Fosamax is a drug that has become very
popular among traditional physicians for the
treatment of osteoporosis. It is typically
used in conjunction with estrogen
replacement therapy. Estrogens' effect on
bone is to inhibit the "osteoclast cells".
These are the cells responsible for the
breaking down of bone as a part of its
natural life cycle.
Estrogen replacement is only effective in
managing post- menopausal bone loss during
the first 5 years after the menses end.
After that, estrogen-replaced and
non-estrogen-replaced women lose bone mass
at the same rate.
Deficiency of estrogen (levels drop by 40%
post-menopausally) therefore is not the main
cause of postmenopausal osteoporosis. What
is? It's the drastic drop in
progesterone (to 1/120 of the
premenopausal values) that is the crucial
factor. Progesterone is one of the only
substances we know of that stimulates the
bone building cells called "osteoblasts". So
how does Fosamax work? Its mechanism of
action, like estrogen's, is as an inhibitor
of osteoclast cells. There is less breakdown
of bone when taking the drug. Does this
produce new bone? Marginally so, but when
osteoclasts are inhibited, the osteoblasts
also become inactive. The end result is
stronger appearing bone which is actually
weaker and more brittle, and a diminished
capacity to form new bone because of
reduction in osteoblast cell numbers, and
activity.
Although for the first 3 years there appears
to be increasing density of bone in Fosamax
users, the incidence of serious hip
fractures actually increases after that,
since the remaining bone is not of adequate
quality. Therefore early "improvement" seen
on bone density X-rays like DEXA scans can
be deceiving, and does not justify a
lifetime commitment to an expensive drug
with rather notable side effects as well.
The proper treatment for osteoporosis
is not osteoclast inhibitors, but rather
osteoblast stimulation, mainly provided
by natural progesterone (not Provera),
testosterone, and human growth hormone.
Osteoporosis can also be caused by mineral
and vitamin deficiencies, corticosteroid
drugs, poor eating habits, lack of exercise,
and too much cortisol. The major influence
on age-associated bone deterioration,
however, would appear to be a severe
deficiency of ovarian-secreted progesterone.
Our treatment programs at CMRS involve
focused natural hormone replacement
therapies and scientific monitoring of the
degree and rate of bone loss in the context
of a complete medical and life style
evaluation. We take all these factors
into account, and will be happy to work with
you to help you treat or prevent
osteoporosis.
Dr. Filice serves patients in the greater
Chicago area
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