23 Dec Osteoporosis (An Excerpt from Balance Your Hormones, Balance Your Life)
Osteoporosis (An Excerpt from the beginning of chapter 16 of Balance Your Hormones, Balance Your Life, by Claudia Welch)
Americans spend about $5 billion a year on drugs to protect bone health, roughly 50 percent more than they spent for this just five years ago. Thinning of the bones is a natural process and not in itself a problem. The problem arises when bone porosity increases to the point where we start fracturing hips, something that about 15 percent of older Americans do, and which often triggers a decline in health.
Although we lean heavily on results of bone density scans to alert us to potential problems, these tests do not always provide conclusive results. It is possible to have normal scores on these tests yet still be at risk, or to have poor scores and be pretty much in the safe zone. A bone density scan is not the only measurable aspect of bone health. Your history of bone fractures; whether you drink alcohol, smoke, or use steroids; your height, weight, agility; even your vision and your mother’s skeletal history are all telling signs. A woman’s risk increases if she has vision problems (especially with depth perception), if she is tall or weighs less in her fifties than she did at age twenty-five, or if she has had broken any bones (wrists, ankles, hips) after age twenty. Her risk also increases if her mother experienced broken bones. (If a woman has a hip fracture before she turns eighty, chances that her daughter may suffer a similar fate increase roughly threefold.) Naturally, the more of these risk factors you have, the higher your risk of fracture. On the other hand, if a woman can get out of a chair without using her arms, she has less than half the risk of fracture than do women who can’t.1
Bone Quantity and Quality
Every tissue in the body is constantly engaged in a building and dissolution process that leads to healthy tissue. New cells come in and build healthy new tissue while old, tired, dirty cells are eliminated to make room for the new cells. This is the case with bones. As yin relates to building-up functions and yang is a lighter force, we can see that yin sex hormones would serve more to build and maintain bone density, whereas the overproduction of yang stress hormones contributes to thinning of the bones.
According to Miriam E. Nelson and Sarah Wernick, of Strong Women Stay Young, the most critical time to prevent bone loss is during the first five years after menopause. This is the time in a woman’s life when she will lose bone mass most quickly, between 1 and 2 percent per year.2 In general, women gain bone mass until they are twenty-five years old, level off until age thirty-five, then lose about a half a percent per year until menopause. After the five-year post menopausal drop, bone loss slows down to about 1 percent per year and back to half a percent again after age seventy. These are useful numbers to know, so we don’t freak out if we see our bone density drop from fifty to fifty-five years old, faster than it had when we were younger. This is a common picture, and loss of bone mass is not necessarily a problem unless it reaches the point where bone fractures increase.
There are two major reasons for excessive bone loss. The first involves a process whereby specialized cells called osteoclasts dissolve the old bone cells too fast. This process is catalyzed by too much yang, which occurs when the body is marinated in stress hormones. The second is an insufficient number of fresh, healthy bone cells—osteoblasts—coming in to rebuild the bones. Eastern medicine would say that this is a result of not enough yin, or substance (i.e., bone mass), relative to yang. [This is a process we explore more on our Women’s Health & Hormones Part I: Hormonal Balance & Stagnation online course]
Quantity of yin is not the only important factor when it comes to bone health. Quality of yin is important, too. If the quality of the available yin is poor, then the quality of tissue will be poor. Suppose bone-building and bone-dissolving are in balance, but the building-material quality is poor. Then bone density could be good, but bone quality poor. This is an area of bone health that Eastern medicine may be more interested in than is Western medicine.
Several factors can lead to osteoporosis. You have an increased risk if you have a strong family history of it, no children, poor nutrition, poor exercise habits, depression, stress, or too many refined carbohydrates in your diet. Not surprisingly, hormone imbalance, poor diet, and lack of exercise could be argued to be the biggest culprits. Happily, these areas are often within our control.
Hormones and Bone Loss
Earlier, we saw how yin is affected by stress levels. A 2007 study related pre- menopausal depression with high levels of the stress hormone cortisol and showed that when cortisol is high, bone density drops. Women with high levels of cortisol were likely to have depression and had significantly lower bone density and a higher risk of osteoporosis.3
Stress hormones are crucial for survival; however, in excess they promote the breakdown of all yin in the body, that is, all structural material including the bones, skin, muscles, and brain.4 This leads to a double assault on bone health. First, bone mass is decreased by high levels of cortisol. Second, many tissues that produce estrogen are depleted, resulting in decreased production of estrogen. Estrogen slows the development of osteoporosis, and it has been common for doctors to prescribe synthetic estrogen (balanced with a progestin if the woman has a uterus) to combat osteoporosis. Aside from the problems that we have al- ready seen with the use of synthetic hormones, other arguments suggest this is a flawed approach to supporting bone health.
Although estrogen replacement therapy does slow osteoporosis, it does not prevent or reverse it.5 In fact, bone loss begins to occur in women at age thirty- five, the same age when progesterone begins to decline, but a time when estrogen levels are fairly stable. Progesterone helps support bone-rebuilding activity; estrogen simply retards bone-dissolving activity. One study shows:
- If a woman uses estrogen replacement therapy, she will not lose any bone mass.
- If she uses bioidentical progesterone replacement therapy, she will enjoy a 15 percent gain in bone mass over a three-year period, as long as she is not on thy- roid medication and has an adequate amount of hydrochloric acid in her stomach juices.
Although there is a case for natural progesterone supporting bone density, it is not clear that the impressive bone mass increase seen in this study was re- lated solely to progesterone supplementation. Results may have reflected other factors as well. For example, the women in the study were also given dietary supplements, exercised, and made changes in their diets.6 It is possible that diet and lifestyle play equally, or more important, roles when it comes to build- ing bone mass.
In the final analysis, I would use bioidentical progesterone supplementation only after it became clear that lifestyle and dietary factors were insufficient to maintain bone health. We discussed the role of stress in hormone imbalance and will look at diet and lifestyle in detail later, but a few points of interest in these areas directly relate to bone health.
(This is just the introduction in chapter 16 of Balance Your Hormones, Balance Your Life, by Claudia Welch). Much more information in the rest of the chapter).