By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

NON-HORMONE TREATMENTS CAN HELP THOSE AT RISK FOR OSTEOPOROSIS

Question: I’m a 56-year old woman who had been taking total hormone replacement therapy -- both estrogen and progestin. After the National Institutes of Health study results were announced, my ob/gyn took me off this therapy but did not switch me to a simple estrogen therapy. Since I’m 5’7” tall, thin and Caucasian, I’m at risk for osteoporosis. Are there other things that I can do to prevent this disease?

Answer: Physicians have prescribed hormone replacement therapy, or HRT, for the prevention and treatment of osteoporosis for many years. HRT can be estrogen alone or in combination with another hormone called progestin. As you said, the NIH did make a surprising announcement last spring that it was terminating early a 16-thousand woman HRT study on the combined use of estrogen and progestin. At that point, results were showing a significant increase in breast cancer, strokes and heart attacks among the women who were on estrogen-progestin therapy compared to those on other regimes. Once this was known, it was unethical to continue the study. A similar estrogen-only NIH study did not show these kinds of risks and is continuing.

Before we talk more about treatments, let’s “bone up” on some relevant bone facts. First, bones are not “static” structures. Your body constantly removes and replaces bone. Bone mass peaks around age 30 and begins to decline after 35. This is due to more bone loss than bone rebuilding. After menopause, the rate of bone density loss accelerates in women, but by age 65, men and women have the same rate of bone loss.
Over 28-million American women have osteoporosis. It’s five times more common in women than men and, as you point out, tall, slender, white women are at greater risk. This also holds true for women of Asian descent. Other risk factors are family history, smoking, sedentary lifestyle, overuse of caffeine or alcohol, never having children, and long-term use of medications such as steroids, anticoagulants and certain seizure drugs.

Conditions such as overactive thyroid (hyperthyroidism), chronic kidney failure, chronic liver disease, alcoholism, gastric bypass surgery and vitamin D deficiency can have osteoporosis as a symptom. Other diseases with this symptom include some cancers and congenital bone diseases.
Osteoporosis usually starts in the spine and pelvis and is easily diagnosed with a bone densitometry scan. This is similar to an X-ray, but it measures the density of the bones. This test will be recommended if you have such tell-tale signs as height loss or an osteoporotic fracture.

It’s possible to slow the progression of osteoporosis with calcium and Vitamin D supplements as well as regular weight-bearing exercises like jogging, stair climbing and walking. If you smoke, stop. Moderate your use of alcohol and caffeine.

Even though your doctor has determined that switching to estrogen-only therapy is not appropriate in your case, there are other medications that can be of benefit. These include bisphosphonates and selective estrogen receptor modulators (SERMs). Dietary magnesium and soy protein have also been shown to be helpful. Calcitonin and fluoride supplements are often used. Some additional drugs are being investigated and may be available in the near future. The best treatment starts in childhood with adequate intake of calcium and regular weight-bearing exercise, which is vital to bone building.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.