Posted by on August 13, 2013 - 8:50pm

After the age of 30, the creation of new bone cannot keep up with the rate of bone loss in your body. The estrogen depletion that comes with menopause results in an increased risk for low bone mineral density, osteopenia and osteoporosis. For 5-10 years after menopause, this bone density loss accelerates into a gradual weakening of your bones and can lead to an increase in the risk for fractures and other injuries.

Physicians and organizations left and right have tried to specify a regimen to  help slow down the weakening of bones in postmenopausal women. The National Osteoporosis Foundation states that both types of hormone therapy, Estrogen therapy and combined Estrogen and Progesterone therapy, reduce the risk of osteoporosis. But what about supplements?

This past February, the US Preventive Services Tasks Force (USPSTF) stated there was insufficient evidence regarding calcium and vitamin D supplementation for bone fracture prevention in postmenopausal women. Now, a new analysis shows the evidence that may very well alter this recommendation.

The North American Menopause Society conducted a trial with 27,347 postmenopausal women, of which 8,000 took supplemental calcium (1,000 mg) and vitamin D (400 mg) daily, and 8,000 took look-alike placebos. These women came from all the hormone groups in the study: on HRT combinations, those on HRT estrogen alone, and the rest on hormone look-alike placebos.

Researchers then studied the hip fracture incidents among women who took hormones and supplements, women who took hormones alone, and women who took neither one. Of the women on both hormones and supplements, there were 11 hip fractures per 10,000 women per year. Of the women solely on hormones, there were 18 hip fractures per 10,000 women per year. And of the women who took neither, there were 22 hip fractures per 10,000 women per year.

Although the researchers could not specify how much of calcium and vitamin D should be taken, they concluded that postmenopausal women taking hormone therapy should also take supplemental calcium and vitamin D to reduce the rate of bone loss. The benefits of calcium and vitamin D seem to increase with increasing total intake, but also depend on the side effects of too much calcium, such as constipation.

So consider taking calcium and vitamin D supplements in combination with your hormone therapy, but don't stop drinking your milk! Continue trying to meet your daily calcium needs with your diet. Furthermore, did you know that weight bearing exercise can also improve your bone health? To learn more about how you can manage your bone health and overall health in menopause, visit http://menopausenu.org/

 

Posted by on October 17, 2012 - 1:18pm

Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside.  In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives.  This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation.  However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.

Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20th century in certain populations and locations [1].  Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3].  Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC.  The question is: How?

In  2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions.  Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA).  Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).

Table 1. Our interdisciplinary team

To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1).  Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2).   Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.

Table 2. Team backgrounds

As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change.   Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.

We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:

  • While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
  • Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
  • Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.

Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.

Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.

The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research

This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD    Read more about the team here in a Northwestern University press release.

1.         Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.

2.         Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.

3.         Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.

Posted by on November 4, 2011 - 3:20pm

Are you or a family member at risk for osteoporosis--a serious, potentially debilitating condition more prevalent in women? Over the past decade a number of treatments have become available including bisphosphonates.   An excellent one-page summary of benefits and risks is now available from the Hormone Foundation and should be read by all who are considering treatment.

Click HERE to view the article.

Posted by on September 13, 2011 - 6:55am

No bones about it:  eating prunes helps prevent fractures and osteoporosis.   When it comes to improving bone health in postmenopausal women — and people of all ages, actually — a Florida State University researcher has found a simple, proactive solution to help prevent fractures and osteoporosis: eating dried plums.

“Over my career, I have tested numerous fruits, including figs, dates, strawberries and raisins, and none of them come anywhere close to having the effect on bone density that dried plums, or prunes, have,” said Bahram H. Arjmandi, of  Florida’s chairman of the Department of Nutrition, Food and Exercise Sciences in the College of Human Sciences. “All fruits and vegetables have a positive effect on nutrition, but in terms of bone health, this particular food is exceptional.”

Arjmandi and a group of researchers from Florida State and Oklahoma State University tested two groups of postmenopausal women. Over a 12-month period, the first group, consisting of 55 women, was instructed to consume 100 grams of dried plums (about 10 prunes) each day, while the second — a comparative control group of 45 women — was told to consume 100 grams of dried apples. All of the study’s participants also received daily doses of calcium (500 milligrams) and vitamin D (400 international units).

The group that consumed dried plums had significantly higher bone mineral density in the ulna (one of two long bones in the forearm) and spine, in comparison with the group that ate dried apples. This, according to Arjmandi, was due in part to the ability of dried plums to suppress the rate of bone resorption, or the breakdown of bone, which tends to exceed the rate of new bone growth as people age.

The group’s research, “Comparative Effects of Dried Plum and Dried Apple on Bone in Post Menopausal Women,” was published in the British Journal of Nutrition.  In the United States, about 8 million women have osteoporosis because of the sudden cessation of ovarian hormone production at the onset of menopause. What’s more, about 2 million men also have osteoporosis.

“In the first five to seven postmenopausal years, women are at risk of losing bone at a rate of 3 to 5 percent per year,” Arjmandi said. “However, osteoporosis is not exclusive to women and, indeed, around the age of 65, men start losing bone with the same rapidity as women.”

Arjmandi encourages people who are interested in maintaining or improving their bone health to take note of the extraordinarily positive effect that dried plums have on bone density.

“Don’t wait until you get a fracture or you are diagnosed with osteoporosis and have to have prescribed medicine,” Arjmandi said. “Do something meaningful and practical beforehand. People could start eating two to three dried plums per day and increase gradually to perhaps six to 10 per day. Prunes can be eaten in all forms and can be included in a variety of recipes.”

Source: Florida State University

Posted by on August 23, 2011 - 10:45am

Due to the growing interest in Vitamin D, we featured that fat soluble vitamin in our August e-newsletter which can viewed by clicking HERE.  Then scroll down to "Vitamin D in the News".  Enjoy the read!

Posted by on May 16, 2011 - 12:13pm

Green tea has become an international mainstay beyond the Orient.   Many observational studies have shown that green tea is full of potent polyphenols (an antioxidant) that lower the risk of several chronic degenerative diseases such as heart disease and osteoporosis.  A recent study from Dr. Chwan-Li (Leslie)  Shen, an associate professor and a researcher at the Laura W. Bush Institute for Women's Health at Texas Tech University Health Sciences Center looked at the mechanism behind this correlation and believes it may have to do with lowering chronic levels of inflammation.

Dr. Shen has developed an animal model to study  green tea consumption and its protective effect on the breakdown of the bone's microarchitecture.  In humans, this can lead to osteoporosis, a condition common in postmenopausal women.  In her most recent study, she investigated the potential for green tea to work synergistically with tai chi, a moderately aerobic exercise popular among Chinese cultures.  Together, can these two interventions enhance bone strength?

Her randomized controlled study (the gold standard) included 171 postmenopausal women (average age was 57) who had weak bones but not full fledged osteoporosis.  They were divided into 4 groups:

  • Placebo (starch pill) and no tai chi
  • Green tea polyphenols (GTP)  and no tai chi (TC)
  • Placebo and tai chi
  • GTP plus TC

Blood and urine samples were collected on all women for 6 months and muscle strength assessed..

The GTP + TC group showed enhanced markers of bone health and muscle strength at 3 and 6 months.   Of greatest interest was the Dr. Shen's finding that both GTP and TC had on biological markers of oxidative stress, the precursor to inflammation.  Inflammation is not only a factor in osteoporosis but other chronic diseases as well.  Her findings were presented in a poster at the Experimental biology meetings in April.   Further studies are needed to confirm and better understand the mechanisms involved.

In the meantime, drinking green tea and trying tai chi sounds like a good idea, especially for premenopausal women!

Posted by on January 21, 2011 - 3:09pm

In an update to its 2002 recommendation, the U.S. Preventive Services Task Force (USPSTF) now recommends that all women ages 65 and older be routinely screened for osteoporosis. This is the first final recommendation statement to be published since the USPSTF implemented a new process in July 2010 in which all of its draft recommendation statements are posted for public comment on the USPSTF Web site prior to being issued in final form.

The USPSTF also recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. White women are used as the benchmark because they have a markedly higher rate of osteoporosis and fractures than other ethnic groups. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass and parental history of fractures.

The USPSTF did not indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age and the evidence indicates that benefits can be realized within 18 to 24 months after starting treatment. The USPSTF also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time. This new final recommendation will become effective when it appears in the January 18 online issue of Annals of Internal Medicine and will also be available on the USPSTF Web site.

Osteoporosis screening involves a measurement of bone density, which is currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on DXA tests alone. The USPSTF noted that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.

In postmenopausal women who have no prior fractures caused by osteoporosis, the USPSTF found convincing evidence that drug therapies (including bisphosphonates, parathyroid hormone, raloxifene and estrogen) reduce the risk for osteoporosis-related fractures.  It should be noted that risks regarding long term use of some of these therapies are being studied and other blogs on this site discuss that.

Osteoporosis, a condition that occurs when bone tissue thins or develops small holes, can cause pain, broken bones and loss of body height. Osteoporosis is more common in women than men and is more common in whites than any other racial group. For all demographic groups, the rates of osteoporosis rise with increasing age.

The USPSTF is an independent panel of private-sector experts in prevention and evidence-based medicine that conducts rigorous, impartial assessments of the scientific evidence and makes recommendations on the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. The USPSTF does not consider costs or cost-effectiveness in creating recommendations. The Agency for Healthcare Research and Quality (AHRQ) is authorized by statute to convene the USPSTF and provide scientific and administrative support.

Posted by on January 6, 2011 - 8:26am

Calcium and Vitamin D are essential nutrients known for their role in bone health.   However, a lot of vitamin companies have been touting these two substances for all kinds of health benefits beyond the skeletal system. This has created some confusion about nutritional messaging.

To help clarify this issue, the US and Canadian governments requested the Institute of Medicine (IOM) to assess the current data and outcomes related to these two nutrients.  Their findings were released in a brief on  November 2010 and are they are summarized below.

The overall conclusion was that most Americans and Canadians are receiving adequate amount of calcium and vitamin D.  However, there is some emerging evidence that too much of either substance can be harmful.  The committee looked at a full range of health outcomes ranging from a variety of health conditions including cancer, pregnancy, hypertension and bone health.   What they found is that a strong body of scientific evidence substantiates the importance of these two substances in bone health.   However, their review in areas outside of bone health, found that those studies often produced mixed or inconclusive results.   Higher levels of these products above the normal recommended amounts (there is a chart with recommendations by age group in the brief) have been linked to other health problems, challenging the concept "more is better".

Posted by on June 4, 2010 - 3:02pm

A recent publication from the National Osteoporosis Foundation reported that many women with postmenopausal osteoporosis underestimate their risk for fractures.  This is particularly alarming when it is coupled with new information released from the Food and Drug Administration (FDA) that found potential increased risk of fracture of the hip, wrist and spine if you take certain drugs for heartburn, acid reflux, or ulcers.

The drugs under study belong to a class of medications called proton pump inhibitors (PPIs), which work by reducing the amount of acid in the stomach.   They are available as prescriptions and as over-the-counter medications.  These drugs treat conditions like gastroesophageal reflux disease (GERD),  heartburn and ulcers of the stomach and small intestines.

Prescription PPIs include:    Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, Aciphex and Vimovo. The over-the-counter PPIs are:   Prilosec OTC and Zegerid OTC (omeprazole), and Prevacid 24R (lansoprazole).

According to the FDA, consumers should:

  • NOT stop taking your PPI unless told to by your health professionals.  They are an effective treatment for many GI disorders.
  • Be aware that an increased risk of fractures of the hip, wrist, and spine have been reported in some studies with the greatest increased risk for these fractures among those who receive high doses of these medications or use them for a year or longer.
  • Read labels and follow instructions carefully and talk to your health provider if you have questions.
  • Be aware that the over-the-counter PPIs should only be used as directed for 14 days for the treatment of frequent heartburn.   If your heartburn persists, talk to your health professional.   No more than three 14-day treatment courses should be used per year.
  • Report any side effects from the use of PPIs to the FDA MedWatch Adverse Reporting Program.

To read the full FDA article click here.  Osteoporosis affects 8 million women and 2 million men in the U.S.