Overview

Osteoporosis and osteopenia are bone disorders in which the bone is weakened by demineralization. Osteopenia is a milder form of the disorder, and may progress to osteoporosis if not treated.

Diagnosis is made by a dual-energy x-ray absorptiometry (DEXA) scan (which is a highly correlated surrogate measure of bone strength). Osteopenia is defined as a bone mineral density T-score between -1.0 and -2.5, while osteoporosis is defined as a bone mineral density T-score below -2.5. (A T-score of -1.0 represents one standard deviation below the bone density of an average 30-year-old white woman). Although there is some radiation exposure during a DEXA scan, it has been estimated to only be equivalent to the amount received flying across the country (cosmic radiation exposure at crusing altitudes of about 5 miles up is somewhat higher than at Earth's surface).

Postmenopausal women and patients on long-term high doses of corticosteroids are most at risk of developing osteoporosis.

Osteoporosis presents a significant risk for bone fractures, most commonly in the proximal femur (hip), vertebrae (spine), and distal forearm (wrist) [ACE-AHFS, pg 395]. While most hip fractures are due to falls, most vertebral fractures result in increased kyphosis ("dowager's hump") and are due to routine activities such as bending or lifting light objects [Cooper1992].

Although good lifestyle and therapy can reduce the rate of progression, age related loss of bone mineral density is a natural part of aging. This loss occurs at a rate of approximately 5 to 10% per decade beginning in the third decade of life. If untreated, bone loss in women is especially rapid during the first five years following menopause [Snow-Harter1991].

Risk factors for developing osteoporosis include [National Osteoporosis Foundation 2008]:

Dr. Weyrich adds additional risk factors:

Complimentary and alternative treatments for osteoporosis that are considered below include:

Etiology

Bone health is affected by a balance between a number of hormones, including calcitonin, parathyroid hormone, estrogen, testosterone, progesterone, prolactin, corticosteroids, thyroid hormones, insulin-like growth factor I (IGF-I), growth hormone, and Vitamin D.

According to [Starr2005, pg 77], osteoporosis can result from either hypothyroid or hyperthyroid conditions. He writes:

Bones may become abnormally thickened and their infrastructure weakened due to hypothyroidism. After the patient is placed on thyroid hormones, the bones begin to remodel. Stronger, thinner bones gradually replace the weak infrastructure. The remodeling process may take as long as 6 or 12 months after an adequate dosage of thyroid hormones is given.
Note that Dr. Starr [and Dr. Weyrich] use basal body temperature and the patient's symptom picture rather than TSH levels to titrate thyroid supplement dosage. This may result in TSH levels being measured that are below the "normal" range, raising concerns among some practitioners that the patient's thyroid status has been over-corrected, and that the supposed hyperthyroid condition will aggravate osteoporosis. Dr. Starr reports that this is not the case in clinical practice, and cites additional studies that agree with this point of view [Starr2005, pg 78], [ Wenzel1992; Franklin1992], [Muller1995].

Diagnosis

The National Osteoporosis Foundation guidelines indicate that Bone Mineral Density testing should be performed on:

Other indications (that may be covered by Medicare for patients over 65 years old every 2 years, but are subject to revision due to government health care cost containment measures) include [ACE-AHFS, pg 401]:

According to the American Council on Exercise, "there is some controversy regarding whether the appropriate level of serum vitamin D needed for bone health is 50 or 80 nmol/L" [ACE-AHFS, pg 403].

Differential Diagnosis

Treatment

Complimentary and Alternative Treatments

Complementary treatments aimed at mitigating the side-effects of conventional treatments and optimizing the immune system response are often employed by naturopathic medical doctors, and supplement rather than replace conventional medical treatment.

Alternative treatments that replace conventional medical treatment are not approved by the FDA, but may be based on traditional or historical theories and practice. Their safety and effectivenes is considered unproven by conventional medical authorities, despite theoretical, anecdotal or historical evidence.

Since complimentary and alternative treatments are not generally proven by double-blind placebo-controlled randomized clinical trials, insurance typically does not cover these treatments, although medical savings accounts may possibly be used.

A general naturopathic approach is described below. Consult your doctor to adapt to your situation and to avoid interactions with prescription drugs:

Pharmaceutical interventions include [ACE-AHFS, pg 404]:

Exciting new sugical interventions have been recently introduced to treat stress (compression) fractures of the vertebral column, in which a special bone cement is injected into the compressed body of the damaged vertebrae. This treatment gives both increased bone strength [Steens2007] and pain relief [Afzal2007], [Steens2007]. Although the technique gives rapid and permanent relief, it is only applicable to freshly fractured bone [personal communication from Dr. Robert E. Gear, Jr.]. Unfortunately, many vertebral compression fractures are not immediately diagnosed.

Neurotransmitter Balancing

Neuro Research [Hinz2015] reports that chronic diseases such as Osteoporosis and Osteopenia can be benefited by balancing neurotransmitter and sulfur-containing amino acid levels in the body, particularly serotonin, dopamine, and cysteine, through targeted nutrition guided by lab testing. Dr. Weyrich has been trained in the Neuro-Research protocols and offers these nutritional protocols as a complement to other therapies.

Note that nutritional supplements and testing are not covered by most insurance policies, but may be eligible for payment out of Health Care Savings Accounts.

Hypotheses

Some practitioners recommend supplementation with strontium, which is chemically similar to magnesium and calcium. Dr. Weyrich has not evaluated the merits of this recommendation. Note that food-grade strontium supplements do not contain the radioactive isotope strontium-90.

ICD-9 Codes

ICD9-CodeDescriptionComments
733.00Osteoporosis NOS 
733.01Osteoporosis - Senile 
733.90Osteopenia 

References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

[ACE-AHFS] American Council on Exercise. "Advanced Health & Fitness Specialist Manual" Chapter 16: Osteoporosis and Osteopenia.

[Afzal2007] Afzal et al. (2007). Cited by [ACE-AHFS, pg 405].

[Bass1998] Bass et al. (1998). Cited by [ACE-AHFS, pg 406].

[Cooper1992] Cooper et al. (1992). Cited by [ACE-AHFS, pg 396].

[Franklin1992] J.A. Franklin et al. Long term thyroxine treatment and bone mineral density. Lancet 340:9-13 (1992). Cited by [Starr2005].

[Gaby1994] Gaby A. Preventing and Reversing Osteoporosis: Every Women's Essential Guide. Rockland, CA: Prima Publishing (1994). Cited by [Starr2005].

  • [Hinz2015] Martin C Hinz. Managing Relative Nutritional Deficiencies associated with the centrally acting monoamines (Serotonin, Dopamine, Norepinephrine and/or Epinephrine. Neuro Research Clinics. AMA Category 1 Continuing Medical Education seminar. September 26, 2015, Phoenix, AZ.
  • [Iwamoto2002] Iwamoto et al. (2002). Cited by [ACE-AHFS, pg 404].

  • [Kharrazian2010] Datis Kharrazian. Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Elephant Press (February 2, 2010). Amazon.

    Available from Amazon.

  • [Keen2007] Keen (2007). Cited by [ACE-AHFS, pg 404].

  • [Marz1999] Russell B Marz . Medical Nutrition from Marz, Second Edition. Portland, OR: Omni-Press (1999). Amazon.
  • [Muller1995] C.G. Muller et al. Possible limited bone loss with suppressive thyroxine therapy is unlikely to have clinical relevance. Thyroid 5(2):81-87 (1995). Cited by [Starr2005].

    [National Osteoporosis Foundation 2008] National Osteoporosis Foundation. "Osteoporosis: Can It Happen to You?" (2008). Washington, DC, 20037. Cited by [ACE-AHFS, pg 397].

    [Paul1988] Paul TL, et al. Long-term L-thyroxine therapy is associated with decreased hip bone density in premenopausal women. JAMA. 259(21):3137-3141 (1988). Cited by [Starr2005].

    [Ross1991] Ross DS, et al. Serum osteocalcin in patients taking l-thyroxine who have subclinical hyperthryoidism. Journal of Clinical Endocrinology and Metabolism. 72(2):507-509 (1991). Cited by [Starr2005].

    [Rossouw2002] Rossouw et al. (2002). Cited by [ACE-AHFS, pg 403].

    [Sambrook2006] Sambrook & Cooper (2006). Cited by [ACE-AHFS, pg 403].

    [Snow-Harter1991] Snow-Harter & Marcus (1991). Cited by [ACE-AHFS, pg 397].

  • [Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic Columbia, MO: Mark Starr Trust (2005). Amazon.

    Updated 2011 added: Hashimoto's & Grave's diseases.

  • [Steens2007] Steens et al. (2007). Cited by [ACE-AHFS, pg 405].

    [Wenzel1992] K. Wenzel. Bone minerals and levothyroxine. Lancet 340:435-436 (1992). Cited by [Starr2005].