A number of steps help to treat osteoporosis. They will minimize further bone loss and prevent fractures. They will also ease pain that may be present. As shown below, there are a number of factors that need to work in concert. You may notice that I did not mention Fosamax and bisphosphonates here.
Clinical trial regarding Fosamax use in women with low bond density
Dr. Murray (Ref. 12) explains how Merck advertised that testing bone mineral density followed by taking Fosamax would prevent hip fractures. A large study showed that there was no correlation between bone density testing and the prevention of fractures with Fosamax. The reason for this is, as I mentioned under “causes of osteoporosis” that a low bone density is only one factor that leads to hip fractures. In addition, there are a number of other factors that contribute to bone fractures as well. In postmenopausal women only 15 to 30 % of all hip fractures had osteoporosis as a cause. Fosamax reduced the relative rate of hip fractures by 50%. However, a closer analysis of the study showed that the study concentrated on high-risk women who had already a history of a fracture due to osteoporosis (Ref. 12, p.116).
Fosamax did not play a significant role in preventing fractures in osteoporosis patients
Only 2 out of 100 women in the placebo group had a hip fracture during the trial. The Fosamax group had only 1 out of 100 women who developed a hip fracture. This is indeed a relative risk reduction of 50%, but it was only a 2% absolute risk reduction. In other words, 98% of the treatment group would have fared just as well as the placebo group, had they NOT taken Fosamax. I had many visits from drug representatives in the past trying to convince me that the relative risk reduction would be the more important figure. This speaks against the evidence based medicine rules that say that a good drug would be one where less than 50 patients have to be treated to prevent one case with the disease. Here that number is 98, which is unacceptably high.
Physical activity helps prevent osteoporosis
A patient affected with osteoporosis needs to work closely together with the treating physician and ask for the various elements of treatment.
Everybody can walk or engage in an exercise program. Smokers need to quit smoking and heavy drinkers need to quit drinking and likely would do well to join Alcoholics Anonymous. Otherwise it would be a waste of all the other elements of therapy, as it does not make sense to built up bone and then destroy it again.
Chelation therapy to detoxify the body
Books like “Breakthrough” (Ref.8) by Suzanne Somers have reviewed newer insights of anti-aging medicine. This points out the importance of detoxifying the body from heavy metals like mercury, lead and cadmium (from smoking and air pollution). Glutathione/Vit. C or EDTA infusions can be given as a series of intravenous injections to detoxify your body. Most naturopaths are informed about this and can administer these infusions. Regular doctors are reluctant to get involved, although the science behind this has been established in the 1980’s and before.
Calcium carbonate (such as in Rolaids), and a sensible diet, which is sugar free and free of refined carbohydrates (without starches, rice, potatoes and pasta), will all help (see Ref. 3 and 4). In other words a low carb diet that allows the low glycemic index foods .
Low glycemic index diet
Low glycemic index foods are green leaf vegetables, lettuce, red and green peppers, broccoli, cauliflower and other cooked vegetables etc, (glycemic index of up to 50) to deliver and absorb the necessary minerals for the bones. Further regarding the recommended diet, it should be a medium healthy fat diet (containing enough omega-3 fatty acids), but also contain adequate amounts of protein. Such diets are also called Mediterranean diet, Zone diet, South Beach diet and all of them will help. Vitamin D3 is useful to improve absorption of calcium. Molecularly distilled fish oil or Krill oil ( 4 to 6 capsules per day) will help to control inflammation, which is part of what is behind osteoporosis.
Treatment of osteoporosis (practical hints)
prevention of falls : carpeting, hip protectors, avoid benzodiazepines; cataract surgery to ensure good vision. Regular exercise will improve balance and muscle co-ordination.
calcium supplements : 1000 to 1500 mg per day is usually the official recommendation. 800 to 1000 mg may be better as an overdose of calcium could cause bursitis and tendinitis. Also an equal amount of magnesium is required to balance calcium (so, if you take 1000 mg of calcium daily, have magnesium 1000 mg daily also).
vitamin K2: 200 micrograms daily are required to keep the calcium in the bones and away from the blood vessels, where calcium could otherwise be deposited causing arteriosclerosis (Ref.14).
List of supplements continued
vitamin D : 400 IU to 800 IU to improve absorption and utilization of calcium. This was the recommendation until about 2005. Now 5000 to 8000 mg per day is recommended. Measure blood 25-hydroxyvitamin-D level (should be between 50 and 80 ng/mL) and titrate optimal dose (Ref. 13).
calcitonin by injection or by nasal spray : calcitonin by injection or by nasal spray
bisphosphonates : alendronate (Fosamax) inhibits osteoclast related bone absorption, increases bone density and prevents fractures in postmenopausal women. Although used widely, this is NOT recommended (see Ref. 10, p. 71)
Final therapeutic measures for osteoporosis
sodium fluoride : used to be popular, but now most physicians have misgivings about it, because the new bone formation is low quality, more fragile bone leading to fractures (not a good idea, if this is what we want to prevent!). See Ref. 10 (p. 85)
physical activity : walking, swimming, expander and stretching exercises builds up bone mass
change of diet : a zone type diet will build up bone by avoiding hyperinsulinism (Ref. 3 and 4)
physiotherapy treatments : strengthen and balance muscles to improve gait and prevent falls
hormone replacement therapy : this will restore the balance of bone rebuilding (osteoblast activity) and bone destruction (osteoclast activity); bone density will be restored to youthful values. Testosterone in males and progesterone in females stimulates osteoblasts directly building up high quality bone.
Bioidentical hormones stimulate new bone formation from osteoblast cells
Your physician or naturopath will help you to decide whether estrogen/progesterone (in women) or testosterone therapy (in men) is necessary. In some patients it might be better to use calcitonin instead. However, as Ref. 8 points out it is important that only bioidentical hormone replacement is used to balance the body’s hormone network. The synthetic hormones that most doctors prescribe do not have the same effect on your hormone receptors as bioidentical hormones (this info comes from the branch of anti-aging medicine).
Dr. Lee (Ref. 10) has shown that in women only progesterone will significantly stimulate osteoblast cells to produce new high quality bone. A saliva hormone test will show to your anti-aging physician or naturopath whether you are in need of bio-identical hormone replacement treatment. Many women beyond the age of 45 to 55 years of age produce less progesterone in their ovaries from this age onward.
Menopause and andropause
Males have their own problem, which is a lower testosterone production beyond the age of 55 to 65. As the male change of life is about 10 years later than the hormone changes in women, osteoporosis tends to have a later onset in men. Men should also have saliva tests for their hormones done (the same set as women should have ordered) and this should include a panel of testosterone, estradiol, progesterone, DHEAS and cortisol. A knowledgeable physician or naturopath will be able to advise you what this means and what you should do. Typically if there is a significant drop in testosterone (in males) or significant drop of progesterone (in females) this will require the start of bio-identical hormone replacement via daily hormone cream applications.
Vitamin D3 often low in osteoporosis patients
Dr. Thierry Hertoghe and Dr. Ron Rothenberg summarized the treatment for osteoporosis at a recent conference in Las Vegas (Ref. 11). Often patients are deficient in Vit. D3 levels (a simple blood test will show this) and replacement with oral vitamin D3 (5000 IU per day) will rectify this. Vit. D helps to absorb calcium and incorporate it into the bones for strength.
Human growth hormone
In postmenopausal women estrogen is often missing while in older men testosterone is often low. In both sexes growth hormone levels are found to be extremely low as evidenced by IGF-1 levels in the blood. When the levels are low the person affected is considered growth hormone deficient and human growth hormone has to be given by injection (small daily needle, similar to insulin injections). There is now a large enough body of human experience according to these speakers at the conference (Ref.11) to know that small replacement doses of human growth hormone given to persons who are low in IGF-1 levels will not cause or aggravate cancer in them.
Supplements to prevent osteoporosis
The following supplements help prevent osteoporosis according to Ref. 9.
- Calcium 250 to 500 mg per day for women on hormone replacement; without hormone replacement 750 to 1000 mg daily. Men: 250 to 500 mg daily when there is evidence of bone loss.
- Vit. D3 : 2000 to 5000 IU per day will prevent osteoporosis and many cancers (now 5000 IU to 8000 IU per day are recommended). Best have your blood levels for 25-hydroxy vitamin D3 checked, as absorption of vitamin D3 from the gut into the blood stream between various people vary greatly.
- Vit. C: 1000 to 2000 mg per day for repair and replacement of connective tissue and as an anti-oxidant.
- Vit. K2 for the manufacturing of osteocalcin that helps to attract calcium to bone. 200 micrograms daily recommended.
Magnesium, manganese and zinc
- Magnesium 200 to 600 mg daily will help together with estrogen supplementation in postmenopausal women to increase bone density by 11%, but with estrogen alone only 0.7% when observed over 8-9 months (study cited in Ref.9).
- Manganese is an essential nutrient for hormone glands and bone; a dose of 5 to 20 mg daily are recommendable.
- Zinc is essential for treating inflammatory arthritis and metabolic andropause in men; it requires about 50 mg per day to stop the formation of estrogen from male hormones in fatty tissues by aromatase. Males need all of the testosterone replacement when the elderly patient’s andropause is treated with testosterone. Zinc supplementation helps to prevent prostate cancer from testosterone aromatization into estradiol in this context. Some men may not tolerate a possible side-effect of stomach upsets from zinc (never take it on an empty stomach).
Folic acid and boron
- Although the RDA for folic acid is 0.4 mg, 1.0 mg daily is better. Folic acid helps prevent the build-up of homocysteine, which triggers osteoporosis and causes heart attacks. This should be taken together with vitamin B12 (1000 to 2000 micrograms); talk to your doctor about this as vitamin B12 could be injected also.
- Boron: This is an essential trace mineral; we need about 1 to 3 mg daily. It is contained in healthy plants from mineral rich soils. However, in a “normal” North American diet it may be sadly missing. Boron helps bone to retain calcium, and it is also needed for normal hormone function of estrogen, testosterone, DHEA and as well as for vitamin D3 function.
Soy protein, remove problematical fluoride from toothpaste
- Soy protein: Some of it is good, but too much may be bad. The natural estrogen substances in soy bind to estrogen receptors, thus blocking excessive amounts of estrogen in males (obese males who are estrogen dominant and get metabolic osteoporosis). This will help to prevent bone loss (Ref.9).
In addition, it is also important to re-emphasize that all fluoride from toothpastes, drinking water or other sources needs to be removed. It poisons enzyme systems in the body leading to premature mortality, but it also leads to brittle bones (osteoporosis) with ultimate fractures. Physicians prescribe bisphosphonates often due to lobbying by the drug industry. As indicated above these drugs should be avoided entirely, as they are not effective. Estrogen dominance from xenoestrogens in the environment (pesticides, cosmetics etc) has to be treated as this causes a relative loss of progesterone, the counter player of estrogens, and weakens bones in men as well (estrogen is a counter player to testosterone as well).
The physician or naturopath is in the best position to advise the patient. Discussion of the pros and cons between patient and physician is important. There is often more than one right way to treat osteoporosis successfully. Physiotherapy treatments are important to strengthen certain muscle groups and to develop strength thus avoiding falls. Other measures to prevent falls as indicated in the table above are also important. An aging person may have cataracts, which lead to poor vision (L-Carnosin is a useful supplement in that case). After cataract surgery the patient often has a much more steady gait. Unfortunately, when elderly persons fall, their life experiences a permanent change. This happens often following a hip fracture. For those patients who end up in nursing home care, they lose their independence permanently.
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