11/14/2013

Stress Hormones Destroy Bones

by Etsuko Ueda

It isn't just estrogen and progesterone that go through changes. FSH and LH rise and so does the stress hormone cortisol, while most hormones, including human growth hormone, DHEA, insulin-like growth factors, inhibins, thyroid, etc. start to decline as early as mid 30's.
Amongst, the hormone well known for its destructive power on bone is a stress hormone cortisol, and it is well established that cortisol increases with age. 

Catabolic effect of Cortisol

Cortisol, also known as glucocorticoid, is well known for it's catabolic (breakdown) effects on bones, muscles, and protein in general. This is one of catabolic hormones along with epinephrine and glucagon. 
Cortisol increases especially during the late perimenopause and early post menopause years when menstrual irregularities are greatest, and menopausal symptoms are most severe.

Cortisol is an important stress hormone that allows us to be alert and energetic to face life's challenges with less pain. But it comes with a price, and our body is not built to stay in that state days and weeks on end, much less months and years. Except for a lucky few (less than 10%), women go through a stressful menopausal symptoms during the late perimenopause and early post menopause years (Bresilda Sierra, et.al. 2005), which is accompanied by elevated cortisol, epinephrine, and norepinephrine levels (Pituitary hormones during the menopausal hot flash. D R Meldrum, J D Defazio, Y Erlik, J K Lu, A F Wolfsen, H E Carlson, J M Hershman, H L Judd, 1984. Biophysical and endocrine-metabolic changes during menopausal hot flashes: increase in plasma free fatty acid and norepinephrine levels. M Cignarelli, E Cicinelli, M Corso, M R Cospite, G Garruti, E Tafaro, R Giorgino, S Schonauer. 1989). That is, unless something is done about it (Here lies a dilemma of research on menopause. You have to find women who agree to do nothing about it, which may not be easy or ethical, and potential for biased sampling).
"Glucocorticoids (GCs) are used frequently in a variety of diseases because of their strong anti-inflammatory and immunosuppressive effects. However, corticosteroids have many metabolic side effects, such as insulin resistance, hypertension, glaucoma, and osteoporosis. GC-induced osteoporosis (GIOP) is one of the most devastating side effects because bone loss during long-term GC treatment is generally irreversible and because of its clinical manifestations (eg, vertebral and nonvertebral fractures)." (Advances in glucocorticoid-induced osteoporosis. Debby den Uyl, Irene E M Bultink, Willem F Lems, 2011).
The mechanism has been identified at molecular level: Glucocorticoid preserves osteoclasts (cells involved in bone resorption) while reducing and impairing osteoblasts and osteocytes (cells involed in bone formation and mineralization). In addition, it impairs bone metabolism via inhibition of calcium resorption in the gastrointestinal tract and inhibition of the kidney's ability to reabsorb calcium (Glucocorticoid-induced osteoporosis: pathophysiology and therapy. E. Canalis & G. Mazziotti & A. Giustina & J. P. Bilezikian, 2010).


Bone series articles:

  1. Menopause and What Really Happens to your Bones
  2. False Promise of Fosamax
  3. Estrogen Paradox
  4. Role of Progesterone in Bone Health
  5. Stress Hormones Destroy Bones <<You are here
  6. Menopause and How estrogen helps bone health?
  7. Sad State of Progesterone Research
  8. Menopause and Bone Quality
  9. How to Maintain Bone Health
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Before you post your HRT questions, please try what I think safe and effective for at least 3 months: estradiol 0.025~0.050mg/day patch, with 20~40mg/day progesterone cream (about 1000mg progesterone in 2oz cream). You can also add DHEA 5~10mg /day.
That is the only recommendation you will get from me.

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