Osteoporosis is a progressive skeletal disease characterized by a reduction
of bone mass, which can cause bone fractures and deformity. Osteoporosis affects
over 25 million people each year—80% of them are women.
Osteoporosis may be secondary to chronic liver or kidney disease, arthritis, or
malabsorption diseases, or caused by prolonged use of corticosteroids. Rare
forms include idiopathic or juvenile osteoporosis. Most common is postmenopausal
osteoporosis, where accelerated bone resorption is the result of reduced
estrogen, and involutional osteoporosis, characterized by the imbalance of bone
resorption and formation.
Most osteoporosis is caused by increasing bone resorption that is due to
decreased estrogen and progesterone production following menopause.
Additionally, women lose about 15% to 30% of their bone mass on average between
the age of 30 and menopause. Decreased testosterone in aging men accelerates
osteoporosis as well. Other causes include the following.
- Glucocorticoid and heparin use
- Renal failure
- Upper intestinal surgery
- Calcium, magnesium, and micronutrient deficiencies
- Low vitamin D intake and/or insufficient sunlight exposure
- Cushing's syndrome
- Anorexia nervosa
- Chronic heparin therapy
- Exogenous glucocorticoid administration
- Low calcium absorption (low gastric acidity)
- Long-term diuretic or antibiotic
- Age—25% of women at age 60 and 50% of women
at age 75 have vertebral fractures
- Caucasians, Asians more prone to the condition
- Thin women with history of amenorrhea and low body fat
- Smokers; regular alcohol or caffeine drinkers; people whose diets are
high in phosphates or low in calcium
- Family history
- Sedentary lifestyle or prolonged immobilization
- Nulliparous women
- Heavy metal toxicity
- Chronic broad-spectrum antibiotic use (destroys normal intestinal
flora, leading to malabsorption of nutrients and decreased vitamin K
|Signs and Symptoms|
- Periodontal disease—an early warning
- Loss of height
- Hunched back/spinal deformity
- Back pain
- Fracture without
- Malignancies (e.g., multiple myeloma, lytic metastatic
- Paget's disease
- Skeletal hyperparathyroidism
The patient with more established disease may have deformities (e.g., dorsal
spine, wrist) and typically appears hunched. Distribution of weight changes in
women with thickening in the waist and upper back and thinning of the hips and
breasts. Periodic measurements demonstrate loss of height.
- Urinary test—indicates breakdown of bone
- Tests identify secondary osteoporosis or underlying illnesses but are
normal with primary osteoporosis (e.g., serum calcium, phosphate, creatinine, or
- Serum assays of bone-specific alkaline, phosphatase, osteocalcin, and
C-terminal procollagen peptides help monitor effectiveness of therapy
- Thyroid function usually normal in primary forms of
- Decrease in cortical bone thickness and in the size and number of
trabeculae of the cancellous bone
- Biochemical indices of bone absorption are usually
- Lack of estrogen decreases bone density, sensitivity of bone to
parathyroid hormone (PTH), intestinal calcium absorption, and increases
calcitonin and osteoclastic bone resorption
- Decrease in 1,25-dihydroxyvitamin D (calcitriol, the active form of
vitamin D) causes lower calcium absorption and
Radiographic screening for bone loss may determine the need for treatment.
Early changes of intervertebral space and accentuation of cortical plates, and
late changes such as plate fractures, intervertebral compression, and deformity
will be seen on X ray. Current bone density does not predict future bone
- Quantitative digital radiography
- Single-photon absorptiometry of the forearm
- Dual-photon absorptiometry of the 2nd to 4th lumbar
- Quantitative computerized tomography and dual energy X ray
absorptiometry—measure cortical and trabecular bone and
total body bone mineral density levels
Risk factors are not diagnostic. Physical evidence may be present, and most
compelling. The most reliable diagnostic tools are imaging techniques.
A variety of pharmacological, hormonal, and phytomedicinal treatments slow
the effects of osteoporosis. Imaging must be repeated to insure adequate
treatment is being given. Diet and exercise, with caution as to any increased
mechanical stresses, may be essential to maximize treatment
- Estrogen—slows bone loss and fractures by
decreasing resorption, increasing intestinal calcium absorption, and lowering
renal calcium excretion. It cannot increase bone growth. Bone loss resumes when
treatment is stopped. Many practitioners advocate treating with the lowest
dosage possible. Estrogen use may be correlated with an increased risk of breast
cancer and uterine cancer, abnormal blood clotting, and gallbladder
- Conjugated equine estrogens (e.g., Premarin 0.625
mg/day)—most commonly used form; can cause metabolic
changes in the liver; contraindicated with obesity, smokers, high blood pressure
or cholesterol, varicose veins
- Estradiol—most easily metabolized,
delivering estrogen directly into the bloodstream; available in transdermal
patch (e.g., Estraderm, 1.0 mg/day of estradiol, 0.05 mg/day of transcutaneous
- Progesterone—enhances bone formation; may
potentiate estrogen, allowing for lower estrogen dosage (e.g.,
medroxyprogesterone, 2.5 to 5 mg/day; progesterone, 0.625 mg, such as Provera);
eliminates uterine cancer caused by estrogen therapy
- Calcium—1,000 mg/day for postmenopausal
women on estrogen and 1,500 mg/day for those not on estrogen; preserves cortical
bone mass, no effect on trabecular; taken early in life aids prevention; better
absorption if taken with meals; no known adverse effects up to 2,500
- Bisphosphonates (e.g., alendronate 10
mg/day)—alternative to estrogen; increases bone density
and reduces fractures (take upon rising with 8 oz. water; do not lie down or eat
for ½ hour); side effects: esophagitis, especially with overdose, abdominal
pain, heartburn, nausea
- Selective Estrogen Receptor Modulators
(SERMS)—estrogen-like effects with reduced breast
cancer risk (e.g., raloxifene, 60 mg/day); side effects: hot flashes or blood
- Vitamin D—increases intestinal absorption of
calcium and osteoblast activity (800 IU/day); take with calcium
|Complementary and Alternative
Nutritional and herbal support, in particular, can slow bone loss and enhance
absorption of essential vitamins and minerals. Weight-bearing exercise and
stress management should be part of any program.
- Eliminate refined foods, alcohol, caffeine, tobacco, sugar,
phosphorous (carbonated drinks and dairy products), aluminum-containing
antacids, and high amounts of sodium chloride (table salt) and animal proteins.
Sea salt, soy sauce, tamari, or kelp granules are preferable to table salt
because they contain many other trace minerals.
- Increase intake of complex carbohydrates, essential fatty acids
(cold-water fish, nuts, and seeds), legumes, and soy. Soy, although it has less
calcium than dairy, contains calcium that is more readily absorbed. Isoflavones
found in soy may inhibit bone resorption and increase bone-building activity.
Studies suggest 30 to 50 mg/day of soy to optimize bone mass.
- Dark berries (blueberries, blackberries, cherries, and raspberries)
contain anthocyanidins which help to stabilize collagen found in bone matrix.
- Mineral-rich foods, especially nondairy sources of calcium, should be
increased. Although dairy is a good source of calcium, it also contains high
amounts of phosphorus, which inhibits calcium absorption and increases urinary
calcium excretion. Nondairy sources of calcium, although lower in actual calcium
content, may provide more bioavailable calcium. Particularly beneficial are
almonds, blackstrap molasses, dark leafy greens, sardines, sea vegetables, soy,
tahini, prunes, and apricots.
- Calcium citrate or aspartate (1,000 to 1,500 mg/day) are the
preferred forms of calcium. Calcium requires sufficient stomach acid (HCl) for
adequate digestion and this is often low in the elderly. Calcium carbonate
buffers stomach acid and may not be the best form. Oyster shell calcium may
contain heavy metals or other contaminants and is poorly digested.
- Magnesium (200 mg bid to tid) enhances calcium uptake, is necessary
for hormone production, and is cardioprotective. Magnesium may actually increase
bone density and may be a more important factor than calcium.
- Vitamin K (100 to 500 mcg/day) is needed to produce osteocalcin, a
protein found in bone tissue that increases calcium uptake. Vitamin K is
produced by intestinal flora that may become depleted after antibiotic use.
Foods high in vitamin K include dark leafy greens. Vitamin K may interfere with
- Boron (0.5 to 3 mg/day) is needed for calcium absorption. Women at
high risk for breast cancer should use boron with caution as some studies
suggest that it increases estrogen metabolism.
- Manganese (5 to 20 mg/day) is a trace mineral that is often low in
osteoporosis. It helps produce the collagen matrix onto which calcium is laid
- Zinc (10 to 30 mg/day) is needed for normal bone growth. Copper (1 to
2 mg/day) is often low in osteoporosis and is needed with long-term zinc
- Chromium (200 to 600 mcg/day) should be used in patients with
unstable blood sugars. Poor glucose regulation is associated with increased bone
- Essential fatty acids (1,000 mg bid) are necessary for hormone
- B-complex (50 to 100 mg/day) reduces the effects of stress. Elevated
cortisol levels from stress increase bone loss. Folic acid (1 to 5 mg/day), B6
(100 mg/day), and B12 (1,000 mcg/day) should be taken for hyperhomocysteinemia,
which interferes with collagen
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
- Some herbs have phytoestrogen/progesterone properties. These can be
used to support hormone levels, which may minimize bone loss. Natural
progesterone may be more effective at increasing bone density than synthetic
progestins. It is important to note that natural progesterone may not be strong
enough to offset the risk of uterine cancer posed by conventional estrogen
replacement therapy. Other herbs can be used in osteoporosis to provide minerals
and enhance digestion. Liver support is also recommended to help with
metabolizing hormones and normalizing ratios. Chaste tree
(Vitex agnus cactus) and black cohosh (Cimicifuga racemosa) help
to normalize pituitary function. Chaste tree must be taken long term (12 to 18
months) for maximum effectiveness. Standardized black cohosh is commercially
available as Remifemin (one tablet bid) through Enzymatic Therapies. Use only
under physician supervision with hormone therapy. Re-evaluate after six months
- Black cohosh, licorice (Glycyrrhiza glabra), and squaw vine
(Mitchella repens) help to balance estrogen levels. Licorice is
contraindicated in hypertension.
- Chaste tree, wild yam (Dioscorea villosa), and lady's mantle
(Alchemilla vulgaris) help to balance progesterone levels.
- Tea brewed from nettles (Urtica diocia) is high in
- Kelp (Laminaria hyperborea), bladderwrack (Fucus
vesiculosus), oatstraw (Avena sativa), nettles, and horsetail
(Equisetum arvense) are rich in minerals and may also help support a
- Milk thistle (Silybum marianum), dandelion root (Taraxacum
officinale), vervain (Verbena officinale), and blue flag (Iris
versicolor) support the liver and may help restore hormone ratios. Taken
together as a tea before meals, they are slightly bitter and enhance digestion.
- Topical applications of natural progesterone may vary in the amount
of active hormone they contain. Usually composed of wild yam, the natural
progesterone sterols are converted in the laboratory to make them bioavailable.
Progesterone levels should be checked periodically with natural progesterone
use. Natural estrogen, an 80-10-10 mixture of estriol, estradiol, and estrone
also works well as a substitute for Premarin in doses of 2.5 to 10 mg/day. It
may have less carcinogenic activity for the uterus and
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve. A combination of homeopathic tissue salts such as
Calcarea carbonicum, Calcarea fluoricum, and Silica may be
helpful. Take as directed.
Acupuncture may be helpful in treating concurrent pathologies such as hormone
imbalances and poor blood sugar control.
Therapeutic massage may be beneficial in enhancing circulation and increasing
overall sense of well-being.
Patients with identified osteoporosis, after stabilization, are seen yearly
to assess and adjust therapy as necessary.
Fluoride treatments increase cancellous bone at the expense of cortical bone
(i.e., increases both bone density and bone fragility).
Thirty percent of women will not be identified with osteoporosis without bone
density tests, allowing initiation of treatment. Prevention of bone fracture is
key to osteoporosis treatment. Weight-bearing exercise before onset with proper
diet and increased calcium and vitamin D, as well as many factors listed under
"Drug Therapies" are actually preventive measures. Osteoporosis is thought to be
a teenagers' disease as this is when its onset takes root. Adequate
calcium/magnesium intake and proper nutrition, coupled with weight-bearing
exercise throughout childhood and adulthood are the primary preventive measures
Fractures, the most common complication, are a significant cause of debility
and death (e.g., 25% within a year of a hip fracture). Acute and chronic pain
can be disabling, and result in associated depression and
Osteoporosis will progress more rapidly without estrogen treatment but will
progress regardless. Nearly 1.5 million fractures result each year, often
causing chronic care status or death. In most patients, stabilization of
skeletal manifestations and reduced pain should be predicted with aggressive
The etiology is unknown for osteoporosis appearing during or just after
Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip
fractures in elderly women. N Engl J Med. 1992;327:1637-1642.
Chesney RW. Vitamin D. Can an upper limit be defined? J Nutr.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K
intake and hip fractures in women: a prospective study. Am J Clin Nutr.
Gaby AR. Preventing and Reversing Osteoporosis: Every Woman's Essential
Guide. Rocklin, Calif: Prima Publishing; 1995.
Goroll AH, ed. Primary Care Medicine. 3rd ed. Philadelphia, Pa:
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
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CommunicationsThis publication contains
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