How to prevent, test for, and treat Osteoporosis.
All women ages 65 and older, along with at-risk postmenopausal women under 65, should be screened for osteoporosis to prevent fractures, according to a final recommendation statement from the U.S. Preventive Services Task Force (USPSTF). MedPage Today (1/14, Monaco) reports that the task force “said with ‘moderate certainty’ that screening for osteoporosis to prevent osteoporotic fractures has a moderate net benefit in all women 65 and older and in postmenopausal women ages 40 to 64 who have at least one risk factor for osteoporosis (both grade B recommendations).” The recommendation statement was published in JAMA.
New Guideline Healthcare Directives and “rules” that doctors receive in the form of “Guidelines” can originate from multiple sources. In general, doctors are trained during residency to learn the guidelines for diagnosing and treating each disease that falls under the umbrella of their specialties. We were never trained to read and follow every guideline that comes from governmental bodies, in fact we didn’t even know about these guidelines until they showed up in various medical journals.
These guidelines take years to develop and are often decades behind the research. As a result, we frequently practice years behind the times, and the recommendations made by various agencies, like the one above from the US Preventive Services Task Force) and specialties are not based on current knowledge; therefore, we cannot provide the most advanced treatment to our patients.
With this basic realization that current guidelines may not be suitable for you as a woman, I will discuss the new guideline published by a governmental agency, the US Preventive Services Task Force, which directs doctors to order osteoporosis screening for women over age 65, or younger, only if a woman is at high risk. They do not specify the high-risk conditions that are considered triggers for doctors to order these tests. You may not know it, but there have been multiple recommendations for osteoporosis screening from every corner of the medical universe over the last 30 years that we have been concerned about osteoporosis. This current directive is the least likely to save women’s lives and the most likely to save insurance companies’ money.
However, first, I will discuss osteoporosis, a condition characterized by thinning and fragile bones that can fracture with minimal stress or trauma. What hormones contribute to strong bones? Estrogen, testosterone, calcitonin, and vitamin D (also considered a hormone). What hormones lead to bone breakdown and thinning? Cortisol and hyperthyroidism contribute to bone loss. Bones are dynamic; even though they may appear inert after we finish growing, they are constantly being formed and broken down. The hormones that break down bone are listed above, and additional factors also contribute to an individual’s risk for osteoporosis. The risk factors I have been using for years are as follows:
Age: As you age, especially in the years following menopause, your bones thin, losing about 1-2% per year after reaching the age of 30 to 40. Age decreases bone density.
Sex: Most women start with thinner bones than men. Testosterone is produced in the infant’s testicles while in utero, which strengthens bones before birth.
Genetics: The thickness of your bones is determined by genetics. Some ethnic groups, such as those of African descent, tend to possess very strong bones, while Asians generally have thinner bones to start with.
Nutrient intake: Vitamin D and calcium levels influence bone strength. Without sufficient amounts of both nutrients, no amount of hormones will promote bone growth.
Weight-bearing exercise and weight training: Working against gravity forces your muscles to pull against the bone insertions, resulting in thicker growth.
A deficiency in sex hormones, specifically estradiol and testosterone, such as that occurring in menopause without hormone replacement therapy, removal of the ovaries, or premature menopause, constitutes a risk factor for osteoporosis.
Drugs such as Lupron, which suppress estrogen and testosterone, are used to treat endometriosis, infertility, and breast cancer.
Chemotherapy can hinder hormonal production from the ovaries and lead to osteopenia or porosis.
Malabsorption in the gut prevents the absorption of essential nutrients needed for bone formation.
How Doctors Think About Osteoporosis
We begin to worry about osteoporosis in women around the age of 40. This is the time when we can observe a deficiency or thinning of the bones on a special scan called a Dexa Scan. I now understand that a loss of testosterone occurring in our late 30s can trigger bone loss. The second contributor is the decline of estradiol around age 50. These two hormones are the key “construction managers” that create thick, sturdy bone.
Men primarily rely on testosterone to maintain bone strength, possessing ten times the amount of this hormone in their blood compared to women. They do not begin to lose bone density until their free testosterone levels decrease. This grants them over a decade of protection from osteoporosis relative to the effects of women’s hormones.
What happens to us when we get Osteoporosis?
The thinning of the bones leads to micro-fractures in the vertebrae, causing misalignment and the breakdown of the female body’s “frame and support structures,” their bones. This results in pain, humped shoulders, low back disk disease, decreased height, and broken hips and forearms. This can be observed as early as age 45 in women who did not have a good diet and experience early menopause, which means an early loss of testosterone.
How do we measure osteoporosis?
A low-dose X-ray was developed to measure the thickness of cortical bone in the spine and hip. This test provides a score compared to those of young and healthy women (or men) aged 29. A score of +2.5 standard deviations above or thicker than that of a 29-year-old indicates that you don’t have osteoporosis and are unlikely to develop it. If your score is 1, your bones are equivalent to those of 29-year-old women. If you have a score of -2.5, then you have thin bones and are at risk for fractures from lifting or falls. By understanding all the facts about bone density testing and osteoporosis, I have devised a logical plan for testing that is based not on money or politics, but on the individual patient.
1.All women should have a baseline bone density between 35-45.
- If a woman has thin bones, then treatment with testosterone, vitamin D, and weight-bearing exercise should be initiated.
- If the baseline bone density is normal at age 40, then another Dexa scan should be conducted at menopause. At that time, if they have osteopenia or osteoporosis, a woman should be placed on Estradiol and T pellets.
- If not, another scan should be scheduled in five years and then every five years thereafter.
- The diagnosis of osteoporosis and the current treatment should be monitored every three years.
This is the protocol I believe should be followed to effectively catch and treat osteoporosis with the least expense and the fewest side effects. Drugs have been available to treat osteoporosis since before we even attempted to prevent its occurrence.
Before 1995, we had no “drug” for osteoporosis except estrogen, and there was no effective test until we had a drug to treat osteoporosis. In the era before FDA-approved drugs for osteoporosis, doctors only diagnosed the condition after a woman fell and broke a bone, a hip, or vertebrae. After the “birth” of the drug Fosamax (one of the Bisphosphonates) in the 1990s, we suddenly had a costly drug to treat osteoporosis, radiology machines to diagnose pre-osteoporosis and osteoporosis, and we began testing women in their 40s to see if they were at risk for the disease. The miracle of medicine is that one new drug generates many other profitable ancillary tests and treatments.
These drugs are still in use but have severe side effects, do not promote strong bones, and are costly. Back in the 1990s, and maybe even today in some regions, everyone in a nursing home took a weekly pill: “Fosamax Fridays,” they called it. Sadly, this did not prevent broken bones or back pain, nor did it stop disc disease and surgery. Doctors continued to be influenced to prescribe these Bisphosphonates despite the drugs’ lack of effectiveness. Worse yet, it has taken four decades for Estradiol and Testosterone to be identified as the best treatment for women to prevent and treat osteoporosis.
By now, if you listen to my healthcasts, you know that I am a “detective” of sorts in diagnosing unusual diseases in my patients, but I am also interested in the forces that influence the practice of medicine in the US. The US medical protocols are adopted worldwide without question. Generally, I have found that monetary gain is the etiology of these changes, which the FDA rapidly embraces. Only after the drugs were distributed did the radiology test, DEXA scan, come into use.
Why do doctors still prescribe these drugs?
ACOG, the American College of OBGYN, produces guidelines for doctors to follow in diagnosing and treating osteoporosis, recommending drugs called bisphosphonates, specifically Fosamax. They still do. Consequently, doctors who are not true scientists and therefore don’t question why they use a drug that doesn’t work as promised continue to use these dangerous drugs. The real concern is that women and their doctors were taken for a ride, given a drug that didn’t work when, all along, the best treatment for osteoporosis was estrogen replacement therapy. Now we know non-oral testosterone pellets make bones very strong and can even improve bone strength after osteoporosis has started. Estrogen is a treatment that not only addresses osteoporosis but also helps women live longer, cures painful intercourse, improves hair growth after menopause, and stops hot flashes.
We have always had estradiol as a tool to prevent osteoporosis, but we haven’t had a method to measure the thinness of women’s bones. DEXA bone scans have been available for decades, yet doctors have received many conflicting messages about who needs them and how often testing should occur. This situation leaves doctors uncertain about who should be tested, leading them to send patients for tests that insurance companies won’t cover. Without a clear path forward, doctors do not take preventive action.
I am a longevity and hormone specialist, and thankfully, we have recently received new information. Doctors who care for women have been advised by a governmental agency, the US Preventive Task Force, to evaluate all women over 65 for osteoporosis using a Dexa scan. Additionally, all women between the ages of 45 and 64 with at least one risk factor should be tested. In another article, the Endocrine Society stated that women over 65 who took estradiol live longer than those who did not. Furthermore, a research article published around the same time described estradiol and testosterone as the least expensive and most effective preventive treatments for osteoporosis. My practice of hormone replacement over 40 years backs up my claim.
I make it a practice to use every method I know to keep my patients healthy by preventing the diseases of aging. I believe every woman should undergo a bone density test at age 40 to determine her future risk of osteoporosis. To prevent osteoporosis, doctors must begin evaluating women early enough to positively impact their bone density through hormones, exercise, and vitamins. In evaluating women, we should avoid following the ineffective advice from government agencies. It seems to be a plan that permits women to develop osteoporosis silently, without any monitoring. The recommendation for testing comes too late in a woman’s life. It appears our government is not interested in promoting women’s health. The WHI started the ball rolling, making women stop HRT for a misinterpreted interpretation of the test. This new guideline that allows women to suffer from osteoporosis as they age, without early diagnosis, reinforces my belief that they are not prioritizing women’s health.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. www.BioBalanceHealth.com • (314) 993-0963. Please subscribe to our YouTube channel and please check “ Like “. Follow us on Facebook and Instagram at BioBalanceHealth.
