Treatment
Of OsteoporosisThere are a number of steps that can be taken to minimize
further bone loss, to prevent fractures and to ease pain that may be present.
As the table below shows, there are a number of factors that need to work in concert.
You may notice that Fosamax and bisphosphonates
are not mentioned here. Dr. Murray (Ref. 12) explains how Merck advertized that
testing bone mineral density would prevent hip fractures. To answer this question,
a large study was done showing that there was no correlation between bone density
testing and the prevention of fractures with Fosamax. The reason is, as already
explained under "causes of osteoporosis" that not only a low bone density
leads to hip fractures, but a number of other factors contribute to this as well.
Only 15 to 30 % of all hip fractures in postmenopausal women were caused by osteoporosis.
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). 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. 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 all the other elements of therapy are wasted, as it does not make sense
to built up bone and then destroy it again. Books like "Breakthrough"
(Ref.8) by Suzanne Somers have reviewed newer insights of antiaging 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
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 (see Calcium carbonate (for instance
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 (green leaf vegetables, lettuce, red and
green peppers, broccoli, cauliflower and other cooked vegetables etc, glycemic
index of up to 50). Further the diet recommended is low fat, but contains adequate
amounts of protein. Such diets are also called Mediterranean diet, Zone diet,
South Beach diet and all of them will help. Vitamin D is useful to improve absorption
of calcium.
| Treatment of osteoporosis |
| Therapeutic steps: | Comments: |
| 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. |
| vitamin D | 400
IU to 800 IU to improve absorption and utilization of calcium. This was the recommendation
until about 2005. Now 5000 mg per day is recommended. |
| calcitonin by injection or by nasal spray | this
hormone reduces bone pains and is also useful for up to 3 months for healing fractures,
however further treatment could lead to renewed osteoporosis |
| 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) | | 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. |
Your physician 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 40 to 45 years of age produce less progesterone
in their ovaries from this age onward. Males have their own problem, which is
a lower testosterone production beyond the age of 50 to 55. 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. 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 is needed to absorb calcium
and incorporate it into the bones for strength. 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. The following supplements help prevent osteoporosis according
to Ref. 9. 1. 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. 2. Vit. D3 : 2000 to 5000 IU per day will
prevent osteoporosis and many cancers. 3. Vit. C: 1000 to 2000 mg per day
for repair and replacement of connective tissue and as an anti-oxidant. 4.
Vit. K for the manufacturing of osteocalcin that helps to attract calcium to bone.
100 to 500 micrograms daily recommended. 5. 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). 6. Manganese is an essential nutrient for
hormone glands and bone; 5 to 20 mg daily are recommended. 7. Zinc is essential
for treating inflammatory arthritis and metabolic andropause in men; 50 mg are
needed per day to stop the formation of estrogen from male hormones in fatty tissues
by aromatase. Males need all of the testosterone replacement when andropause is
being treated with testosterone and zinc helps in preventing prostate cancer from
testosterone aromatised 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). 8. Folic acid: although the RDA is 0.4 mg, but 1.0 mg daily is
better. Folic acid helps to 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. 9. 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. 10.
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). It will help to prevent bone loss (Rerf.9). 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.
Bisphosphonates, although prescribed due to pressure from the drug industry, are
to be entirely avoided. 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). The physician 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. Sometimes it is overlooked
that an aging person may have cataracts, which lead to poor vision (L-Carnosin
is a useful supplement in that case). Once this is corrected with cataract surgery,
the patient often has a much more steady gait. Unfortunately the life of an elderly
person is often changed permanently following a hip fracture from a fall. For
those patients who end up in nursing home care their independence is lost as well.
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