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MENOPAUSE AND OSTEOPOROSIS
Author, Nita Bishop, Clinical Herbalist
Researchers at the Mayo Clinic recently concluded that, Osteoporosis is the most common bone disorder encountered in clinical practice. It is also one of the most important diseases facing our aging population. Ironically, Osteoporosis is primarily a disease of modernized or developed countries unlike other diseases which affect countries with less advanced technologies. In women, bone loss accelerates after menopause. This may be due in part to what is called estrogen dominance, an effect of the abundant use of hormones and chemicals in our foods and environment.
Bone cells, like all cells in the body, are continually renewing themselves. Discrete cell types, anatomically and functionally connected, are continually renewed and maintain the complex skeletal tissue. Within bone, specific cells are responsible for the creation (osteoblasts) and destruction (osteoclasts) of bone tissue. Complex cellular, physiologic and metabolic factors control the balance between bone formation and destruction. Changes in the dynamic between formation and destruction (often called resorption) underlie the development of osteoporosis. Several systemic hormones and a number of additional factors regulate bone cell activity. In osteoporosis, as in hypertension, there is often a long latent period before clinical symptoms or complications develop.
Clinical Signs and Symptoms
Osteoporosis is a skeletal condition characterized by decreased density (mass/volume) of normally mineralized bone. Not only does the reduced bone density lead to decreased mechanical strength, but the skeleton is prone to fracture. Next to age-related osteoporosis (Type II), postmenopausal osteoporosis (Type I) is the most common primary form of bone loss seen in clinical practice. Often an episode of acute back pain occurring when a person is at rest or during such routine activity as bending, standing from a seated position, lifting a heavy object or opening a window can signify problems in this area.
In conventional medicine, the mainstays of prevention and management of osteoporosis are estrogen and calcium. Estrogens affect bone development by influencing osteoclast activity. They prevent rapid bone resorption which helps to slow the rate of bone loss. However, there is no evidence showing that estrogens actually increase bone formation. If estrogen supplementation stops, bone loss resumes, possibly at an accelerated rate. In Dr. Alan Gaby's book, "Preventing and Reversing Osteoporosis", he states that in order for estrogen therapy to prevent osteoporosis, it must begin before significant bone loss has occurred and must continue indefinitely. In addition to the proactive therapies prescribed by doctors, he emphasizes nutrition as a key aspect. Women are urged to treat and prevent osteoporosis through essential nutritional guidelines.
Getting the right dose: Is the RDA on Calcium Supplementation too low?
In 1984 the National Institute for Health convened an international meeting on Osteoporosis. The suggestion by the NIH conference panel was that calcium intake in the range of 1200 to 1500 mg/day might result in higher peak adult bone mass. The usual daily intake of elemental calcium in the United States, 450-550 mg, falls well below the National Research Council's (NRC) recommended dietary allowance (RDA) of 1000 mg; the RDA is designed to meet the needs of approximately 95% or more of the population and menopausal females are not included in this figure. According to the calcium metabolic balance studies, 1,000 mg of calcium is indicated for premenopausal and estrogen-treated women. Postmenopausal women who are not treated with estrogen require about 1,500 mg daily for calcium balance. The RDA for calcium is criticized for being extremely low**, particularly for postmenopausal women, not to mention the elderly. Clinical trial data and reanalysis of calcium balance studies have provided the momentum for considering the upward revision of recommended calcium intakes for adolescents.
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