Causes
Of OsteoporosisThere are a few risk factors worth mentioning: being elderly;
also, females are at a higher risk than males; lack of exercise, drinking too
many soda drinks, eating too much red meat, sugar and drinking too much coffee
and alcohol. According to Dr. Murray (Ref. 11) only 15 to 20% of all hip fractures
in postmenopausal women are due to osteoporosis. One third of women with hip fractures
have normal bone density measurements. The other risk factures that have caused
these fractures are listed in the table below. It may be that only one of these
factors is the cause of osteoporosis or of a fracture. However there could be
two or three factors that are the cause.
At age 90 about 50% of females have osteoporosis
whereas only 15% of males have it. One of the effects of smoking is to develop
osteoporosis and in women this also contributes to an early menopause, which is
in itself a higher risk (loss of progesterone production and less estrogen exposure).
High alcohol consumption such as the equivalent of more than 14 beer for women
and more than 21 beer for men per week are a risk factor for osteoporosis. This
may be also because of hypogonadism that is associated with heavy drinking leading
to lower testosterone production and lower progesterone production. For the same
reason hypogonadism from starvation (anorexia nervosa) or excessive athletic exercise
is also a cause of osteoporosis. There is a strong hereditary factor in about
2/3 of all cases, but this may be an inherent tendency to produce too little progesterone.
On the other hand Dr. Lee has tested bone mineral density in 70 and 80 year old
women on progesterone cream replacement and found that their BMD was not reduced
(Ref.10) turning the dogma of conventional medicine upside down that age would
be a risk factor for osteoporosis.
Osteoporosis is usually divided into
primary and secondary osteoporosis.
With secondary osteoporosis there is another primary cause as shown in the table,
which causes the osteoporosis. In other words, osteoporosis is only a symptom
of another underlying disease, which affects bone metabolism. Primary osteoporosis
means that this is the primary disease. Primary osteoporosis can be divided again
into two osteoporosis types, type I and type II osteoporosis (see table below,
modified from Ref. 1).
| Causes
of Osteoporosis | | Primary
Osteoporosis | | Causes: | Comments: |
| Type I | postmenopausal
(low progesterone, low estrogen in women) or with andropause (low testosterone
in men) | | Type II | senile,
possible lack of vitamin D utilization | | ideopathic
| age less than 50, possibly genetically
caused | | Secondary
Osteoporosis | | Causes: | Comments: |
| endocrine | hyperthyroidism,
hyperparathyroidism, hypogonadism, Cushing syndrome, diabetes |
| gastrointestinal | celiac
disease, partial gastrectomy, liver disease like primary biliary cirrhosis |
| rheumatological | ankylosing
spondylitis, rheumatoid arthritis | | cancerous | multiple
myeloma, bone metastases from cancer | | drugs | heparin,
corticosteroids, alcohol abuse | | other | small
frame, low BMI, conditions with poor balance and muscular weakness (MS, Parkinson's,
after stroke etc.) | Type I osteoporosis is due
to postmenopausal (or andropausal) bone changes. It occurs because of a lack of
progesterone and also estrogen in women or a lack of testosterone in males, affects
the ages of 50 to 75 and leads to fractures of the radius close to the wrists
(Colles' fractures) or the tibia (ankle fractures). Type II osteoporosis is the
senile type, occurs beyond age 60 and affects the femoral neck (hip fractures),
upper arm and upper tibia bones, the vertebral bodies and the pelvic bone. Interesting
to note that men have a mortality from hip fractures of 30% at the age of 75 years.
Women in that age have a mortality from hip fractures of only 9% (Ref.9). While in North America Premarin was given for menopause, in many
other countries including Europe some women insisted on bio-identical estrogen
replacement. These women were found to have only 50% of bone loss over the past
50 years, particularly when this was combined with bioidentical progesterone (Ref.8).
The real news is that the dogma of estrogen loss after menopause being the "cause"
of osteoporosis in post menopausal women, is not true. Papers published in the
1980's and early 1990's have shown that it is a lack of progesterone that is the
culprit: progesterone stimulates osteoblasts in the female and testosterone stimulates
osteoblasts in males, which leads to remodeling of bone all of our lives. Estrogen
slows down bone resorption by osteoblasts, the other cells in the bone that are
essential for bone remodeling. Dr. Lee has done a 3 year study in post menopausal
women where he checked their bone marrow density following progesterone supplementation,
estrogen supplementation and he also had a control group without any supplementation
(Ref. 10, p. 76).The progesterone group who was treated with bio-identical progesterone
cream had a 14% increase in bone marrow density, the estrogen group had a 3% increase
and the control group with no treatment lost 4% bone density. Dr. Lee concluded
that the cause of osteoporosis is a lack of progesterone production, which starts
already 5 to 10 years before menopause; other factors are poor nutrition and lack
of exercise. Unfortunately the synthetic hormones do not stimulate the cells involved
in the remodeling process of bone. Only
bio-identical hormones will stimulate the natural receptors of the osteoblasts
(building bone up)and osteoclasts (removing aged bone that would be brittle).
Women with osteoporosis need natural progesterone creams, men with osteoporosis
need natural testosterone creams. However, attention needs to be paid to the other
nutritional factors and to a regular exercise program. According to Ref.
9 the chief danger substances are sugar, salt, caffeine and alcohol. We are filling
our food baskets with empty calories and unknowingly deplete our food of vitamin
B12, folic acid, copper, zinc, magnesium, manganese and calcium. Excess cortisol
from stress in our lives, and lack of testosterone, estrogen and progesterone
all can contribute to osteoporosis. Vitamin D and calcium are important for normal
bone matrix formation. Cola beverages are the worst combination to ruin your bones
as there is sugar, caffeine and phosphoric acid in it. According to Ref. 9 sugar
depletes the body of calcium as it is excreted in the urine. Sugar also increases
cortisol levels, the stress hormone that it known to cause osteoporosis in excess.
High protein diets cause organic acids to accumulate in the body that are neutralized
(buffered) by calcium having been mobilized from the bone. Phosphorus in colas
is doing the same thing. Caffeine from colas, coffee or tea increases calcium
excretion in the urine that has been mobilized from bone and so does too much
alcohol. A healthy diet with fresh, unprocessed fruit and vegetables and whole
grains will protect your bones.
The anabolic effects of progesterone,
testosterone and growth hormone help build up bone via stimulation of the osteoblast
cells in the bone. With aging in the male and in the female the sex hormones decline
(menopause and andropause) and cytokines such as interleukin-6 will stimulate
osteoclast cells to destroy bone. It is only through careful saliva hormone test
analysis with subsequent replacement using natural bio-identical hormones that
the hormone balance can be re-erected and osteoporosis can be successfully treated
(balancing of osteoblast and osteoclast activity in the bone).
Here
is a link to a chapter that gives an overview of hormone
replacement in women and men. For more info on causes of osteoporosis
and an image
of osteoporotic bone click on the link.
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