Osteoporosis subdivides into:

    1. Primary, such as postmenopausal (Type 1) which is most common in Caucasian and Asian women. This is due to excessive and prolonged acceleration of bone resorption following menopausal loss of sex hormones secretion (estrogen, progesterone, and testosterone). Involutional (Type 2) which occurs in both sexes above age 75 and is due to prolonged imbalance between bone resorption and formation. A third classification is idiopathic, meaning no known cause. This osteoporosis seldom occurs in premenopausal women and in men below age 75. It is usually not related to secondary causes or risk factors predisposing to bone loss
      1. Secondary: This is due to extrinsic factors such as eating disorders, corticosterios excess, rheumatoid arthritis, chronic liver/kidney disease, malabsorption syndromes, hyperparathyroidism, hyperthyroidism, overtraining athletes/ ballet dancers with hypoestrogenism, a variety of hypogonadal states, idiopathic hypercalciuria, chronic anticoagulant use, chronic anti-seizure medication and others.
      2. The DIAGNOSIS of osteoporosis is usually made by patient presentation and physical examination. The most well known test is the bone density test. Usually this is the central DEXA which measures bone density in lumbar spine and upper femur. There is also a peripheral DEXA which measures BMD (Bone Mass Density) of the calcaneus (heel), distaltibia, and distal radius. This test confirms the diagnosis and assesses the severity of bone loss.

        TREATMENT options include activity, exercise, various medications and most importantly DIET. Changing diet if overweight, eating raw and fresh vegetable foods, avoiding excess phosphate intake, i.e. avoid phosphoric-acid-containing beverages and excess animal food intake. Also important is intake of 600-1000 IU vitamin D daily from preferably vegetal sources. Also calcium intake 1500 mg/day from vegetal sources as well.

        MEDICATIONS

        The medications conventionally used for osteoporosis include Alendronate (Fosamax), Risedronate (Actonel), Calcitonin, a hormone that decreases bone calcium loss, Raloxifene (Evista) a selective estrogen receptor modulator (SERM) which binds to estrogen receptors and parathyroid hormone, which when appropriately used can increase bone mass.

        Unfortunately as with all medications there are precautions and side effects. For example, for alendronate and risedronate, esophageal dysfunction and reflux disease can occur. The recently discovered occurrence of osteonecrosis of the jaw has further complicated the use of these medications.

        Both the prescribing of conventional hormone replacement therapy by physicians and its request from patients have dramatically decreased since 2002 when the results of the Women’s Health Initiative study were published. WHI showed that combined artificial estrogen-progestin treatment increased risk of fatal and nonfatal heart attacks by about 29%. Other important relative risks included a 40% increase in stroke, a 100% increase in venous thromboembolic disease (clots in lungs, legs, and pelvis) and a 26% increase in risk of breast cancer. As we can see conventional hormone replacement therapy is associated with increased risk of endometrial cancer, breast cancer, venous thromboembolism, gallbladder disease, endometrial bleeding, breast tenderness, fluid retention. Raloxifene Evista can have problems of thromboembolic disease (deep vein thrombosis). Parathyroid hormone is usually reserved for special situations.

        People with osteoporosis are now facing shrinking choices of what treatments are available. We in the field of natural medicine have long been aware that chemical hormones are not advisable and medications have many side effects. Happily many people would like to know that Bioidentical Hormone Replacement done with hormones structurally identical to human formulas has been available in the US since the 1930s. Suzanne Sommers in her books The Sexy Years and Ageless has done much to diffuse this information to the public. Evidence for PREVENTION of bone loss exists for natural hormones such as oral estradiol plus progesterone, topical estradiol plus progesterone and estradiol and testosterone pellets.

        We were interested in the possibility of REVERSING bone loss in osteoporosis and showing improvement in BMD using bioidentical hormones. We used estradiol, testosterone administered subcutaneously in pellet form and natural progesterone in extended release oral form.

        We studied a group of 56 pts of ours who underwent this program for 2 to 3 years. After the statistical analysis was done, there was an overall improvement in BMD from before to after treatment with a mean positive change of 0.41 which equals a p value of 0.012. This in medicine is called statistically significant and is the basis of scientific validation.

        The data obtained in this small patient sample group, suggests that bioidentical HRT administered with the subcutaneous and oral routes can be effective in significantly improving BMD in post-menopausal patients. We believe this warrants further studies and it is exciting news for patients who prefer natural ways to treat their bone loss after menopause.

        Doctors who are trained in using bioidentical hormone therapy are available and can be found by referral or via the web.

        Anthony J. Bazzan, M.D., practices in the Philadelphia area and is Medical Director of The Functional & Wellness Sciences Institute. Board Certified in Internal Medicine, Geriatrics, Functional Medicine. Attending Physician Jefferson Myrna Brind Center of Integrative Medicine, Thomas Jefferson University Hospital. Clinical Instructor of Medicine, Thomas Jefferson Medical College. Philadelphia, PA, USA drbazzan@gmail.com

        Vol 27 Issue 1 page 42


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