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Osteoporosis
 

Osteoporosis Introduction

Osteoporosis is a condition marked by a substantial decrease in bone mineral density. This is a progressive disease causes skeletal weakness and usually begins around the age of 40. The rate of bone resorption (breakdown) is greater than the rate of bone formation as we age, thereby leading to a decrease in overall bone density.

This age related trend begins in women post-menopause, and in men, after 60 years of age. This is, in large part, due to the normal decreases in boney formations, but is also the result of hormonal change. As the loss in bone density further decline, individuals become susceptible to fractures. These fractures can occur with little or no trauma. [1] Osteoporosis affects the bones of the spine, hips, and ribs with the greatest regularity. [2]

Osteoporosis affects both men and women indiscriminately. It can affect any race or ethnicity, though Caucasian and Asian races are at an increased risk for onset. Although the average onset of the disease is approximately 40 years of age, it can begin in the 20’s. Risk factors for the development of osteoporosis include; smoking, family history, menopause, lean body type, absence of exercise, low calcium intake, nulliparity (no children), hormone disregulation, long-term drug use, and heavy alcohol consumption. [3]

Osteoporosis Statistics

  • It is estimated that between 10 and 20 million people in the US have osteoporosis, with another 20-30 million suffering from low bone mass.
  • 55% of Americans over the age of 50 have osteoporosis. 80% of these individuals are women.
  • 20% of Caucasian and Asian women, 10% of Hispanic women, and 5% of African American women over the age of 50 have osteoporosis.
  • 20% of individuals with osteoporosis are men, 7% of whom are Caucasian and Asian men. 4% of African American men, and 3% of Hispanic men over the age of 50 have osteoporosis. [4]
  • 1 in 2 women and 1 in 4 men over 50 years of age will have a fracture related to osteoporosis.
  • There are about 1.5 million fractures caused by osteoporosis annually. Of these, some 300,000 are hip fractures, 700,000 are vertebral fractures, and 250,000 are wrist fractures. An additional 300,000 fractures at other sites within the body. [5]

Osteoporosis Symptoms

Osteoporosis can go without any symptoms for some time. Eventually, pain may be felt in the bones, particularly in the spine. Fracture of the vertebrae can also develop without trauma and may result in localized pain and tenderness. The pain is usually acute onset and does not radiate. Weight bearing will usually aggravate pain. Overtime, some individuals with osteoporosis will develop an abnormal curvature of the spine, resulting in what’s known as Dowager’s hump. [6]

Osteoporosis Treatment

The goal of treatment for individuals with osteoporosis is to prevent fractures, decrease pain if it is present, and to maintain the physical function of skeletal structures. Most medical doctors will prescribe a Vitamin D/Calcium supplementation routine for women. If women have osteoporosis caused by postmenopausal cycles, estrogen replacement therapy is recommended, with or without progestin. If women do not want to take the hormone therapy or if bone loss is extensive, biphosphates are recommended. Biphosphates (Alendronate) inhibit further bone resorption (loss), but are paralleled with adverse side effects. Another popular treatment option, which is also recommended for the prevention of bone resorption, is calcitonin. [7]

Alternative treatment is also focused on preventing bone loss. Several effective treatments have been proven in clinical studies to be effective at preventing bone loss, decreasing bone density, and even promoting the growth of new bone.

Supplements helpful for Osteoporosis

Ipriflavone

Ipriflavone is a synthetic isoflavonoid compound. It is similar to a naturally occurring compound in soy. Ipriflavone inhibits bone resorption and also promotes bone growth. It exerts its effects on the cells that produce and break down bone.

In one study, supplementation fwith ipriflavone for 2 years increased bone density in the vertebra of women with osteoporosis. [8] In another clinical trial it was proven to suppress bone resorption via the osteoclastic cells. Results were evaluated by measuring bone density in the lumbar vertebra, which did not show a decrease in bone density after 1 year. [9] Ipriflavone has also been proven in study to reverse the bone loss normally caused by normal estrogen deficiency in postmenopausal women. [10]

Calcium

Calcium supplementation is a necessary aspect of any treatment regimen for osteoporosis. Calcium is effective at reducing bone loss and can help prevent fractures by building stronger bones. Different forms of calcium are better absorbed, such as calcium citrate.

A study of calcium supplementation for 1-2 years in postmenopausal women proved that its supplementation reduced bone loss and exerted a protective effect on fracture prevention for women 3 years post menopause. [11] Another study, which included elderly women suffering from osteoporosis, used calcium citrate supplementation to reverse age related increases in bone resorption and to decrease bone loss. The use of calcium citrate in these women was shown to be as effective as conventional treatments using biphosphates. [12]

Vitamin D

Vitamin D is needed to maintain proper calcium metabolism in bone. It increases absorption of calcium by the intestines and bone. It also affects parathyroid hormone, which regulates bone turnover and release of calcium from bone.

In a study with vitamin D3 (cholecalciferol) supplementation caused an increase in bone mass in the lumbar vertebra of 2% of participants, as compared with a loss of 2% in the placebo group. [13] In another study, supplementation with vitamin D increased bone density in the femur by 3% and in the lumbar spine by 2.3%. This finding was, again, compared with a loss of bone density in the placebo groups. Cholecalciferol has also been shown to increase strontium absorption in the gut and decreased parathyroid hormone. [14]

Vitamin K1

Vitamin K regulates the formation of bone. It increases the calcium concentrations in the bone via osteocalcin. Individuals who are deficient in Vitamin K have impaired bone mineralization. This is important as the severity of fracture is related to bone mineralization.

In a study of postmenopausal women that supplemented with Vitamin K, bone loss was reduced. When vitamin K was combined with a mineral supplement, bone loss was reduced even further. [15]

Magnesium

Magnesium is believed to be as important as calcium in the treatment of osteoporosis. Magnesium is a mineral cofactor for the conversion of vitamin D3 to its more active form, calcitrol. It also assists in the mediation of parathyroid hormone.

Women with osteoporosis were found to be deficient in magnesium compared to controls in certain studies. [16] Furthermore, other studies have found that magnesium improves bone strength, and is necessary for the preservation and remodeling of the bone matrix. [17]

Trace Minerals

There are many other trace minerals that are necessary for healthy bone formation. Copper, manganese, and zinc are all cofactors for specific enzymes involved in the metabolism of bone. One study proved that copper, manganese, and zinc were all essential for optimal bone matrix development and bone density sustenance. [18] Boron is equally important, as it activates vitamin D to vitamin D3 in the kidneys and also reduces calcium loss via the urine. Boron has also proven its effectiveness in reducing bone loss when individuals are deficient in other bone-building nutrients, namely, Vitamin D and calcium. [19]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pp: 469-473.

[2] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. 1999. Pp: 372-377.

[3] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone New York. 1999. Pp: 372-377.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Health Osteoporosis and Related Bone Diseases Natural Resource Center. Oct 2004

[5] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Health Osteoporosis and Related Bone Diseases Natural Resource Center. Oct 2004

[6] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pp: 469-473.

[7] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pp: 469-473.

[8] Agnusdei D et al. A double blind placebo controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss. Calcif Tissue Int. 1997 Aug; 61(2): 142-7.

[9] Ohta H et al. Effects of one year ipriflavone treatment on lumbar bone mineral density and bone metabolic markers in postmenopausal women with low bone mass. Horm Res. 1999; 51(4): 178-83.

[10] Scheiber MD and Rebar RW. Isoflavones and postmenopausal bone health: a viable alternative to estrogen therapy? Menopause 1999 Fall; 6(3): 233-241.

[11] Ruml LA, Sakhee K, Peterson R, Adams-Huet B, Pak CY. The effect of calcium citrate on bone mineral density in early and mid-menopause period: a randomized placebo controlled study. Am J Ther. 1999 Nov 6; (6): 303-311.

[12] Riggs BL et al. Long term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. Bone Miner Res. 1998 Feb; 13(2): 168-174.

[13] Chen JT et al. 1-alpha-hydroxyvitamin D3 treatment reduces bone turnover and modulates calcium-regulating hormones in early postmenopausal women. Bone 1997 June; 20(6): 557-562.

[14] Sairamen S et al. Bone mass and markers of bone and calcium metabolism in postmenopausal women treated with 1,25 dihydroxyvitamin D (calcitrol) for four years. Calcif Tissue Int. 2000 Aug; 67(2): 122-127.

[15] Braam LA et al. Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int. 2003 Jul; 73(1): 21-26.

[16] Gur A, Colpan L, Nas K, Cevik R, Sarac J, Erdogan F, Duz MZ. The role of trace minerals in the pathogenesis of postmenopausal osteoporosis and a new effect of calcitonin. J Bone Miner Metab. 2002; 20(1): 39-43.

[17] Schaafsma A, de Vries PJ, Saris WH. Delay of natural bone loss by higher intakes of specific minerals and vitamins. Crit Rev Food Sci Nutr. 2001 May; 41(4): 225-249.

[18] Saltman PD, Strause LG. The role of trace minerals in osteoporosis. J Am Coll Nutr. 1993 Aug; 12(4): 384-389.

[19] Schaafsma A, de Vries PJ, Saris WH. Delay of natural bone loss by higher intakes of specific minerals and vitamins. Crit Rev Food Sci Nutr. 2001 May; 41(4): 225-249.