Did you know that the first symptom of osteoporosis is a broken bone? Osteoporosis is now considered to be the second leading public-health concern to that of only cardiovascular disease. Morbidity and mortality from fractures increase by over 20% after a hip fracture. Did you know that most fractures occur in women with osteopenia, who have not been diagnosed with actual osteoporosis.
As we age, hormones that continue to increase are cortisol, FSH, LH, and parathyroid hormone known (PTH). Bone is active and alive metabolically and provides a storage system for the calcium within our body. This calcium concentration is in a steady equilibrium and governed by three very important hormones: parathyroid hormone from the parathyroid gland, calcitonin from the thyroid gland, and calcitrol from the kidneys. The most important of these three hormones is the parathyroid hormone. There are detectors within the parathyroid gland to monitor calcium. As our blood level calcium decreases, this triggers the release of parathyroid hormone which acts directly on the osteoclasts of our bone to release calcium into the bloodstream (known as resorption). Continual stimulation of parathyroid hormone on the bone will cause a reduction in the bone density and weakening of the bone. Calcitonin, on the other hand, will directly stimulate osteoblasts which builds bone.
Osteoporosis is also link directly to immunosenescence. Immunosenescence is a consequence of chronic immune system stimulation which produces inflammation in our body from pro-inflammatory cytokines. One way to measure this inflammation is with C-reactive protein. Studies show that there is an inverse correlation between levels of CRP and bone mineral density. As our hormones decline, inflammation begins to increase. This leads to an imbalance between bone formation and bone loss, resulting in the development of osteoporosis. Osteoporosis is a disease characterized by a reduction in bone mass, a reduction in the bone structure, and an increase in both bone fragility and in fracture risk. There is also a direct link between bone loss and the loss of muscle mass called sarcopenia. In fact, the impact of osteoporosis involves the loss of muscle, the loss of collagen, and the loss of bone. Recent studies involving individuals with muscle loss(sarcopenia), show that these individuals have the same or even greater fracture risk as someone with osteopenia. As we age, there is often a reduction in total energy expenditure. Along with reduced physical activity, there is a reduction in the basal metabolic rate. As caloric intake is maintained, a progressive decline in muscle mass will occur with an increase in fat mass. Although a person’s BMI may still be and the normal healthy range, the patient may actually have sarcopenic obesity. This is where the body mass may be preserved, but there’s a greater amount of fat and less amount of muscle.
New therapies in both the treatment and prevention of osteoporosis and osteopenia are encouraging. Bio-Identical Hormonal optimization remains foundational in the treatment and prevention of bone and muscle loss. The two greatest risk factors for developing osteoporosis are aging and estrogen deficiency. Estrogen has a direct inhibition of osteoclastic activity reducing bone resorption. Progesterone and testosterone are direct stimulators of osteoblasts and maintain and build bone. Certainly bio identical hormonal optimization as well as proper nutritional supplementation should be instituted at an early enough age to prevent both osteopenia and osteoporosis from occurring. Nutritional supplementation is also an important factor in both osteoporosis reversal and prevention. Vitamin D together with calcium helps protect older adults from osteoporosis. Vitamin D also helps maintain skeletal calcium balance. Boron is important in preventing in alleviating both osteoporosis and osteoarthritis due to its effects on calcium metabolism. Strontium, along with calcium, work together in calcium absorption which is important in both the prevention and treatment of osteoporosis. Strontium also stimulates the production of cartilage. Vitamin K is important in bone health as vitamin K facilitates the transport of calcium from the bloodstream into the bone. Individuals with low vitamin K have been shown to have increased circulating levels of osteocalcin. This has been shown to be associated with increased bone loss in postmenopausal women.
There is no doubt that the maintenance of our musculoskeletal system is vital as we age. Both bone loss and muscle loss have serious consequences not only in the quality of our life, but also in the morbidity and mortality associated with bone fractures. Bone mineral density testing through DEXA scans is highly encouraged and should be routinely checked in the management of your bone health. What is your fracture risk? By undergoing the proper osteoporosis diagnostic profile, you can find out and begin treatment before it’s too late.