What is a person to do? Most of my patients are aware of the risks of bone fracture with aging. The statistics are indeed pretty frightening. Fractures in old age are the kind of thing that sends us to bed and from which we may never get up. Most women routinely get bone density testing and many of my patients know their “T-score” by heart. It is also my experience that many women are leery of the medications that are often recommended for women at risk of fracture.
Risks of Medications: The FDA recently issued a warning for the entire class of medicines most frequently used for osteoporosis, the bisphosphonates. Doctors and drug makers are debating the use of osteoporosis drugs, as discussed in this recent New York Times Health article. There appears to be an increased risk of fracture of the femur (although rare). The medications are complex to take because of the warnings and precautions regarding esophageal irritation. There is also a recent study suggesting these medications may double the risk for esophageal cancer. And there seems to be an increased risk for an unusual form of bone degeneration in the jaws, called osteonecrosis.
Think twice before starting a Medication: Given the risks of medications I strongly urge women to think through their options prior to taking one of these drugs:
1) First of all, get a good handle on your risks. A great resource is http://www.shef.ac.uk/FRAX/
2) Given your risk of fracture as assessed by this WHO calculator, consider your options. There are some really important factors that you can alter through life style change. Smoking, use of alcohol, use of soft drinks, exercise, and your weight influence your risks for bone fracture many times more powerfully than the risk reduction that you can make by taking a medication that has risks of its own. Make some lifestyle changes and unless your risk is very high for age-related bone fractures wait to see if you make a difference with these changes. You’ll benefit in many more ways than risk for fracture–you’ll decrease your risks for many other diseases as well.
3) If you are on a proton pump inhibitor try and get off it. These are the medications used to treat heartburn and impair calcium absorption. Most heartburn can be eliminated by changes in diet.
4) Consider nutritional supplements. These are by and large risk-free and have been shown, using double blind placebo-controlled studies, to reduce the risk of osteoporosis and fracture.
For those at Medium Risk:
o Make sure you get optimum amounts of vitamin D and calcium. I recommend Vitamin D3 and have your Vitamin D level measured. Adjust your dose to maintain a blood level of total Vitamin D higher than 50 mg/mL.
o Calcium. There is some current controversy about the best form and the optimum amount of calcium. More is not necessarily better. Ideally you should calculate your daily intake from all sources including diet and aim to get about 1200 mg/day
o My Recommendations: D3 1000 or D3 5000 depending on blood level (I’m starting all my patients on 2 of the D3 1000 until I see results) and Cal Apatite with Magnesium, 3 capsules a day with a healthy diet. Both of these are made by Metagenics.
For those at Elevated Risk:
o Add microcrystalline hydroxyapatite (MCHC) and silicon to the mix. Although the evidence for silicon is preliminary, it makes sense physiologically because of the known role of silicon in the body’s synthesis of collagen.
o My Recommendation: OSAplex by Xymogen one packet twice a day. I like the combination of ingredients in this product. Follow both your Vitamin D level and your T-score.
For those at High Risk: I urge you to undertake this protocol only under the supervision of a physician.
o If you consider yourself at high risk for bone fracture after taking the risk assessment tool mentioned above and if you have made lifestyle adjustments, there are some measures I believe are worth trying before taking a prescription medication.
o Ipriflavone has been shown with placebo-controlled studies to prevent bone loss and in some to increase bone density. It should be used with supplemental calcium and Vitamin D. Your physician will want to follow your Vitamin D level, your bone density T-score and your white blood cell count.
o In my opinion some women will want to consider low dose natural estrogen and progesterone. There is substantial evidence that adding estrogen to Ipriflavone decreases bone loss more effectively and in some women actually increases bone density. I do not believe estrogen should be given without progesterone. This decision would need to be made taking into consideration the now well-known risks of hormone replacement therapy. It is my opinion these risks can be minimized using bioidentical hormones, low doses and balanced progesterone. I believe that the combination of MCHC, silicon, Calcium, Vitamin D, ipriflavone, bioidentical estrogen would prove to be more effective and much safer than prescription medications for osteoporosis if that study were to be done.
o My Recommendations:
- Use this protocol under the supervision of a physician
- OSAPlex by Xymogen one packet twice a day
- Ipriflavone by Thorne Research, one capsule three times a day
- Discuss with your health-care provider the risks and benefits of adding bio-identical estrogen (and progesterone) in your specific situation
To your good health,