Osteoporosis – Part 2
Hello, this is Dr. Ellen. In last month’s ‘Real Common Sense’ newsletter, I wrote about an increasingly prevalent and problematic health issue that affects us, especially as we get older … osteoporosis. The progressive thinning of bone leads to an increasing risk of pathological fracture, which can result in pain in the region affected as well as functional impairment and decreased quality of life. In the case of hip fracture, the resulting immobility may lead to severe adverse effects.
In this month’s newsletter, I will go over some of the approaches that have been employed to address the bone pathology and the resulting fragility caused by osteoporosis. This will include an overview of the most commonly used pharmacological 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.
Before I continue, I want to add information about the DXA scan used to evaluate bone to help diagnose osteoporosis. Its results are accurate, but its interpretation is somewhat arbitrary regarding its ability to predict the likelihood of a pathological fracture. A trabecular bone score (TBS) looks at the findings of the DXA scan that reflect the bone’s microarchitecture, thus enhancing the assessment of bone health.(1) Also of note, a new tool was just developed in Japan for predicting the risk of falls of community-dwelling older adults; this may become another means to help determine the optimal treatment for those with osteoporosis.(2)
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’.
Pharmacological Interventions
Estrogen treatments have been offered to postmenopausal patients to alleviate hot flashes and night sweats as well as to prevent and treat osteoporosis. However, trials done 20+ years ago found increased risk of significant adverse effects, including coronary heart disease, stroke, venous thromboembolism, and an increased likelihood of invasive breast cancer. This led to a shift away from their use, making them a second-line treatment for osteoporosis for postmenopausal women after bisphosphonates (see below). Selective estrogen receptor modulators such as tamoxifen (Nolvadex) and raloxifene (Evista) have also been used for osteoporosis prevention and treatment. Unfortunately, they appear to be less effective than estrogen therapy and have their own possible adverse effects. In men, testosterone therapy may be used, but only when there is low testosterone production causing the osteoporosis.(3)
The primary class of medications used to treat osteoporosis has been the bisphosphonates, which work by inhibiting the action of osteoclasts, the bone cells that break down existing bone (as opposed to osteoblasts, which build new bone). The bisphosphonate drugs include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). They are most effective at reducing vertebral fractures, though statistically it takes treating 71 women to prevent just one woman from getting a vertebral fracture. And although no preventive benefit from bisphosphonates has been found for initial hip fractures, bisphosphonates may cut the risk of a second hip fracture, but statistically would require treating 91 people for 3 years to prevent one recurrent hip fracture. Unfortunately, bisphosphonates can cause two rare but severe side effects: osteonecrosis of the jaw (with death of bone tissue, exposed bone, and/or bone or sinus infection) and atypical femur fractures. When this became evident, there was a definite drop in the use of this class of drugs.(4) Another inhibitor of osteoclasts, denosumab (Prolia), has also been found to potentially lead to the same kinds of rare but significant side effects.(5) Romosozumab-aqqg (Evenity) works by blocking the action of a regulating protein of bone metabolism produced by osteoclasts; it also can lead to the rare but potentially severe side effects of osteonecrosis of the jaw and atypical femur fractures, and also can increase the risk of cardiovascular problems, including heart attack and stroke.(6)
Lifestyle Interventions
There are a number of modifiable risk factors that can predispose one to osteoporosis. Three of these are smoking, alcohol consumption, and excessive coffee drinking. Two other especially important lifestyle choices that can have a significant impact on bone health are physical activity and diet.(7) Being physically active refers to maintaining an active lifestyle which includes appropriate exercises. These can help slow down bone loss, especially in older adults. Prescribed weight-bearing and resistance exercises can be incorporated into a regular routine, as can exercises aimed at balance training to help prevent falls (e.g., Tai Chi). Aerobic exercises such as moderate to brisk walking as tolerated can also have a positive impact. However, safe activities and exercises need to be accompanied by any individually necessary precautions, which need to be adhered to in order to prevent the risk of fractures. For example, avoidance of excessive spinal flexion (e.g., sit ups) or heavy weightlifting should be avoided, especially in those with severe osteoporosis.(3,8)
The other important lifestyle choices have to do with diet, which has a significant impact on bone physiology. It has been my experience that a whole food, plant-based diet is optimal for bone health. In fact, reducing meat in one’s diet reduces the risk of losing bone density. Animal protein may actually leach more calcium from the bones than is ingested. Interestingly, whole food plant-based diets protect against bone loss, thus tending toward lower rates of osteoporosis.(9) It is important to ensure an adequate intake of vitamin D, ideally D3,to allow adequate absorption of calcium (and, of course, adequate supplemental B12). On the other hand, there is some concern that calcium supplementation, long supported by many, may increase rates of heart disease and stroke. Preferably, individuals should obtain their calcium requirement from their diet, which is easily obtained through a well-balanced whole food plant-based diet, as are other vitamins and minerals including magnesium, potassium, and vitamins C and K.(4,9,10) Another nutrient, strontium, helps build new bone and reduce its absorption and is found in a number of plant sources, including Brazil nuts, root vegetables, unrefined wholegrains, spinach, and California-grown lettuce.(11)
Other Non-pharmacological Interventions
A number of complementary/alternative approaches may be useful in preventing or mitigating bone loss.(12) Soy products, black cohosh, and red clover contain phytoestrogens that may protect against bone loss. Other herbs that may be helpful include red sage, horsetail, thyme, and turmeric.(13) Melatonin, commonly used to help induce sleep, has also been shown to promote healthy bone cell growth. As mentioned above, Tai Chi helps reduce the risk of falling in older adults, and also can improve muscle strength and coordination. Also, acupuncture has been used in China to treat osteoporosis. One review concluded that acupuncture might be an effective adjunctive therapy for osteoporosis.(14) Additionally, some homeopathic preparations may be helpful for bone thinning. These include Silicea, Calcarea carbonica, Calcarea phosphorica, Calcarea fluorica, Phosphorus, and Natrum muriaticum.(15)
Ellen Cutler Method (ECM)
In my clinical practice, I have had many opportunities to use ECM energetic testing and clearing methods for those with bone thinning. This has been vital in achieving the greatest benefit for those with osteoporosis, helping determine the optimal non-pharmacological interventions for each individual. My ECM testing usually finds that most are best off with a well-balanced whole food plant-based diet. That benefit is reinforced by taking a full spectrum digestive enzyme. I usually recommend Dr. Ellen’s Way ‘Digest Supreme’ at the beginning of each meal. Taking digestive enzymes with mineral-rich foods such as greens enhances the minerals’ absorption. As an alternative, I sometimes recommend using Dr. Ellen’s Way ‘G.I. Calm’ for those with gastrointestinal complaints. Another supplement that my testing usually finds helpful is Proenzol ‘Bone Matrix’, which is also taken with meals. It contains a combination of vitamins, minerals, phytonutrients, and digestive enzymes. Fortunately, many have seen improvement in their bone health using ECM’s individualized testing and desensitization.
Please be well, be healthy, but remember…
“A plant-based diet is more likely to produce good health and to reduce sharply the risk of heart problems, cancer, diabetes, osteoporosis, gallstones, and kidney disease.”
― T. Colin Campbell
Dr. Ellen
References:
- “Osteoporosis: New tests and new concerns about drugs” at https://drhoffman.com/article/osteoporosis-new-tests-and-new-concerns-about-drugs/
- “Development and validation of a prediction model for falls among older people using community-based data” at https://link.springer.com/article/10.1007/s00198-024-07148-8
- “An Overview of Osteoporosis Management” at https://lidsen.com/journals/geriatrics/geriatrics-05-04-181
- “Preventing and Treating Osteoporosis” at https://www.youtube.com/watch?v=JBmCkOcNGiw
- “Atypical femur fractures: current understanding and approach to management” at https://journals.sagepub.com/doi/full/10.1177/1759720X20916983
- “All About Evenity” at https://www.healthline.com/health/drugs/evenity#_noHeaderPrefixedContent
- “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
- “The 2024 Guidelines for Osteoporosis – Korean Society of Menopause: Part I” at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103071/
- “Eating less meat may help reduce osteoporosis risk, Cornell studies show” at https://news.cornell.edu/stories/1996/11-0
- “Are there any natural treatments for osteoporosis?” at https://www.drugs.com/medical-answers/natural-treatments-osteoporosis-3444574/
- “Vegans and Osteoporosis – Strontium, K2, and Vitamin D3” at https://www.thetastyvegan.com/blog/vegans-and-osteoporosis-strontium-k2-and-vitamin-d3/
- “Are there any natural treatments for osteoporosis?” at https://www.drugs.com/medical-answers/natural-treatments-osteoporosis-3444574/
- “The Best Herbs for Osteoporosis” at https://www.verywellhealth.com/herbs-for-osteoporosis-5206635
- “Acupuncture for Osteoporosis: a Review of Its Clinical and Preclinical Studies” at https://www.journal-jams.org/journal/view.html?doi=10.51507/j.jams.2022.15.5.281
- “Homeopathy for Prevention and Treatment of Osteoporosis” at https://homeopathytoday.net/homeopathy/homeopathy-for-women/item/42-homeopathy-for-prevention-and-treatment-of-osteoporosis
* 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.