Hormones, Osteoporosis, and Hip Fractures by Candice Lane, M.D.
Posted Sep 22 2008 10:59am
Elderly women are at greater risk of death after a hip fracture than after breast cancer, according to a recent article in Medscape Medical News citing a study by Jane A.Cauley, DrPH, at the University of Pittsburgh. The death rate was 48.1% after a hip fracture versus 25.1% after a breast cancer diagnosis.
What causes hip fractures? Osteoporosis! Women with osteoporosis are the most likely to sustain a hip fracture. Osteoporosis advances rapidly after menopause due to the dramatic drop in hormones.
According to the National Osteoporosis Foundation, half of the women over 50 will have an osteoporotic fracture before they die. Half of the women surviving a hip fracture will not be able to walk and a quarter will need long term nursing care. A woman’s risk of hip fracture is equal to her combined risk of developing breast, uterine, and ovarian cancer.
Women are not the only ones who suffer from this problem. Men also get osteoporosis, although it is poorly recognized by the medical community. Men typically develop osteoporosis slower and it appears later than in women. Testosterone begins to diminish in the early 30’s and decreases 1-3% per year, increasing the risk for bone loss. Men over 65 have a hip fracture rate of 5 in 1,000. Men over 65 are at risk and should have a bone density test done, as well as calcium, magnesium, thyroid, Vitamin D, and hormone levels.
By 2010, over 52 million men and women age 50 years and older will either have osteoporosis or be at increased risk because of low bone mass per the National Osteoprosis Foundation. Approximately 20% of those that develop hip fractures will die the year after the fracture from surgery complications such a pneumonia or blood clots in the lung according to the CDC.
The best therapy for osteoporosis is replacing lost hormones. In women, estrogen saves more bone tissue than very large doses of calcium according to the National Institute on Aging. In the May 2004 Journal of the American Medical Association, British researchers described a link between hormone replacement therapy and a reduced risk of bone fracture in post-menopausal women.
Poor nutrition and inadequate intake of nutrients, lack of adequate exercise, unhealthy lifestyle including cigarettes and alcohol, and race also contribute to osteoporosis. Hormone replacement in men and women is of key importance for bone health.
Replacemen with biodentical hormones is key. All three hormones are necessary in order to build and maintain bone: estrogen, progesterone, and testosterone. If you are taking Premarin, you are only getting an estrogen effect, and a dangerous one.You don’t want to trade one problem for another by taking alien synthetic molecules orally, like Premarin and Provera, that can increase heart disease, stroke, and breast cancer. Remember all estrogen, even bioidentical, should be taken transdermally. Any oral estrogen can increase C-reactive protein which correlates with a higher incidence of heart disease. Provera or medrxyprogesterone has no benefit for bone, and in fact inhibits beneficial progesterone production and effects by binding to progesterone receptor sites.
The synthetic pharmaceutical medications for osteoporosis, like Fosamax, are problematic. They do not allow for the natural turn-over and remodeling of bone and what you essentially wind up with is a lot of old brittle bone. In addition, one study showed that combining estrogen with Fosamax may increase fractures. In addition, Fosamax is correlated with bone problems in the jaw.
Vitamin D is very important to build bone and prevent osteoporosis. Even in the sun belts, Vitamin D levels are low among men and women due to interior jobs, sun-screen over-use, and lack of ability of aging skin to convert sunlight to Vitamin D. Get your 25 hydroxy Vitamin D levels checked with a blood test, and if they are low step up your supplementation until they come up.
Nutrient supplementation needs to be more than just calcium to build bone. Calcium citrate is OK, but calcium hydroxyapetite is best. Don’t exceed 1600 mg total of calcium per day unless you want calcium in your arteries and kidneys too. Other important nutrients for bone building are Vitamin K, magnesium, manganese, boron, and strontium. Othomolecular makes a great supplement that has all you need for bone maintenance or improvement of osteoporosis called ProBono. Patient report joints feeling better on it as well.
Make sure you get a baseline bone density scan when you are in the perimenopausal years so you know where you are starting out. If you have osteopenia, take action. You can prevent osteoporosis!
Candice Lane, M.D., 1250 La Venta Drive, Westlake Village, CA 91361, 877-496-4289, 805-496-7869.