The Osteoporosis Solution

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I'm too young to get osteoporosis. Osteoporosis tends to develop silently, with few symptoms. It can develop in women in their 20s and 30s and it's not unusual for women in their 40s to start feeling its effects.

Only women get osteoporosis. While it is true that most osteoporosis victims are postmenopausal women, men are far from immune. It is estimated that almost two million American men have osteoporosis and another three million are at risk. Nearly one third of elderly American men will suffer hip fractures and of these, a third will die within a year.

I drink lots of milk--I won't get osteoporosis. It is true that calcium is important for bones but calcium is only one of many minerals and nutrients that affect bone health. Milk is certainly not the best source of calcium anyway.

If I take calcium supplements, I won't get osteoporosis. Again, calcium is important but neglecting the other nutrients necessary for healthy bones is not going to help with prevention. If other important factors are not in place, including exercise, diet and life style, all the calcium in the world won't protect the bones.

OSTEOPOROSIS: THE STATISTICS

Osteoporosis is a painful, affecting more than 25 million Americans--both men and women. Worldwide there are more than 75 million people who have some form of this disease. It is characterized as a slow progressive loss of bone density that eventually leads to poor quality bone and increased risk of fracture. More than one million fractures per year in the United States are thought to be a result of osteoporosis.

The three most common sites of fracture are the vertebrae, the wrists and the hips. The risk of hip fracture in older women is greater than the risk of all female cancers combined. Osteoporosis substantially increases the risk of death in the elderly within six months of an injury that involves a fracture. In addition, more than 50 percent of American women over 70 years old will suffer spinal compression, a severely painful collapse of the vertebrae that can cause paralysis. The disease is seriously debilitating and may be fatal. The social cost of osteoporosis is staggering: almost $14 billion yearly. It's not hard to see why osteoporosis is considered a silent killer disease of epidemic proportions.

My attention to osteoporosis was predicated not only on the staggering statistics of the disease, but the misinformation that is disseminated about its cause and treatment and the lack of safe, effective, long-term options given to women today. A comprehensive, effective treatment for osteoporosis has long eluded traditional medical professionals. Calcium alone has been proven to have severe limitations and conventional drug regimens such as high-dose estrogen therapy can have severe harmful effects. Interestingly, the most exciting news comes from new dietary supplements that can dramatically improve bone health--ipriflavone and isoflavones. With numerous clinical trials on ipriflavone, increasing bone density in a manner similar to prescription drugs without the side effects can be attained. A more comprehensive nutritional approach must be provided that includes a mineral and vitamin protocol above and beyond calcium, modifying the diet to exclude foods that break down bone and incorporate a moderate exercise regimen in order to safely and effectively maintain healthy bones throughout one's entire life.

OUR BONES, HORMONES AND THE IMMUNE SYSTEM

While our skeleton is the basic foundation of support and protection, the bones that make up this organ system are not a lifeless collection of minerals stuck together. Essentially bone is a dynamic organ system composed of both hard and soft tissue which requires more than just calcium. Bone is an integral part of the human metabolism, not an isolated mechanical structure and it affects many bodily systems and functions; Despite its appearance, our bones are a dynamic living tissue that supports human form and function. The delicate balance between bone breaking down (via specialized cells called osteodasts) and bone building up (via specialized cells called osteoblasts) and hormones that regulate their activity, underscores the bone's importance to all body systems.

Today we now know that estrogen and progesterone have an important part to play in influencing the osteoclasts and osteoblasts. Estrogen is known to decrease the rate of bone breakdown and block the effects of certain hormones such as PTH (parathyroid hormone) that break down bone. Therefore, as the levels of estrogen significantly drop, the risk for osteoporosis increases. The overriding problem is that in order for estrogen to affect bone density, levels greater than 0.625 mg must be used. Levels at/or below 0.625 mg are considered "low dose" estrogen therapy and only addresses menopausal symptoms--this level does nothing for bone density. Levels above 0.625 mg are effective in treating osteoporosis but significantly increases one's risk for certain cancers and other undesirable side effects. Thus, I believe estrogen, by itself, is not a viable option for women, given that we now have alternatives such as ipriflavone and isoflavones.

Finally, the role of progesterone--the forgotten hormone--must now be seriously considered as an important hormone that compliments estrogen. Work by Dr. John Lee presented the hypothesis that natural progesterone, and not estrogen, is the missing factor in osteoporosis, as published in Medical Hypothesis 1991. He was able to demonstrate that natural progesterone was extraordinarily effective in reversing the osteoporotic process without the use of estrogen. It seems that progesterone works to influence the bone building process by stimulating osteoblasts independent of estrogen. Today, taken with or instead of estrogen, progesterone is beginning to be recognized and used to treat osteoporosis. It seems that adding progesterone to estrogen therapy can significantly enhance the cardioprotective effects of lowering LDLs and raising HDLs. With all of this, more research needs to be conducted and more physicians need to be willing to review this intriguing work.

While bones are positively affected by our sex hormones, estrogen, progesterone and testosterone, the most interesting relationship exists between our bone and the immune system. When we think of the immune system we generally visualize busy white blood cells are protecting us from pathogens. We have come a long way in our understanding of the immune system and how it communicates and influences every organ system in the body, including the skeletal system. The immune system communicates with our bones through chemical messengers called cytokines. In general, cytokines can be either pro-inflammatory agents (amplifying the immune response and causing inflammation) or anti-inflammatory agents (calming the immune response). Cytokines are able to control how long, how fast and in what part of the body the immune system acts. When it comes to osteoporosis we now know that certain cytokines influence the activity of the cells that build up bones (osteoblasts) and the cells that break down bones (osteoclasts), directing them to buildup or break down bone. The pro-inflammatory cytokines such as interleukin-1, interleukin-6, interleukin-8, interleukin-12 and nitric oxide can promote osteoporosis by turning on and assisting osteoclasts in their destructive roles. Fortunately we have an arsenal of important nutrients that are capable of addressing the inflammation and pain caused by these bone-destroying cytokines. The nutrients that modulate cytokine activity include vitamin E, vitamin D, quercetin, the herbs curcumin and boswellia, pycnogenol Registered Trademark (pine bark extract) and the omega-3 fatty acids found in fish.

OSTEOPOROSIS--THE COMPLIMENTARY APPROACH
While traditional approaches have their limitations, they should be combined with safer complimentary nutritional therapies and appropriate life style changes in diet and exercise. This is especially significant since one of the most important nutritional agents on the market today is ipriflavone--a safe alternative to high-dose estrogen. With numerous clinical trials behind it, ipriflavone has been shown to inactivate certain destructive cytokines and increase bone density in a manner similar to estrogen, yet without estrogenic activity or its side effects.

WHAT IS IPRIFLAVONE?
Ipriflavone is derived from the class of important phytonutrients called isoflavones, which are naturally found in soy. Ipriflavone is widely accepted around the world and is a registered medication for the treatment of osteoporosis in Europe, Japan and Argentina. Its chemical structure is similar to estrogen and consequently the body uses it in much the same way to help reduce bone loss. With over 60 human clinical trials behind it, ipriflavone has been Shown to be an effective agent for the treatment of osteoporosis. It works in the following ways:

inhibits bone breakdown and enhances bone growth by boosting the activity of osteoblasts
may help in the repair of fractures and increase bone matrix proteins (soft bone tissue)
may enhance the secretion of calcitonin, the primary bone-building hormone
works primarily on bone tissue and not on other organs the way estrogen does
helps relieve pain associated with bone disorders
works better than calcium or calcitonin in maintaining bone mass
works as an excellent adjunct to either low-dose estrogen, calcitonin or low-dose calcium supplements.
The best part is that ipriflavone consistently showed that it is safe while being effective. A major paper rounded up the data on safety and efficacy of ipriflavone in 60 clinical studies performed in Italy, Japan and Hungary that involved more than 2,769 people. The paper looked at long-term (two-year) reactions to ipriflavone and found no significant side effects.

OSTEOPOROSIS--THE DIET
We are a society highly aware of nutrition and diet. We measure portions and count calories and are obsessed with the grams of fat and fiber in every bite we put into our mouths. But beyond the much publicized calcium connection to osteoporosis, few Americans realize the extent to which nutrition influences healthy bones. Adequate nutrient intake and regular physical activity are significant factors in the development of greater bone mass. Make no bones about it--while calcium is absolutely essential for healthy bones, it is not the only factor or important nutrient that addresses the entire bone tissue--both hard and soft.

Other important dietary considerations from sugar to fiber can affect calcium levels and other aspects of keeping one's bones healthy. Most interesting are the weak estrogens called phytoestrogen found in fermented soy foods. Numerous studies (from cancer to osteoporosis) have extolled the benefits of soy in the diet. It seems that these phytoestrogens influence the bone breaking cells and contribute to greater bone mass. In summary, from a diet and dietary supplement standpoint, the following recommendations are detailed in The Osteoporosis Solution book and represent a comprehensive nutritional approach to preventing and treating osteoporosis.

DIET
Avoid sugar, caffeine and excess sodium--all can increase the excretion of calcium.
Choose the right types of fat--emphasize omega 3s (fish) that decrease inflammation and bone loss; avoid saturated fats.
Avoid excess protein intake--excess protein increases the loss of calcium from bone.
Consume more soy and soy containing foods for their beneficial phytoestrogen content.
Avoid alcohol and caffeine, that increase the loss of calcium from bone.
Important Dietary Supplements

Calcium, magnesium, vitamin D, vitamin K, boron, silicon, zinc, copper, vitamin C, homocysteine modulators such as folic acid, vitamin B 12 and Vitamin B6.

Nutritional science has gained extraordinary insight into how compounds found in foods and dietary supplements can address both the symptoms and causes of osteoporosis. How well we maintain our bones and heal from osteoporosis strongly depends upon how well we educate ourselves about its causes, effects and treatments. The Osteoporosis Solution will serve as a resource that lets you take charge of your bone health--to improve the quality of your life and the lives of those you love. Most importantly, I provide alternatives to present drug treatment and a comprehensive nutritional protocol that can be immediately implemented. You don't have to settle for what is being offered to you.

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By Carl Germano, R.D., C.N.S., L.D.N.

Adapted by R.D., C.N.S., L.D.N.

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