Not too long ago, osteoporosis was associated with fractured hips and often led to permanent residence in a nursing home. Nowadays, the scenario is about the same, except that, because of modern surgical methods, nursing homes are rarely the patient’s final destination any more.
With the advent of DEXA scans, which measure bone density, we can now measure the state of bone health and easily measure the extent, if any, of bone loss. These studies can also be used to assess the response (if any) to therapy. DEXA stands for dual-energy X-ray absorptiometry. The most important measurement is called the T-score, a measure of the standard deviation away from the “norm,” which is based on the bone density in a 24-year-old person. A reading of -2.5 below the norm is considered osteoporosis. A reading between -1.0 and -2.5 is designated as osteopenia.
The diagnosis “osteopenia” was created after DEXA scans were put in use. Realistically, a person in their 50s or 60s is not likely to have the same bone density as a person in their mid 20s. So is this a condition that needs pharmaceutical intervention, or is it a natural condition of aging that simply requires hormonal balance and natural supplementation to maintain bone health?
This question is important because doctors often prescribe the same toxic medications for osteopenia as they do for osteoporosis.
Again, this blog is not intended as a diatribe against conventional medicine. However, I feel patients should be better informed so that perhaps more healthful decisions can be made.
TRADITIONAL TREATMENTS FOR OSTEOPOROSIS AND OSTEOPENIA
The traditional approach to treating osteoporosis in women was to give them estrogen, usually in the form of Premarin, along with a high dose of calcium. Improving bone health was touted as one of the major benefits of taking estrogen. The problem is, there has never been a single study indicating that estrogen has any benefit in reversing osteoporosis— in fact, in 1999 the FDA eliminated osteoporosis as an indication for giving estrogen. It is true that when a woman is still having menstrual cycles, and for several years after menopause, estrogen does have a positive effect on bone health. But it will not prevent the eventual onset of osteoporosis.
The main classes of therapeutic drugs utilized for osteoporosis (and, unfortunately, osteopenia) are called bisphosphonates. They go by several brand names, such as Fosamax, Actonel, and Binova. Bone is in a constant state of regeneration, aided by cells that help resorb bone (the osteoclasts), and then cells that build bone (the osteoblasts). The bisphosphonates act in a way that prevents the osteoclasts from resorbing bone but at the same time prevents the osteoblasts from forming new bone.
OSTEOPOROSIS—MYTH VERSUS REALITY
As a result, you wind up with old, brittle bone that looks good on a DEXA scan but can actually be more easily fractured than an untreated bone. This is certainly not the desired effect.
In addition, bisphosphonates have serious potential side effects. They are very similar to the same chemicals used to clear drain pipes and clean away bathtub residue. This is why it is necessary to avoid lying down after taking these pills because they can eat a hole through the esophagus. They can also cause gastric erosions and severe diarrhea.
Other side effects include blindness and a condition referred to as osteonecrosis—an eating away of the jaw bone leading to the teeth falling out as well as other dental nightmares.
Bisphosphonates are the largest-selling drugs in the world for osteoporosis and, unfortunately, osteopenia as well. Another fact to keep in mind is that these drugs have a ten-year half-life, which means this is how long it takes to eliminate 50 percent of the medication from your body.
So what about taking calcium supplements—another traditional approach that no one seems to question? Is it really safe and is it necessary?
Consider the fact that most of the foods we eat have calcium in their makeup. In 35 years of practice, I have never seen a patient with a calcium deficiency. Interestingly enough, Asians, who traditionally cannot digest milk products due to a low level of lactase, have an extremely low incidence of osteoporosis.
Another thing to consider: Is it possible that taking an excess of calcium may enhance calcification (hardening) of our arteries? This can certainly explain why women who use calcium supplements have a much higher incidence of strokes and heart attacks. Calcium stimulates gastric acid secretion, which possibly contributes to reflux esophagitis. There are other concerns as well. Calcium can promote prostate cancer and can also promote kidney stones.
My own feeling is that if one does take calcium, perhaps in the form of calcium citrate, it is wise to limit the intake to one tablet per day. Magnesium is a lot more important than calcium for building bones and should be taken in a quantity two to three times that of calcium.
A BETTER APPROACH TO BONE HEALTH
There are two points of view to consider with osteoporosis and osteopenia—prevention and treatment. Since hormones are important for both prevention and treatment, let us start with them.
The primary hormones involved in bone health are testosterone, progesterone, estrogen, and or DHEA. There is a strong hereditary factor to osteoporosis, but what we’re really talking about is inheriting a hormonal predisposition to osteoporosis. If a person is aware that their mother or father has or had osteoporosis, then the primary concern should be hormone balance. I, for one, suspect that the number one cause of osteoporosis in both men and women is a low progesterone level.
Women who are on birth control pills, and thereby are not ovulating and have no progesterone, are certainly setting themselves up for bone problems. On the other hand, women who are estrogen dominant (who have or did have PMS, cramps, breast tenderness, and so on) often have great bone densities; however, they also have a high incidence of breast cancer. Balance seems to be the key when it comes to estrogen.
Testosterone is also intricately involved with bone metabolism. Women who have had hysterectomies, whether total (with the ovaries removed) or partial (with the ovaries left in) will have low testosterone levels. In men, the level of testosterone starts dropping when they are in their 20s and continues steadily downward. A man who has lost his libido, often due to low testosterone, is a person obviously at risk for osteoporosis.
Osteoporosis in men, the incidence of which is almost on a par with women, can have deadly consequences. A fractured hip in a male over the age of 65 is associated with a 25 percent mortality rate during the following year. In addition, men very commonly have low progesterone levels. This situation becomes moot around the age of 50 when virtually all men stop producing progesterone.
Needless to say, I feel that both testosterone and progesterone are extremely important for preventing osteoporosis. DHEA is another hormone that gradually but consistently declines as we age; it is a balancing hormone, in that it helps produce both estrogen and testosterone—both being important for bone health.
Another hormone that certainly bears mentioning is melatonin, which is put out by the pineal gland. It is generally known as the hormone that puts us to sleep at night. However, it has other functions as well. It is extremely important in bone metabolism. It also plays a significant role with regard to our immune system. It helps to produce natural killer cells and interleukin-2, both of which the body uses to fight cancer on a daily basis (cells are constantly mutating and have to be dealt with regularly). The problem is that we stop producing this hormone around the age of 60. So one should consider melatonin for both prevention and treatment of osteoporosis, especially as one gets older.
The bottom line concerning osteoporosis is that it can often be prevented—though unfortunately, we live in a world where preventive medicine is not practiced. The preventive approach for osteoporosis is not only a matter of achieving hormonal balance, but includes other factors of extreme importance, such as exercise, proper nutrition, and lack of stress.
I certainly appreciate and admire people who are able to avail themselves of the benefits of a disciplined lifestyle. I am talking about people who eat right, exercise three to four times a week, do breathing exercises to reduce stress, avoid taking medications with toxic side effects, and so on. I know there are millions of people in this category. Not surprisingly, they have rarely come to see me. In a perfect world, everyone would live this way—and would maintain a balance of their hormones.
I would recommend, for those who for whatever reason cannot fit precisely into this scheme, a minimum of getting their hormones balanced and utilizing one particular supplement, vitamin D.
VITAMIN D—THE ULTIMATE SUPPLEMENT
First off, vitamin D is not a vitamin. It is considered a prohormone—a substance that converts into a hormone. This helps to explain the multiplicity of its benefits. It is known to help prevent 26 cancers, including cancer of the breast, colon, prostate, and pancreas. Not only does it help prevent cancer, it actually kills cancer cells. It is kind of ironic when you consider that doctors continually advise patients to avoid the sun to prevent skin cancers, which for the most part are readily treatable. Yet for most people the sun is the main source of vitamin D, a substance that helps prevent many types of cancer that are much more dangerous than skin cancers. (By the way, I do not believe melanomas are always sun-related.)
Among its many benefits, vitamin D acts as an ace-inhibitor and may lower blood pressure. In addition, it is reported to effectively prevent the flu, help prevent multiple sclerosis, alleviate seasonal affective disorder, and help prevent Alzheimer’s disease.
When it comes to bone health, vitamin D is unsurpassed. In England, where osteoporosis is common because of a lack of sunshine, this condition is often treated only with high doses of vitamin D. Vitamin D aids in the absorption of calcium from the diet and the deposition of calcium into bone.
My recommendation for the treatment of osteoporosis is 10,000 I.U./day of vitamin D3. Compare this dosage to the RDA (recommended daily allowance) of 400 I.U., which is only enough to prevent rickets, with no other benefit. Most people take 400 to 600 I.U., which I feel is very inadequate to help with osteoporosis. I recommend at least 5,000 I.U. of vitamin D3 daily as a preventive dose.
Vitamin K2 is extremely important for treating osteoporosis. It takes calcium out of blood vessels and puts it into bone—a double benefit. My recommendation is 180 mcg of vitamin K2 daily.
Magnesium, again, is extremely important—much more so than calcium. I recommend taking around 1,000 mg per day. Strontium is probably the best mineral for building bone.
Other bone-building supplements are boron, whey protein, proline, silica, lycopene, and glutathione (from N-acetyl cysteine and/or alpha lipoic acid), and there are many others.
Every system in the body is controlled by hormones and that includes the skeletal system. Prevention and treatment of osteoporosis requires the use of bio-identical hormone therapy. Taking certain supplements enhances the effect of these hormones, and exercise is the icing on the cake. Together these approaches may help obviate the need for toxic medications, which may not provide the benefits one is looking for in any case.