Osteoporosis

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

It is estimated that 50 percent of women between the age of 45 and 75 in the United States will be affected by osteoporosis to some degree, with 16 percent experiencing serious bone deterioration that could lead to fractures and injuries. The most common injuries associated with osteoporotic bone fragility are compression fractures of the vertebrae, often unnoticed because they are microfractures, and fractures of the hip from falls, that often are difficult to heal and debilitating. Studies in recent years show that women are 4 times as likely to experience these vertebral fractures with aging, which often go undiagnosed. Spinal vertebral microfractures often cause syndromes of nerve root pathology, or radiculopathies, chronically inflamed spinal tissues, and irritation or impingement of the nerves leading to various organs. Inexplicable symptoms, such as difficulty controlling urination could be related to chronic microfractures of the lumbosacral vertebrae. Since osteoporosis is a gradual and systemic disorder, signifying a problem with hormonal regulation and metabolic dysfunction, and is potentially related to other health problems, this is a problem that all women should become familiar with and understand. A comprehensive and holistic approach to therapy is needed to truly prevent and treat osteopenia and osteoporosis, and the specialty of TCM (Traditional Chinese Medicine) provides a array of therapies that will help one achieve this goal.

A research study published in the January 18, 2012 New England Journal of Medicine finally provided accurate statistics of how slowly true osteoporosis actually develops. This study of the progression of osteoporosis after age 65 showed that current guidelines of bone density tests every two years, and many women prescribed osteoporosis drugs when the first signs of osteoporosis, or osteopenia, were detected, did not reflect accurate information about the real risks and slow progression of the disease. New recommendations would call for a baseline test at age 65 with a followup in 15 years for most women. The study author, Margaret Gourlay, of the University of North Carolina at Chapel Hill, stated: "There is a strong belief that the more we test, the more we are helping patients. This is a good example of why that does not hold up at all." While current testing and use of problematic pharmaceutical biphosphonate drugs have not been proven successful to address slowly progressing osteopenia and osteoporosis, an holistic regimen over time has.

This study also started the process of determining which subset of women were at increased risk, identifying health problems that could be corrected to prevent the progression of true osteoporosis. Current drug therapies that try to block valuable calcium molecules from leaving the bone matrix come with considerable risks related to the many dysfunctions associated with an altered calcium metabolism. Many experts believe that the unnecessary tests lead to many false positives and prescription of harsh drug regimens that create greater patient risk than protection, according to this researcher, Margaret Gourlay. She stated that all osteoporosis drug therapy should be based on the speed of progression of the disease, comparing a baseline test to current bone density results, not a supposed normal bone density, which may vary considerably between individuals and with age, depending on body size, weight, and variations in the bone structure. Of course, what is missing from her assessment is an actual endorsement of evidence-based Complementary and Integrative Medicine (CIM).

In 2012, the American Board of Internal Medicine Foundation enlisted 17 medical specialty organizations to discourage proven overuse of medications, unproductive tests, and treatments by changing professional testing and treatment guidelines. It was determined that these unnecessary procedures currently waste at least $700 billion per year in the United States, and create an enormous financial and health burden on patients that should be avoided. The American Academy of Family Practice Physicians was one of the first professional specialty organizations to respond, and recommended that bone density screening for women younger than 65, or men younger than 70, be discouraged for those with no significant risk factors for osteoporosis. This new guideline was initiated to discourage the widespread prescription of anti-osteoporosis drugs that may be causing more harm than good, most of which are prescribed unnecessarily, and have produced no significant benefits. In an August 28, 2012 article in the New York Times Health, the president of the American Academy of Family Physicians, Dr. Glen Stream, noted that for patients with modest bone loss, the taking of biphosphonate drugs to treat osteoporosis may do more harm than good, and physicians are compelled to prescribe these drugs for want of a better treatment in standard medicine. Dr. H. Gilbert Welch, professor of medicine at Dartmouth Institute for Health Policy and Clinical Practice stated that "postmenopausal women represent a huge market...That's a big part of the story." While there is finally more sensible advice concerning diet and exercise, there is still little medical guidance to avoid problematic prescription drugs, such as acid inhibiting drugs for heartburn and gastric reflux, some antidepressants, and corticosteroids, commonly used to treat asthma, allergy and skin problems, and most importantly, there is still almost no advice to utilize Complementary and Integrative Medicine and the array of therapies in Traditional Chinese Medicine (CIM/TCM).

To truly prevent the onset of osteoporosis and resulting bone fractures a holistic course of therapy should be initiated as the problem starts to slowly develop. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) can provide such a comprehensive strategy and individualized course of therapy, utilizing short course of acupuncture and physiotherapy (Tui Na) with an individualized prolonged course of herbal and nutrient medicine, prescribed in a step-by-step goal-oriented manner.

On May 9, 2012, an F.D.A. review of medical guidelines concerning the widely prescribed osteoporosis drugs biphosphonates, e.g. Fosamax and Boniva, was published in the prestigious New England Journal of Medicine. This review of FDA guidelines warns that concrete evidence of serious adverse health effects with long-term use of these drugs, such as fractures of the femur at the hip, osteonecrosis of the jaw, and esophageal cancer, and combined with the results of an FDA systematic review of clinical studies showing little if any benefit from the drug use after three years, led to a recommendation that long-term prescription of these drugs be used only for a subset of women with true osteoporosis whose condition was advanced to a high risk of fractures, and who were not improving. Experts in the field state that a large number of women are expected to be taken off the biphosphonate drugs, and these women, and their physicians, would be wise to integrate Complementary Medicine to improve the underlying health problems causing osteoporosis, since this is perhaps the only alternative to these problematic drugs.

While the treatment with osteoporosis drugs may be unnecessary, and problematic, with greater risk than benefit for most women, there is much that a woman can do to improve bone health and the overall hormonal balance related to bone density regulation. Improving the strength of bones with a quality strontium supplement, utilizing the correct form of calcium molecule, calcium hydroxyapetite, with herbal and nutrient cofactors that would increase the absorption, correcting the hormone Vitamin D3 metabolism, which involves an endocrine feedback involving the thyroids and parathyroids as well as the kidney/adrenal and hypothalamus, and improving the gastrointestinal health to aid daily absorption of calcium and essential minerals, are basic health improvements that would insure improved bone health. Improving the overall bone matrix, with healthier collagen and circulation, and learning how simple targeted exercises, correction of postural mechanics, and even improved diet can benefit bone health are all valuable tools in your health maintenance. More importantly, hormonal balance and restoration may be the most important therapeutic consideration, since the calcium metabolism is highly regulated, and evaluation of steroid hormone and thyroid hormone balance and function, and appropriate therapy with bioidentical hormonal creams and herbal and nutrient cofactors will usually reverse osteoporosis and the only side effects are better overall health. To view an early lecture by the famed Dr. John R. Lee on this subject, the pioneer of the reintroduction of phytohormonal therapy in standard practice, just click here:https://www.youtube.com/watch?v=vBvH1zktooQ . A proactive approach, aided by a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist (CIM/TCM), is the best way to take charge of your health and prevent osteoporotic fractures.

Understanding of a common and potential health problem like osteoporosis, that is interrelated to other health problems, and could go unnoticed for some time before it becomes disabling, is an extremely important first step in preventing or reversing the osteoporotic disease mechanisms. Osteoporosis is a slowly developing condition. Waiting until osteoporosis becomes severe to treat, and then blocking calcium resorption from the bone is not the best strategy to treat this common problem. Our bodies need a very regulated calcium supply to maintain healthy function, and this important molecule comes from our bones. Maintenance of the entire calcium metabolism is important.

Osteoporosis is a complex pathology of bone degeneration and fragility that occurs mainly with aging, but it is caused by a variety of common health imbalances, and can be both reversed and prevented. A variety of disease mechanisms are involved in the creation of osteoporosis, and a holistic, or complete approach to correcting these various disease mechanisms is necessary to restore healthy bone metabolism. Both deficient deposition and absorption from dietary sources of calcium and other minerals that store in our bones, and excess resorption, or usage of these minerals, such as in buffering acidic conditions, are key components of the multifactorial causes. What is almost always overlooked in the physiological mechanisms of osteoporosis is the proper regulation of bone formation, with collagen fiber alignment, healthy ground substance, and calcium hydroxyapatite together forming strong bones. The organic matter in our bones has the same composition as our tendons and ligaments, constantly remodels, and thus a variety of factors must be considered to maintain healthy bone maintenance and remodeling. Another aspect of healthy bone maintenance often overlooked is blood circulation. Our bones depend upon blood circulation, healthy blood vessels, and healthy blood cells, and bone cells not receiving adequate circulation and blood nutrients die. Osteoporosis thus cannot be defined simply, or treated simply, if the goal is to restore the body's regulation of calcium deposition and collagen formation in the bones and prevent fractures.

Osteoporosis is a pathology that also reveals other health problems, and is intimately tied to hormonal deficiency and imbalance, acidity imbalance, and other metabolic concerns that a sensible patient will want to correct to achieve a healthier life and prevent other diseases. Osteoporosis is like the tip of an iceberg. What is obvious to the eye is only a small part of the whole threat. When we are diagnosed with osteoporosis we should understand that there are a variety of unhealthy metobolic and hormonal dysfunctions that need to be addressed. Taking a simplistic approach to this problem may have devastating consequences. While the modern pharmaceutical approach of blocking part of the mechanism of bone remodeling may result in better numbers for a percentage of patients on their bone density tests, at least for a short period of time, it should not put the patient's health concerns to rest. Osteoporosis is a symptom of various disease mechanisms, not a disease itself. Failure to address these disease mechanisms with a thorough and holistic attention to health will result in a variety of other health problems eventually denying one a healthy and productive life with aging.

In addition to osteoporosis that is a primary disease, osteoporosis may occur secondary to other diseases, and most importantly, as a side effect, or adverse event resulting from medication use. This secondary osteoporosis resulting from medication use has been largely overlooked by the medical community, especially since it occurs slowly and with an insidious onset in almost all cases, and medical doctors are hesitant to discourage use of other medications. Long term use of many common types of pharmaceutical medications may cause or contribute to osteopenia and osteoporosis, though.

Experts agree that a high percentage, if not a majority of cases of secondary osteoporosis occurs due to use of corticosteroid medications, or glucocorticoids. Glucocorticoids are a class of steroid hormones that are synthesized in the adrenal cortex, affect every cell in the body, have a broad array of effects related to the various types of cell receptors and interactions with other hormones, and play a central role in regulation of gucose metabolism along with insulin, another steroid hormone. The most common type of glucocorticoid is cortisol, which is highly regulated and released in a diurnal pattern. Glucocorticoid medications are now found in combination with other drugs and appear in a wide variety of medications, even many without a prescription need. Corticosteroids are taken via asthma inhalers, in skin creams, in many types of oral medications, and in injections. The most common types of glucocorticoid medication are prednisone, methylprednisolone, hydrocortisone, and beclometasone. Since glucocorticoids such as cortisol are highly regulated in a diurnal pattern, use of synthetic corticosteroids that are not delivered in a diurnal pattern may upset the hormonal balance in the body. In addition, when synthetic corticosteroids are introduced in the feedback regulatory system of our endocrine physiology, this may stop or inhibit our bodies from producing natural glucocorticoids. This is especially problematic when we suddenly stop taking these medications, or when we stop and start them.

Other common medicationst that may cause or contribute to osteopenia and osteoporosis include SSRI antidepressants, diuretics, antibiotics, anti-seizure medications (e.g. phenytoin), lithium antidepressant, and the birth control drug Depro-Provera, which comes with such a warning by Canadian health authorities. Chronic use of antacids or drugs that inhibit gastric acid production may also cause or contribute to osteopenia and osteoporosis. Medical conditions that may cause secondary osteoporosis include liver impairment, malabsorption diseases such as celiac disease, chronic obstructive pulmonary disease (COPD), anorexia nervosa, bulimia, multiple sclerosis, chronic kidney failure, and rheumatoid arthritis. Overlooked and underdiagnosed health problems such as hyperparathyroidism and thyroid dysfunction, and diabetes/metabolic syndrome, may also cause secondary osteoporosis, as well as subclinical adrenal stress syndromes with transitory hypercorticolism. Thalassemia (a form of anemia), leukemia (often chronic), and bone and bone marrow cancers, are linked to osteoporosis, and use of barbituates, excessive alcohol consumption, cigarette smoking, and environmental aluminum toxicity are linked as well. Experts in public health emphasize that secondary osteoporosis must be treated differently than primary osteoporosis, not only addressing the disease mechanisms, but actually treating underling causes and eliminating drugs that many be causing or contributing to the disease when possible.

Problems with correct diagnosis and treatment strategies

Osteopenia is a condition that is often treated like osteoporosis. This condition involves a bone mineral density that is lower than normal (T score between -1.0 and -2.5) but not indicating the disease of osteoporosis. In the past, osteopenia was a diagnosis that was used to explain many bone fractures in elderly patients, but in 1992, the World Health Organization defined the condition of a bone density that was just one standard deviation below that of an average 30 year old white woman. This classification was not meant to indicate that there was an actual disease, but rather to alert the treating doctor to the possibility of risk of developing the disease of osteoporosis, or to indicate that there may be some underlying health concerns that need to be explored. Instead, many women were prescribed harsh hormonal medications that are intended to treat osteoporosis.

In 2003, the pharmaceutical giant Merck, which markets Fosomax for treatment of osteoporosis, estimated that at between 2 and 3 million women were prescribed an osteoporosis medication like Fosomax for the condition of osteopenia. When this information became public, health experts such as Dr. Steven R. Cummings of the University of California, San Francisco, stated that there was no treatment basis, or biological reason, to prescribe these drugs to women that had a bone density that was one standard deviation lower than that of a healthy 30 year old white woman. Population studies found that between 28 and 45% of the patients that were given a bone density study were found to have osteopenia, and that this deviation was attributable to the quality of testing device and type of machine. The use of cheaper scanners, which detected a higher rate of osteopenia, were heavily promoted by Merck, which increased sales of Fosamax considerably. The National Osteoporosis Foundation recommended that treatment with osteoporosis drugs is indicated if the bone density T-score is between -1.0 and -2.5 coupled with a probability of hip fracture or a 10 year probability of major osteoporotic fracture. The proper assessment of risk for these fractures is often not considered in the analysis when prescribing the osteoporosis drugs, and this has generated much concern among medical experts around the world, especially considering the risks and side effects of long term usage of these drugs.

Osteopenia, like osteoporosis, occurs most frequently in the post-meonpausal woman as a result of an estrogen deficiency, but can also be exacerbated by the chronic use of steroid glucocorticoid inhalers and medications prescribed for asthma, a by a host of factors that would contribute to a subclinical hormonal imbalance. It may also be exacerbated by a lack of weight bearing exercise, excess consumption of alcohol, significant cigarette smoking, of other factors that may lead to poor calcium absorption, such as the deficiency of the hormone called Vitamin D3, which we now know is becoming endemic in our population. Even young women are found to have osteopenia, though, and two groups are of special significance. The very young woman who trains heavily for athletic competition and maintains a low body weight and fat index often has amenorrhea (cessation of the menstrual period), and later may have significant probems with premenstrual syndromes and irregular menses due to a hormonal imbalance. Studies show that female athletes tend to have lower body weight, lower fat percentage, and a higher incidence of asthma than their active peer. Young women with eating disorders are also monitored for osteopenia, both due to problematic calcium absorption and hormonal imbalance. Osteopenia can be transitory as well, occurring after a period of illness or accident with more than 3 days of bed rest. Dieting, increased stress, excess caffeine consumption, sodium imbalance, poor diet, excess phosphorous intake with a large consumption of carbonated beverages, and a relative excess consumption of protein in the diet, may all cause transient osteopenia.

Osteopenia is also seen with Vitamin B12 deficiency, celiac disease, inflammatory bowel disease, irritable bowel syndrome, diabetes, after a gastrectomy, in malabsorption syndromes, with Sickle-cell anemia, thalassemia, Lupus, and with some cancers. Transitory osteopenia is also associated with scoliosis and various chronic skin disorders. Certain pharmaceutical medications may also induce osteopenia, such as glucocorticoid asthma medications or other steroids, diuretics, antibiotics, anti-seizure medications (phenytoin), and the birth control drug Depro-Provera, which comes with such a warning by Canadian health authorities. Chronic use of antacid medications may also induce osteopenia, either by causing a malabsorption of calcium, or when common mineral salt pills are taken in excess. Certain chelation therapies may also induce transitory osteopenia. Poor quality or the wrong type of calcium supplements may play a part in osteopenia in some patients as well, as this may put a stress on the complex regulation of calcium in the body, especially if there are underlying hormonal imbalances or deficiency of Vitamin D3 hormone. This connection between hormonal regulation of calcium and osteoporosis explains why gluococorticoid drugs, or synthetic corticosteroids, are by far the major cause of secondary osteoporosis. This could also explain why osteopenia and osteoporosis is a problem for such a large percentage of the population, since corticosteroids are now prescribed to more and more patients, are used in high dosage with less caution, and now are even available in common drugstore medications without prescription.

There is thus a high association between osteopenia and osteoporosis, and this has led to overuse of harsher osteoporosis drugs, and increased alarm and stress in the population unnecessarily. The patient with a diagnosis of osteopenia, or with an incorrect diagnosis of osteoporosis based on a mild finding of low bone density, should look to this as a sign to analyze and improve one's health to avoid the onset of osteoporosis, or to correct any of these other health imbalances, especially hormonal imbalances, that may be present. Holistic Complementary Medicine can help the patient understand and analyze this situation and guide appropriate health improvement. If the bone density study reveals a bone density T-score of under -2.5, and if the risk of osteoporotic fracture is significant, more intense treatment of the condition is warranted. The treatment should incorporate Integrative Complementary Medicine as well. This article is intended to educate the patient to the potential problems with standard pharmaceutical approaches and the array of healthy treatment strategies that are backed by much scientific research.

An unhealthy dependence on drugs that have limited effect and alarming long-term risks and adverse effects

The current allopathic approach to treatment in osteoporosis is largely limited to a class of drugs that block the calcium and other mineral ions from exiting the bone. These popularly prescribed drugs are called biphosphonates. While a number of studies have demonstrated that osteoporotic fractures overall have been reduced in a percentage of patients taking biphoshphonates, a significant amount of alarm has been generated concerning negative health effects, especially with long term use, and many patients, as well as physicians, are now exploring a less risky treatment protocol with Complementary and Integrative Medicine (CIM/TCM) to integrate into long term therapy, as well as to treat early and milder stages of osteoporotic disease. Since the body depends greatly on the hormonal regulation of these calcium and other mineral ions to achieve a healthy cellular function, buffer acid conditions, and many other essential physiological mechanisms in the body, blocking the healthy release of these minerals from the bone with biphosphonates seems to be a therapy destined to create other health problems down the road.

Fosamax (alendronate sulfate) is the brand name of the first drug of this class, bisphosphonates, and has faced a number of lawsuits concerning a relatively large number of patients that claim a serious side effect of joint degeneration, particularly in the jaw. For patients who have been seriously debilitated from this metabolic side effect, Fosamax has lost a number of large lawsuits already. Other companies have stepped up and offered the same drug in other forms and dosages, including Boniva (ibandronate), Actonel (risedronate sodium), Reclast (zoledronic acid), and Atelvia. A 1999 study found that biphosponates significantly impaired bone healing in cases of fracture (Journal of Bone and Mineral Research; Vol.14, No.6, 1999. Jiliang Li, Satoshi Mori et al). Other scientific studies acknowledge that bone fractures, especially microfractures, may be common to a subset of the aging population with more severe osteoporosis, often go unnoticed, and require the body to constantly promote bone repair. Inhibition of this bone repair would present a considerable problem for patients, and explain the large percentage of patients complaining of spinal and back pain with long term use of biphosphonates. A March 2008 FDA Patient Safety News alert warned healthcare professionals that all of these biphosphonate drugs can cause severe muscle, joint or bone pain that is sometimes incapacitating and usually occurs months or even years after starting the drugs.

A 2016 study at the Gongli Hospital in Shanghai, China, compared the effects of this biphosphonate alendronate, or Fosomax, to the simple extract of Pomeganate seed in reversing osteoporosis secondary to use of corticosteroid drugs such as Prednisone. Study of a number of biochemical markers of this homeostatic imbalance of calcium showed that the simple Pomegranate extract worked as well as the expensive and harmful drug Fosomax. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/27278225 . Of course, this would be just one of the treatment protocols used in actual TCM clinical practice, amplifying the success of the treatment, and the patient would not need to keep taking these herbal and nutrient medicines forever, like with Fosomax prescription, and short courses of frequent acupuncture stimulation could be used to also enhance the effects. The healthcare costs savings would be enormous. To see more evidence of Chinese herbs and specific acupuncture treatments proven to help restore calcium homeostasis, go to Additional Information at the end of this article.

This question of whether long term therapy with biphosphonates inhibits natural bone repair of degenerative spinal microfractures now is accompanied by evidence that some types of bone fracture may actually be caused by metabolic problems with long term use of biphosphonates. Bone maintenance is a complex and ongoing process that depends on a host of metabolic factors. Biphosphonates have also been linked to joint degeneration, cardiac arrhythmias, and esophageal cancer, and present the possibility that inhibition of normal calcium and mineral ion metabolic balance may lead to a number of physiological dysfunctions over time that contribute to weakening of the bone, and indirectly cause fractures of the bones that get the most stress supporting body weight. The complexity of factors involved in osteoporotic bone degeneration creates difficulty in definitively proving that biphosphonate drugs may cause bone fractures, but a series of warnings have nonetheless been issued by the FDA warning of various health risks with long term use. In October of 2010, the FDA again warned that biphoshonates may increase the risk of hip fractures at the head of the femur, and in the long part of the femur, at mid-thigh, and added a warning box to the drug labeling, although it was stated that clear explanation of how the drug caused these fractures is still elusive. One study that triggered much alarm was conducted by the American Society for Bone and Mineral Research, which found that in a study of 310 patients with these types of hip and thigh fractures, more than 90% of these patients were taking biphosphonates, most for at least 5 years. The Society formed a task force to investigate risk versus benefit, which recommended: "Health professionals should reserve biphosphonates for patients with certain cancers, Paget's disease of bone, and patients with osteoporosis who are at high risk of having a fracture. They should also assess annually whether this therapy is appropriate for each patient." While there is still a reluctance in standard medicine to support Complementary and Integrative medicine, a growing number of MDs are now exploring a more comprehensive approach to help patients with this difficult disease.

The pharmaceutical industry has responded to concerns in standard medicine, public health, and health research, of serious health risks with long term use of biphosphonate drugs, and FDA and health institute guidelines to restrict its use to more seriously threatening cases of osteoporosis, not by supporting a more cautious approach, but instead by attempting to expand its use to other disease treatments. One of these drugs, Zoledronic acid, or zoledronate (Zometa, Reclast, Zomera or Aclasta), is marketed to treat bone loss in cancer as well as osteoporosis. The attraction to this type of osteoporosis drug is the fact that it can be administered as a yearly intravenous infusion, or for cancer treatment, a monthly infusion. This biphosphonate has also been marketed to treat breast cancer recurrence in younger women, though, and a widely publicized trial showed a modest benefit in this regard. The large follow-up study, though, in Britain (AZURE), followed thousands of women for 5 years after lumpectomy or mastectomy, and found no difference in rates of recurrence or mortality with use of the drug. There was a significant reduction in recurrence for women who were at least 5 years past menopause, but this also indicates that the rate of recurrence for younger women, whom the drug is marketed to, was significantly worse with use of this biphosphonate drug, since the rate of recurrence for all women was equal. Once again, instead of proceeding with caution, or a new approach, drug supporters are now suggesting that estrogen deficiency in the postmenopausal women was probably the deciding factor, and that estrogen blocking drugs be given to younger women to increase the chance that the biphosphonate could still be marketed for cancer therapy. While it is clear that this treatment option for women with serious breast cancers spreading to the bone is a positive option for the patient, many questions surrounding the patient choice in early stage breast cancers, precancerous lesions, and with long term osteoporosis therapy presents confusing risk versus benefit considerations that need to be explored by a proactive patient.

In September of 2011, FDA advisory panels voted 17 to 6 in favor of recommending additional labeling information about the potential risks and lack of evidence of effectiveness for use of biphosphonate drugs past 3 years of continuous use. The panel concluded that for women taking biphosphonate drugs for five years, there was no evidence of clear benefit. FDA scientist Dr. Theresa Kehoe MD told that panel that there was no subset of patients who showed a clear and consistent reduction in fracture risk with long term use. The FDA panels also found that after more than 15 years of prescribing biphosphonates, that the only published study presented by the pharmaceuticals was a single study of Fosomax that followed some of the women for an additional five years. This study showed that for fractures other than the spine, there was no evidence of continued benefit after 5 years. Most of the industry studies followed women for only 3 years. Dr. Kehoe stated: "A prevention indication, I think, is being revisited all the way around, including by the FDA. Certainly it's something we're struggling with and dealing with." Certainly, women concerned with osteopenia and osteoporosis are now considering integrating Complementary Medicine into their protocol to prevent and treat these debilitating problems.

A second class of drugs used to treat osteoporosis, selective estrogen receptor modulators (SERMs), has also been the subject of controversy on the subject of risk versus benefit. Evista (raloxifene) has been the subject of lawsuits, as the drug maker, Eli Lilly, failed to disclose that their own studies showed that Evista induced ovarian cancer in rats and mice at well below therapeutic level, which was confirmed in a University of Southern California study in 2001. As time has gone on since the introduction of SERMs, a long list of serious side effects and risks has emerged, including a significant risk of thromboses and clots causing strokes and heart atttacks, glaucoma, chronic muscle and joint pain, and driving of endometrial and other cancers. Noncompliance due to these side effects and risks is now common. Another drug created due to these negative warnings and lawsuits is a type of estrogen specific called Actonel, which affects estrogen calcium regulation. Of course, other estrogen specific drugs, called hormone replacement therapy (HRT), were used for quite some time until the Women's Health Initiative brought forth proof from long-term studies that HRT actually could cause or worsen osteoporosis. Scientific studies in recent years has also found that the common prescription of calcium supplements with Vitamin D were not effective, and in fact probably caused a large number of women to experience urinary or kidney stones, gallstones, and calcium deposition in joint tissues related to arthritis and frozen shoulder syndrome.

Because of the negative consequences and poor efficacy of these various pharmaceutical treatments of osteoporosis, a new drug strategy is now emerging. Studies in recent years have demponstrated that serotonin, which is largely produced in the tissues of the intestinal system, plays a key role in calcium regulation and bone maintenance and formation. This is the apparent reason why selective serotonin reuptake inhibitors (SSRIs) come with a significant risk of osteoporosis with long term use. Pharmaceutical companies are now introducing drug therapy that would inhibit the production of gut-derived serotonin as a therapeutic protocol for the treatment of osteoporosis. Hopefully, the patient population, as well as their physicians, will question the logic of this approach, and not just succumb to announcements that these drugs appear to have few immediate side effects. Serotonin in the intestinal system has a broad array of effects and is important to the healthy function of the individual. This chemical is not just an inhibitor of bone formation, obviously, and to suggest that serotonin is a harmful agent in the body is ridiculous. Upsetting the natural serotonin homeostasis in the body will come with a wide variety of negative effects over time. Supporting the natural homeostatic mechanisms that support bone health and maintenance will have only positive effects.

The need for a thorough holistic approach to osteoporosis, a disease that most certainly entails a complex and multifactorial cause

The problem with these allopathic pharmaceutical therapies is that there is no holistic approach to reestablish healthy hormonal balance and regulation, and without healthy hormonal regulation of calcium, Vitamin D3 prohormone, and other related systems, the woman does not establish a proper metabolic environment to utilize dietary calcium, Vitamin D, and to establish the necessary hormonal feedbacks needed to maintain healthy bone. Since estrogen receptor imbalance is not only related to osteoporosis, but also to breast cancer, and joint tissue maintenance, etc., anything less than a restoration of hormonal and metabolic balance may not be effective, or wise, in the long run. In fact, the type of calcium in our bones, calcium hydroxyapatite, is also the type of calcium that collects in atherosclerotic plaques in our arteries. Simply taking a lot of calcium pills without correcting the underlying health problems has been shown to cause formation of urinary stones and calcification in both joints and arteries. Poor regulation of the calcium metabolism can lead to a variety of devastating health consequences, and it cannot be emphasized enough that a comprehensive and holistic treatment approach is necessary.

How the patient and their standard physician, or medical doctor, assesses this complex subject and establishes a healthy overall treatment protocol is vitally important. For example, the 1999 study of Raloxifene (Evista), a selective estrogen receptor modulator (SERM), showed that women greater than 15 years postmenopausal could have a reduced risk of osteoporotic fractures of 3.5% with use. This drug now comes with an FDA black box warning that taking raloxifene may increase the risk of developing blood clots in the legs and lungs, stroke, and heart attack, and commonly causes hot flush, leg cramps, swelling of the ankles and feet, joint pain, unusual sweating, and insomnias, with difficulty falling asleep or staying asleep. Quality of life issues, as well as individualized assessment of risk versus benefit needs to be discussed. Even with use of Evista or other SERM, the patient still fits into a category of osteoporotic risk where nearly 7 percent of the female patients experiences osteoporotic fractures of the spinal vertebrae and head of the femur at the hip. Taking the drug does not remove all worry about this condition.

Integrating Complementary Medicine may add much to the overall treatment plan, helping to restore bone and joint health, hormonal balance, calcium metabolism, strengthen bone, improve circulation and reestablisment of the bone matrix, correct postural mechanics, and alleviate the side effects of pharmaceutical medications. Complementary Medicine may also help improve the cardiovascular profile to reduce risk of blood clot, atherosclerotic plaque, stroke and heart attack. The patient and their doctor need to discuss the reasons to incorporate Complementary Medicine or discourage it. There are obviously many reasons to incorporate, but perhaps the main reason to discourage this medicine in the treatment plan is purely a sense of economic competition for the health care dollar. This is not a good reason. While the medical doctor may complain that these treatments are not proven by long-term human clinical trials, and dismiss all of these treatments under the term acupuncture, as if the Licensed Acupuncturist only utilizes this one mode of treatment, this is a dishonest assessment. Of course, there is insufficient proof of the many efficacies from long-term human clinical trials, as these trials in the U.S. have not yet been conducted, yet there is abundant proof in a wide variety of scientific studies supporting these therapies today. Dismissing all of the TCM therapies as "acupuncture" is also misleading, as acupuncture is a term that applies both to the profession and to a specific therapy, and there are more than a dozen therapies under the scope of practice of the License of Acupuncture in California. With an honest assessment, the patient and their medical doctor will probably agree that it is smart for a lot of patients to incorporate, or integrate, Complementary Medicine into the overall treatment plan for osteoporosis, osteopenia, and avoidance of bone fractures and joint degeneration.

The Complementary Medicine physician is able to offer the woman a thorough and complete package of understanding, correction of underlying health problems, and a comprehensive treatment package, both for prevention and treatment. This holistic package of care is individualized and is not the one-size-fits-all approach that allopathic medicine offers. Of course, this medical care is more complicated than taking a single pill. Complementary Medicine is a medical approach for women who want to take a safe, comprehensive, pro-active, and thorough approach, rather than the I-don't-want-to-think-about-it-just-give-me-a-pill approach. This article is the first step in gaining understanding of the condition to effectively prevent or treat it in a pro-active manner, and to get the side effects that are beneficial, namely better overall health, instead of harmful side effects.

Types of Osteoporosis and an array of causes

While osteoporosis is an end result of various disease mechanisms in the body, a symptom, rather than a disease itself, modern medicine has tried to simplify diagnosis and typing. There are basically 2 main mechanisms involved, decrease in bone building or remodeling rate, called osteoblastic activity, and/or increase in bone breakdown, called osteoclastic activity. Since these are highly regulated in our bodies, they usually occur together, and the rate of osteoblasty is less than the rate of osteoclasty in osteoporosis. The 4 main types of osteoporotic syndromes are 1) deficiency of estrogens accelerating loss of bone calcium, 2) chronic acidity in the body stimulating excess need for calcium buffer and accelerating loss of bone calcium, 3) dietary deficiency of calcium and what we call Vitamin D3, which is actually a prohormone, which may create an increase parathyroid hormone response, accelerating loss of bone calcium, and 4) hyperparathyroidism, an often ignored hormonal problem at a subclinical level, that is often accompanied by subclinical hypothyroidism, adrenal insufficiency, and general hormonal struggle. Hyperparathyroidism leads to excess stimulation of osteoclastic activity, or breakdown of bone that exceeds rebuilding rate. For a great many aging patients, the chronic use of various pharmaceutical medications that inhibit absorption of nutrients such as calcium or create hormonal imbalances related to bone maintenance are the primary cause.

The subject of steroid hormone balance has been stubbornly ignored in this assessment of osteoporotic risk and pathology, though, especially the relative homeostatic balance of progesterone and estrogens. A virtual ban on significant publication of the role of progesterone and the role of the balanced ratio of progesterone and the three types of estrogen in the pathology of osteoporosis has been evident since the introduction of synthetic estradiol variants in pharmaceutical treatment, a type of therapy that can be patented, rather than use of natural phyotohormones and bioidentical animal extracts that are not able to be patented, and thus present no potential for large profit. We have seen the disastrous results from this, with numerous large studies clearly showing that unopposed synthetic estrogen in hormone replacement therapy (HRT) resulted in much harm, with high risks of cancers, osteoporosis, cardiovascular disease and other threatening pathologies, and the use of hormonal contraception likewise entailing such risks. A 2015 study at the University of Campinas School of Medicine and the Brazil Institute of Hormones and Women's Health, in Sao Paolo, Brazil, showed that long-term use of synthetic progestins, such as medroxyprogesterone acetate, was also highly associated with low bone mass and osteoporosis (PMID: 26098552). These synthetic progestins, called progesterone, are not human progesterone, though, and thus create these health problems over time, which have been completely ignored, especially in prevention of osteoporosis. Restoration of hormonal balance and limiting the use of synthetic hormones in contraception to shorter terms, especially less than 10 years of use, could have a major impact on the future risk of osteoporosis and fractures with aging. If increased risk factors are evident, such as the long-term use of hormonal contraceptives, the use of corticosteroids, or the use of immune suppressing drugs that come with increased risk of osteoporosis, and even the chronic use of stomach acid inhibiting drugs, restoration of hormonal balance and normal physiological production of steroid hormones with short courses of bioidientical hormonal creams and complements is especially important. If a history of thyroid and parathyroid imbalance, and/or low hormone Vitamin D level, is apparent, the use of CIM/TCM to restore these important metabolisms is also important. Both prevention and treatment are available with CIM/TCM help.

Osteoporosis is a multifactorial problem, meaning that a variety of causes usually contribute. Each patient may have a different presentation of causes, and must objectively examine these causes and work to correct them, as well as the underlying disease mechanisms that lead to osteoporosis. Lack of physical activity and weight bearing exercise is a major contributor. This is something that can be corrected by a simple change in daily lifestyle routine. Malnutrition of specific nutrients needed to remodel bone, and a diet that creates a gradual imbalance of necessary nutrients needed for bone remodeling, control of chronic acidity, hormonal functions, and tissue maintenance. Correction of the dietary problems may require some effort to fully understand, but simple changes in the daily diet are very important and effective. Postmenopausal hormone deficiencies and imbalances are another common cause and contributor, and we have learned that synthetic hormone replacement does not correct the problem, but merely relieves symptoms, while the problem of osteoporosis and increased risk of breast cancer and cardiovascular problems increase. Natural hormone stimulation and balancing with a Complementary Medicine and holistic approach is now backed up with much scientific evidence and study. Aging and decrease in growth factors are a contributing cause, and this is related to depressed hypothalamic function and hormonal imbalance. This contributor is more complicated to understand and correct, but is the subject of much research and professional understanding in recent years.

There are some major contributors to osteoporotic mechanisms that are easy to avoid in your diet. Excess consumption of soft drinks and other phosphate containing foods cause excess excretion of calcium, which binds to the phosphates to facilitate excretion. This causes the kidneys to excrete too much calcium from circulation, and increases the demand to draw more calcium from the bones. Also, excess phosphates will cause resorbed calcium in circulation to form calcium salts, which may accumulate in joint tissues, atherosclerotic plaque, and organ tissues in the kidneys, heart and liver, causing dysfunction. Of course, this could be a major contributor to the formation of urinary stones. High phosphate sources in the diet also include fruit syrup beverages, chocolates, candies, ice cream, skim milk powder, commercial baked goods, processed foods in general, especially processed chees, hot dogs, and lunch meats, baking powder, and commercially processed foods with emulsifiers, lecithin, and preservatives. Some foods that we may think are healthy, such as soy milk, and soy beverages, are also high in phosphates. Excess protein consumption, especially animal proteins, create excess phosphates and potassium, and the breakdown or proteins may cause excess nitrogen waste products that stress kidney and liver function. In addition, excess animal protein consumption may create too much arachidonic acid, and other acid-forming metabolites, that require increases in calcium to buffer and alkalanize.

General dietary deficiencies may also contribute heavily to osteoporotic mechanisms. Of course, a deficiency of usable dietary calcium may be a factor with some people, and more importantly, a standard diet that gradually creates an acidic environment in the body with aging has been shown to be a significant cause. Later in this article this subject will be more fully discussed. Calcium is more readily available from food than pills, and since calcium and magnesium are the backbone of chlorophyll, increase in dark green leafy vegetables is the most helpful dietary improvement that one could make. Calcium from milk and dairy may not be all that accessible, especially if the milk and dairy is from cows that do not graze on green grasses, since chlorophyll is the source of most calcium in the dairy products. Calcium from seaweeds may also be an excellent source.

There are many pharmaceutical drugs that contribute to increased osteoporotic risk. A Canadian study of 5000 patients greater than 50 years of age, found a 2.1 increase in bone fractures from falls associated with long term use of anti-depressant SSRIs (selective serotonin reuptake inhibitors). Many drugs also stress liver function by increased stress on detoxifying biomechanisms, and add stress to the hormonal regulation in the body. Increased stress for the liver may be associated with a metabolic marker associated with osteoporosis, high circulating homocysteine levels and low glutathione metabolism. A 2006 study by the University of Texas Medical School (see study link below), published in the Journal of the American Osteopathic Association, found that glucocorticoid prescription (e.g. Prednisone) was the most common cause of iatrogenic osteoporosis (secondary to normal medical treatment) but physicians did not routinely evaluate patients for osteoporosis when prescribing these drugs. Glucocorticoids are now widely prescribed for asthma, rheumatoid arthritis, inflammatory bowel diseases, autoimmune disorders, skin disorders, and other conditions. Patients prescribed synthetic thyroid hormone replacement are at increased risk of osteoporosis if the dosage exceeds the bodily needs, which may inhibit parathyroid hormone and increase loss of calcium from the bone. Anti-seizure medications, such as phenytoin (Dilantin) and carbamazepine (Tegretol etc.) come with warnings of potential osteoporotic risk. Anti-cancer therapies, such as the use of aromatase inhibitors in the treatment of breast cancer, and hormonal suppressant therapy in prostate cancer treatment, also come with significant risks of osteoporosis. Birth control, such as the Depo-Provera injection, have been found to increse osteoporosis risk with long-term use, and long-term use of the blood thinner Heparin also may increase the risks of osteoporosis. Understanding these risks is important to patients with other risks of osteoporosis when evaluating risk versus benefit in therapy. If these drugs need to be taken, Complementary and Integrative Medicine (CIM/TCM) may offer an array of therapies to decrease the risk of osteoporosis generated by the drug use.

High homocysteine levels and osteoporosis

High circulating homocysteine levels are an accurate marker for osteoporosis, as well as atherosclerosis, and are consistently found in patients suffering ischemic strokes and end stage renal failure. In addition, high homocysteine is a risk factor for diabetes, hypothyroidism, Alzheimer's, Crohn's disease, ulcerative colitis, and complications in pregnancy. Unfortunately, homocysteine levels in standard blood tests are still not being performed. Since high homocysteine levels are a marker for disease, not a cause, the simple taking of homocysteine will not correct the problem, and the blocking of homocysteine with an allopathic drug would not only not correct the disease mechanism, but would cause many health problems. The question is, then, what does this marker of disease tell us about what's wrong with us, and how do we correct this underlying imbalance that is related to osteoporosis?

When a metabolic imbalance is discovered that is a marker for a disease, this could mean that it signifies the cause, or it could mean that the cause of the disease causes both the disease in question and the imbalance that we see as the marker. High homocysteine in circulation relates to a variety of potential health problems. Homocysteine is a normal metabolite of the essential amino acid methionine, and is kept in balance in the body by easily converting back to methionine as the body needs it, as long as there are sufficient cofactors in the chemical processes, such as Vitamins B12, B6, B9 (folic acid), betaine, and, apparently, if low glutathione is not a problem. Homocysteine is an important chemical for our bodies but is not obtained from the diet. It's vital role in our bodies appears to be its function as a biological intermediate, providing bioavailability of the key chemicals that it converts to, methionine and cysteine.

High homocysteine is not linked to bone density, yet it is linked to osteoporosis. This is because high homocysteine is related to poor quality collagen, the material that creates the matrix for calcium hydroxyapatite and other minerals. What does this tell us about osteoporosis? It tells us that an allopathic pharmaceutical strategy to inhibit calcium from being pulled out of our bones may not be enough to actually reverse osteoporosis. If high homocysteine and poor collagen health is important, then this also must be addressed in the comprehensive treatment protocol. When we read medical websites, and research about homocysteine, this fact is never made clear. Instead, researchers continue to try, unsuccessfully, to link high homocysteine to a toxic process that causes osteoporosis. Why is the actual pathophysiological link not made clear? The only reason is that the truth does not fit into the purpose of the research, which is to find facts that support the sale of the pharmaceutical treatment.

One study, a placebo controlled human trial, the HOPE-2 trial, found that in patients with a prior stroke, supplementation with B12 and B9 folic acid lowered circulating homocysteine levels dramatically and resulted in an 80% reduction in fractures over 2 years. There was no difference in bone density between the placebo and vitamin groups, and no significant difference in the number of slip and falls. Instead, normalization of homocysteine levels in circulation with cofactors of biological conversion resulted in more bioavailable cysteine and better replacement of collagen matrix within the bones. The problem with weak bones due to osteoporosis and aging involves more than the level of calcium in the bones, and more than bone density. It involves a holistic process of bone maintenance and overall health. This requires a more comprehensive holistic treatment strategy, which allopathic medicine cannot deliver on its own. Allopathic medicine must integrate with Complementary Medicine.

High homocysteine relates to poor quality collagen matrix in the bones because homocysteine converts to cysteine, an amino acid integral to collagen production, elastin, and keratin. Homocysteine converts to either methionine or cysteine in the body as the body needs these amino acids. When we have nutritional deficiencies, or unhealthy metabolic processes in our body, there is poor conversion of homocysteine to these important amino acids, and hence, there are a variety of diseases. N-acetyl cysteine increases glutathione levels in the liver, kidney, lungs and bone marrow. In fact, cysteine, N-acetylcysteine, and methionine all play important roles in glutathione biosynthesis, and all three of these chemicals are converted from homocysteine as the body requires them. Glutathione is a key chemical that protects the liver from toxicity and damage. Liver toxicity is found, for instance, when a patient takes phenobarbitol for a seizure disorder, and the chemical bromobenzene stresses liver function, sometimes causing liver necrosis. Higher levels of glutathione have been found to be dramatically liver protective in these cases.

Glutathione is one of the most important peptides, or partial proteins, in our bodies. A peptide is made of a combination of amino acids, and plays important regulatory roles in cellular and membrane functions. Glutathione plays a number of important roles, including antioxidant activity, modulation of immune function, and detoxification of xenobiotics. Glutathione is synthesized in all mammalian cells, and thus plays an important role in the health of bone cells, especially as xenobiotics, or pollutant or drug chemicals not natural to the body, accumulate with aging. Researchers at the USC Liver Disease Research Center wrote in 1998: "Two of the major determinants of GSH synthesis are the bioavailability of cysteine, the sulfur amino acid precursor, and the activity of the rate-limiting enzyme, gamma-glutamylcysteine synthetase (GCS). In the liver, the major factors that determine the bioavailability of cysteine are the activities of the membrane transport processes of three sulfur amino acids, cysteine, cystine (under certain oxidative stress conditions) and methionine, and the conversion of methionine to cysteine through the trans-sulfuration pathway (homocysteine metabolism)." Restoration of this metabolism and providing healthy amino acids in the diet in aging, especially for the female, is essential.

While these metabolic processes are complicated and the explanation perhaps boring to most patients, the knowledgeable Licensed Acupuncturist can sort out these metabolic problems and utilize his or her medical knowledge and professional research to provide the patient with the most important comprehensive holistic treatment to prevent and reverse osteoporosis and protect the patient from debilitating fractures and vertebral microfractures that cause a variety of symptoms related to nerve irritation. The key point for the patient is that a holistic therapeutic protocol is important, and in fact, when this protocol is followed, the health benefits extend holistically to prevent other health problems and improve overall health. For example, glutathione levels generally decrease with aging, because of both increased need and decreased production. Glutathione is needed for carbohydrate metabolism and aids in the breakdown of oxidized fats that may contribute to atherosclerosis. Glutathione also helps to maintain the integrity of red blood cells and white blood cells. Direct glutathione supplementation is expensive and the effects are questionable, whereas supplementation with N-acetylcysteine is considered particularly effective to raise glutathione levels. A combination of N-acetylcysteine, L-glutamine, L-glycine and P5P is especially effective. Since excess supplementation with glycine may produce fatigue, it may be better to derive this amino acid from foods. Foods and herbs high in glycine include carob, watercress, cumin, coriander, sesame, and pumpkin seeds, peanuts, soy, chives, spinach, and a variety of beans, as well as asparagus and fennel.

Understanding Osteoporosis to correct the whole problem

Osteoporosis may occur due to a primary array of imbalances in the body, and is a multifactorial health problem. On the other hand, osteoporosis may occur secondary to a number of diseases or due to side effects and health problems caused by medications. Prescription of glucocorticoids, or synthethic corticosteroids, is considered the chief cause of secondary osteoporosis, and problems with the endocrine health, particularly the thyroid function and parathyroid health, are also significant causes of secondary osteoporosis. Endocrine imbalances in post-menopausal disorders are also a significant cause. No matter whether osteoporosis is primary or secondary to other health problems, or side effects, an array of dysfunctions are involved in the pathology, including body acidity, deficiency of the hormone that we call Vitamin D, excess of parathyroid hormone, deficiency of the thyroid hormone calcitonin, unhealthy collagen metabolism, and other factors. To maintain or restore bone strength it is important to become acquainted with the physiology of bone deposition and resorption.

Osteoporosis is a condition whereby bones become gradually porous and fragile due to diminished bone matrix. Bone matrix is the substance between the bone cells consisting of collagen fibers, ground substance or base material, and inorganic bone salts. The inorganic bone salts are what provide hard substance to make your bones strong and resistant to fracture. The inorganic bone salts are mainly composed of calcium hydroxyapatite, which ideally makes up about 70% of the matrix. Calcium hydroxyapatite is a calcium phosphate, Ca10PO4H02. Phosphates are molecules integral to cellular energy (ATP), as well as our genetic composition (DNA and RNA), and play a key role in buffer solutions (e.g. potassium salts) which control acidity. Calcium phosphate not only makes our bones strong but also plays key roles in most of our body systems. Demand for calcium salts, which is one of the chief buffering agents used in our bodies, may be integral to the creation of osteoporosis, and a chronic acidity in the body has been found to be one of the array of factors that promote osteoporosis.

Besides calcium hydroxyapatite, our bone strength is also dependent on collagen, the main connective tissue in our bodies, and a protein that makes up between 25% to 35% of total body protein. There are 29 known collagen types, made up of various amino acids, and collagen types 1 and 3 are found in the bone, as well as in repairing tissues, tendons, artery walls, and fibrocartilage. During the repair process, when bone is damaged, the body used collagen type 2 to create healthy collagen matrix, and then replaces this type of collagen with collagen type 1. Collagen type 1 is the most abundant collagen protein in the body. Vitamin C is cofactor in key enzyme functions that build this health collagen. Vitamin C deficiency is well known for causing various collagen diseases, such as scurvy. Collagen destruction may also occur in various autoimmune pathologies. Hyaluronic acid is a natural substance that hydrates and maintains health connective tissue, or collagen, and may play a beneficial role in maintaining bone health as well. Other mineral salts also deposit into bone, and strontium is now a widely used strong mineral that easily deposits into bone with the aid of certain herbal cofactors, and does not easily resorb from bone, making it a widely used therapeutic supplement to strengthen osteoporotic bones. To treat or prevent osteoporosis in aging, a number of therapeutic strategies can be employed.

While it has been assumed that oral calcium supplementation will increase bone density, scientifically, this is a rather naive and simplistic view. Calcium does seem to be at the heart of bone density regulation, and the hormonal regulation of calcium absorption in the gut, deposition into the bone, and reposition into blood circulation, controlled mainly by the parathyroid hormones, which are intricately tied to levels of circulating hormone D3 (the active product of what we mistakenly call Vitamin D, which is actually a prohormone), thyroid hormone, estrogen/progesterone balance, and other factors, is very important to a strong bone density. The important point to understand, though, is that this elaborate hormonal regulation is not specific to maintaining healthy bones, but the chief reason for this elaborate calcium regulation, is to insure proper levels of calcium ion in circulation. This is because calcium is a very large and very electrically charged molecule, or ion.

The reasons that calcium and other charged mineral molecules, or electrolytes, are so regulated in our bodies is interesting. Land animals evolved from aquatic forms that were surrounded by salt water, composed of much mineral salt, and when animals started migrating to land, they brought this saltwater, or mineral salts, with them, internally. Today, our body fluids are still composed of an electrolyte blend that is identical in mineral salt content with natural sea salts. While these electrolyte mineral salts, particularly the large molecule called calcium, are potentially harmful to our tissues and cells, land animals evolved uses for them, as well as elaborate means of protecting our cells and tissues from problems caused by electrolytes. Almost all of the calcium in our bodies is sequestered into bone to provide protection against excess calcium in our tissues and cells. Calcium ions in circulation are almost all bound to carrier molecules and proteins. When we take calcium supplements, we notice that the calcium is always combined with another molecule, usually a citrate, malate or lactate, which determines its use in our bodies. If you take a calcium supplement, the type of calcium you take is all important, and the question of whether your body is able to regulate the calcium intake properly is even more all-important. In women with poor calcium regulation, supplemental calcium salts may increase incidence of urinary stones, and tissue calcifications that lead to painful joint pathologies, atherosclerotic plaques, and diminished organ functions. If there is a question of hormonal deficiency, first address this problem before taking a lot of calcium pills, and never take poor quality calcium supplements.

The most common type of calcium supplement is calcium citrate, but this is not the best type of calcium supplement to prevent or treat osteoporosis for most patients. As far back as 1928, researchers knew that citrate inhibited calcification, while lactate and acetate did not. Calcification is the hardening of tissues, or noncellular material, by the accumulation of calcium and magnesium salts. Calcification of the bones make them stronger, while calcification of the joint tissues leads to stiffness and pain. Calcium citrate is thus a poor choice of calcium supplementation, although it absorbs more easily in digestion and assimilation than other forms of calcium. In the body, calcium citrate is naturally formed when calcium carbon dioxide molecules are combined with sodium citrate in the blood and intercellular fluids. Carbon dioxide (CO2) levels are dependent on the regulation of acidity, since plasma CO2 is a chief buffer in the body, regulated by the kidneys mainly, and also upon levels of oxygen and oxygen molecules, called oxidants, or free radicals. Thus, levels of calcium citrate are already dependent upon a number of health factors, and acidity in the body may inhibit deposition of calcium into bone by creating this type of calcium molecule. The elaborate biochemical system of calcium metabolism has made it difficult to determine what is the best type of calcium for each individual, and thus, simple taking of a calcium supplement is insufficient when considering proper health protocol in osteoporosis.

Parathyroid hormones appeared to act upon calcium in a manner similar to citric acid, creating a slightly ionized calcium molecule that is less likely to calcify. Calcification into bone occurs mainly with calcium carbonate and phosphate. Since a hormone is a simple molecule that acts differently on each type of receptor, parathyroid hormone also may create various processes in the regulation of calcium in the body, dependant upon the type of receptor, balance of receptors, and inhbibition by other hormones, such as thyroid hormone, estrogen, etc. The accumulation of calcium in the other tissues of the body, such as joint tissues and organs, occurs when there is too much circulating calcium, circulating calcium of the wrong type, especially highly charged calcium molecules that more easily attract to molecules in the tissues, and when an alteration of pH, or acidity, seems to cause precipitation of calcium salts in these tissues. The key point that we see when looking at the complexity of calcium regulation in our bodies is that there is no allopathic way to insure calcium health. Regulation of calcium in our bodies is dependant upon a quantum of factors, or interrelated and balanced array of metabolic factors.

Health experts are finally focusing upon acidity as a key factor, and perhaps the most important factor, in the array of health concerns that cause osteoporosis (refer to a 2009 New York Times article below in additional information). Various studies have found that a dramatic decrease in osteoporosis occurs in the elderly population when a more alkaline diet of fresh vegetables, alkaline fruit (such as figs, raisins, dates, blackcurrants, papaya, berries, pears), whole grains (lentils, amaranth, quinoa, millet, buckwheat), goat milk and cheese, whey protein, almonds, hazelnuts, green tea, herb teas, lemonized mineral water, stevia, and maple syrup, is observed, and acidic commercial cereals, granola, meats, cow's milk and cheese, cane sugar, and simple carbohydrates in the form of breads, pastries and pasta, are reduced dramatically. This is because many of us have created internal acidic environments in our bodies with a predominant meat and potatoes, or other type of acidic diet. Excess dependency on pharmaceutical drugs, poor kidney function, increased stress, and other health factors also contibute to an internal acid state. With a chronic acidic condition the body utilizes an excess of calcium to buffer acids. When calcium metabolism is poorly regulated, this excess need leads to greater osteoporosis. Measurement of acidity in the body is a difficult propositition. We can measure acidity in the urine, blood and saliva, yet our bodies may have adapted and show a generally acceptable level of acidity in these fluids, while the deep areas of acidity are generally unseen. Since acidity must be managed to survive, our bodies may be pulling excess calcium from the bone to maintain an acceptable level of acidity, and the measurements may reflect this, masking the real problem.

Hormonal mechanisms in bone maintenance and remodeling are complex. Because calcium is a large and usually a highly charged molecule, it must be tightly regulated in the body to avoid health problems. Simple taking of a calcium supplement will not result in increased calcium hydroxyapatite deposition in the bone. Since calcium is utilized by almost every cell and system in our body, maintenance of calcium levels in the circulation and in the tissues and cells is very important to our health. Since bone is the storehouse of calcium, our body depends upon healthy bone remodeling, and the balance of osteoblast and osteoclast cells and functions is extremely important to our overall health. The key hormones involved in this calcium regulation are calcitonin, parathyroid hormone, estrogens, leptin, the hormone Vitamin D, and active thyroid hormones. Hormonal balance is essential to healthy calcium metabolism and bone health.

How our bones remodel and repair

The long bones in our body are continuously replacing old bone with healthy bone. In osteoporosis, we obviously have a condition whereby this replacement of bone tissue and cells is not working well over a long period of time. By taking drugs that block calcium from exiting into our metabolism as we need it, we may stop the advanced deterioration of our bones, but do we really address the need to correct the problem of bone remodeling? To understand how this remodeling occurs, and to make correct choices in therapy, you need to know a little bit of bone anatomy and physiology.

Long bones are supplied directly with blood circulation, which carries nutrients for bone remodeling, only on the long shaft of the bone. The heads, or ends of the bones, are thicker, stronger, and have a less direct blood supply. The shaft of the bone is also covered with a membrane, called a periosteum, which is innervated and has a blood supply. At the ends of the bones there is no periosteum at the joint articulations, but rather a thin cartilage. This cartilage also has to continuously remodel, and when the cartilage does not remodel correctly, we have cartilage degeneration and joint pain and immobility. We now know that cartilage turns into the bone at the articulation, and that this calcification of cartilage is regulated by one of the D3 hormones produced by the kidneys. When there is a hormonal deficiency, or a kidney dysfunction, the cartilage will have trouble calcifying and turning into bone, and both the cartilage and the bone will deteriorate. The cartilage remodels in layers, with the softer upper layers remodeling as the lower layers calcify and turn into new bone. When the lower cartilage layers do not turn into bone efficiently, the upper softer layers are inhibited from remodeling. The end result is a degeneration of both the cartilage and heads of the bone. While allopathic medicine promotes a wait till it gets severe and get an artificial knee joint approach, most patients really would like to avoid this scenario. Restoration of healthy bone remodeling thus includes both attention to repair of the shaft of the bone and attention to the cartilage degeneration.

The long shaft of the bone is where the most direct blood circulation is achieved. This is where the body is able to extract most of the calcium phosphate and other minerals as needed. To aid the remodeling of the bones, one must insure that circulation along the long shaft of the bone is sufficient. This therapeutic protocol demands that chronic myofascial contracture, especially in the legs, low back and hips, is resolved, so that the circulation to the bones is not impinged. Myofascial release and a daily therapeutic routine of targeted stretch and exercise is necessary to achieve this goal. Weight bearing exercise has also been shown to be necessary to promote more bone growth and remodeling as you progress with correction of metabolic problems, hormonal regulation, and incrased circulation. The long shafts of the bones are covered with a membrane, or periosteum, and the periosteal bone under this membrane remodels also in layers, like the cartilage at the ends of the bones. Here, the periosteum forms new fibrous tissue under it first, composed mainly of collagen protein, or connective tissue, and then calcification of this tissue and bone formation occurs.

Even in a healthy individual, decreased circulation in the form of immobilisation, such as when an athlete has a limb placed in a plaster cast, results in quick and profound bone atrophy and osteoporosis. Weight bearing bone stress is also found to be an important factor, and astronauts suspended in a weightless, or gravity-free environment quickly experience osteoporosis. When there is a deficiency of bone stress and circulation, there is also a deficient feedback mechanism to incite healthy hormonal regulation. In like manner, when there is a deficient or imbalanced thyroid and parathyroid function, there is also a poor maintenance of bone health. When there is both a thyroid and parathyroid imbalance and lack of weight bearing excercise and poor circulation, osteoporosis cannot be avoided. A complete regimen of healthy activity, healthy diet, and a holistic restoration and maintenance of hormonal health is vital to prevention and treatment in osteoporosis.

A Holistic Course of Therapy in Osteoporosis Prevention and Cure

Each patient presents a unique individual set of health concerns that must be addressed to achieve a successful therapeutic approach. A knowledgeable professional that utilizes a package of therapies, such as herbal medicine, nutrient medicine and dietary advice, and acupuncture, provides a customized and practical protocol. The treatment suggestions listed here are just some of the well studied and evidence-based medical approaches available to the physician and patient. Of course, no single herbal or nutrient medicine is a cure, by itself, of osteoporosis, and a complete package of care is recommended. No herb, herbal formula, or nutrient medicine has been approved by the FDA, and very few of these medicines are even being evaluated by the FDA. The difficulties in designing human clinical trials of a comprehensive holistic protocol are great, and such trials in the present format, which is designed to evaluate safety versus efficacy of pharmaceutical medicines, may never be accomplished.

Diet and exercise are perhaps the most important part of the treatment protocol, and light weight-bearing exercise on a daily basis, sufficient chlorophyl-rich green vegetables in the diet, and healthy fats are the basis for a proper regimen. With CIM/TCM care, the use of bioidentical hormonal creams, especially progesterone stimulation and pregnenelone with monitoring of normal physiological levels and balance, is the most important therapeutic consideration, but should be used intelligently, and minimally, with the goal of quickly restoring natural innate production of steroid hormones, not replacement. A symbiotic array of therapeutic tools, with short courses of acupuncture stimulation, and a more persistent step-by-step approach with herbal and nutrient medicine that is individualized, is very important to achieve the best outcomes. The importance of soft tissue mobilization and deep tissue massage (Tui na) should not be overlooked as well, with many proven benefits both for hormonal balance and for decreasing stress on the frail bones.

  • Herbal Formulas: various companies formulate standard professional herbal formulas utilizing a combination of herbs that stimulate hormonal health, provide key nutrients, invigorate circulation, and warm the tissues by promoting a healthier metabolism. Research has found a variety of Chinese herbal chemicals that directly increase bone deposition, regulate bone calcium resorption, and inhbibit mechanisms that contribute to osteoporosis, and formulations are based on a wide variety of research findings. Below, I list a variety of know mechanisms whereby herbal and nutrient chemicals help treat the commplex disorders in osteoporosis. Various chemicals, such as triterpenoid saponins, which are steroidal chemicals bioidentical to plants and animals, act as building blocks to key chemicals that maintain bone health and hormonal regulation, and herbs chosen in high quality professional formulas may concentrate on these chemicals. Besides direct herbal therapy for osteoporosis, a variety of other strategies may be prescribed by the professional herbalist for the individual conditions. For example, other herbal formulas may be used to stimulate faster healing of bone and tissues if microfractures are suspected. Herbal formulas to stimulate improved kidney and liver function are also routinely prescribed, and as we see below in links to scientific studies, many of these herbs are proven scientifically to aid in osteoporosis therapy. Some of the herbal chemicals useful in the stimulation of improved bone health are best captured in alcohol and glycerite extracts. Phytoestrogen flavonols from the Chinese herb Gu sui bu, or Drynaria fortunei, have been found to be most potent in this regard, and a tincture of Drynaria, European Olive Leaf, and Gotu Kola may exert a significant benefit in both bone formation and tissue maintenance.
  • Strontium supplements: strontium is a mineral that is very similar to calcium and has been found to easily deposit into bones for this reason, acting like calcium to strengthen the bone matrix. Unlike calcium, the body does not easily resorb the strontium from the bone. Various herbs have been proven to increase strontium absorption and utilization, and are included in professional products. Health Concerns uses strontium carbonate and BioPiperine extract. Strontium has been used in medicine to treat osteoporosis since 1884, and recent studies at the Mayo Clinic and McGill University show significant increase in bone formation and symptom improvement. Other beneficial effects of strontium include improved neurotransmitter release and nerve function. Supplementation should continue for a year for full benefit.
  • Cholecalciferol D3: although originally called a vitamin, we now know that D3 is a prohormone, or hormone precursor. Cholecalciferol is the form of D3 that our bodies use to produce the D3 hormone that helps regulate bone deposition and resorption of calcium. Recent research has found that our bodies use D3 to aid many cellular functions, and double-blinded placebo trials have proven that cholecalciferol will decrease insulin resistance as well, indirectly aiding hormonal health in ways that will help the body to better maintain bone maintenance. Much of the normal population is deficient in circulating D3, which is normally produced via a process where healthy cholesterol is transformed to cholecalciferol in the skin via exposure to midday sunlight, and then processed in the liver, and finally in the kidneys. A healthy diet, with healthy fats and oils, exposure to 10 minutes of midday direct sun on the skin at least a few times a week, and healthy liver and kidney function are the best way to maintain D3 levels. Supplementation should utilize a high dose of quality cholecalciferol (4000 to 5000 IU) to be effective, and a simple blood stick metabolite test can be performed to measure active levels in the body. Poor quality Vitamin D supplement is of little use. Food sources from both meats and vegetables/grains provide some nutritional resource. Since this nutrient is essential to bone maintenance, it would be best to observe all of these protocols. Supplementation should continue for at least 6 months to restore levels if you suffer from a significant deficiency.
  • Essential mineral supplement formulas: while the goal is to get your body to deposit more calcium hydroxyapatite into your bone than it removes, an increase in various essential minerals to the body with aging helps in both direct and indirect ways to accomplish this goal. Care should be taken with purchase of supplements as quality and formulation is important, and many companies sell mineral supplement packages that are not well designed and are of poor quality. The problems with these supplements could be difficulty in absorption, untrue information on content since there is no regulation in the United States to speak of, and poor combinations of minerals. Intake of some minerals will inhibit absorption of others, and lack of some minerals will decrease absorption of another mineral. High quality professional products are sometimes costlier but provide value. These products come with much research guiding all phases of selection, preparation and combination. Advanced Essential Minerals from Vitamin Research is an example of a high quality product that combines minerals and mineral types in a scientifically sound product. Alkalanyzing potassium salt, Vitamin K, folic acid, potassium iodine, selenium, copper, manganese, chromium, zinc monomethionine, boron, silica, and molybdenum are combined with actual calcium hydroxyapatite (the calcium in bone). Coral calcium complex is popularly prescribed and includes a broad spectrum of natural minerals combined with cholecalciferol, boron, Vitamin C, and magnesium.
  • Calcium citrate-malate-carbonate and Magnesium combination: a proven form of calcium supplement to aid bone health includes elemental calcium in the form of calcium citrate, carbonate and calcium malate. Studies show that inclusion of magnesium in a 1:1 or 2:1 ratio may be very helpful to calcium absorption and utilization. Also, added nutrients may increase utilization, such as Krebs cycle intermediates, succinic acid, citric acid, and malic acid. Always take the supplements with calcium rich foods, such as dark green leafy green vegetables, nuts and seeds, if you want to acutally utilize this calcium instead of lose it in urination, or worse, see it deposit in your joints. While calcium supplements may be problematic for patients with hormonal deficiencies, and may be difficult for the body to utilize in bone deposition, the physiology of calcium in the body is so complex that we still do not know if these supplements will be beneficial and what form is best for each individual. Discussion of your individual case with a professional who is knowledgeable is recommended.
  • Calcium AEP (aminoethanol phosphate): besides being a bioavailable form of calcium phosphate (the type of calcium actually deposited in your bones), Ca-AEP is a proven supplement to aid hypothalamic function, and the hypothalamus is the control center of hormonal regulation. Ca-AEP also aids neurological health and function, which is essential in prevention of age-related neurodegeneration as well as improved muscle firing. Since hypothalamic function is essential to hormonal regulation of many systems in the body, this is very beneficial to the prevention of osteoporosis.
  • Collagen supplement and antioxidants: since collagen is a key component of bone and contributes to the health formation of new bone matrix and calcium deposition, taking a collagen extract may be essential to rebuilding healthy bone when bone density is poor. A complete therapeutic regimen, involving acupuncture, physiotherapy, hormonal stimulation and balancing, and correction of related health problems, should be utilized, and when progress is able to be made biochemically, inclusion of a collagen and antioxidant supplement could be essential for progress in creating new health bone. I suggest Collagenex by Health Concerns and the antioxidant Pomegranex.
  • Chemical nutrient strategies proven to aid in the treatment of osteoporosis are numerous and varied, and the array of chemicals and activities found in a single medicinal herb are also numerous and varied. This makes herbal and nutrient medicine complex and difficult to understand for the untrained individual. While pharmaceutical medicines are designed to accomplish basically a single chemical goal with a single chemical, nature has evolved a quantum of chemicals that work synergistically to solve health problems. The USDA Agricultural Research Service (ARS) Germplasm Resources Information Network (GRIN) lists these biochemical activities of plant medicines that serve to aid in the treatment of osteoporosis: hormone-balancing, increase DHEA-S, Estrogenic, phytoestrogenic, increase osteocalcin, osteoblast stimulant, osteoclast suppressant, increase Vit D bioavailability, incease Vit K bioavailability, increase Boron bioavailability, increase Calcium bioavailability, increase alkaline phosphatase, increase Manganese bioavailability, C-teleopeptide-inhibitor, decrease deoxypyridinoline excretion, and provide calcium, magnesium, boron, manganese, silicon, zinc, Vit D, and Vit K. Because of this complexity, research designed to prove efficacy and safety of simple pharmaceutical medicines is difficult to design and accomplish with herbal formulas. Professional herbal medicine utilizes a broad array of scientific information, both empirical and laboratory generated, to arrive at herbal formulas that work. Below are a few of the scientific studies proving efficacy of single herbs, but the wealth of data available on this subject is enormous.
  • Chinese herbs listed on the USDA ARS GRIN website to aid in the treatment and prevention of osteoporosis include, wolfberry (Gou qi zi), knotweed (He shou wu), privet (Nu zhen zi), white peony (Bai shao), Valerian, Gingko biloba, ginseng (Ren shen), licorice (Gan cao), siberian ginseng, moutan (Mu dan pi), kudzu (Ge gen), perilla (Zi su ye), astragalus (Huang qi), white mulberry (Sang bai pi), cinnamon (Rou gui), schisandra berry (Wu wei zi), wild yam (Shan yao), skullcap (Huang qin), coptis (Huang lian), magnolia (Xin yi hua), bupleurum (Chai hu), psyllium (Che qian zi), pearl barley (Yi yi ren), atemesia annua (Qing hao), Saint Paul's wort (Xi xin), balloon flower (Jie geng), ophiopogon (Mai men dong), magnolia (Hou pou), and many more. We see the benefit in regular consumption of common Chinese herbs and herbal formulas, even if they are not specifically formulated for osteoporosis therapy.
  • California native herbs listed on the USDA ARS GRIN website to aid in the prevention and treatment of osteoporosis include red clover, valerian, alfalfa, fenugreek, echinacea, goldenseal, black walnut, saw palmetto, devil's claw, hawthorn, self-heal, uva-ursi, elderberry, white willow bark, feverfew, butterburr, lemongrass, barberry, oregon grape, sarsaparilla, comfrey, black cohosh, club moss, and more. Once again, herbal intake in a variety of forms is helpful, and a professional herbalist can regularly prescribe herbs that will not only treat speciic problems, but help with general health and prevent osteoporosis.
  • Food therapy, or healthy diet, is essential in the holistic protocol. Calcium and magnesium are the backbone of chlorophyl, the green in fresh green vegetables. Lots of dark green leafy vegetables are highly recommended, such as collards and mustard greens. Foods that are listed on the USDA ARS GRIN website to potentially treat osteoporosis include: basil, oregano, thyme, dill, rosemary, tarragon, sage, cilantro, parsley, celery, carrot, pea, string bean, corn, artichoke, beet, parsnip, garlic, shallot, tomato, cabbage, dandelion greens, endive, cucumber, asparagus, spinach, okra, turnip, avocado, prickly pear cactus, ginger, tumeric, cumin, clove, nutmeg, anise, fennel, spearmint, peppermint, tea, pomegranate, grapefruit, cantelope, peach, plum, apricot, apple, pear, grape, plantain, coconut, strawberry, raspberry, cranberry, black currant, stevia, steel cut whole oats, amaranth, barley, chickpea, soybean, mung bean, black bean, black eye pea, black pepper, cayenne, horseradish, hazelnut, pumpkin seed, almond, walnut, cashew, flax seed, poppy seed, . Also, alkilinizing foods proven to correct chronic acid conditions and benefit in treatment of osteoporosis are listed above in the article. So, start expanding your diet with local fresh healthy foods, preferrably organically grown in nutrient rich soil.
  • Nutritional supplements, beyond those mentioned above, that are proven to help in various ways to prevent or treat osteoporosis include dried barleygrass powder, bitter melon extract, spirulina,
  • Vitamin B12, P5P (active metabolite of B6), and folic acid were found to be very effective in reducing osteoporotic hip fractures in a subset of patients with hyperhomocysteinemia. High homocysteine levels are now an accurate marker of risk for both ischemic stroke and osteoporosis. Supplementation with these nutrients for a prolonged course will significantly decrease homocysteine levels.

Information Resources: Additional Information and Links to Scientific Studies

NOTE: the citations below represent just a small amount of the current research validating herbal and nutrient therapy in the prevention and treatment of osteoporosis

  1. A May 9, 2012 review of the standard drug treatment guidelines for osteoporosis, with biphosphonates, was published in the prestigious New England Journal of Medicine, and clearly outlines the results of clinical studies, which show little of no benefit from biphosphonate use after 3 years, and in fact, fewer fractures reported from the patients switched to a placebo in a large, blinded trial. This cautious review states that "the emergence of safety concerns warrants consideration of new treatment algorithms for patients with osteoporosis.": http://www.nejm.org/doi/full/10.1056/NEJMp1202619?query=featured_home&
  2. An article reviewing the new 2012 FDA osteoporosis guidelines and revised label warnings on biphosphonate drugs in the New York Times, entitled New Cautions About Long-Term Use of Bone Drugs, May 9, 2012, reports that there is a serious concern that use of osteoporosis drugs after 3 years may lead to weaker bones in certain women, and no benefit is seen in large studies with long-term use. Researchers acknowledged that women with a diagnosis of osteopenia, often called mild osteoporosis by a treating doctor, are unlikely to benefit from long-term use, and that there is a lot of uncertainty regarding the incidence of serious adverse effects, still considered relatively rare, and the possibility of less serious adverse health effects: http://well.blogs.nytimes.com/2012/05/09/new-cautions-about-long-term-use-of-bone-drugs/?src=me&ref=general
  3. A current 2015 list of the U.S. FDA warnings for biphosphonate drugs used to treat and prevent osteoporosis: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm101551.htm
  4. The Mediterranean Osteoporosis Study (MEDOS) revealed in 1995 that about half of hip fractures in women over the age of 50 could be explained on the basis of reversible risk factors, and recommended that women be screened more effectively, and educated to changes in lifestyle, diet and health maintenance, to prevent osteoporotic fractures, rather than prescribing harsh drug therapy to all of these women. Physicians also need to exert more intelligent analysis to select women at higher risk: http://www.ncbi.nlm.nih.gov/pubmed/8592959
  5. A 1997 osteoporosis study in Japan found that high risk of osteoporotic fracture of the hip was associated with late age at menarche (first menstruation), having 5 or more children, excessive and regular alcohol intake, baseline low body mass index (BMI), and a diet low in calcium: http://www.ncbi.nlm.nih.gov/pubmed/9199997
  6. A 2015 study at the University of Campinas School of Medicine and the Brazil National Institute of Hormones and Women's Health, in Sao Paolo, Brazil, clearly showed that long-term use of synthetic progestins in contraception is strongly associated with low bone mass and osteoporosis. Shorter terms of use for these synthetic drugs commonly called 'progesterone', even though they are not natural progesterone, but a synthetic variant that disrupts normal progesterone feedback homeostasis, and use of therapies in Complementary and Integrative Medicine to effectively treat women who took these hormonal contraceptions for 10 years, are clearly warranted: http://www.ncbi.nlm.nih.gov/pubmed/26098552
  7. A 1999 osteoporosis study in southern Europe identified common risk factors for osteoporotic hip fractures in men, a followup to the 1995 MEDOS study. These significant risk factors included baseline low body mass index (BMI), low sunlight exposure midday, a low degree of physical activity, low calcium in the diet, and a poor mental score. Co-morbidities, or associated health problems included sleep disturbances, senile dementia, alcoholism, prior fractures related to bone fragility, gastrectomy, periods of sudden loss of significant weight, and previous stroke with hemiplegia. The study authors concluded that 54 percent of these osteoporotic hip fractures could be prevented with attention to BMI (weight), exposure to midday sunlight of just 5-10 minutes, decreased alcohol, coffee and cigarette consumption, and improved diet: http://www.ncbi.nlm.nih.gov/pubmed/10367029
  8. A 2004 study at Utah State University Department of Nutrition and Food Sciences showed that higher healthy protein intake in women and men aged 50-69 was associated with a reduced risk of hip fracture, but not in men and women aged 70-89. During these crucial years of postmenopausal and androgenic changes, a diet with increased plant proteins and possibly quality whey protein supplements, could supply the needed protein amino acid building blocks along with usable healthy calcium and magnesium, the backbone of chlorophyl in green vegetables: http://www.ncbi.nlm.nih.gov/pubmed/9199997
  9. A 2006 study at Utah State University Department of Nutrition and Food Sciences showed that improved antioxidant intake, especially of beta carotene and selenium, was associated with reduced risk of osteoporotic fracture in women and men over 50 years of age, with a greater benefit for those that were or had been regular cigarette smokers: http://www.ncbi.nlm.nih.gov/pubmed/16306312
  10. A 2002 study at Channing Laboratory, associated with Harvard Medical University, utilized an 18 year study associated with data from the comprehensive Nurses' Health Study, and found that a long-term intake of high Vitamin A retinols from supplements and foods may promote the development of osteoporotic hip fractures in women, age 34 to 77. The lipid vitamins in the Vitamin A category are numerous, and women taking a specific single Vitamin A supplement regularly, excluding beta carotene, had a 40 percent increase of osteoporotic risk fracture. Retinols in food include both plant based (e.g. beta carotene and pro-Vitamin A carotenoids) and animal based (retinols in liver and eggs). The conversion of beta carotene to active Vitamin A retinoids may be slow (21:1 conversion), accounting for the safety of beta carotene supplement and carrot juice. Beta carotene accumulation in the tissues has been associated with health benefits, perhaps supporting a healthier bioavailability of Vitamin A retinoids. Vitamin A supplements of about 10,000 IU per day present evidence of toxicity, and the body converts carotene into active Vitamin A retinoids and retinols as needed, whereas esterized animal forms of Vitamin A present a greater threat of toxicity and dysfunction: http:/www.ncbi.nlm.nih.gov/pubmed/11754708
  11. Causes of secondary osteoporosis are listed by the International Osteoporosis Foundation: http://www.iofbonehealth.org/patients-public/more-topics/secondary-osteoporosis.html
  12. A 2015 study at the Sun Tat-sen University School of Medicine, in Zhuahai, China, found that the well studied active chemical in a number of Chinese herbs, Curcumin, attenuated osteoporosis induced by glucocorticoid corticosteroid medications such as Prednisone: http://www.ncbi.nlm.nih.gov/pubmed/26884838
  13. A 2015 study at the Shanghai Jiaotong University School of Medicine, in China, showed that an active chemical in the Chinese herb Epimedium brevicornum, or Yin yang huo, called Icariin, prevented osteoporosis by modulation calcium homeostasis effectively: http://www.ncbi.nlm.nih.gov/pubmed/26221270http://www.ncbi.nlm.nih.gov/pubmed/26221270
  14. A 2009 New York Times article reveals research that finds a low-acid diet with reduction of meat and simple starches and high consumption of alkaline fresh vegetables to significantly prevent and reverse osteoporosis: http://www.nytimes.com/2009/11/24/health/24brod.html
  15. A 2003 study at the World Health Organization Collaborating Center for Public Health in Liege, Belgium, found that strontium supplement significantly strengthened osteoporotic bone and prevented fractures: http://www.ncbi.nlm.nih.gov/pubmed/12698204
  16. A 2006 study at the Xian Red Cross Hospital Department of Orthopedics, in Xian, China, found that boron supplement can increase stimulation of cone formation and inhibit bone resorption: http://www.ncbi.nlm.nih.gov/pubmed/17259120
  17. A 2003 study at the Kyungpook National University School of Medicine in Daegu, Korea, found that an alcohol extract of the Chinese herb Gu sui bu, or Drynaria fortunei, contained the most potent array of phytoestrogen flavonols to stimulate bone osteoblastic proliferation to alleviate osteopenia and osteoporosis in estrogen deficient women: http://www.springerlink.com/content/g4l53740554l0047/
  18. A 2003 study at the Catholic University of Daegu, in Gyeongbuk, South Korea, found that of 30 Chinese medicinal herbs studied, that an alcohol extract of Drynaria fortunei (Gu sui bu) proved most potent in treating post-menopausal osteoporosis, with proliferative effects much stronger than synthetic E2 (estradiol) and genistein: http://www.ncbi.nlm.nih.gov/pubmed/12967197
  19. A 2007 study at the University of Hong Kong Biomedical and Tissue Engineering Research Group found that extracts of both the Chinese herb Drynaria fortunei (Gu sui bu) and Curculiginis orchioidis (Xian mao) increased bone density, altering bone histomorphology and trabecular numbers by 10 percent when combined. Alcohol extracts were used, dehydrated and rehydrated with distilled water, and treatment lasted 5 weeks: http://www.cmjournal.org/content/2/1/13
  20. A 2013 study at The Hong Kong Polytechnic University found that the Chinese herb Drynaria fortunei (Gu sui bu) contains potent bioflavonoids that may be standardized, and that these active herbal chemicals, or bioflavonoids, exerted significant osteoblastic cell proliferation in laboratory animals, improving mineral bone density and bone strength at the femur, tibia and lumbar spine, and that these effects were abolished with co-administration of an estrogen receptor chemical agonist, showing that they worked via the estrogen receptor effects: http://www.ncbi.nlm.nih.gov/pubmed/23302510
  21. A 2010 study at the Hospital Universitario Reina Sofia, in Cordoba, Spain, found that chemicals in European Olive Leaf extract may reduce fatty deposition in bone that is associated with bone loss in aging and hormonal deficiency: http://www.ncbi.nlm.nih.gov/pubmed/20495905
  22. A 2008 study at the Shenzhen Research Institute in Hong Kong found that a Chinese herb Fructus Ligustri Lucidi (nu zhen zi) could improve bone density via direct action on osteoblastic cells by enhancement of mineralization: http://www.ncbi.nlm.nih.gov/pubmed/17764596
  23. A 2010 study at the Hong Kong Polytechnic University found that the common Chinese herb Epimedii (yin yang huo) is shown to regulate calcium balance and increase bone density in hormone deficient states: http://www.ncbi.nlm.nih.gov/pubmed/17764596
  24. A 2000 study at the Department of Endocrinology of Tianjin Medical University in China, found that the Chinese herb epimedium (yin yang huo) had a variety of biochemical effects to prevent and treat osteoporosis, including inhibition of an inflammatory messenger, IL-6, which contributed to increased regulation of calcium bone resoprtion in patients with chronic inflammatory mechanisms contributing to osteoporosis: http://www.ncbi.nlm.nih.gov/pubmed/11286030
  25. A 2010 study at Chubu University in Aichi, Japan, found that a chemical in the Chinese herbs Magnolia obovata and Magnolia officianalis (Hou pou, or Ko bou ku) has the ability to inhibit the progression of osteoporosis by attenuating bone resorption by disrupting actin rings in mature osteoclasts, via suppression of MAPKs, c-Fos, and NFATc1, which are protein regulators of cell proliferation, in a modulatory fashion: http:/www.ncbi.nlm.nih.gov/pubmed/20190414
  26. A 2013 study at the CSIR Central Drug Research Institute, in Lucknow, India, found that a chemical in the Ayurvedic herb Withania somnifera (Ashwaghanda) effectively stimulates bone formation, inhibiting a proteasomal pathway, exerting anabolic effects on bone, and other metabolic effects: http://www.ncbi.nlm.nih.gov/pubmed/23969857
  27. A 2006 study at the General Hospital of the Chinese Air Force in Beijing, China, showed that a common Chinese herbal formula to treat osteoporosis significantly improved bone density and hormonal regulation: http://www.ncbi.nlm.nih.gov/pubmed/17357560
  28. A 2014 study in China found that in laboratory animals, that electroacupuncture stimulation at just the one point commonly used to treat osteoporosis, DU4, on the lumbar spine, significantly improved the maximum load and fracture values, and the chemical signal bone morphogenetic protein-2 (BMP-2), when combined with pentatoic acid estradiol medication, enhancing these effects significantly over medication alone, or the control treatment. By improving hormonal balance naturally, with bioidentical hormone therapy and herbal/nutrient medicine, this type of combination therapy may prove to be very significant in future studies: http://www.ncbi.nlm.nih.gov/pubmed/24818497
  29. A 2007 study at the Fourth Military Medical University, in Xi'an, China, found that in a randomized, controlled clinical trial of laboratory animals with induced postmenopausal hormone deficiency and osteoporosis, that electroacupuncture at just 2 points, SP6 and ST36, resulted in normalized levels of estradiol, and improved bone density, over controls, and equaled the effect of standard medication: http://www.ncbi.nlm.nih.gov/pubmed/17580439
  30. A 2006 study at Mitate Hospital in Tagawa, Japan, utilizing a randomized controlled trial, found a 4-fold decrease in hip fractures in patients with hyperhomocysteinemia with supplementation with Vitamin B12 and folic acid: http://www.ncbi.nlm.nih.gov/pubmed/15741530?dopt=Abstract
  31. Medical definitions of the various lipoproteins are available from the free dictionary online: http://medical-dictionary.thefreedictionary.com/lipoprotein
  32. A study linking deficiency of HDL cholesterol to poor transport of testosterone and estradiol is seen here: http://humrep.oxfordjournals.org/cgi/content/full/21/9/2266
  33. Many websites now try to clearly educate the public about osteopenia so that the patients with this finding can make informed decisions on care and lifestyle and diet changes. The group osteopenia3 is one of them: http://www.osteopenia3.com/Cause-of-Osteopenia.html
  34. The FDA has issued a series of warnings of health risks with long term use of biphosphonate drugs to treat osteoporosis, although the exact physiological mechanisms of harm still elude researchers: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm229127.htm
  35. A March 2008 patient safety news alert warned physicians that biphosphonate use can cause severe and debilitating muscle, joint and bone pain that often onsets months or even years after starting the drugs and is often discounted as pain related to osteoporosis by prescribing physicians: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=73#3
  36. A NY Times Health article from October 13, 2010, reviews the FDA warnings of health risks associated with biphosphonate drugs used to treat osteoporosis: http://prescriptions.blogs.nytimes.com/2010/10/13/f-d-a-issues-warning-on-bone-drugs/
  37. A 2006 study of prednisone-induced osteoporosis by the University of Texas Medical School found that while this is the most prevalent iatrogenic cause of osteoporosis, prescribing physicians did not routinely evaluate patients for this adverse side effect. : http://www.jaoa.org/cgi/content/full/106/11/653/