Osteoporosis drugs questionmark

Some years ago I set up the Natural Progesterone Information Service to provide women with the latest news on natural hormones rather than synthetic ones such as HRT. One of the things that John Lee talked a lot about all those years ago was how in his opinion the biphosphonate drugs given for osteoporosis were actually weakening the bone rather than helping to build it. He had seen great results with women using natural progesterone to build bone density, though the medical profession did not accept that progesterone could work more effectively than the drugs. Now after all these years, more questions have emerged about whether long-term use of bone-building drugs for osteoporosis may actually lead to weaker bones in a small number of people who use them. Case reports show an unusual fracture pattern in people who have used bone-building drugs, the biphosphonates, for five years or more.

If you are taking such drugs please ensure you are also having regular bone scans to check your progess and it would be worth looking at your diet and natural supplements that can help build bone such as horsetail and silica. If you would like information on natural progesterone for osteoporosis and HRT replacement (I no longer have any connection with the service since I gave up running it) you can obtain a booklet from the Natural Progesterone Information Service, tel: 07000 784849 or visit their website at www.npis.info.
Wellspring Trading in Guernsey also have an excellent free booklet on natural progesterone cream which is written by my good friend and colleague, Dr Shirley Bond – a private GP who specialises in hormone therapy for women. Wellspring’s telephone number is – 01481 233 370.

Progesterone’s role in mental health

Last week I talked about testosterone and this week there is more news on the hormone front – but this time about progesterone. This is one of the key reproductive hormones in women, but it also has a host of other functions; one of the most important being it’s effect on brain chemistry and function. Dr. John Lee, the American pioneer of natural progesterone usage for osteoporosis, once was quoted as saying famously said that if anyone in his family had a brain injury, he would slather them with progesterone cream. He said that over ten years ago, and as ever he was ahead of his time, as new research has vindicated what must have seemed a completely lunatic idea.

Sadly Dr Lee was not given the respect of his peers, but I was privileged to host several seminars for him in London and he was certainly one of the most generous and compassionate of men, as the many thousands of women who benefited from his research have proved. He has been vindicated on the brain chemistry front by a fellow doctor working in an ER department and who saw a lot of saw a lot of head injuries. He was curious about why brain injuries were worse in men than in women, and got approval to do a study in which brain injury patients were given injections of progesterone when they arrived in the ER. His research showed that those who received the progesterone did significantly better than those who didn’t and later studies have also shown the same result.

Around the same time, researchers discovered that progesterone was a key component of the myelin sheath that protects or insulates the nerves-so important in fact that progesterone is made in the myelin sheath. Other research showed that progesterone stimulates the brain’s GABA receptors, those feel-good, calming neurotransmitters. Now we know, according to this review paper, that “…progesterone has multiple non- reproductive functions in the central nervous system to regulate cognition, mood, inflammation, mitochondrial function, neurogenesis and regeneration, myelination and recovery from traumatic brain injury.” Furthermore, progesterone is everywhere in the brain: “Remarkably, PRs [progesterone receptors] are broadly expressed throughout the brain and can be detected in every neural cell type.”

Those who have experienced the mental fog of hormone imbalances – otherwise known as the ‘what did I come into this room for ‘syndrome – can now point to their brain and say, “It’s not me that’s confused, it’s my brain!”

Osteoporosis – Men at risk

For the first time, men over 50 are mentioned in new guidelines for prevention and treatment of osteoporosis issued in the USA by the National Osteoporosis Foundation. Menopausal women are usually considered the biggest risk group but the new guidelines have now been extended to both men and women. Traditionally a diagnosis of osteoporosis is rarely given for men, generally because it is not considered to be likely, but these new guidelines make it clear that this is no longer the case. If you are subject to more than the average falls and broken bones then it makes sense for everyone who may be at risk of osteoporosis to seek medical advice for a scan and treatment, whatever your gender.

Warning on Osteoporosis drugs

As the woman who set up the Natural Progesterone Information Service many years ago to alert women to the benefits of progesterone for osteoporosis I used to talk to lots of women who were on drug medication for their condition. I, and others, were concerned about the long-term effects of these drugs and just how effective they actually were.

Now according to a report in the January 19 2008 issue of the British Medical Journal it appears that pharmaceutical companies exaggerate the benefits and downplay the risks of prescribing osteoporosis drugs for women whose bones appear to be slightly weakened. This condition (osteopenia) is not full blown osteoporosis but the pre-stage and this new report says that pharmaceutical companies are pushing doctors to prescribe osteoporosis drugs for this group of women.

The problem with this is that women with osteopenia have such a low risk of experiencing fractures that taking osteoporosis drugs would provide almost no benefit. The study co-author Dr. Pablo Alonso-Coello, a family physician at Hospital Sant-Pau in Barcelona, contends that four studies that found benefits to giving osteoporosis drugs to women with osteopenia exaggerated those benefits.

Statistics can be tricky things, but Dr. Alonso-Coello gives the following example:

** The absolute risk of a woman with osteoporosis having a fracture in a given year might be 10 percent so the effect of an osteoporosis drug is to lower that risk by half, so the absolute benefit is a 5 percent reduction.

** But in women with pre-osteoporosis (osteopenia), the risk of fracture is very low, say 1 percent a year, so if you lower that by half, you go down to 0.5 percent absolute reduction.

One study cited in Dr. Alonso-Coello’s paper claimed a 75% relative reduction in risk of fracture. The absolute risk reduction was 0.9 percent, which, from a statistical perspective, means that up to 270 women with pre-osteoporosis would have to take osteoporosis drugs for three years to avoid a single fracture. Risks of Taking Osteoporosis Drugs These drugs are not risk-free and the pioneering work of the late Dr John Lee alerted many women to the potential hazard to their health they were risking by taking them. Just this month, researchers at the University of British Columbia and McGill University issued a warning on a class of osteoporosis drugs (bisphosphonates) taken by millions of women around the world that can lead to bone necrosis, a painful and disfiguring condition. The U.S. Food and Drug Administration also issued an alert on bisphosphonates, including alendronate and risedronate, warning that these medications can cause severe bone pain.

Vitamin D reduces fall risk in older women

Australia is a country with no shortage of sunshine, but even there in the winter months there may not be enough to keep the body adequately supplied so you can imagine that the situation is even more pronounced in more northern climes. Sunshine is the main source of vitamin D, and one very specific element of that – Vitamin D2 – appeared to reduce the risk of falls, especially during the winter months. This is important news for women at high-risk, such as those with osteoporosis, and the simplest advice is to get as much natural sunlight as you possibly can, and make sure you have adequate amounts of calcium in your diet as that helps vitamin D to be best utilized by the body.

Approximately one-third of women over 65 fall each year, and if a woman has a vitamin D deficiency then she is at greater risk of fracture. Those women given a vitamin D2 and calcium supplement in a trial at the University of Western Australia had a 19% lower risk of falls compared with patients given calcium alone. The trial studied 300 women over the age of 70 living in Perth, Australia who had a history of falling in the previous year. Older people who fall frequently do tend to have more risk factors for falling, including greater degrees of disability and poorer levels of physical function, so supplementing with D2 is only one factor to be considered. Taking any one vitamin in isolation can cause problems so before you decide to supplement please talk first to a qualified nutritionist, or treat yourself to a couple of weeks in the sun during the darkest days of winter. If you can’t get away, then take advantage if every ray of sunshine you can find and get outdoors as often as possible.

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