SAN ANGELO, Texas —Estrogen, progesterone, DHEA and testosterone are hormones that play critical roles in women’s health. Estrogen alone performs 400 essential functions ranging from increasing our metabolic rate and decreasing blood pressure to maintaining memory and sustaining bone density. Adequate estrogen levels contribute to our skin’s youthful appearance, our energy levels and our mood.

Estrogen, progesterone, DHEA and testosterone work in concert, traveling down metabolic pathways to achieve needed balance.

In young, healthy women, these four hormones achieve a natural balance, ensuring that each hormone does its job and doesn’t cause problems. for instance, if estrogen is present without the buffering effects provided by progesterone, the “unopposed” estrogen can attach to hormone receptors in the breasts and can increase the risk of breast cancer.

Either because of aging or the influence of environmental factors such as smoking or stress, our ovaries begin producing hormones more erratically as we approach midlife. As our hormones diminish, women experience a wide variety of symptoms including foggy thinking, mood swings, weight gain, anxiety, insomnia, and heart palpitations.

This period of hormonal fluctuation and diminishment is known as perimenopause. at this stage, most women still have adequate estrogen, but are experiencing changing levels of progesterone, testosterone and DHEA. Doctors can perform a blood test that identifies the levels of circulating hormones in a woman’s body, determining shortages and excesses.

Over a period of 10-15 years, the ovaries eventually quit producing the hormones necessary for menstruation causing menopause. at this stage, estrogen supplies have diminished, too, causing symptoms such as hot flashes, night sweats and increasingly wrinkled skin. Low estrogen levels also contribute to thinning bones that can lead to osteoporosis.

For many years, the only treatment available to deal with the symptoms of “the change of life” was Hormone Replacement Therapy (HRT), a regimen that uses estrogen as the primary therapeutic tool. This estrogen’s chemical make up is different from the estrogen that occurs in our bodies, which affects the way it interacts with our cells. It also is stronger and since it is administered alone, it is unopposed. a landmark study noted that HRT increased the risk of heart attack, stroke, blood clots and breast cancer prompting the medical community to rethink the use of HRT as a long-term solution. now, HRT is prescribed only as a short-term treatment.

In recent years, an alternative, known as Bioidentical Hormone Replacement (bHRT), has become widely available. the hormones used in this treatment are synthesized in certified labs from plants and are chemically identical to the hormones that naturally occur in our bodies; therefore, they interact with our cells and follow the same metabolic pathways as our own hormones. because the hormones are identical to those produced by our bodies, they can be used for as long as the patient benefits from them.

The only women who cannot undergo bHRT are women who have a history of or are at high-risk for sex-hormone-fed cancers such as breast cancer, ovarian cancer, uterine cancer, and endometrial cancer.

BHRT strives to restore the balance between the four primary sex hormones. Doctors use the results of the initial blood test and follow-up urine or saliva tests to prescribe a mixture of hormones specific to an individual patient’s needs. for instance, if a patient’s progesterone and testosterone levels are low, her treatment will supplement only these hormones. because naturally occurring chemicals cannot be patented and the prescriptions are individualized, they can only be filled at compounding pharmacies, which are pharmacies that have the ability to create custom-made medicines.

For women, finding balance in our lifestyles is not always easy. Fortunately, though, science has provided an opportunity to restore hormonal balance. if you are plagued by the symptoms of hormone imbalance, talk with your doctor to determine whether or not bHRT offers a pathway to well-being for you.

Kathy Cubine, D.O., is a family practice physician at Community Medical Associates and a member of the medical staff at San Angelo Community Medical Center.

Osteoporosis is a condition in which bones are weakened and may fracture easily. Menopause can increase a woman’s risk of developing osteoporosis. The drop in oestrogen levels that occurs at menopause results in increased bone loss. It is estimated that the average woman loses up to 10 per cent of her bone mass in the first 5 years after menopause.

Osteoporosis in Menopause

Osteoporosis is often called the “silent disease” because initially bone loss occurs without any symptoms. A woman may not know that she has osteoporosis until weakened bones cause painful fractures usually in the back or hips. consequently, once a woman has a broken bone due to osteoporosis, she is at high risk of having another. These fractures can be debilitating. Fortunately, there are steps she can take to prevent osteoporosis from ever occurring. And treatments can slow the rate of bone loss if she already has osteoporosis.

Osteoporosis is best diagnosed using a specialised x-ray technique (DEXA). A DEXA measures the severity of bone mineral loss (loss of bone mineral density) and presents the result as a T-score. The T-score compares the bone density of the woman with that of a young woman (when peak bone mass is at its best).

The various T-scores used in diagnosis are:

• Normal bone density – the T-score measures between 0 and -1.
• Osteopaenia – the T-scores are between -1 and -2.5. This means there is some bone loss, but it’s not severe enough to be called osteoporosis.
• Osteoporosis – the T-score measures -2.5 or less.

Physical activity is very important

Exercise can’t stop bone loss, but the activity, especially walking, can slow down the pace of osteoporosis. in addition, exercise keeps muscles toned and strong, making falls less damaging. just 30 minutes of brisk walking several days a week is all you need to increase strength and overall fitness.

Two types of physical activities that are most beneficial to bones are weight bearing and resistance training exercises.in addition to reducing bone loss, physical activity will improve muscle strength, balance and fitness and also reduce the incidence of falls and fractures.

When you start an exercise program, you’d better consult with your doctor, physiotherapist or health care professional.

Weight Bearing Exercise

Weight bearing exercise refers to any exercises performed on feet. Examples include walking, running, tennis and dancing. Studies to evaluate the effects of exercises such as walking have not shown a drastic improvement in bone mass unless this activity is performed as a high intensity activity (walking at a fast pace, jogging and etc.).

Resistance Training Exercises

Resistance training exercises are also known as strength training exercises. Strength training uses weights of some kind (machines, dumbbells, ankle or wrist weights) to create resistance. This helps build muscle mass and places a load (force) on the involved limb bones. in addition, it includes exercises that use one’s own body weight as the load, such as push-ups where the load is placed through the arms and shoulders.

It’s good to note that you should only perform these exercises under the supervision of an accredited trainer, exercise physiologist or physiotherapist to avoid unnecessary injury.

There are a number of medical treatments available for management of osteoporosis including bisphosphonates, selective oestrogen receptor modulators (SERMs), hormone replacement therapy (HRT), vitamin D derivatives and calcium supplements and strontium ranelate. Potential therapies include tibolone and parathyroid hormone.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) relieves menopausal symptoms such as vaginal dryness, hot flushes and night sweats. when taken at the beginning of menopause, HRT can also prevent bone loss and should be started soon after menopause for maximum benefit. This treatment is sometimes called hormone therapy (HT).

HRT should be considered ‘first line’ treatment for osteoporosis in young women and those in their 50s for up to 5 years. Some studies conduct that HRT can increase bone density by around 5 % in 2 years. HRT reduces the risk of spinal fractures by 40 per cent. Bone loss will resume once HRT is stopped.

For those women who cannot take hormone therapy for health reasons or choose not to because of personal reasons, there are some other alternatives.

Calcimar, Miacalcin

These drugs are made up of a naturally occurring hormone, called calcitonin, involved in calcium regulation and bone metabolism. Calcitonin helps slow bone loss and increase spinal bone density. These drugs are used to treat osteoporosis. This drugs may ease pain associated with bone fractures.

Evista

This drug is a selective estrogen receptor modulator (SERM) that has many estrogen-like properties. It is approved for prevention and treatment of osteoporosis and can prevent bone loss at the spine, hip, and other areas of the body. Studies have shown that it can decrease the rate of vertebral fractures by 30%-50%. It may increase the risk of blood clots like estrogen.

Forteo

This is a type of hormone used to treat osteoporosis. It helps rebuild bone and increases bone mineral density. It is given by injection and is used as a treatment for osteoporosis.

Prolia

This is a so-called monoclonal antibody — a fully human, lab-produced antibody that inactivates the body’s bone-breakdown mechanism. This drug is used to treat women at high risk of fracture when other osteoporosis medicines have not worked.

Bisphosphonates

This group of medications includes the drugs Actonel, Fosamax, Reclast, and Boniva. Bisphosphonates are used to prevent and/or treat osteoporosis. they have been shown to slow bone loss, increase bone density and reduce the risk of spine fractures. Actonel and Fosamax have also been shown to reduce risk of non-spine fractures. possible side effects of treatment with bisphosphonates include gastrointestinal upsets.

The female body contains oestrogen receptors, which are located on many body tissues including bone. These receptors respond to the hormone oestrogen. Selective oestrogen receptor modulators (SERMs) are medications that work by blocking the oestrogen effect at some receptor sites, while prompting an oestrogen effect at others. in bone they work like oestrogen and lead to an increase in bone mass (density), mainly in the spine (less in the hips).

You should keep in mind that potential side effects of SERMs include hot flushes and a slightly increased risk of deep vein thrombosis (DVT).

Vitamin D and Calcium Supplements

A woman experiencing menopause may be prescribed a vitamin D derivative by a doctor and calcium supplements. These supplements may reduce the incidence of bone fractures by 30 %. five to 15 minutes of sunlight exposure every day can also boost vitamin D production and contribute to bone health. Vitamin D is activated by the liver and kidneys to boost calcium absorption.

Women age 51-70 require 400 units of vitamin D per day, and women over the age of 70 need 600 units. Vitamin D-fortified milk is one of the best food sources for this nutrient – one 8 oz. glass provides 100 units, or 25% of the daily requirement.

Excellent sources of calcium are milk and dairy products, canned fish with bones like salmon and sardines, dark green leafy vegetables, such as kale, collards and broccoli, calcium-fortified orange juice, and breads made with calcium-fortified flour.

Strontium Ranelate

Strontium is a trace element that is naturally found within soft tissues, blood, teeth and bone. although it is unclear how it works, it seems to reduce bone loss and may enhance bone formation. Studies with this medication in postmenopausal women have shown a reduction in both vertebral (spinal), hip and other fractures.

Like other osteoporosis therapies, you may also require additional vitamin D and calcium supplements if your vitamin D levels are low or dietary calcium intake is insufficient.

Potential Therapies – Tibolone

There is evidence that tibolone has beneficial effects on bone and leads to an increase in bone mineral density and reduction in fracture and risk.

Tibolone may not have the same stimulatory effects on the breast as standard forms of hormone therapy; studies have shown no increase in breast cancer for up to five years of use. Note: tibolone should not be used in women with breast cancer.

Potential Therapies – Parathyroid Hormone

This hormone is administered daily through an injection just below the skin (subcutaneous injection). It increases bone formation and absorption of calcium from the gut and kidney. It’s good to note, Calcium and vitamin D supplements may be necessary with this medication and must be monitored under the care of a specialist physician or endocrinologist.

There are some other recommendations for women who have osteoporosis:Avoid certain medications. Steroids, some breast cancer treatments (such as aromatase inhibitors), drugs used to treat seizures (anticonvulsants), blood thinners (anticoagulants), and thyroid medications increase the rate of bone loss if not used as directed. If you are taking any of these medications, you should talk to your doctor about how to reduce your risk of bone loss through diet, lifestyle changes and, possibly, additional medication.

Other preventive steps. You’d better limit alcohol consumption and do not smoke. Smoking causes your body to make less estrogen, which protects the bones. Too much alcohol can damage your bones and increase your risk of falling and breaking a bone.

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(ARA) – As the cold weather approaches and the task of heading outside to shovel heavy snow looms, it is important for men to think about their bone strength and overall health. Osteoporosis is a disease that many people assume only affects women – but did you know it can also impact men and their health? According to data from the National Osteoporosis Foundation, osteoporosis affects approximately 2 million American men and few recognize the condition as a significant threat to their mobility and independence. Men may also be unaware of other causes or conditions that can increase their risk of developing osteoporosis. throughout life, bone density is affected by heredity, diet, physical activity, lifestyle choices and the use of certain medications. Research has also shown that men with a condition called hypogonadism, more commonly known as low testosterone, may have an increased risk for osteoporosis. A combination of factors can play a role in the rate of bone loss in the body which can lead to low bone mineral density, fragility of the skeleton and ultimately osteoporosis.”Unfortunately many men do not realize that a decrease in bone mineral density may be attributed to undiagnosed low levels of testosterone,” says Dr. Natan Bar-Chama, director of Male Reproductive Medicine and Surgery at Mount Sinai Medical Center in New York. “But studies have shown that the prevalence of osteoporosis in men is higher than previously thought because of the increased risk associated with other conditions like hypogonadism, making it important for men to visit their doctor to discuss the condition and potential risk factors.”Hypogonadism affects up to 4 million men in the U.S., most of whom remain untreated because its signs and symptoms are nonspecific. These men may experience sexual dysfunction, decreased sexual desire and muscle mass, loss of body hair and decreased bone mineral density, which can negatively impact their lives. These symptoms can interfere with vital daily functions. Make no bones about it – osteoporosis can severely impact men and their health, including potentially leading to broken bones and limited mobility. Men who believe they are experiencing symptoms of low testosterone should consult their physician about proper diagnosis and potential treatment options.for more information about low testosterone and a medical condition known as hypogonadism, visit IsItLowT.com.

The views expressed here are those from a third-party content provider, and not necessarily the views or recommendations of the Lexington Clipper-Herald.

Osteoporosis means “porous bone””, often no symptoms of bone loss until the bones become so weak that sudden strain, bump or fall causes a fracture.  Osteoporosis is a bone condition distinguished by low bone density and weakening of bone strength.  it can be diagnosed by means of a low radiation scan, which measures bone mineral density.   Most associate osteoporosis to elderly, however, some cases showed as early as 19 years old suffer from osteoporosis.

Heredity is the significant risk factor in acquiring osteoporosis, if a parent has an history of this disease the children has double the risk to occur on them.  another is malnutrition of a fetus, which results in lower bone density in childhood.  also, certain medical conditions, such as Cushing’s disease, diabetes, and hyperthyroidism can contribute to osteoporosis.   The reason why four times more women suffer from osteoporosis than men is due to menopause in women results in reduction of estrogen that protect bone mass.  and, a diet low in calcium and vitamin D is an adding factor to bone failure.  Lastly, lifestyle of limited physical activity, such as smoking, is an additional risk factor of osteoporosis.

Prevention of Osteoporosis is put down in childhood and adolescence foundation.  that is when 90 percent of a person’s total bone mass is reached.  Calcium plays an important role in having a strong skeletal structure, because it is stored  mainly in the bones.  Sources of calcium are milk and dairy products such as yogurt and cheese; canned sardines and salmon (eaten with the bones); almonds; oatmeal; sesame seeds; tofu; and dark green leafy vegetables.  Vitamin D however is required for the calcium to be absorbed by the body.  Vitamin D is produced in the skin through sunlight exposure.  at least ten minutes sunbathing contributes to preventing the development of osteoporosis as it provides around 600 units of Vitamin D.   It can also be found in foods such as egg yolks, saltwater fish and liver.  Exercise is usually not being stressed out as one way prevention.  Exercise during childhood and adolescence helps to increase bone mass, and in old age helps to prevent loss of bone mass.  Exercises in which muscles work against gravity or other forces without overstressing the bones and joints such as weight-bearing and resistance exercises are highly recommended.  Walking, climbing stairs and light dancing are simple but effective weight-bearing exercises.

True changing lifestyle is difficult but what benefits come to those who make the effort to do so is that they may avoid being one of the many millions worldwide who suffer from osteoporosis.