ASHEVILLE  - Dr. Mark L. Hoch, MD

Bones are living tissues that support our body structure and enable us with the help of our nerves and muscles to move.  Our bodies, when healthy, are constantly remodeling our bones to keep them strong and flexible and in tune with our need for this support and healthy movement in the activities of daily living.  To be healthy our bones need exercise and proper nutrition including certain minerals, vitamins, and proteins.

  

Osteoporosis is the thinning of bone tissue and loss of bone density that can occur to some degree with normal aging but also with a number of lifestyle issues and medical conditions.  It is the most common type of bone disease and is a major risk factor for fractures of the spine, hip and wrists.  Such fractures are a major cause of disability and medical expense (about $13.8 billion per year in the US as of January 2010 per the Southern Medical Journal).

According to the National Institutes of Health, researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis (about 24 million Americans overall). Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both.   For women there is a normal significant loss of bone (decreased bone density) beginning just before menopause and extending through the first 5 years or so after menopause.  Then bone density usually stabilizes if the body is healthy and none of the situations listed below are present.

Men experience a loss of bone too but this is normally later in life past age 70.  The major reason for the decline in bone density in both sexes is a decrease in hormones.  For women this is estrogen and progesterone and for men a decrease in testosterone.  Lower levels of the adrenal hormone DHEA later in life for both men and women, in my experience is often another key cause of loss of bone.

 

Other causes include:

 

*Vitamin D deficiency – which is actually very common.

 

*Excess intake of alcohol (More than seven drinks per week for women and seven to ten drinks  per week for men.) 

This is likely the #1 cause of osteoporosis in men.

 

*Smoking.

 

*Family history of osteoporosis.

 

*Poor diet such as eating processed foods, sodas which are high in phosphates, and acid diets which are low in fruits and vegetables.

 

*Immobilization or being confined to bed for prolonged periods.

 

*Chronic medical conditions such as hyperparathyroidism,

rheumatoid arthritis, multiple myeloma, chronic kidney disease, eating disorders.

 

*Taking Coumadin (a vitamin K blocker), corticosteroid medications such as

prednisone or taking some anti-seizure drugs.

 

*Early menopause such as surgical removal of the ovaries prior to menopause.

     

*History of hormone treatment for prostate cancer or breast cancer.

 

*Low body weight.

 

*Toxic metals in the environment, especially lead which accumulates in bone.

 

There are several medications that are used to improve bone density.  The most common of these are the bisphosphonates which include Fosamax, Boniva, and Actonel. These can be helpful but they work by blocking the body’s ability to reabsorb and remodel bone.  It is well recognized by the FDA and medical doctors that after 5 years of use of these medications the benefits wear off.  This is because although bones may be denser they can start becoming more brittle and more prone to breaking because the drugs interfere with the normal remodeling process.

 

In my many years of clinical experience the vast majority of people can improve their bone density by eliminating lifestyle risk factors for osteoporosis and getting on a good diet, exercise and nutritional program and supplementing certain hormones if the levels are low as documented by testing.  Bone density starts improving quickly but may take several weeks to show improvement on special urine tests or a year to be seen on DEXA bone densitometry testing.

 

The keys to maintaining and improving bone health are:

 

*Healthy diet, regular weight bearing exercise, adequate vitamin D and other vitamins and minerals, adequate hormone levels, treating any medical problems that decrease bone density, and avoiding excessive alcohol and smoking.

*Knowing what your blood level of vitamin D is.

*If you have any risk factors for osteoporosis getting a bone density test to get a baseline.  If your test results show T-scores less than -1.5 in any area it is important to get on a good program to reverse bone loss.

*Following bone density testing and other specialized testing to monitor progress after risk factor reduction is achieved and a treatment plan is in place.  It is important to know if what you are doing is helping.

 

*Nutritional factors in a healthy diet and with supplementation include:

     - Vitamins:  D, K, C, folate and B12

     - Minerals:  calcium, magnesium, zinc, silicon and strontium

                 

*Also Hormones, when indicated by low levels on testing:

     - Progesterone, testosterone and DHEA which can build bone

     - Estrogen which can slow bone loss

     - The soy isoflavone, ipraflavone

 

Doses of the above can be individualized for optimal results based on test results of body levels, bone density and other factors.  The book Reversing and Preventing Osteoporosis by Alan Gaby, MD although published in the late 1990’s is still a very good resource and is both scientifically based and very useable by the lay person.

 

Dr. Hoch received his training from Cornell University in Biology, his MD from the University of Pittsburgh School of Medicine and residency training in Family Medicine from the University of Connecticut.  He is board certified in Family Medicine and Integrative/Holistic Medicine.  He was Lead Physician at the Arizona Center for Health and Medicine, worked at the Atkins Center for Complementary Medicine in New York City, and helped found Partners in Healing of Minneapolis.   Currently he is at Western North Carolina’s regionally renowned Great Smokies Medical Center in West Asheville. Dr. Hoch also serves on the Steering Committee of the Asheville Center for Integrative Health and the Leadership Team of Asheville Natural Wellness. 

Mark L. Hoch, MD

Great Smokies Medical Center

1312 Patton Avenue

Asheville, NC 28806