Hormonal Update Volume 2 Number 3

The Health and Care of Your Bones

When it comes to health concerns, breast cancer is generally at the top of the list for most women. And yet, by the time a woman reaches 75, her risk of developing osteoporosis is three times greater than her risk of developing breast cancer. Osteoporosis is a disease characterized by a decrease in bone mass, which leaves bones increasingly more fragile and porous. Often referred to as a silent killer because there are no early warning signs, this disease causes an estimated 1.5 million bone fractures every year and costs upwards of 13 billion dollars in healthcare expenditures. 

During her lifetime, one out of every five women experiences the tiny vertebral fractures that can lead to spinal collapse and the dreaded Dowager’s Hump. One in every seven women will experience a hip fracture. Startlingly, 50% of the women who suffer a hip fracture end up in nursing homes or other assisted care institutions, relinquishing their independence. And, the most disturbing statistic of all, one out of every three women who does sustain a hip fracture actually dies from it. In reality, the incidence of osteoporosis is second only to heart disease, the number one health risk for women. 

For many years it was believed that osteoporosis was an inevitable part of the aging process. We now know that this is not the case. Much can be done to prevent, slow or even reverse bone loss. In the same way that regular check ups, mammograms and breast self exams are recommended by the medical community for the prevention and early detection of breast cancer, there is much that can be done to protect our bones. 

The ABC's of Bones

This Hormonal Update will focus on the health and care of your bones. Most of us think of bones as the solid, unchanging framework that supports our body. But, bones are actually active and constantly changing. Old bone cells are discarded, then replaced by new ones. This process of continual renewal is known as remodeling. When we are very young and our bones are still growing, the production of new bone cells out paces the loss of old ones. Even into our 20’s our bones are increasing in density. By the time we are in our 30’s this process is complete and a reversal gradually begins. At first, bone loss only begins to slightly exceed bone building. However, as a woman approaches and then enters menopause, her risk of osteoporosis can go up exponentially. As important bone protective hormones begin to decline, bone loss can begin to accelerate. 

Bones and Hormone Replacement

Substantial scientific evidence exists to demonstrate that estradiol, the most potent of the body’s three estrogens, substantially reduces a woman’s risk of bone fracture and osteoporosis. Estradiol supports the body’s use of calcium. It also retards the bone-remodeling process by slowing the action of osteoclasts, the cells responsible for breaking bone down. By slowing down remodeling, estradiol helps protect your bone mass. However, estradiol may not be the only hormone necessary for preserving the strength of your bones. Exciting new scientific studies and clinical evidence show that replacement with the hormones DHEA and testosterone may also play a role in the health of your bones. Conversely, we now know that continually elevated levels of cortisol, the stress hormone, can negatively impact bone health by increasing bone loss. 

A note if you are among the women who would like to try hormone replacement therapy (HRT) for bone protection and osteoporosis prevention. A simple saliva test can help you determine your hormone levels and tell you which hormones your body needs. This uncomplicated, accurate test can help you and your healthcare practitioner design and monitor an HRT program suited to your specific needs. Once you begin taking hormones, further monitoring with saliva hormone tests can show whether or not your hormone levels are staying within the target range that provides optimal bone protection.

Alternatives to HRT

 Women at risk for osteoporosis who do not want to take HRT may want to consider other alternatives. Selective estrogen receptor modulators (SERMS), or ‘designer’ estrogens as they are also known, act much like estradiol in the body, but selectively. Raloxifene, for example, mimics estradiol’s interactions with receptors in the bone, but not with receptors in the breast or uterus. Calcitonin, available as a nasal spray, is a hormone that inhibits bone resorption. Bisphosphonates such as Fosamax are yet another category of drugs used in the prevention and treatment of osteoporosis. These non-hormonal compounds are absorbed into the bone, where they help slow down bone loss. 

Under investigation for treating osteoporosis is the use of fluorine and parathyroid hormone, each of which stimulates the formation of new bone. Also new on the horizon for bone protection are drugs called statins, commercially available as Lipitor, Zocor and Pravachol. Originally prescribed to help lower cholesterol, these drugs have now been shown to reduce the risk of fracture. In spite of these positive statin reports, it is still too early to say conclusively whether or not postmenopausal women should take statins to reduce the risk of bone fracture instead of other, more well-studied solutions. 

Start Bone Care Early with Diet and Exercise

Building good strong bones early in life is good insurance for your later years. A healthy, balanced diet that includes plenty of calcium rich, low-fat dairy products, orange juice, dark leafy green vegetables, whole grains, and nuts is essential. As you get older, supplementing with at least 1000 to 1500 mg of calcium is a good idea. As important as calcium is, though, it is only one of the nutrients necessary for building and maintaining strong bones. Equally important nutrients include: 

A well-rounded exercise program throughout life also protects bones. Bones love movement, particularly weight bearing movement, which signals bones to build up strength. An effective bone building plan includes exercises that impact bones such as running, stair climbing, brisk walking, rope jumping, gymnastics, or tennis. If you add resistance training, such as weightlifting or rowing, benefits increase. In addition, exercise helps build muscle that supports bone, as well as relieves stress which helps keep stress hormone levels lower. 

Assessing and Monitoring Your Bone Health

A regular assessment of bone health should be a part of every woman’s bone care program. For many years the gold standard for determining bone mineral density (BMD) has been dual-energy x-ray absorptiometry or DEXA. More recently, advancements have been made in bone loss detection yielding less expensive, easier-to-use bone-scanning tools such as ultrasonographic bone densitometry and bone resorption urine tests. Ultrasound measures bone density by transmitting high frequency sound waves through the heel bone. It is quick, painless, noninvasive, and no radiation is used. A DEXA or ultrasound will tell you the status of your bone mass. 

A urine deoxypyridinoline (Dpd) test measures the byproducts of bone breakdown (bone resorption). A Dpd test reveals how slowly or rapidly your bones are remodeling. Using a combination of these diagnostic tools provides the most comprehensive bone assessment. Once your bone health has been evaluated, you can make informed decisions about prevention or treatment. 

Long Term Health Insurance

Taking excellent care of your bones is really long term health insurance. While it is widely believed that osteoporosis only affects women, 30% of hip fractures actually occur in men. A good program for bone protection for women and men suggests that you: