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.
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. | 
