Osteoporosis, defined as a reduction of bone mass or bone density, was long viewed as a disease unique to aging women, and has been treated primarily with conjugated equine estrogens (CEE) in hopes of mitigating the decline in endogenous female hormone levels that occurs during menopause (Leong 1998, Wylie 2010). Sadly, much of what conventional wisdom held true about osteoporosis turns out to be flawed; it is now clear that osteoporosis (like many age-related conditions) is not a disease with a singular cause affecting a specific population. Rather, it is a multi-faceted disease driven by a barrage of interrelated factors, and must be addressed as such for optimal prevention and treatment (Clarke 2010).
Today we realize that osteoporosis not only impacts the lives of women, but of men as well; fully one third of those affected by the condition are males (about 2.8 million of them as of 2011), and that number is likely to grow as the population ages (Cawthon 2011, Kawate 2010, Nuti 2010). Indeed, one out of every four men will sustain an osteoporotic fracture during their lifetime (Ahmed 2009). Conventional physicians have been slow to recognize the prevalence of osteoporosis in men; as a result the diagnosis is often delayed even more than it is in women, allowing the disease to progress to an advanced stage before it is detected. (Kawate 2010).
Scientific advancements have revealed that the etiology of osteoporosis stems not only from hormonal imbalances, but oxidative stress, elevated blood sugar, inflammation, and components of the metabolic syndrome as well (Clarke 2010, Confavreux 2009, Lieben 2009; Zhou 2011).
Overlooked by mainstream medicine is the critical role that micronutrients play in bone health. For instance, emergent research on vitamin K has attracted great scientific interest through the revelation of its involvement, along with vitamin D, in both bone health and atherosclerosis, a condition to which osteoporosis is intimately related (Baldini 2005, Abedin 2004).In fact, these two conditions can be thought of as mirror images of one another (McFarlane 2004, D'Amelio 2009). Osteoporosis is characterized by loss of calcium from bones, shifting them from their healthy hard state to a diseased state of softness. Atherosclerosis, on the other hand, is characterized by excessive influx of calcium into arterial walls, shifting them from their healthy flexible state to a diseased state of hardness. Insufficiency of vitamin K contributes to this unhealthy balance.
Similarly underappreciated contributors to bone loss in both men and women are advanced glycation end products (AGE’s); byproducts of high blood sugar. AGE’s interact with proteins in bone causing impaired mineralization and increases in the number of osteoclasts – bone resorbing cells. Moreover, AGE’s encourage vascular calcification by activating a specialized receptor called RAGE, which recruits calcium into vascular smooth muscle cells, leading to hardening of the arteries. This relationship between elevated blood sugar, osteoporosis, and atherosclerosis comprises a vicious cycle linking the conditions in a manner unknown to the majority of mainstream physicians (Tanikawa 2009; Franke 2007; Hein 2006; Zhou 2011).
Pharmaceuticals, such as Actonel® or Fosamax®, have shown limited success, and are associated with some potentially serious side effects including atrial fibrillation and osteonecrosis of the jaw (Jager 2003, Howard 2010). These drugs work chiefly by inhibiting the cells responsible for breaking down bone tissue, but neglect multiple other factors responsible for osteoporosis (Roelofs 2010, Varenna 2010). Although these drugs do increase bone density, poorly appreciated is that they disrupt the natural cycle of regeneration and resorption that is important for the strength of the bone (Abrahamsen 2010).
An integrative approach, based on the human body’s finely tuned relationship with its environment and the nutrients that support bone health, makes much more sense (Confavreux 2009, Hanley 2010). This realization has led to an awakening to the tremendous potential of nutrient and mineral supplements along with hormonal optimization in the prevention and management of osteoporosis. The myriad complexities of osteoporosis necessitate the need to integrate pharmaceutical, nutritional, and lifestyle interventions in order to maintain bone health into advancing age.