Hormone Health MD Bioidentical Blog

July 26, 2008

Hormones, Osteoporosis, and Hip Fractures

Elderly women are at greater risk of death after a hip fracture than after breast cancer, according to a recent article in Medscape Medical News citing a study by Jane A.Cauley, DrPH,  at the University of Pittsburgh. The death rate was 48.1% after a hip fracture versus 25.1% after a breast cancer diagnosis.

What causes hip fractures?  Osteoporosis! Women with osteoporosis are the most likely to sustain a hip fracture. Osteoporosis advances rapidly after menopause due to the dramatic drop in hormones.

According to the National Osteoporosis Foundation, half of the women over 50 will have an osteoporotic fracture before they die. Half of the women surviving a hip fracture will not be able to walk and a quarter will need long term nursing care. A woman’s risk of hip fracture is equal to her combined risk of developing breast, uterine, and ovarian cancer.

Women are not the only ones who suffer from this problem. Men also get osteoporosis, although it is poorly recognized by the medical community.  Men typically develop osteoporosis slower and it appears later than in women.  Testosterone begins to diminish in the early 30’s and decreases 1-3%  per year, increasing the risk for bone loss. Men over 65 have a hip fracture rate of 5 in 1,000. Men over 65 are at risk and should have a bone density test done, as well as calcium, magnesium, thyroid, Vitamin D, and hormone levels.

            By 2010, over 52 million men and women age 50 years and older will either have osteoporosis or be at increased risk because of low bone mass per the National Osteoprosis Foundation. Approximately 20% of those that develop hip fractures will die the year after the fracture from surgery complications such a pneumonia or blood clots in the lung according to the CDC.

            The best therapy for osteoporosis is replacing lost hormones. In women, estrogen saves more bone tissue than very large doses of calcium according to the National Institute on Aging. In the May 2004 Journal of the American Medical Association, British researchers described a link between hormone replacement therapy and a reduced risk of bone fracture in post-menopausal women.

            Poor nutrition and inadequate intake of nutrients, lack of adequate exercise, unhealthy lifestyle including cigarettes and alcohol, and race also contribute to osteoporosis. Hormone replacement in men and women is of key importance for bone health.

            Replacemen with biodentical hormones is key. All three hormones are necessary in order to build and maintain bone: estrogen, progesterone, and testosterone. If you are taking Premarin, you are only getting an estrogen effect, and a dangerous one.You don’t want to trade one problem for another by taking alien synthetic molecules orally, like Premarin and Provera,  that can increase heart disease, stroke, and breast cancer. Remember all estrogen, even bioidentical, should be taken transdermally. Any oral estrogen can increase C-reactive protein which correlates with a higher incidence of heart disease. Provera or medrxyprogesterone has no benefit for bone, and in fact inhibits beneficial progesterone production and effects by binding to progesterone receptor sites.

            The synthetic pharmaceutical medications for osteoporosis, like Fosamax, are problematic. They do not allow for the natural turn-over and remodeling of bone and what you essentially wind up with is a lot of old brittle bone. In addition, one study showed that combining estrogen with Fosamax may increase fractures. In addition, Fosamax is correlated with bone problems in the jaw.

           Vitamin D is very important to build bone and prevent osteoporosis. Even in the sun belts, Vitamin D levels are low among men and women due to interior jobs, sun-screen over-use, and lack of ability of aging skin to convert sunlight to Vitamin D. Get your 25 hydroxy Vitamin D levels checked with a blood test, and if they are low step up your supplementation until they come up.

             Nutrient supplementation needs to be more than just calcium to build bone. Calcium citrate is OK, but calcium hydroxyapetite is best. Don’t exceed 1600 mg total of calcium per day unless you want calcium in your arteries and kidneys too. Other important nutrients for bone building are Vitamin K, magnesium, manganese, boron, and strontium. Othomolecular makes a great supplement that has all you need for bone maintenance or improvement of osteoporosis called ProBono. Patient report joints feeling better on it as well.

            Make sure you get a baseline bone density scan when you are in the perimenopausal years so you know where you are starting out. If you have osteopenia, take action. You can prevent osteoporosis!

For further information contact:

Aref Bhuiya, M.D., 5655 Lindero Canyon Rd., Ste. 202, Westlake Village, CA 91362, 818-597-3223..

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July 10, 2008

Menopause and the Women’s Health Initiative Study

Filed under: bioidentical hormones,Menopause,Safety of Hormones — Dr. Bhuiya's Bioidentical Hormone Blog @ 6:43 am
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Every day in the United States 3,500 women enter menopause.  Symptoms, however, can begin as long as fifteen years prior.  

         

          The normal age to go through menopause ranges from 35 to 55. Therefore, you may easily live one half of your life missing your hormones, and we age because we lose our hormones.

 

Until recently, the only hormonal therapy available in this country has been synthetic hormone replacement, that is, Premarin and Provera or Prempro.

 

          The government sponsored Women’s Health Initiative Program halted its study on Prempro, containing Premarin (horse urine estrogen) plus Provera, a progestin (synthetic progesterone, also called hydroxy-progesterone), on July 9, 2002.  This was three years early because of an increased risk of breast cancer in women taking this drug.

         

          The study revealed the following results:

· The stroke rate was 41 % higher in women taking Prempro 

· Women on Prempro had double the rate of blood clots.    

· Women on Prempro had an increase in breast cancer of 26%.

· Women on Prempro had a 22% increase in heart disease.

 

The results of the Women’s Health Initiative Study brought to the forefront why synthetic hormonal therapy will become a treatment of the past.

 

It is clear that Prempro increases the risk for disease and prompted the call for women to get off these synthetic hormones. Due to the above study Wyeth, the drug company that makes Prempro, has lost tremendous sales. Women and doctors have turned to a safe alternative which is bio-identical hormones. Wyeth’s loss of revenue has prompted the company to lobby for restrictions on compounding pharmacies to turn people back to using Prempro.

 

The safe alternative, bioidentical hormones: estradiol, progesterone, and testosterone, are all approved by the FDA in other medications at a set dose. The difference in compounding is that the dose is tailored to the patient’s needs through laboratory testing so they are not overdosed or under-dosed.

 

The recent Wyeth-provoked onslaught by the FDA on compounding pharmacies is the loophole that estriol, a weak estrogen present in the human body and often added to bio-identical estrogen compounds for breast cancer protection, is not in any FDA approved medications, but it is not necessary for treatment. Note that estriol is a part of the U.S. Pharmacopeia (USP).

 

The Wyeth-driven FDA also objected to compounding pharmacies using the term “bio-identical”.  What better term to describe substances that have the same exact molecular structures as those found in the human body (perhaps human-identical)?

 

The answer for hormone replacement is customized, safe, compounded, bio-identical hormone replacement that is a prescription issued in response to individual symptoms and laboratory analysis and tailored to the individual’s needs.

 

For further informattion contact

Aref Bhuiya M.D., 5655 Lindero Canyon Rd., Ste. 202, Westlake Village, CA 91362,

818-597-3223.

July 8, 2008

Progesterone in Women

  Progesterone is one of your sex hormones and is made inyour ovaries before menopause. After menopause, some progesterone’s made in your adrenal glands. As we age, we lose our hormones, and progesterone is one of the first to go. In women, progesterone declines first, then estrogen. You could suffer from progesterone loss for 15 years before you lose your period.

   In our 40’s, we usually start to experience progesterone decline. Symptoms of decreased progesterone include anxiety, depression, irritability, mood swings, insomnia, pain and inflammation, osteoporosis, decreased HDL, weight gain, and excessive menstruation. Why do we gain weight with low progesterone? Estrogen is a building up hormone, and if you do not have enough progesterone to balance the estrogen you have, then you will gain weight. Estrogen without progesterone equals gaining about 10 pounds.

   Causes of low progesterone levels are peri-menopause, impaired production, low luteinizing hormone (LH), increased prolactin production, stress, sugar, and saturated fat, deficiency of vitamins A, B6, C, zinc, and decreased thyroid hormone.

    Be aware that progestin is not bioidentical progesterone. I have spoken to doctors and nurses who did not know the important difference. Synthetic non-bioidentical progesterone is called progestin. It is very different from natural bioidentical progesterone since it does not have the same chemical structure nor the same effects as the progesterone that your body makes on its own. Natural bioidentical progesterone is biologically identical to what you produce. Also, progestins do not reproduce the actions of natural progesterone. Progestins are contained in birth control pills, Provera, and Prempro. Don’t be fooled by the similarities in names.  Medroxyprogesterone is a progestin, not progesterone.

   What’s the difference? It could be your life. To start, progestins have many side effects. The side effects of progestins (synthetic progesterone) that do not occur with natural bioidentical progesterone include: increased appetite, weight gain, fluid retention, irritability, depression, headache, decreased energy, bloating, breast tenderness, decreased sexual interest, rash, acne, hair loss, nausea, insomnia, breakthrough bleeding/spotting. Progestins interfere with your bodys own production of progesterone and do not help balance estrogen. They remain in your body longer and can cause spasm of your coronary (heart) arteries. Progestins stop the protective effects estrogen has on your heart, attaches to many of your bodys receptor sitesnot just your progesterone receptors (long-term affects of this are unknown), and may make the symptoms of progesterone loss worse. Progestins increases LDL (bad cholesterol) and decreases HDL (good cholesterol). Progestins counteract many of the positive effects of estrogen on serotonin and may cause depression.

    Here’s the life-threatening part: a recent study has shown that the use of synthetic progesterone or progestinincreases the risk of breast cancer by 800%as compared withthe use of estrogen alone. Another study showed that women taking natural bioidentical progesterone had a 10% lower rate of cancer than the general population. 

     Natural bioidentical progesterone helps balance estrogen, leaves your body quickly, helps you sleep, has a natural calming effect1, lowers high blood pressure, helps your body use and eliminate fats, lowers cholesterol, may protect against breast cancer , increases scalp hair, normalizes libido, helps balance fluids in the cells, and increases the beneficial effects of estrogens on blood vessel dilation in atheroscelerotic plaques (hardening of the arteries), has an anti-proliferative effect (decreases the rate of cancer)on all progesterone receptorsnot just the ones in the uterus, does not change the good effect estrogen has on blood flow, increases metabolic rate, is a natural diuretic and a natural antidepressant.

      Natural bioidentical progesterone offers a safer approach to hormone replacement therapy than synthetic progesterone (progestin). It is very important that you have your levels of progesterone

measured before you begin bioidentical hormone replacement and then on a regular basis to confirm that you are on an optimal dose for you.

   If you have had a complete hysterectomy you still need natural progesterone since it  has the many positive affects on your body discussed above. Progesterone can be prescribed as a pill or a topical cream. A compounding pharmacist would fill your prescription. It is made from an extract of soy beans or yams with an enzyme added to convert the diosgenin in the yam into bioidentical progesterone. Over-the counter progesterone frequently does not contain this enzyme. If one of your main symptoms is insomnia, then choose the pillform which affects the GABA receptors in your brain, having a calming effect which allows you to sleep.

   If you think you have progesterone changes, consult with a doctor who has experience with peri-menopausal hormone changes and bioidentical hormone replacement.

For further informattion contact:

Aref Bhuiya M.D., 5655 Lindero Canyon Rd., Ste. 202, Westlake Village, CA 91362, 818-597-3223.

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