Osteoporosis and bone pain

Townsend Letter for Doctors and Patients,  April, 2005  by Jacob Teitelbaum

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Osteoporosis, or decreased bone density/strength, can worsen with age, inactivity, and hormonal deficiencies (estrogen, testosterone, and DHEA). Currently, the rate of osteoporosis among older women is estimated to be about 29%. Yet only 13% of older women have been diagnosed with the disease. Osteoporosis can be diagnosed by performing a test called a DEXA scan. Fortunately, many treatments can be effective at restoring bone strength and eliminating osteoporosis pain.

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Although using calcium to increase bone density has received most of the media attention, it is actually a rather small player when it comes to improving bone strength. In addition to weight-bearing exercise and natural estrogen, many other nutrients and treatments can dramatically improve bone density and decrease bone pain. Sadly, except for calcium, most doctors only hear about expensive prescriptions such as Fosamax[R] and calcitonin. Although these can be helpful, I would certainly start first by adding the nutrients that your body needs to make strong bones.

If the patient already has osteoporosis, consider Fosamax[R] or a related medication in addition to the treatments below. The usual dose is 70 mg once a week on an empty stomach taken with a full glass of water. It is best to take it immediately on waking and then stay upright for 30 minutes so gravity helps it get past the stomach quickly (it can irritate the stomach). For those on the 35 mg a week prevention dose, you should be aware that the 35 and 70 mg tablets cost exactly the same amount; you can save half the cost with a 70 mg tablet by breaking it in two. The same price for both low and high dose tablets is commonly seen with many medications.

There are many nutrients that are critical for bone production. These include magnesium, boron, folic acid, copper, manganese, zinc, and vitamins B6, B12, D, and C. All of these are present in the Energy Revitalization System vitamin powder. In addition I recommend adding:

1. Calcium, 1000 to 1500 mg daily. Be sure you get a form that dissolves in your stomach. Unfortunately, most calcium tablets are chalk (calcium carbonate) and do not dissolve. If you get one that is a chewable, powder, or liquid, this is not a problem. If you get a tablet, put it in some vinegar for an hour and see if it dissolves. If it does not, it will not dissolve in your stomach either, and I recommend that brand not be used. If you are taking thyroid hormone supplements, do not take the calcium within 2-4 hours of the thyroid hormone or you will not absorb the thyroid hormone. In addition, make sure that your Free T4 thyroid blood test (not the TSH test) is not above the upper limit of normal because too high a thyroid dose can also cause osteoporosis. You may choose to take your calcium at meals and bedtime (e.g. 500 mg at lunch, dinner, and bedtime) because it is better absorbed with food, and calcium taken at night can help you to sleep.

2. Strontium. This mineral is highly effective at improving bone density. I am not speaking about strontium-90, the very dangerous radioactive compound released during nuclear testing. The strontium available in health food stores is non-radioactive and very safe--even in high doses. Studies using strontium in the treatment of 353 osteoporosis patients showed a dramatic 15% increase in lumbar spine bone mineral density (BMD) over two years in patients using 680 mg of strontium (2000 mg of strontium ranelate) a day. (1) They then repeated the placebo-controlled study with 1649 osteoporotic women. New fractures decreased by 49% in the first year of treatment, and bone mineral density in the lumbar spine increased by an average of 14.4% after 3 years. There was an 8.3% increase in hip BMD as well. (2) Other forms of strontium have shown similar benefits, and 680 mg of elemental strontium daily appears to be a good dose. Strontium gluconate is better absorbed than strontium carbonate. If possible, take the strontium on an empty stomach and at a different time of day than the calcium, as calcium can block strontium's absorption. Early data also suggests that the strontium may also be helpful in the treatment of osteoarthritis. Although it took 3 to 36 months of therapy, taking strontium was associated with a marked reduction in bone pain in osteoporosis patients. (3)

3. Hormonal support. Make sure that DHEA and testosterone levels are optimized, since these hormones can also improve bone density considerably. It seems that even very low dose transdermal (by patch) estrogen replacement therapy improves bone density in menopausal women. The findings come from a study of 400 postmenopausal women aged 60 to 80 with thinning bones who received either the patch containing natural estradiol or a placebo. The results showed that women in the treatment group had improved bone density in the spine and hip and experienced reduced bone turnover. The lead investigator stated that the ultra-low dose estrogen patch offers a more natural approach to menopausal hormone therapy, because it is replacing circulating estrogen rather than increasing it. This study's results were presented at the 52nd Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG) 2004 held in Philadelphia.