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Osteoporosis – Part 1

Hello, this is Dr. Ellen. In this month’s ‘Real Common Sense’ newsletter, I want to write about a problem that has become increasingly prevalent as our population ages. Osteoporosis results from a progressive thinning of bone. The major concern of having been diagnosed with osteoporosis is the risk of sustaining a pathological fracture, especially of the hip, spine, or wrist. They are called “pathological” fractures because they occur from an injury (which may not even seem to be an “injury”) that without the underlying bone being abnormal, would otherwise not have resulted in a fracture.

In next month’s newsletter, I will go over some of the approaches employed in addressing the bone impairment and resulting fragility caused by osteoporosis. This will include an overview of the most commonly used pharmacologic agents (as well as some of their potential adverse effects), lifestyle modifications, and complementary-alternative agents that can potentially help prevent worsening and ideally improve the structural integrity of bone.

By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Media’.


What is Osteoporosis?

As mentioned above, osteoporosis is a disorder causing thinning and increased fragility of the bones. There is a loss of bone density, which occurs because the bones lack both sufficient minerals and structural integrity. When the bones initially begin to show decreased bone density, but not to the degree that would qualify as osteoporosis, the condition is termed ‘osteopenia’. The word comes from two Greek root words that together mean a ’poverty of bone’. Osteopenia can be localized. For example, the bones of a limb that has been immobilized and not bearing weight can develop a disuse osteopenia. However, the osteopenia that would be a precursor to osteoporosis is generalized. It is estimated that over 40 million people in the US have osteopenia, which may worsen over time to become osteoporosis. Although less so than osteoporosis, one can still fracture a bone more easily after a minor injury than bone with normal mineralization.(1)

The word osteoporosis also comes from two Greek root words which combined literally mean ‘porous bone’. Osteoporosis is a significant bone disorder resulting in low bone mass, severely deficient bone mineral density (more so than with osteopenia), and deterioration of the microstructure of the bones. In the United States, approximately 10 million men and women suffer from osteoporosis. The bone fragility that results from osteoporosis dramatically increases the risk of fractures, which are most often seen at the hip joint in the neck of the femur, at the wrist/forearm, or of one or more vertebrae of the lumbar spine. More than 1.5 million fractures annually can be attributed to osteoporosis! Although osteoporosis is typically thought of as a disease in women, one-third of hip fractures occur in men. The lifetime risk of osteoporotic fractures for white men and women aged 50-years-old is 40% and 13.3% respectively.(2,3)

Most commonly, osteoporosis results from either estrogen deficiency (aka postmenopausal osteoporosis) or from aging (aka senile osteoporosis). Other predisposing factors include familial predisposition, Caucasian race, history of fractures in adulthood, dementia, and generally poor health. Osteoporosis can also occur secondary to certain medical conditions and specific medications, the latter including stomach acid-blocking proton pump inhibitor drugs such as Prevacid and Nexium, the other major class of heartburn drugs (the H2 blockers) such as Pepcid and Zantac, antidepressant and antianxiety drugs, oral corticosteroids, and antiepileptic drugs. Other modifiable risk factors include vitamin D deficiency (sometimes because of insufficient sun exposure), smoking, alcohol consumption, low calcium intake, deficient or excessive dietary protein, excessive consumption of coffee, and a sedentary lifestyle which can lead to a lack of mobility and reduced weight-bearing especially through the long bones of the lower limbs.(2,3,4)

Plain radiographs (standard x-rays) are not a reliable method for diagnosing osteoporosis, especially in its early stages. Both osteopenia and osteoporosis are most effectively screened and diagnosed using noninvasive dual-energy x-ray absorptiometry (DXA) scans. The advantages of DXA over other methods is that it is highly accurate, causes minimal radiation exposure, and is easy to use and interpret. Unfortunately, diagnosis of bone thinning is often delayed. For example, osteoporosis is often undiagnosed even after the first occurrence of vertebral fracture!(2,5)


The Health Concerns

The first manifestation of osteoporosis can be acute pain due to a pathological fracture. Vertebral compression fractures may first present this way but are often of a more insidious onset causing a persistent local back pain. Osteoporotic wrist/forearm fractures often occur during a fall, the person reaching out to protect themself. Hip fractures are also usually sustained after a fall. Similar to wrist fractures, they cause significant pain, but they usually result in even greater functional impairment. Hip fractures are associated with a 15-20% increased mortality rate within one year, higher in men than in women. Hip fractures also make the patient more susceptible to other diseases brought on by chronic immobilization. This includes pneumonia and thromboembolic (clotting) disease that can result in pulmonary embolism or stroke.(2,5)

In older individuals, osteoporosis can also cause chronic bone pain even without a diagnosed fracture, which can result in decreased functional capacity and quality of life in those affected. Mechanisms causing bone pain without an overt fracture in those with osteoporosis are poorly understood. One possibility is that the pathological remodeling of bone causes pathological modifications of the pain-signaling nerve endings in the bone. Another is that the pain results from ‘microfractures’ caused by the pathological remodeling of the bone in the symptomatic areas. This in turn would lead to the pain fibers in the bone sending sensory feedback to the central nervous system indicating tissue damage. If the pain becomes persistent, the peripheral nerves and subsequently the central nervous system pathways can become hyper-sensitized, which may then transition into a chronic pain syndrome.(6)


In Osteoporosis, Part 2 (Next Month)…

Having said all of the above, in the next newsletter, I’ll address some of the modalities used to help prevent, slow down, and even reverse the progression of osteoporosis. I have seen significant benefits in many patients over my years of practice, in particular with the individualized use of lifestyle changes and appropriate supplementation. I use the Ellen Cutler Method (ECM) in order to personalize each individual’s treatment plan, as well as to clear any sensitivities or reactivities the person has that may be impacting their current health circumstance and any interventions being used at that time.


Till then, please be well, be healthy, and remember…

Although approximately 80% of osteoporosis sufferers are women, as the longevity of the male population increases, the disease will assume increasing importance in men.”

Gro Harlem Brundtland (former Director General of the World Health Organization)

Dr. Ellen


References:

  1. “What Is Osteopenia?” at https://www.webmd.com/osteoporosis/osteopenia-early-signs-of-bone-loss  
  2. “An Overview of Osteoporosis Management” at   https://lidsen.com/journals/geriatrics/geriatrics-05-04-181
  3. “Preventing and Treating Osteoporosis” [May 2024] at https://www.youtube.com/watch?v=JBmCkOcNGiw
  4. “Osteoporosis-risk factors, pharmaceutical and non-pharmaceutical treatment” at https://www.researchgate.net/profile/Anna-Szymanska-Chabowska/publication/351703729_Osteoporosis_-_risk_factors_pharmaceutical_and_non-pharmaceutical_treatment/links/61094c4c1ca20f6f86fc9046/Osteoporosis-risk-factors-pharmaceutical-and-non-pharmaceutical-treatment.pdf
  5. “The 2024 Guidelines for Osteoporosis – Korean Society of Menopause: Part I” at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103071/
  6. “Pathogenesis and clinical aspects of pain in patients with osteoporosis” at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269137/

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, mitigate, or prevent any disease.

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