ASK THE DOCTOR

by Mary Bunker

Osteoporosis means thin bones resulting from inadequate bone mineralization. Unfortunately, osteoporosis became identified as a disease of menopausal women for two reasons: (1) “Combined HRT” (Premarin and Provera) became primary treatment for both menopause and osteoporosis when they became defined as estrogen deficiency diseases; and consequently, (2) osteoporosis in males was ignored because no conventional medical treatment existed for this disease identified as menopausal hormone deficiency. 

Interestingly, the same two factors have changed the evolving view of osteoporosis: (1) “Combined HRT” is no longer viewed as a primary safe and effective treatment for osteoporosis in women, so it is no longer being defined as an estrogen-deficiency disease; and, (2) a new conventional medical treatment for osteoporosis in men is now available and has thus broadened the market for osteoporosis diagnosis and treatment. 

A recent article called A Guy Thing in the April 15 edition of Family Practice News points to this 180 degree change in perspective, as it relates that “osteoporosis rates are equal between genders, but men remain undertreated.” This statement parallels that regarding the undertreatment of women with heart disease during the 1990s when HRT was being recommended for the treatment of heart disease in women. 

In both men and women the risks for developing osteoporosis are essentially the same: increasing age, low body weight, alcohol and cigarette use and positive family history. Medications contributing to osteoporosis risk include prolonged steroid use and excess thyroid hormone. 

Family Practice News lists treatments for osteoporosis in men as calcium, 1200 mg and vitamin D, 600-800 I.U. daily; bisphosphonates; parathyroid hormone (PTH), 20 micrograms; and testosterone replacement where deficiency is demonstrated. 

The first treatment arm recognizes osteoporosis as a bone mineral deficiency and recommends the mineral and vitamin currently recognized and diagnosable by conventional medical approaches. Other key bone minerals include magnesium and many trace minerals. 

The use of HRT as primary pharmaceutical treatment for osteoporosis in women was supplanted by the bisphosphonates, such as Fosamax. The availability of parathyroid hormone (PTH) has opened the diagnosis and treatment of male osteoporosis. The hormone secreted by the parathyroid gland, (so named because it sits atop the thyroid gland), contributes to bone resorption of calcium in response to low blood levels of calcium. PTH also increases bone remodeling. 

Key to bone remodeling, a dynamic, lifelong process of removing old bone and replacing it with new, is exercise. Thin people are at greater risk of developing thin bones because they do not carry the excess weight of the overweight. (However, being overweight is not a recommended method because it carries multiple health risks, including diabetes, high cholesterol, heart disease, arthritis and cancer.) A regular weight-bearing exercise routine is essential for building strong bones. 

A new group that some of us are recognizing as being at increased risk of osteoporosis are the marathoners whose exercise program places them at risk of depleting their bodies of needed nutrients and of optimal hormone levels. To sustain this level of exercise and maintain optimal health, these people require an appropriate nutritional program individualized to meet their demands. 

Prevention of osteoporosis for both men and women, like prevention of all chronic disease, is found in a diet high in vegetables and fruits and low in animal fats, sugars and refined, processed foods, in conjunction with a regular exercise and strengthening program. The use of nutritional supplements should be based on evaluation of each individual’s needs. 

Regarding the role of HRT for women, another article in the same edition of Family Practice News provides an update from the Women’s Health Initiative (WHI), the first placebo-controlled, double-blind study of “combined HRT,” that is, Premarin plus Provera. The article, entitled Study Questions HRT’s Benefit to Quality of Life, states: “Researchers found no significant effects of estrogen plus progestin on such factors as general health, vitality, social functioning, mental health, depressive symptoms, or sexual satisfaction – reasons why many women had chosen to go on hormone replacement therapy (HRT).” The “combined HRT arm of the study was stopped early by the Data Monitoring and Safety Board due to increased risk of invasive breast cancer, heart attack, strokes and blood clots using HRT. Some benefits were demonstrated in colon cancer and osteoporosis prevention, but the risks of using HRT outweighed the benefits.

Mary M. Bunker, DO is a holistic physician, with offices in Milford, Highland and Royal Oak. Send questions to1641 S. Milford Rd., Ste A103, Highland, MI, 48357 or call (248) 889-5644.