Osteoporosis

Introduction

Osteoporosis is a disease of the skeletal system where the bone mass is reduced, there is a deterioration of the micro-architecture of the bone and an associated increased fracture risk.

100 years ago very few people developed osteoporosis, a fact that points to the importance of changes in our eating habits, lifestyle changes such as sitting more in the office, in cars, in front of the TV and computers (lack of exercise). As will be discussed under “causes” below, all of these factors combined are responsible for reducing the bone density and leading to fractures. Bone is constantly remodelled through the action of osteoclasts that spot old bone and remove this and through the action of the osteoblasts that are building up strong new bone.

Some facts about bone growth

The medical community seems to be slow in accepting the fact that estrogen is only working on slowing down the action of osteoclasts, but does not stimulate osteoblasts. It does not make sense to push for estrogen replacement as this will only allow poor, more brittle old bone to accumulate, but will not produce new, strong bone that the woman needs for bone health.

Misconceptions about Bisphosphonates

Similarly it does not make sense as the drug companies’ advertisements state that the bisphosphonates (Fosamax, Boniva, Actonel, Zometa etc.) would be the “cure” for osteoporosis as they only slow down the osteoclasts, so that the increase in bone density is not due to NEW bone, but due to OLD bone that has not been removed leaving the patient with the same fracture risk when treated on a long-term basis. In addition to this Fosamax has a half-life of 10 to 15 years, it gets bound to protein, gets incorporated into bone for a very long time and stays there, even if the patient stops taking it. This way Fosamax only blocks bone resorption, when the treatment should instead balance bone resorption with new bone building.

Hormones that build up bone

The only known osteoblast stimulators are not drugs, but hormones. The reason is that the body works differently, namely through receptors on osteoblasts for testosterone and progesterone that need to be stimulated before new bone formation can take place. Hormones are the natural way how the body forms bone and balances new bone formation with bone replacement through osteoblasts (Ref. 8). This will be discussed in detail along with important life style changes under “treatment of osteoporosis” (Ref.9).

Osteoporosis

Bone densitometry is aa test that helps to measure the bone density. You find values and normals for bone density in the table  below.

These values are standard deviations and are compared to 35-year old normal controls matched for sex and race.

Bone density classification

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Densitometry score

above -1 : normal bone density

Between -1 to -2.5 : osteopenia, which means there is a certain lack of calcium in the bones

less than -2.5 : osteoporosis is established

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So, if the bone density is less than 2 1/2 standard deviations below the comparative value of a 35-year old normal control, then this is a patient who has osteoporosis (see above).

Here are a few facts about bone growth and osteoporosis (see Ref. 1 and 2).

Some Facts About Osteoporosis and Bone Growth

• Peak bone growth has been achieved at the age of 30 and from then on there is a loss of 1/2 to 1% of bone mass per year. This may be because of a slow loss of growth hormone after the age of 30.
• In women there is a 3 to 5 year accelerated loss of bone mass after menopause due to estrogen and progesterone loss.
• There is a mortality increase of 20% in the first year after a hip fracture.
• Compression fractures of the vertebral bodies with osteoporosis lead to a deformity called kyphosis (permanent forward bending mostly of the thoracic spine), which can lead to chronic pain from impinging of the costal margin on the pelvic bone and also is hard on the lungs and the heart circulation.

• Chronic disability from osteoporosis

• Chronic disability from osteoporosis leads often to a loss of independence, earlier nursing home admissions and premature death due to complications from fractures or from coexisting medical disease.
• It is an old teaching that old age is a risk factor for osteoporosis; however newer human studies have shown this to not be true. As we age, we lose some of the hormones that stimulate osteoblast cells to produce bone. If the physician orders the hormones that are missing with bio-identical hormones as a replacement, bone can regenerate itself to youthful levels even in patients who are 70 or 80 years old. You can find a discussion about this further under “causes of osteoporosis” and “treatment of osteoporosis” .

• Supplements of calcium, vitamin K2 and vitamin D3

• A lack of calcium can cause osteoporosis. However, calcium supplementation alone can cause calcification of blood vessels and organ tissue; an equal amount of magnesium is necessary to prevent this in addition to vitamin K2 in the amount of 100 micrograms daily to keep the calcium in the bones and away from the blood vessel walls. Vitamin D3 (about 5000 IU per day for most people) is also necessary for calcium absorption and for integration of calcium into bone. A June 2014 study has shown that mortality is reduced by 50%, if enough vitamin D3 supplement is taken. Another study from August 2014 has shown that calcium supplementation reduces mortality. 
• Another study showed that low bone density is associated with a significant risk of developing heart failure. 

• References

1. ABC of rheumatology, second edition, edited by Michael L. Snaith M.D., BMJ Books, 1999.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 57.

3. B. Sears: “The age-free zone”.Regan Books, Harper Collins, 2000.

4. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.

5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

8. Dr. John R. Lee: Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.

9. 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011).