Osteoporosis

Osteoporosis is a generalised, progressive decline in bone tissue density causing skeletal weakness. Patients with uncomplicated osteoporosis may remain asymptomatic or they may experience aching pain in the bones, particularly the back, develop curvature of the spine, or experience a loss of height. It can progress without symptoms for many years to such advanced stages where debilitating fractures are the first painful symptoms of the disease. Research shows that one in two women and one in three men will sustain an osteoporosis related fracture in their lifetime.

The most common risk factors for osteoporosis include: low levels of estrogen, progesterone, testosterone and DHEA, chronic low intake of dietary calcium, cigarette smoking, high caffeine consumption, acidic diet, below average body weight, early menopause, family history (genetic), sedentary life style, use of certain drugs such as corticosteroids, alcohol, barbiturates, tobacco and heparin. If detected early, osteoporosis can be treated thus preventing further development of the disease.

A major factor contributing to the onset of osteoporosis in women is the decline in hormone levels after the onset of menopause, as all the major sex hormones play an important roll in maintaining bone density. One in four postmenopausal women has osteoporosis. Progesterone is considered the most important hormone as it is able to stimulate osteoblast mediated new bone formation (see bone remodelling below). Dr John Lee has been the pioneer in research on bioidentical progesterone’s effects on osteoporosis. He followed 100 postmenopausal women, average age of 65.2, with evidence of osteoporosis for three years. His treatment program included 300mg calcium, 150mg magnesium and transdermal progesterone (dosage protocol below). The results were astounding with a 15.4% increase in bone mineral densities and no loss of height. Since this initial study thousands of women have used bioidentical progesterone to safely and effectively treat their diminishing bone density. The synthetic progestins have been found to produce only modest bone benefits when compared to bioidentical progesterone. Progesterone therapy has also been used in men to prevent osteoporosis whom cannot take testosterone supplements due to prostate cancer.

A lack of estrogens are known to stimulate the production of interleukin-6, which stimulates the growth of osteoclasts, thus increasing bone resorption (see bone remodelling below). Research has shown that by supplementing oestrogens the rate of bone loss is significantly reduced. They also are able to increase the absorption of calcium from the intestinal tract. Since oestrogens can retard, but not reverse osteoporosis, they should be started sooner rather than latter to prevent excessive bone loss. They should be used in conjunction with progesterone, which has been shown to stimulate new bone formation.

Testosterone also contributes substantially to bone density. It has not yet been established if testosterone acts directly on bone, via receptors, or as a precursor for estrogen biosynthesis. Either way its presence is essential for higher bone mineral densities. It has been also been proposes that DHEA is able to stimulate bone formation, increase calcium absorption as well as inhibit bone resorption. Therefore it is important that as part of any women’s Individualised Bioidentical Hormone Replacement Therapy all these hormones are monitored and supplemented to obtain normal physiological levels.

Some men who do not produce sufficient adrenal progesterone may be given low doses of progesterone daily for the safe and effective treatment of osteoporosis. There seems to be a common misconception that progesterone will cause feminizing effects in males. This however is not true as estrogen is the feminising hormone. Men may also be treated by supplementing testosterone and DHEA, however progesterone is preferred where their use is contraindicated.

Bone Remodelling

The process of bone turnover (deposition and resorption) are critical in bone density and stability. Bone is continuously being remodelled throughout life through a coupled process of bone resorption and bone formation. During the resorption stage osteoclasts (cells that resorb calcified bone) degrade old or damaged bone tissue by escavating small pits into the affected bone area. Fragments of escavated bone collagen are then released into circulation for utilisation or excretion. The bone formation stage involves osteoblasts (cells that form bones) replacing the old or damaged bone collagen, removed by the osteoclasts, with healthy new bone bone tissue. When these two processes are in balance there is no net change in bone density providing a healthy maintenance of bone tissue. As previously mentioned these processes are both controlled by hormones, especially estrogen and progesterone.

Diagnosis

Bone Mineral Density Testing is now one of the most widely used techniques for the diagnosis of osteoporosis. However its inherent imprecision of bone density measurements can result in patients not being identified as being at risk of developing osteoporosis at a stage where early intervention therapy may be most effective. A new specific urine test is now available to detect the EARLY onset osteoporosis well before significant changes to bone density can be identified using the older methods. This urine test actually measures the bone remodelling process by measuring cross-linked N-telopeptides (NTx) which are specific to bone type I collagen released by osteoclasts as they break down bone.

Elevated levels of NTx in urine indicate an elevated bone resorption process. In the interest of preventative medicine this early detection can initiate early intervention well before significant changes in bone density have occurred.

Treatment of Osteoporosis:

Bioidentical Hormones for Women

Bioidentical Estrogens

Estrogens have been routinely used in the treatment of osteoporosis which retard osteoclast mediated bone resorption. Estrogens should always be used in conjunction with progesterone to ensure the correct balance.

Bioidentical Progesterone

The use of bioidentical progesterone, alone and in combination with estrogen, has shown to significantly improve bone densities.

DIET

You should also stick to a healthy diet high in calcium and protein and low in sugars and other calcium robbers such as tobacco, caffeine and soft drinks. Acidic diets destroys your bones as the body has to steel alkalizing minerals such as calcium from your bones to keep the blood pH from dropping into the acidic range where it starts to burn your cells. Acidic foods to avoid include: fried foods, eggs, dairy, beef, beer, coffee, sugar, soy, corn, excess nuts and chicken. Alkaline foods such as fresh fruit and vegetables should be eaten instead. Click here for more information on alkaline diet

Exercise

In conjunction with any osteoporosis therapy a regular exercise programme to help build your bone mass should be employed.Light weight baring exercises are best.

Calcium Supplements

Calcium Supplements should be used in patients whom have an inadequate dietary intake. Calcium supplements alone have shown not to significantly increase circulating calcium levels or improve bone density. The right bioavailable form of calcium must be used to maximize its absorption. Normal bone formation also requires the presence of Vitamin D, boron and Vitamin K2. Our lab produces a combination of nutrients formulated to help stimulate bone growth we call Bone Builder capsules which is available online through the members section of this website. Without the presence of these elements the supplemented calcium will not be utilized and be therefore ineffective.

Biphosphonates

Biphosphonates (Fosamax, Ditronel, etc) are pharmaceutical drugs which only prevents further bone loss which leads to a gradual retention of old bone tissue, which is not good bone. They do nothing to stimulate new bone formation and the incidence in bone fractures increases after the third year of their use, they are complicated to use and have a long list of side effects. We do not recommend their use.

Selective Estrogen Receptor Modulators

Selective Estrogen Receptor Modulators {eg. Raloxifene (Evista)} is reported to protect against osteoporosis and heart disease without increasing the risk of breast cancer. However, it does not protect bones as well as estrogen. It also has been reported to increase the risk of colon cancer, hot flushes and other menopausal symptoms. These new drugs have not been around long enough to truly access their benefits and risks. What if the long term implication of blocking estrogen receptors in the brain may cause Alzhiemer’s disease? Unless there are no alternatives avoid these drugs until more is known.

Contact Us

In order to obtain more information or alternatively to arrange a consultation you can contact us. You can also click here to find an integrative doctor open to prescribing these treatments.