Menopause and What Really Happens to your Bones

by Etsuko Ueda

Osteoporosis is a serious health threat. As you get older, your bones become more brittle and easy to fracture. According to International Osteoporosis Foundation's Facts and statistics about osteoporosis and its impact, 1 in 3 women over 50 will experience osteoporotic fractures, as will 1 in 5 men. We have been told that in menopause, (1) estrogen supplementation will save your bones from rapid erosion and prevent osteoporosis, and (2) if you cannot take estrogen because you are at high risk for cancer, blood clot, etc., (3) Fosamax or a similar Bisphosphonate drug (alendronate, incadronate, etc.) will save your bones.

In Safe Use of Hormones: the Hard Evidence, I have examined the evidence for (2), the notion that you cannot take hormones if your are at high risk for cancer and blood clot, and determined that it is an erroneous conclusion derived from the unfortunate history of fake non-human hormone use, especially the progesterone mimicking drugs and estrogen only use (without real progesterone). If the drug companies had taken a different route and promoted estradiol and real progesterone, both in low dose transdermal form, we would have been in a totally different place today in terms of the risk concerns, and (3) would not be necessary. 

Because Fosamax or a similar Bisphosphonate drug is widely used, and it can do more harm than good, I will examine its problem first, before examining (1), the role of estrogen and progesterone as well as other hormones on bone health.

False Promise of Fosamax

Just like most of hormone related issues, the drug companies have succeeded in persuading doctors and consumers with half truth as late Dr. John R. Lee has pointed out in his What Your Doctor May Not Tell You About Menopause (1996). If you have been taking Fosamax, thinking it will save your bones, you need to do your research on "bisphosphonate-associated osteonecrosis".

• Bisphosphonate-induced osteonecrosis (bone cell death) of the jaws is the most widely recognized damage that appears after 2.5 years of continued use. Your dentist may refuse to do certain procedures if you have been on Fosamax or a similar Bisphosphonate drug.

• Bisphosphonate-induced osteonecrosis of the jaws: Prospective study of 80 patients with multiple myeloma and other malignancies., Thacharot Boonyapakorn, Ingrid Schirmer, Peter A Reichart, Isrid Sturm, Gero Massenkeil 2008.

• Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper.  Cesar A Migliorati, et. Al. 2005.

• After 4 to 5 years of continued use, the initial BMD (bone mineral density) gains no longer protect the bones, and the weakening of the bones manifest as:

• Increased fracture risk (Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study., B Lenart, A Neviaser, S Lyman, C Chang, F Edobor-Osula, B Steele, M van der Meulen, D Lorich, J Lane, 2008).
• Accumulation of microdamage without healing (Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. T Mashiba, T Hirano, C H Turner, M R Forwood, C C Johnston, D B Burr 2000)
• Compromised bone mechanical properties (Bone micromechanical properties are compromised during long-term alendronate therapy independently of mineralization. Y Bala, B Depalle, D Farlay, T Douillard, S Meille, H Follet, R Chapurlat, J Chevalier, G Boivin 2011; see the bone quality section below)

• If you are suffering from a fracture, high dose bisphosphonate treatment impairs healing of a large stress fracture line by reducing the volume of bone resorbed and replaced during remodeling (Bisphosphonate treatment delays stress fracture remodeling in the rat ulna., L J Kidd, N R Cowling, A C K Wu, W L Kelly, M R Forwood, 2011).

Taken together, these studies are telling you that Bisphosphonate treatments should not be your choice of treatment.

If you are taking Fosamax or a similar Bisphosphonate drug to avoid the risks hormone therapy may pose, you are only trading one risk with another more certain health hazard. Besides, hormone therapy poses health risks only when you do it the wrong way as I reviewed in Safe Use of Hormones: the Hard Evidence, Hormone overdose: How can you tell?, and Hormones: Dos and Don'ts. Furthermore, to prevent accelerated bone turnover, Bisphosphonate drugs cannot do it as well as estrogen + real progesterone in terms of maintaining the effective turnover rate (Microdamage accumulation in the monkey vertebra does not occur when bone turnover is suppressed by 50% or less with estrogen or raloxifene. Jiliang Li, Masahiko Sato, Chris Jerome, Charles H Turner, Zaifeng Fan, David B Burr 2005) and bone quality (see the section on bone quality), not to mention the safety. Besides, your body needs estrogen and progesterone while Bisphosphonate drugs are foreign to our body.

Bone series articles:

1. Menopause and What Really Happens to your Bones
2. False Promise of Fosamax <<You are here
   
3. Estrogen Paradox
4. Role of Progesterone in Bone Health
5. Stress Hormones Destroy Bones
6. Menopause and How estrogen helps bone health?
7. Sad State of Progesterone Research
8. Bone Quality Is Just as Important as Density
9. How to Maintain Bone Health