Calcium, Bone Health, and Menopause: What’s a Girl to Do?
In response to Caveman Doctor’s recent post on calcium, he has received several comments regarding calcium usage for menopausal women, as well as prescription medications that are often prescribed for menopausal women. Caveman doctor appreciates the fact that he is a CaveMAN, and the title of this post questions “What’s a girl to do?” However, Caveman Doctor has always been on the sensitive side of things and a momma’s boy, so he feels totally comfortable discussing this topic. If you have any issues, please contact his grandmother or cavemom.
Help I’m Menopausal!
Studies have shown that with risk of osteoporosis increases with menopause and undoubtedly your doctor has discussed this with you. There are likely may reasons why this shift in bone health happens with menopause, including decreased activity and weight bearing activities as well as changes in diet. However, the obvious target here is estrogen, which decreases markedly during menopause, causing those oh so wonderful side effects like hot flashes and joint aches. While Caveman Doctor never has experienced these because he has not gone through menopause and likely never will because he is a caveMAN, he does feel all of your pain. In fact, many of Caveman Doctor’s male patients with prostate cancer are on hormone therapy and get these same side effects and he is very sensitive to them.
Back to estrogen: It decreases with menopause and giving estrogen may help bone synthesis1. In our society, we love the easy fix with a pill or injection, and this presents an easy target as a medication. However, estrogen has been associated with an increased risk of several cancers in women, including endometrial2 and breast3 cancer, and the health risks of hormone replacement therapy was a hot topic in the news for the past couple of years. As a result, this treatment is usually avoided, and rightly so.
However, the importance of another pill in bone health, vitamin D, was discussed extensively in the last post and some studies in women have shown that estrogen supplementation works through increasing serum levels of vitamin D, so perhaps we can skip the estrogen therapy4 and go right to the D.
Back to the Gym:
Also, as touched upon before, resistance and weight training work to increase bone density in menopausal women as well5. Importantly, as we discussed in the last post, make sure it is high intensity training as this appears to provide the real benefit6. Resistance exercise actually works similarly as the drug Foxamax, which decreases bone resorption and favors bone formation7. A main difference between the two is that exercise also carries with it many more health benefits like stress relief, increased insulin sensitivity, and weight loss, while Fosamax brings with it many side effects, including osteonecrosis (literally death of the bone) of the jaw, abdominal upset, and muscle and bone pain. It is ironic that these are all things that could prohibit us from exercising and helping our bones the natural way.
Another commonly prescribed drug, Reclast, was shown in a randomized controlled study to reduce the occurrence of hip fracture in women from 2.5 to 1.4% and vertebral fracture from 10.9 to 3.3%. Many praised these results, which in actuality show quite a minimal benefit. More alarming, this study also revealed that Reclast significantly increases the occurrence of serious (this was the term they used) atrial fibrillation (irregular heartbeat)8, likely from induced mineral deficiencies. Basically, the medication can cause lower levels of calcium and magnesium in the blood than our body requires. Joint pain can occur in almost a fourth of patients on this medication, and other common side effects include muscle pain, fever, headaches and high blood pressure. Thinking about this in perspective, the hip fracture benefit is minimal at best (1.1%) and the vertebral fracture benefits are minimal (7.6%), while you have a much greater chance of getting joint pain (25%) and other side effects that may actually limit you from other healthy activities, causing even further health issues.
What’s the risk of weight gain, high blood pressure, or other health issues from being sedentary as your joints ache from the medication? Studies often forget to look at these factors. Once again with your health, there is no magic bullet and if we don’t aim to achieve health the natural way by healthy lifestyles that allow us to avoid medications, we often suffer the consequences.
Most importantly: Osteoporosis is much easier to prevent than to fix, so it’s never too soon to get started.
In summary (including info from the last post):
Please have a thorough discussion with your physician about the benefits and risks of these medications before coming to any conclusions. If you do decide to take a calcium medication, you should still take care of your health through diet and exercise, as the medication only slightly decreases your risks of fractures. Having healthy bones is still up to you, not your doctor!
1. Breslau NA: Calcium, estrogen, and progestin in the treatment of osteoporosis. Rheumatic diseases clinics of North America 20:691-716, 1994
2. Grady D, Gebretsadik T, Kerlikowske K, et al: Hormone replacement therapy and endometrial cancer risk: A meta-analysis. Obstetrics & Gynecology 85:304-313, 1995
3. Schairer C, Lubin J, Troisi R, et al: Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk. JAMA: The Journal of the American Medical Association 283:485-491, 2000
4. GALLAGHER JC, RIGGS BL, DELUCA HF: Effect of Estrogen on Calcium Absorption and Serum Vitamin D Metabolites in Postmenopausal Osteoporosis. Journal of Clinical Endocrinology & Metabolism 51:1359-1364, 1980
5. Suominen H: Muscle training for bone strength. Aging clinical and experimental research 18:85-93, 2006
6. Layne JE, Nelson ME: The effects of progressive resistance training on bone density: a review. Medicine and science in sports and exercise 31:25-30, 1999
7. Chesnut CH, 3rd, McClung MR, Ensrud KE, et al: Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. The American journal of medicine 99:144-52, 1995
8. Black DM, Delmas PD, Eastell R, et al: Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. The New England journal of medicine 356:1809-22, 2007
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