Natural Treatments for Osteoporosis
- For Women
- For Men
Rant O' the Month - Headline Writers Boot it Again
Monroe Street Clinic News - Services for Business Needs
Natural Treatments for Osteoporosis
Section titled “Natural Treatments for Osteoporosis”My 50-year-old patient Donna (not her real name) sat uneasily in her chair and watched me anxiously as I studied the results of her bone density test. She appeared healthy, but her regular doctor had told her she was at risk for bone fracture and should take alendronate (Fosamax®) to prevent this.She didn't like the idea of taking a prescription drug, and she had heard the tablet could injure her esophagus if it became stuck on the way down. But she didn't want to become shorter as her aging mother had and she didn't want to end her life with a broken hip. Knowing that I often work with alternative natural therapies, she came to me for help.
If you're a woman over 50 and you're worried about osteoporosis, the first thing I want to tell you is not to panic. Over the next ten years the average fifty-year-old woman has about a 6 percent chance of a fracture due to osteoporosis. The threat is more immediate for the average 85-year-old woman, who has a 27 percent chance over the next ten years.
A bone density test should not be a cause for alarm, but a wake up call to pay attention to your bones and develop a natural program to prevent bone loss and give you the healthiest bones possible. What would the results be if alendronate were compared with comprehensive nutritional treatment? No one knows, and, because most medical studies are funded by drug companies, I don't anticipate an answer any time soon. However, in the clinic,working with the individual woman, we can prescribe natural treatments and monitor bone density to make sure the treatments work.
Understanding Bone Density Tests
With Donna, I started by explaining what the test actually tells us. The bone-mineral density test uses X-rays to measure the weight of mineral in a standard volume of bone. When you take a bone density test, your results will be expressed as a percentage of the normal bone density for a young woman.
The purpose of the test is to identify people more likely to fracture bones. Click here to see a table showing bone strength at various ages. In this table, the"T-score" measures bone density compared to the average 20-year-old.
Although it is natural for a 50-year-old woman to have fewer minerals than a twenty-year-old, the report on this test always considers the 20-year-old bone density as "normal". So you can have stronger bones than average for your age and still be told that your bone density is "below normal".
Looking at this bone density test, doctors define osteopenia as a bone density in the lowest 16 percent for young women. We define osteoporosis as having bones as strong (or as weak) as the lowest one percent of young women.
To repeat and elaborate, a T-score more negative than -1 is defined as osteopenia. Sixteen percent of young women will have such a bone density, and about three-quarters of 85 year older women. A T-score of less than -2.5 is defined as osteoporosis. One percent of young women fall into this category, as do almost half of older women.
By the way, it is best to measure bone density in the areas you are concerned about, the hip and the spine. It costs less to scan the wrist, but the wrist may have normal bone density while the hip may be weak.
Conventional Treatment
Looking again at the graph in the link above, you can see that about half of women aged 65 will have a bone density classified as osteopenia and will probably be prescribed alendronate. (Want a tip on a hot stock?) Why do doctors prescribe so much alendronate? No one gets in trouble for prescribing a common drug for a common condition, and the drug company will cover any liability suits. Also, alendronate does reduce the fracture rate. In the 75- to 79-year-old age group, give alendronate to 2800 women with osteoporosis and, compared to doing nothing, you will prevent 70 hip fractures and 134 vertebral fractures. Looked at another way, for every 20 women treated, you'll prevent a vertebral fracture, for every 40 treated, you'll prevent a hip fracture. In the 55- to 59-year-old age group, the results are not as dramatic. You will prevent one vertebral fracture per 60 osteoporotic women treated, and one hip fracture per 190 women treated. For more information click here.
Bones Contain Protein, Too
Natural treatment begins with understanding the structure of bone. Bone, made of calcium and minerals, is in some ways similar to limestone (calcium carbonate). You can imagine how weak a piece of limestone shaped like a forearm bone would be. In nature, however, bones are made not just of minerals but of a protein material as well. This protein material surrounds and permeates the calcium in much the way that a tire casing surrounds the air in the tire and that metal bars reinforce concrete. When nature tightly packs the calcium into this very tough, fibrous casing of protein, she creates a firm structure. The protein matrix and the machinery to incorporate calcium into it require vitamin D, vitamin K, vitamin C, vitamin B6, and folic acid. Vitamin K is usually associated with blood coagulation but is also required for the function of osteocalcin, an enzyme involved in bone production. Elevated homocysteine interferes with production of the protein matrix that strengthens bone. A couple of large studies have shown a much higher fracture rate in women with higher levels of homocysteine. A good daily vitamin with plenty of folic acid effectively lowers elevated homocysteine levels. To learn what homocysteine is, click here.
Bone Minerals
We usually think that since bones are made of calcium, the more calcium we take, the stronger our bones will be. That's not necessarily so - our bones are more complicated than that. Case in point: South African blacks get about 200 milligrams of calcium a day, but fracture bones at only a twentieth the rate of people from Finland, who get about 1300 milligrams of calcium per day. General diet, level of exercise, and exposure to sunshine all affect how much of the calcium people eat will actually go to the bones. There are millions of aged people with little calcium in their bones, but plenty of calcium in their arteries and joints. Studies show that taking calcium supplements does not always improve their bones. (Am J Epidemiol 1997 May 15;145:926). Add vitamin D and the protective effect is greater. Vitamin D ensures that we absorb the calcium we take, and that it goes into the bones. So, with calcium, quantity is not the only issue. The more important question is what our body does with the calcium we take in.
In addition, our bones require other minerals, including magnesium, copper,zinc, boron, silicon, manganese, and molybdenum. Did you know that Bill Walton, the basketball player, had repetitive foot fractures until his physicians detected that he had low levels of manganese, copper and zinc? Once these were replaced, he stopped fracturing his foot and continued his basketball career. Interestingly, high intakes of calcium or iron can interfere with the absorption of manganese.
Another mineral that's been shown not only to strengthen bone but also to reduce fracture risk is strontium. Many people have only heard of strontium as its radioactive isotope, but in nature strontium is a non-radioactive mineral in the same family as calcium and magnesium. In a study in the New England Journal of Medicine, strontium was shown to reduce fracture rate by 44 percent after three years and to increase bone mineral density by 14 percent. This is the same level of protection offered by alendronate.
How You Can Measure Results
Every day our bones are being torn down and built up. When they are torn down, some of the bone protein is lost in the urine. We can now measure this protein and get an idea of how much bone is being torn down. A person with active osteoporosis will have a large amount of such protein in the urine as bone is being torn down very rapidly. When we slow the tear-down rate of the bone, less bone protein will appear in the urine. Currently we have no way to measure how fast we are building bone each day, so we have to rely on the tear-down rate, measured by these special proteins in the urine, to give us an idea of whether or not our treatments are effective. (Versions and names for this test are N-Telopeptide Cross-Links, Collagen Cross-Linked N-Telopeptide, N-Telopeptide, NTX, Pyridinium Crosslinks, and Deoxypyridinoline Crosslinks. We use the NTX test.) Fortunately, many of our treatments work by reducing the tear-down rate, so the test can measure our success.
Natural Treatment
After giving Donna an NTX test, we advised her to consume more whole foods in her diet. We didn't want her to imitate the average Finn or American, who is more prone to bone fractures than the average South African black. Africans eat less meat and processed food than do Finns and Americans. Meats, dairy, and processed foods are rich in phosphorus, an excess of which pulls calcium, magnesium, and other minerals from our body. Ironically, we in the West consume more calcium than people in other countries but have weaker bones.
Second, we asked Donna to avoid refined carbohydrates. These increase the body's tendency to inflammation, which in turn increases bone loss.
Third, we suggested that Donna avoid sunburn, but otherwise to enjoy the sun. She liked this recommendation, and it improved her vitamin D status.
Fourth, we endorsed exercise. Physical stress on the bones creates electric currents along the lines of stress. This stimulates those cells to produce new bone. This is why exercise is required for bone strength, and why women who spend less than four hours a day on their feet are more likely to suffer osteoporotic fractures. And this is another reason why, in South Africa where you find fewer couch potatoes, people have stronger bones. If you are not very active and you start walking four hours a week, you can reduce your fracture rate by 40 percent (according to the Journalof the American Medical Association Nov 13 2002;288:2300, and other studies as well.) Alendronate doesn't do much better. Muscle strength developed by exercise is also important. Most fractures are the result of falls; exercise and strengthening can prevent falls.
Since Donna already enjoyed a whole-foods, low-animal-protein diet, we estimated she would need about 1000 mg of calcium a day. She consumed some dairy products, so we advised about 600 mg from a supplement. Donna had no symptoms suggesting poor stomach function, so we advised calcium carbonate, or TUMS, a very cost-effective source of calcium. Some people won't assimilate TUMS, and do better with calcium citrate, calcium malate, or calcium hydroxyapatite.
Most of the studies comparing calcium to placebo show no benefit from calcium alone. Only when given with vitamin D does calcium consistently improve bone strength. Since Donna had no medical conditions that would prevent it, we suggested she take 4000 units of vitamin D a day, a highe rdose than other authorities recommend. See our February 2004 newsletter. Vitamin D not only helps with absorption of calcium, it has also been shown to prevent falls (New England Journal of Medicine May 1 2003; 348:18). We advised a high-potency daily vitamin. We can test trace minerals and magnesium, but the tests are expensive and the daily vitamins we recommend for everyone over 50 will contain everything you need unless you are already deficient in magnesium, which about a third of US citizens are. Wesuggested an additional one milligram of vitamin K.
Since Donna had not had a hysterectomy and had a normal libido, we assumed her levels of testosterone and DHEA were normal. Both these hormones are required for bone strength. We can test for hormone levels. If you suffer from menopausal symptoms, you may choose to take a natural estrogen replacement, which will provide the additional benefit of increasing bone density. For more information on natural estrogen replacement and the Women's Health Initiative Study showing harmful effects from non-human estrogen replacement, see our July 2002 newsletter.
Finally, we made sure that Donna was not taking pharmaceuticals, such as thiazide diuretics, that can cause bone loss.
Three Months Later
We checked Donna's NTX three months later. It did not show a reduced bone tear-down rate. We went over her medical history and exam once again, and decided to check vitamin D levels in the blood. Despite 4000 units ofvitamin D, they were low. Because vitamin D is a fat-soluble vitamin, this indicated impaired ability to assimilate fatty substances due to poor pancreatic function. We told Donna she would absorb her vitamin D better if she took a pancreatic enzyme. That did it. Within a month her vitamin D levels were optimal and in another two months her NTX had decreased.
My bet on her next bone density test? That it will show an increase in bone strength. In the meantime, Donna is feeling better. Although she wasn't aware of a fat-absorption problem, she finds that French fries and other fatty foods don't sit in her stomach as they used to. She's getting more sunshine and exercise. She's spending more time in the fresh air. And she feels more in control of her health.
Osteoporosis and Men
Although we usually think of osteoporosis as a women's disease, men are not immune. Our bones lose minerals just as women's bones do; it just occurs at much older ages than in women, so most of us die first. Most men with excessive bone loss suffer from testosterone deficiency, and testosterone supplements can help such men restore more normal bone density. In addition (with the exception of estrogen replacement!), all the advice above is important for men as well.
Rant o' the Month -- Headline-Writers Boot it Again
Recently a friend sent me this news item, the headline reading, "Echinacea flunks another test." The abstract read as follows.
"A randomized, double blind, placebo-controlled clinical trial has found that an Echinacea purpurea preparation did not prevent infection with rhinovirus type 39 (RV-39). The study involved 48 previously healthy adults who received echinacea or placebo, 2.5 ml 3 times per day, for a week before and after intranasal inoculation with the virus. Viral culture and serologic studies were performed to evaluate the presence of rhinovirus infection; and symptoms were assessed to evaluate clinical illness. A totalof 92% of echinacea recipients and 95% of placebo recipients became infected. Colds developed in 58% of echinacea recipients and 82% of placebo recipients. This difference was not statistically significant, but the authors noted that the study could have been too small to detect a significant difference. [Sperber SJ and others. Echinacea purpurea for prevention of experimental rhinovirus colds. Clinical Infectious Diseases38:1367-1371, 2004]"
Here is how I read this. Whether or not this group of patients got Echinacea or placebo, the virus invaded their system. So the researchers were doing a thorough job of infecting the patients. Good work. Then, six of ten Echinacea recipients became ill and eight of ten placebo recipients became ill. The rest threw the infection off without becoming ill. In conclusion, two of ten patients in this study benefited from taking Echinacea compared to placebo.
However, when the statisticians came along, they said, "given your sample size of 48 people, statistics won't tell us if this was due to chance or an actual effect. Your result is not statistically significant."
The headline writers should have just passed this study up. It ain't worth reporting on. The conclusion is, as noted above, that the study was too small.
Monroe Street Clinic News - Services for Business Needs
Our clinic provides special services geared to business needs. These include expedited care and return to work for on-the-job injury. We provide employee health care at reasonable rates. We do pre-employment, DOT, and Coast Guard physical examinations. We do NIDA drug screens and assist with WAC 296-62 (Respirator Safety) Compliance. And, as always, we provide laboratory work direct to the employee (no physician visit required).
More and more workers and employers are finding that Health Savings Accounts allow for lower health insurance premiums while putting the individual back in charge of their health care dollar. A Health Savings Account is like an IRA. Money goes in tax-free and either accumulates interest or is withdrawn for health expenses. The Health Savings Account is coupled with a lower-cost high-deductible major medical policy which covers major medical expenses. Not only is this combination less expensive than first-dollar coverage, but the employee pockets any savings from healthful living and careful health care spending. To read more, click here.
1/3/07