Ian Spohn, ND, is a staff naturopathic doctor for Energique who enjoys challenging the dogmas of both conventional and alternative medicine. He is a passionate supporter of the paleo diet and classical homeopathy.
Osteoporosis is a disease characterized by deficient bone mineralization. As a consequence, it is associated with an increased risk of fractures, particularly of the femur and spine, which are a serious cause of morbidity and mortality in the elderly population – more than half of patients who suffer a hip fracture will require permanent assistance with activities of daily living, and 20 to 30 percent will die within one year[i]. Although osteoporosis can affect both sexes, it is by far more common in women and therefore constitutes a legitimate women’s health issue.
Because osteoporosis involves a loss of calcium from the bones, the natural strategy for treating it has long been dominated by increasingly broad and far-reaching approaches to nutritional supplementation. For a long time, osteoporosis has been regarded as a calcium deficiency disease or, at least, a vitamin D deficiency disease, similar to rickets. Because rickets was largely eradicated by fortifying foods with vitamin D and because nutrition plays such an important role in natural healing, most natural practitioners have faith that osteoporosis, too, can be addressed merely by providing the body with all of the nutrients required to form healthy bone. The only problem with taking this approach is that it simply doesn’t seem to work very well. Regarding the dogmatic assertion that nutrition is the key, the US Preventative Services Task Force (USPSTF) recently conducted a review of the evidence behind supplementing calcium and vitamin D for osteoporosis. This is what they found, published in JAMA in 2018:
The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit [emphasis added] for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women.[ii]
While calcium and vitamin D are a necessity for proper bone mineralization, alone they are clearly not sufficient. The failure of this old routine has prompted a series of successively deeper explorations into possible additional nutrient requirements for the maintenance of healthy bone. Just as additional calcium is useless without additional vitamin D to support its absorption in the small intestine, there must be, it is assumed, some additional nutrient required beyond even these which if deficient will derail the body’s every attempt to re-mineralize bone. The first likely candidate for this was vitamin K2, which is required to activate osteocalcin, a protein involved in bone turnover. However, there is now research which questions whether vitamin K was ever involved in driving calcium into bone as was originally supposed. It is now thought that osteocalcin, activated by vitamin K2, has more to do with regulating glucose metabolism than bone turnover[iii]. Nevertheless, the current approach to treating osteoporosis naturally has been to supplement not only calcium, vitamin D, and vitamin K2, but also an additional host of prospective trace minerals known or suspected to somehow play a role in bone health, such as zinc, copper, manganese, fluoride, silica, boron, strontium, and vanadium. The quest continues to find that one nutrient the mere supplementation of which will restore normal bone mineral density and reverse osteoporosis. But are we even looking in the right place? Although it has long been assumed that osteoporosis must be a deficiency disease, several facts suggest that it might be more rightly considered an endocrine disorder that would benefit more from hormone-balancing treatments than nutritional supplements.
The first fact which should cause one to question whether indeed osteoporosis stems from a nutrient deficiency is the fact that it overwhelmingly affects women. Why would a nutrient deficiency consistently affect women more than men? Would it not be far more reasonable to suppose that something like estrogen might be the culprit in a disease which primarily affects women? Especially given that estrogen is a hormone which directly inhibits osteoclasts, the very cells responsible for demineralizing bone. Not only is being a woman a major risk factor for developing osteoporosis, but early menopause or anything that would lower lifetime estrogen exposure is also one of the most well-established risk factors. Most bone loss is noted to occur following menopause, as a direct consequence of falling estrogen levels. The latest pharmaceutical treatments for osteoporosis, selective estrogen receptor modulators (SERMs), act by selectively stimulating the estrogen receptors on osteoclasts to suppress the breakdown of bone. By continuing to push nutritional treatments rather than hormonal support, natural practitioners are clinging to an outdated notion of the pathogenesis of bone loss long since abandoned by their conventional colleagues. This is a shame, particularly because there are so many excellent natural approaches to balancing hormones.
Another osteoporosis fact is that hip fractures occur most commonly in countries with the highest intakes of calcium and dairy[iv]. This has already led many to question the dairy industry’s long-held claims that drinking milk will prevent bone loss. Hormones are essentially the master regulators of the body, and it makes perfect sense that no matter how much calcium, vitamin D, vitamin K, or whatever else you force-feed the body, this will not result in bone mineralization if the body’s hormones are constantly telling it to do something else. Besides estrogen’s role in suppressing bone loss, another critical hormone to consider is cortisol, which suppresses bone mineralization. While estrogen suppresses the bone-destroying osteoclasts, cortisol directly suppresses osteoblasts, the cells which make bone. This is why long-term use of corticosteroid medications has been identified as the most common secondary cause of osteoporosis. Stress management should feature as prominently into any osteoporosis treatment as calcium and vitamin D, given cortisol’s direct deleterious effects on bone mass.
Osteoporosis may remain asymptomatic until a fracture occurs, but if a hormone imbalance is present then a thorough, holistic assessment of the patient is sure to identify symptoms which reveal the specific problem. Even seemingly minor concerns like fatigue or a diminished sex drive indicate a fundamental imbalance in the body, which if untreated may, in the course of years, result in a chronic pathological condition like osteoporosis. Energique’s Osteocom™ is a spagyric bone support formula which combines nutritive herbs to support healthy bone with herbs to support healthy estrogen levels*, like black cohosh, providing a more holistic approach than nutritional support alone. Other formulas to support healthy hormone levels include our Rainforest Botanical Stress Formula and our homeopathic formulas Erogetone™ and Endopar F™.
*Use caution with estrogenic herbs if there is a history of blood clots or estrogen-receptor-positive breast cancer.
[i] US Preventive Services Task Force. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(15):1592–1599. doi:10.1001/jama.2018.3185
[iii] Lacombe J, Ferron M. Gamma-carboxylation regulates osteocalcin function. Oncotarget. 2015;6(24):19924-19925.
[iv] World Health Organization. Vitamin and Mineral Requirements in Human Nutrition, Second Edition. Accessed online 8/29/18 at http://apps.who.int/iris/bitstream/handle/10665/42716/9241546123?sequence=1
Any homeopathic claims are based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.