improve balance. Your balancing ability naturally declines with age. By improving both your balance and your muscle strength, you will go a long way to preventing falls.
TREATMENTS UNDER STUDY
Drug therapy is important in osteoporotic women for whom the risk of a fracture is significantly increased. Drug therapy may also be important for reducing bone loss and preventing osteoporosis in osteopenic women at risk for developing osteoporosis. Drug therapy should never be considered a substitute for good nutrition, a bone-building supplement and exercise, however, because of the many physical, emotional and mental wellness benefits nutrition and exercise provide, especially exercise’s ability to significantly reduce fall risk.
Drugs that lower cholesterol are known as statins. Millions of people take them every day. Recently, doctors have noticed that their postmenopausal patients who are taking statins such as Zocor have fewer osteoporosis-related fractures than their postmenopausal patients not taking the statins. Researchers at Erasmus University in the Netherlands found that statins can reduce the risk of fractures. They studied 3,469 men and women who used statins for a year, and found that those taking the drug had half the vertebral fractures of those people who did not. According to the lead author of the study Mariette Schoofs, “Statins appear to increase bone formation.” This is useful information for those already taking these medications to lower cholesterol.
However, this was a short study so it is too early to reach any conclusions and certainly too early to use these drugs to prevent bone loss. Statins also have many potentially serious side effects, one of which is to deplete the heart of an essential nutrient known as co-enzyme Q-10, so this nutrient should always be taken along with the statins.
There is considerable controversy about the effects of fluoride on bone strength and fracture risk. It is one of the few treatments known to stimulate osteoblast activity and actually increase bone density—an apparently desirable outcome. But increased bone density does not necessarily mean stronger bone. Experience with fluoride has shown that past a certain point, bone may in fact become more brittle and fracture more easily.
Dr. Susan Ott writes in her website, Osteoporosis and Bone Physiology, http://courses,washington.edu/bonephys
“In a large well-designed randomized, blinded clinical trial, women who used fluoride for four years had increased fracture rates compared to placebo controls. The bone density of the spine increased by 32 percent, but the hip did not show increased density and the rate of hip fractures was nearly three times as high in the fluoride group. At this time fluoride cannot be recommended for clinical use. Because it is one of the few medications that can enhance osteoblast activity, it thus deserves further research.”
There is some evidence that fluoridated water is linked to an increased risk of hip fracture, suggesting that even exposure to low levels of fluoride may put elderly people at greater risk. A 1995 study of elderly women in 75 parishes in southwestern France found that the risk of hip fracture was 86 percent greater in those areas with water fluoride concentrations above 0.11 parts per million (ppm). Optimal concentrations of fluoride in drinking water are considered to be between 0.7 and 1.2 milligrams per liter (0.11 milligrams per liter (mg/L) is the same as 0.11 parts per million).
In October 2002, researchers reported that when tested in mice, a newly identified synthetic hormone called estren is more effective than estrogen in strengthening bone. Unlike estrogen, it does not increase the risk of breast or uterine cancer. As a gender-neutral treatment that does not affect the reproductive tissues, it can be used in both men and women for the treatment of osteoporosis, according to the journal Science. This new compound is years away from human testing, but researchers are very interested in it, because it belongs to a new class of drugs that have the potential to work better to prevent and treat osteoporosis and other chronic diseases of aging than any drugs now available. Researchers report that the drug works similarly to hormone replacement therapy, but doesn’t appear to have HRT’s risks for cancer and heart disease. It is still in the early stages of testing and is part of a new class of compounds called ANGELS (Activators of Non-Genomic Estrogen-Like Signalling).
PROMISING NATURAL TREATMENTS
Strontium is an abundant natural element found in the earth’s crust and sea water. It is number 38 of the periodic table. It was discovered in 1801 and named after the Scottish town of Strontian. According to Dr. Alan Gaby in his book, Preventing and Reversing Osteoporosis, the human body contains 320 mg of strontium, nearly all of which is in bone and connective tissues. Gaby cites studies that indicate that strontium may have a significant role in the prevention and treatment of osteoporosis and other bone diseases, particularly metastatic bone cancer.
Strontium ranelate appears to reduce the incidence of vertebral fractures in postmenopausal women with low bone density. The precise mechanism of bone changes resulting from strontium ranelate treatment have not yet been elucidated but like PTH, strontium ranelate appears to decrease bone resorption and stimulate bone formation at the same time.
Researchers conducted a recent three-year trial of 1,649 women, most of whom had a previous fracture. They found that after one year of treatment, 44 women experienced a new vertebral fracture in the treatment group, compared with 85 in the placebo group. After three years, 139 had a new vertebral fracture in the treatment group compared with 222 in the placebo group. There did not appear to be any significant adverse effects. It is not clear whether it is useful in the treatment of hip fractures. Patients also receive calcium and vitamin D3 supplement daily. It is important not to take calcium and strontium at the same time.
Human Growth Hormone
Human growth hormone (hGH) is the most abundant hormone made by the pituitary gland in the brain. It hits its peak during the rapid growth phase of adolescence, then steadily declines as we age. Until recently hGH was difficult to obtain and very expensive. However, in the mid 1980’s two drug companies were able to produce hGH through recombinant DNA technology, making it widely available for research and treatment. Human growth hormone may have an important role in the treatment of osteoporosis. It increases bone remodeling and may be useful during late postmenopause or postandropause. It is another treatment that could be useful for both men and women. Much more research is still needed.
Endocrinologist Dr. Daniel Rudman estimated that one third of men between the ages of 60 to 80 have hGH deficiency. Women probably also have a similar deficiency. In July 1990 Rudman published a small study in which 21 men between the ages of 60 and 80 were divided into two groups. One received hGH injections three times a week for six months and the other no treatment. The men receiving hGH all showed a marked improvement in health and appearance. They gained an average of 8.8 percent in muscle mass, lost an average of 14 percent body fat and increased skin thickness without changing diet or fitness levels. European physician Dr. Thierry Hertoghue has been using minute doses of human growth hormone (hGH) injections combined with oral DHEA and bio-identical estrogen, progesterone and testosterone to achieve almost miraculous anti-aging effects. Most side effects are due to over-dosing. These include edema, carpal tunnel syndrome and joint pains. There are, however, serious concerns of whether hGH might promote the growth of cancer.
THE ROLE OF BIO-IDENTICAL HORMONES
The possible benefits of natural estrogens have already been discussed. Typical doses of 2.5 to 5 milligrams per day of “Tri-Est” (E1, E2, and E3) or “Bi-Est” (E2 and E3) are given in combination with bio-identical progesterone and, if needed, bio-identical testosterone. In my experience, side effects are much less than with more altered chemical hormones.
The Role Of Progesterone In Bone Health
Thanks to the pioneering work of University of British Columbia professor, Dr. Jerilynn Prior, the critical role of progesterone in bone health has been brought to the forefront.
There has been some evidence that progesterone enhances the formation of new bone. Progestins (progestagens) used in HRT and contraceptives have been reported to prevent or reverse bone loss in certain clinical situations. Dr. Jerilynn Prior made a detailed study of 66 women who were not ovulating but who were having regular periods. They were losing two percent of their bone every year and had low progesterone levels. Dr. Prior found she could reverse the bone loss by giving 10 mg of Provera daily. She believes that the hormone progesterone is very important for bone health. She also advises women to find out if they are ovulating, because a woman who is not ovulating regularly has a higher risk of bone loss. However, a new study involving young women taking injectable medroxyprogesterone acetate (Depo-Provera), synthetic progesterone for birth control, found that their bone density was 7 percent lower than young women not using the drug.
Dr. Prior used progestins in her studies, and there is much confusion between these progestins and natural progesterone. Natural progesterone is synthesized in a laboratory from the wild yam or from soy. It is what is known as a “bio-identical” hormone, because its molecular structure is identical to a woman’s own hormone progesterone produced by her ovaries. Its structure is completely different from synthetic progesterone whose proper name is progestin, but often mistakenly called progesterone and confused with natural progesterone. These synthetic progestins are used in Provera, which has been commonly prescribed with Premarin and in birth control pills and injections.
The Popularity Of Progesterone
The popularity of progesterone is based largely on the work and the writing of Dr. John Lee. Dr. John Lee was an internationally recognized authority on fluoride and a clinical instructor at the University of California Medical School. He authored two books, What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About The Perimenopause. Dr. Lee believed that applying progesterone to the skin in the form of a cream helped increase bone mineral density (BMD) in postmenopausal women. In his small study, 100 women used the cream during a three-year period. Sixty-three of the women had bone density tests that indicated an average bone density increase of 15.4 percent over the three-year period, compared with an expected loss of 4.5 percent. Most of the women studied had previously fractured, but no new fractures were reported during the three-year study. This study was conducted as an observational study—that is, there was no control group and as such is viewed with skepticism by the medical community.
In addition to the progesterone, the women in the study were encouraged to consume green, leafy vegetables; to avoid cigarettes and carbonated beverages; to supplement with “molecular targeted” food-based, bone-building supplements containing calcium, vitamin D3, vitamin C and the many bone-building cofactors; and to participate in a regular exercise program. Some of the women were also taking estrogen vaginal cream. Because each of these additional recommendations may have a positive influence on bone density, it is difficult to say whether it was the progesterone or the combination of the strategies that had the effect.
In a more recent, randomized controlled trial in the United States, 102 healthy postmenopausal women used progesterone cream and calcium and vitamin supplements. During the one-year study, there was no significant difference in bone density between the progesterone and the control groups. However, the natural progesterone was effective in relieving menopausal symptoms. It may be possible that, the effect of natural progesterone on bone may not become apparent until after more than one year of use, or it may require higher dosages. Another study showed that transdermal progesterone was effective in raising blood levels of natural progesterone.
Natural progesterone is very safe and appears to have few side effects.
Personally, I believe that bio-identical natural progesterone in the form of creams or prescription pills (known as prometrium) can have a beneficial effect on bone to help prevent bone loss, and to treat osteopenia, but only as a part of a comprehensive program including exercise and supplements.
I prescribe natural progesterone alone, or in combination with bio-identical estrogen and testosterone, and bisphosphonates medications if necessary, in addition to exercise and a comprehensive food-based, bone-building supplement to treat osteoporosis once it has occurred. I believe that natural progesterone is a bone-preserving hormone, but as in the case of BERT, there is no funding for further research at this time.
Testosterone Is Important
Testosterone is a hormone that is important to bone health, particularly for men, but it can also be useful for women as well. There is a lot of exciting research going on in this field. Studies so far indicate that testosterone in the form of transdermal creams and pills can help reverse bone loss in men. This is a very promising research area. Even now, natural testosterone can be safely added to treatment regimens for both men and postmenopausal women whose free testosterone levels are low.
DHEA (dehydroepiandrosterone) and DHEA-S (DHEA sulphate) are steroid hormones secreted by the adrenal cortex. Levels peak between the ages of 20 to 30 years. Levels decline steadily thereafter, and at 70 years are found to be less than 20 percent of the peak values. Several studies have shown that supplementation with DHEA strengthens the immune system, heightens brain activity, and improves overall well being. An increase in levels of estrogen in postmenopausal women, and testosterone in postandropausal men, after supplementation with DHEA, has been noted as a possible link to increasing bone mineral density. Please see Chapter 2 of this book, the section subtitled “Hormone Imbalances—An Underlying Cause of Osteoporosis”, for an in-depth look at DHEA and melatonin replacement therapies and bone-building health.
Isoflavone are plant estrogens. Ipriflavone is a synthetic isoflavone made from naturally occurring isoflavone dadizein found in soy. There have been over 100 published studies on ipriflavone, roughly half these studies have been done on humans and half done on animals. The research shows that ipriflavone inhibits bone resorption and may even enhance bone formation. The usual dosage of ipriflavone is 600 mg to 1200 mg a day.
According to Dr. Alan Gaby, author of Preventing and Reversing Osteoporosis, and The Natural Pharmacy, “Many clinical trials including numerous double blind trials have consistently shown that long term treatment with 600 mg of ipriflavone per day along with 500 mg of elemental calcium in a comprehensive bone-building supplement is both safe and effective for bone loss in postmenopausal women or in women who have their ovaries removed. Ipriflavone has also been found to improve bone density in established cases of osteoporosis in most, not all, clinical trials.”
A recently published well designed study looked at 474 women between the ages of 45 and 75; average age 63.3 and most had severe osteoporosis. However, only 132 women in the treatment group and 160 in the control group completed the study. At the end of the three years there was no discernable difference in bone density or fracture rate between the two groups.
However, as the authors state in the study, a one percent difference in spinal BMD would require a study subject of about 1,300 subjects. The same is true of the fracture incidence. The study was too small. The authors also note that women in the study came from different parts of Europe which may be important for behavioral, nutritional and environmental factors influencing bone mass, which were not controlled in this study.
A worrisome side effect of some of the women taking ipriflavone emerged—these women had lower levels of certain white blood cells that are an important part of the immune system, than those taking the placebo. What is interesting about this study is that the soy derivative being used was altered chemically so it could be patented. If you are going to use soy products be sure to use organic, fermented soy products such as tempeh or miso.
According to British researcher Dr. Susa Lanham, new studies have shown that soy protein has a beneficial effect on bone mass in premenopausal and perimenopausal women. More data is required. But she adds that “A large study that examined the relationship between soy food consumption and fracture incidence in 24,403 Chinese postmenopausal women who had no history of fracture or cancer found that soy consumption reduced the risk of fracture in women after menopause, especially those in early postmenopausal years.
BOTTOM LINE: Soy consumption is probably helpful as part of a program to help build bone. But, in my opinion, it should only be fermented organic non-GMO soy. Although ipriflavone has possible effects on white blood cells that are reversible, it is probably at least as safe or safer as currently prescribed drugs for osteoporosis.
WHAT DOES THIS HAVE TO DO WITH YOU?
What should be clear to you by now is that if you have been diagnosed with osteoporosis or osteopenia, there is a lot you can do to treat and even reverse your condition, naturally. Remember that drugs can be, if needed, an addition to any successful treatment and not a substitute for a healthy lifestyle, exercise and a bone-building supplement. For each individual person, the optimal program will vary a little to meet your biological individuality.
The future looks bright. I’m convinced that within the next four or five years, we will see major breakthroughs in the development of medications and treatments to help us keep our bones strong and healthy.
In the meantime, though, it is important to—eat well, exercise often, get a BMD test if you are at high risk, and, if you have a problem, start treating it right away with a natural, food-based “molecular-targeted” bone-building supplement and, if necessary, with one of the many osteoporosis drugs available.
Regular, daily use of a micro- and macro-nutrient rich, “molecular-targeted” bone-building supplement, a diet abundant in ancient color-coded and “cell friendly” foods, wise sunshine exposure and daily exercise practices could help to prevent, forestall, or even reverse osteoporosis in men and women regardless of age. About 10 years ago, I became intrigued by the bone-building process. I had a bone scan and “osteopenia” was diagnosed. When the radiologist gave me the diagnosis, I felt very frightened. I became motivated to build up my bone mineral density and strength—naturally. I followed the step-by-step sensible action plan and comprehensive bone-building program that lifestyle researcher Sam Graci has set out in this book. I have opted not to use medications, and my bone density has greatly improved—I no longer have osteopenia. But the biggest benefit has been increased levels of overall health, vitality and self-confidence. I believe that the majority of you can achieve the same increased bone density and health I have, by simply following the breakthrough and unique action plan, for every decade of your life, outlined so well in Chapter 10.
You too will see and feel the amazing results I did, as you solve your personal bone-building equation. Metaphorically our bones are comparable to a foundation of a house. When we go back to basics and strengthen the foundation, we are making sure that our house will stand for a long time. Each new day will be filled with a renewed appreciation of your revitalized bone health, well being and vitality.
My Concluding Thoughts, As A Physician
Breakthrough, state-of-the-art science and knowledge show us that you can normalize bone-building, and reduce your fracture risk naturally, no matter what your age is. Throughout my 25 years of clinical practice I have tried to combine the best of scientifically proven medicine with the best of natural medicine. Fortunately, when necessary, we can benefit from the use of well-researched medications to deal with the most serious effects of osteoporosis.
Remember as well that within each of us is a vast intelligence at work, beyond our comprehension. An intelligence that provides for balanced homeostasis (biochemical balance) and instantaneous communication between our 100 trillion cells, that orchestrate 8 trillion individual, yet coordinated, biochemical reactions every single second. A living, monitoring intelligence that faithfully struggles 24 hours a day, 7 days a week to develop and maintain a multipurpose skeletal system from whatever food, water, rest, supplements, exercise, air and sunlight we give it.
This astounding phenomenon is not just limited to bone cells but to every cell in your body. As my friend Dr. John DeMartini says, “The force that made the body can heal the body.” As physicians we are often guilty of forgetting that the body has amazing self-healing capacities. We tend to focus on drug therapies, and lab and X-ray results, forgetting to look at the whole person and their lifestyle.
I encourage you to embrace the message of this book for maximizing both bone-repair and bone-building for a happy and healthy life. It’s time to get a complete makeover of your lifestyle, food choices, exercise choices and even your way of thinking. Your lifestyle choices and how you have been eating are intimately associated with your personality. You may have to cut through societal or family barriers to achieve your dietary goals. But the pay-off is tremendous. Your new lifestyle, menu and food-based, bone-building supplemental makeover—equate to a healthier and better you!
Let a vibrant, balanced and healthy physical, mental, emotional and spiritual life be the rallying cry of a new generation of motivated men and women who commit to optimizing and maintaining the absolute magic of their healthy bones, brain, body and spirit.
Medical research breakthroughs can light the pathway to our ultimate well being. Walking it is still up to us.
Healthy bones, healthy brain, healthy heart, healthy life, healthy you