Treatment and Prevention of Osteoporosis
If you’ve been diagnosed with osteoporosis, or think you might be, How do you know what actions to take next? There is a lot of information out there about osteoporosis and how to treat it, but what does the science say? And how do you choose a treatment for yourself? In this article we’ll answer these questions and more, and help you choose your treatment plan using trusted sources.
Are you at Risk of Osteoporosis?
When thinking about possible treatments for osteoporosis, it’s important to know your overall risk of diagnosis and possible fractures and breaks. Some treatments come with associated risks of heart disease and other side effects, so balancing your risks and rewards with potential preventions and treatments is crucial to minimizing harm.
When evaluating for osteoporosis, your doctor will usually use what is called a T-score, which is a measure of how your bone density compares to a healthy young adult of the same sex. The T-score uses the data from healthy, 25-35 year olds of your same sex, meaning that at some point, if you are old enough, you may measure as having osteoporosis, even if you have a healthy bone density for your age. A Z-score will measure your bone density against other individuals of your same age, so it’s important to view this score, as well as examine your family genetic history of bone fractures, to understand if your risk of fracture is higher or lower than the normal population.
Additionally, while hip fractures can be dangerous, they are extremely rare. Spinal fractures are much less likely to cause harm, and are only symptomatic, causing pain and decreased mobility, in about a third of cases. Studies have shown that people overestimate their risk of fracture, and doctors have been encouraged to convince their patients to take drugs that may not be the most effective for them, driving drug sales and the public perception of overall risk.
If you and your doctor have evaluated your risk of a dangerous fracture, and decided a treatment may be necessary, there are several options available today, but not all of them harmless. Below are a few popular treatments and their potential risks and rewards.
Do Calcium Supplements Help Osteoporosis?
For women who are worried about their risk of osteoporosis, and subsequent fractures, it has often been recommended that they take calcium supplements. The idea behind this originated from the fact that bones are made up of calcium, and therefore more available in the body would mean stronger bones. In fact, the causes of osteoporosis are much more complex than this and calcium supplements have been proven ineffective, and even harmful in long-term studies. (NutritionFacts.org)
Original recommendations for calcium supplements came from a study in 1992 about calcium and vitamin D supplementation in women. However, this study was conducted on a group of women who were institutionalized, and may already have been vitamin deficient due to poor diet, low sun exposure, and poor exercise. Significant bone loss is only associated with levels of calcium as low as 200 mg, meaning most people with healthy diet and exercise do not need supplements. No studies since have shown a significant improvement of bone density in healthy adult women with correct diets.
Not only is the effectiveness of calcium supplements not proven, but research shows that spiked calcium levels in the blood after consuming calcium supplements causes increased coagulation and causes risk of clots in small arteries, Which then leads to an increased risk in cardiovascular disease (CVD). (Johns Hopkins Medicine) This side-effect was not found with consistent, bioavailable calcium found in a healthy diet.
Other problems with calcium supplementations include:
- Randomized controlled trials show greater risk of hip fractures, not lower, with calcium supplements.
- The disagreement in calcium level recommendation between countries (In the U.S, it’s up to 1,200mg/day. The UK recommendation is 700mg/day.)
- The American supplement industry is not required by the Food and Drug Administration (FDA) to prove effectiveness of supplements, and is only required to pull products from stores after negative side-effects have been reported and verified.
Do Vitamin D Supplements Help Treat Osteoporosis?
Vitamin D supplements have in fact been proven to help somewhat with reducing the risk of osteoporosis over long periods of time, however, much like with calcium supplements, vitamin D supplements are only effective in people who are already deficient, and do not continue to help build bone after normal levels are reached. As with calcium as well, these supplements carry the same problems that many supplements do, in that they are not regulated by the FDA, and without consistent and proper measurement of the nutrient levels in your blood, supplementation may be ineffective and expensive.
An additional problem with vitamin D supplementation is that aging can case the loss of receptors that use Vitamin D in the first place, leading to muscle weakness and other deficiency symptoms, even if sufficient levels are maintained by a supplement. This is why, if you are using a supplement, it is important to measure many factors to be sure that elevated blood levels are in fact effective in treating things like osteoporosis, and not simply processed out by your body’s waste system as excess.
Low activity and a sedentary lifestyle may cause low vitamin D as well, meaning that supplementation may not be any more effective than adjusting those lifestyle factors, and does not replace the myriad of other benefits that a healthy diet and exercise routine brings, such as increased mood, energy, weight loss, lowered risk of CVD, and much more.
Exercise and Osteoporosis
Exercise, especially weight bearing exercise, stimulates new bone growth and is generally very good for overall well being. Long-term and consistent exercise is proven to make a significant impact on aging bones, and it’s never too late to start, as it can have a positive effect on your body at any age. However, one drawback to this natural solution is that some people, especially those who are already elderly or disabled, are unable to do the amount of exercise needed to make a significant change or to prevent osteoporosis. Exercise may, in fact, cause more fractures because of increased movement and exposure to risky situations.
Does Diet affect Osteoporosis?
Additional calcium consumed through a healthy diet is bioavailable and consistent, unlike that found in supplements, and can have many other combined benefits unrelated to osteoporosis that may create a cascade effect of having the ability to exercise more and eat better food. But of course a good diet requires a bit of research and knowledge as well, so some people may eat the wrong things based on incorrect information. For instance, large campaigns by the dairy industry have created a popular belief that milk is good for bones because it contains calcium. Unfortunately the calcium availability in milk is outweighed significantly by increased risk in fractures, CVD, and general poor health due to galactose sugar in milk and other dairy products. A plant-based diet rich in leafy greens, nuts and legumes is most likely to contribute to healthy bones, but that fresh, healthy food can be difficult to obtain sometimes due to high prices and inaccessibility.
Targeted Drug Treatments for Osteoporosis
The main class of drugs used to treat osteoporosis is called the Bisphosphonates. These include drugs such as Fosamax, Actonel, Boniva, and Reclast. If you have been diagnosed as having osteoporosis, or are at significantly higher risk of bone fractures, your doctor may prescribe one or more of these drugs to help restore your bone density.
These drugs are most effective at preventing vertebral fractures, reducing the Overall risk of vertebral fracture over 50%, but since the overall risk was only 2.8% to begin with, a 50% reduction means a doctor would have to treat 71 women to prevent one vertebral fracture. Not a very big impact, but one that can make a difference if the patient has a prior fracture, family history, or unusually low T-score.
The problem with this prevention is twofold. First, the definition of fracture is commonly misunderstood and different among doctors due to the infinite variety in location and severity in fractures. Second, only about a third of all recorded vertebral fractures cause any pain or reduced mobility, leading to possible unnecessary prevention measures . This may lead to some confusion on the actual risk reduction by these drugs.
Truly dangerous fractures are hip fractures. These fractures and breaks tend to lead to more serious side-effects overall such as nerve pain, reduced mobility, and complications like infection. There is scant evidence that Bisphosphonate drugs help prevent hip fractures. These drugs cannot be said to reliably prevent first hip fractures, but could be used to lower the risk of a second hip fracture in people who have already experienced fracture, or have a family history of fracture, but absolute risk reduction is only about 1%. (NutritionFacts.org)
One final drawback of this class of drugs is that these prescriptions can be prohibitively expensive and inaccessible, especially in the modern American healthcare system, where insurance may not cover such-non-emergency treatments. Couple that with the extremely low risk reduction rates, and many patients may decide that this treatment is not worth it at all.
How BHRT can Help Treat Osteoporosis
All of these treatments so far have had major drawbacks, and the cause can usually be attributed to the fact that no other treatment addresses the root cause of bone density Loss. As we explained in our article on what osteoporosis is (Link to What is osteoporosis? article), the causes can be complex, and simply stimulating new bone growth temporarily or adding more nutrients to the body might not be effective if the mechanisms for bone growth do not work. This is where Bioidentical Hormone Replacement Therapy (BHRT) comes in.
Bioidentical Hormone Replacement Therapy (BHRT) involves supplementing hormones that are identical to those naturally produced by the human body. The highest risk demographic for osteoporosis is postmenopausal women, which tells us that we must take a look at the role of hormones in bone remodeling. (Estrogen matters)
High estrogen levels in a young woman’s body help to keep the action of osteoclasts under control, and balance bone remodeling throughout her young-adult years. When estrogen levels drop during menopause, osteoclasts accelerate their rate of bone breakdown, and no new hormones come in to boost osteoblasts to build the bone back again, resulting in bone density loss.
BHRT has been used many times to successfully prevent and reverse rates of osteoporosis and related bone fractures because of the crucial role that hormones play in bone growth. Risk reduction is often much higher than other drug treatments, and side effects are nothing more than the effects of natural estrogen occurrence in the body. Drug treatments like Bisphosphonates are not recommended to take for more than five years due to increased risk of negative side-effects like CVD, whereas BHRT is proven to be safe to receive much longer, leading to greater impact on health long-term.
In addition to improving bone density, supplemental estrogen may in fact help improve muscle growth, energy, and metabolism, leading to greater rates of exercise, which also builds bone density and potentially creates a positive feedback of improvement in overall wellbeing.
Depending on your situation, BHRT may be the most effective at treating osteoporosis, as no other treatment targets this hormonal cause directly. For postmenopausal women who have received a diagnosis of osteoporosis, the outlook may look bleak with so many ineffective, unregulated, or problematic treatments. But with BHRT, it is possible to halt and even reverse the natural effects of aging on bones, and help individuals live long, active, and fulfilled lives.
If you’ve been diagnosed with osteoporosis, low bone density, or have concerns that you may be at risk, learn more about our BHRT services.
