Osteoporosis

This page is in response to the many frequent questions I have received e-mail on regarding osteoporosis. These questions represent the most frequently asked questions and are not intended to be all inclusive.

1. What is the purpose of Hormone Replacement Therapy (HRT) and why is it recommended?

There are basically two hormones that are prescribed for HRT, estrogen and salmon calcitonin. These two hormones have different functions in the body. Estrogen helps to block the resorption of calcium from the bone into the blood stream. As women reach the stage of menopause their production of estrogen decreases. As the woman matures she will stop producing estrogen all together as her monthly cycles end. When this occurs, she is now set-up for loss of bone density as the resorption of calcium from the bone begins. (As a side note concerning the male patient, this same condition occurs when androgenic hormone production falls during the seventh and eighth decade of life.)

Calcitonin, on the other hand, is responsible for the absorption of calcium by bone. This hormone promotes the up-take of calcium from the blood by placing it into the boney matrix forming solid bone. This hormone is produced in the thyroid gland and is under hormonal control from the pituitary gland. As we age the function of the thyroid gland diminishes leading to a decrease in the production of calcitonin. In this case salmon calcitonin is usually given as a nasal spray to help increase the presence of this hormone in the blood stream and promote healthy bone growth.

It appears that the best results are achieved when these two therapies are combined. With this dual therapy approach the patient is given the hormone to prevent or slow down the resorption of calcium from the bones, and the hormone necessary to promote the absorption of calcium by the bones. Therefore, this approach helps to decrease the depletion of bone mass over time.

In addition to the previous two medications in HRT it is also essential for the patient to acquire vitamin D form some source. Vitamin D also acts like a hormone in the body. First vitamin D is produced from cholesterol in the skin by UV (ultra-violet) radiation and its photo-effect on cholesterol. This vitamin D precursor is next transported to the liver where it is converted into 25-hydroxy calciferol (vitamin D3) by the liver enzymes. After this step this new precursor is transported in the blood to the kidneys where yet another enzyme reaction occurs to make the final active product 1,25-dihydroxycholecalciferol (also known as vitamin D4).

Vitamin D is essential for the uptake of calcium from the digestive tract. Individuals with either liver or kidney dysfunction can have these enzymatic reactions disturbed thus also affecting the quality of bone produced independent of the other two previous hormones. In other words, if we can not get the calcium into the blood stream for deposition into the bone matrix, we will not have enough calcium for the bone. Bone acts as a depository for the calcium necessary to run the rest of our bodily functions such as muscle contraction.

2. How much calcium should I be taking?

The literature that I have read suggest that an individual should be getting about 1,000 mg (milligrams) of calcium per day. What is important here is that the dosage not lead to toxic signs and symptoms. Toxic signs of excess calcium include soft tissue calcification, polydipsia (excess thirst), polyuria (excess urination), headaches, tetany and others. Your Chiropractor should be able to monitor you for these and other signs of calcium toxicity.

3. I am taking Tums (registered trademark) as a supplement for prevention of osteoporosis. How often and how many should I be taking daily?

Unfortunately, this medication is not one I would recommend. I see two basic faults with the manufacturer and their claims that you need their product to prevent osteoporosis. The first problem that I see is that this product contains calcium-carbonate (chalk). In my opinion the above named product is not a practically good source of calcium. This particular form of calcium is not as readily absorbed in the gut as either calcium-oxalate, calcium-malate or calcium-citrate. If you want to take a calcium supplement look for combinations of these three forms of calcium, also expect to pay a higher price for these products since their manufacture is more expensive.

The second problem is one of necessity for this antacid. If the product is not needed to neutralize excess acid in the stomach, then the excess base will bleed over into the blood stream and raise the pH of the blood (make the blood more alkaline). This excess alkalinity needs to be decreased -since the blood has to be within a certain pH range for normal function. This decrease will have to occur in the kidneys. The kidneys will become taxed in their function and if they are already dysfunctional or have decreased function the harm of extra work may be detrimental.

In addition to this necessity is the aspect of when it is necessary to take this antacid. If the patient is taking the antacid to stop heartburn, the antacid is used to neutralize excess stomach acid. During this reaction, the calcium-carbonate structure is broken down by hydrochloric acid (HCl) in the stomach to produce water, carbon dioxide gas, chloride and calcium ions. While some calcium ion may be absorbed in the gut it is not one of the best nor most dependable sources of calcium -as stated above.

4. Explain more about the old age vs young age bone density.

Women reach peak bone mass at about the age of 21 - 25 years. That is to say that after the age of about twenty-five years the boney mass will not continue to grow. This bone mass must be adequate to supply the woman during her child bearing years and beyond into the postmenopause period. If there is adequate mass then the calcium supplements will be able to slow down the aging effects, but the aging effects will not cease. The individual will still continue to lose bone at the same rate as normal, but with more bone present these effects will not be as noticeable with time.

I like to use this analogy to explain what is going on. Suppose we have two buckets (bone) , one 2-gallon and the other a 4-gallon. Both are filled with water (calcium). We are filling both buckets with water at a rate of 1-gallon per minute, while at the same time we are draining both buckets at a rate of two gallons per minute. It would take about three minutes to drain the water out of the 2-gallon bucket and about four minutes to drain the 4-gallon bucket. What I am suggesting is that we should try to achieve the 4-gallon size of bone mass rather than the 2-gallon size, it takes longer to deplete the available calcium in the bone.

As I stated earlier, bone serves as a depository for calcium in the body. We, therefore, supplement our bodies in the later years not so much to add calcium to the existing bone as much as to supply calcium for other bodily functions. In this way we can save the calcium in the boney matrix for use by the bone. In other words, without HRT, we are supplementing calcium for daily living and saving the bone calcium for future use -if one chooses to think of it this way.

5. Are you saying that aerobic exercise is of no value in preventing osteoporosis?

Definitely not. I am saying that its value in prevention of osteoporosis is of questionable. Aerobic exercise is primarily a cardiovascular enhancement activity. I admit I have not read all the articles out there, but what I have seen indicates this to be true. As I stated in the article on osteoporosis, the primary types of exercises for prevention of this condition should be weight bearing exercises.

I am not advocating that all women -and especially not older women- should try to attain the physic of Arnold Schwarzenager or Lee Haney, but they all should practice GOOD COMMON SENSE weight lifting. We all need to get some sort of physical exercise. A good exercise program should include both aerobic and some weight training. I am not saying that we should go into the gym and try to squat 400 pounds on a regular basis, but we can go to a gym and do leg and hip extension, leg and hip flexion, arm and wrist flexion and extension exercises in MODERATION. It would be even more acceptable for the older woman to practice LIGHT WEIGHT-HIGH REP exercises.

DO NOT place the body at risk of injury to the bone and supporting structures in an effort to ward off the natural aging effects. Do Not risk an injury now to prevent osteoporosis later. And remember, as we all continue to age, the likelihood for all of us to develop osteoporosis increases, after all it is a normal process of aging. Taking steps to prevent or retard losses now and not waiting for the cure later is always the key to good health.

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