One of the basic concepts of “Anti-Aging Medicine” is that hormonal decline leads to the onset of degenerative diseases. On the top of the list is degenerative osteoarthritis, a common form of progressive joint destruction from years of wear and tear. Recent medical research shows that menopausal estrogen deficiency is a causative factor in developing degeneration of the joints.
Anti-Aging Medicine accepts the idea that hormonal replacement is beneficial for preventing the various degenerative diseases of aging, such as the joint degeneration of osteoarthritis. Bioidentical hormone supplementation not only reduces risk for developing degenerative disease, it also reduces over-all mortality.
Mainstream Medicine Says Hormonal Decline is NORMAL
This is vehemently denied by Mainstream Institutional Medicine which clings to the politically acceptable yet incorrect thesis, that hormonal decline DOES NOT lead to degenerative disease, and does not require treatment. These “mainstream medical institutions” consider low hormone levels of aging to be “NORMAL”.
Mainstream medicine marches to the tune of the pharmaceutical industry, and a major source of profit for the drug industry comes from “Blockbuster Drugs” used to treat degenerative diseases, such as anti-inflammatory NSAID drugs for treatment of osteoarthritis.
The drug industry views bio-identical hormone replacement as a direct threat to profits from its pipeline of blockbuster drugs. Since Mainstream Medicine serves as a vending machine and a mouthpiece for the drug industry, it is no surprise that bio-identical hormones have been neglected, ignored and even rejected by Institutional Medicine.
Growing Baby Boomer Population in Hormonal Decline
Imagine a growing population of baby boomer generation retirees, over the age of 50, all on their way to hormonal decline and degenerative diseases such as osteoarthritis, coronary artery disease, osteoporosis, immune and cognitive function decline. Imagine the beneficial outcome if this entire population was given bio-identical hormones? These aging baby boomers and retirees would no longer need many of the drugs freely prescribed by their doctor for degenerative disease, eliminating a large chunk of profit for the pharmaceutical industry. In addition these people would live longer in good health, bankrupting the government Medicare and Social Security programs. Obviously, this is politically unacceptable
Osteo-arthritis and Estrogen Replacement
Osteoarthritis increases dramatically in women after menopause suggesting that estrogen deficiency increases risk of osteoarthritis. Studies of women who take estrogen replacement therapy after menopause consistently report reduced risk for osteoarthritis when compared to women not using estrogen replacement. This suggests a role for estrogen supplements for prevention of osteoarthritis in women after age 50.
A nice summary article by Dr. Herrero- Beaumont from Spain came out in the 2009 Seminars in Arthritis and Rheumatism. This author reviewed the medical literature from 1952 to 2008 and found three causes for osteoarthritis :
2) menopause-related Estrogen deficiency
Estrogen Replacement Reduces Osteoarthritis of the HIP by 43%
A 1996 study on estrogen replacement and osteoarthritis published in the Archives of Internal Medicine, entitled, ” Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women” was from Dr Genant at the University of California, San Francisco. This study examined 4,366 post-menopausal women over the age of 65. Hip X-Rays were used to assess osteoarthritis of the hip joint. They found that women who took oral estrogen had a 38% reduced risk osteoarthritis of the hip. The authors concluded that ” Postmenopausal estrogen replacement therapy may protect against OsteoArthritis of the hip.”
Framingham Study – Arthritis of the Knee Reduced by 60%
The Framingham Study on Arthritis of the Knee was published in Arthritis and Rheum in 1998 by Dr Zhang of Boston University School of Medicine entitled, “Estrogen replacement therapy and worsening of radiographic knee osteoarthritis: the Framingham Study. ” Their study examined whether estrogen replacement therapy prevents worsening of radiographic knee osteoarthritis in elderly women.
They followed 551 post-menopausal women (over the age of 63) over 8 years with serial weight bearing AP knee X-Rays, looking for worsening of osteoarthritis over time. The authors found a 60% decrease in osteo-arthritis in the estrogen users compared to non-users.
Genetic Causes of Arthritis
A study was published in 2010 in the journal Osteoarthritis Cartilage by Dr Riancho from Spain entitled,” Common variations in estrogen-related genes are associated with severe large-joint osteoarthritis: a multicenter genetic and functional study.”
The authors explored the association of genetic abnormalities with severe osteoarthritis in 3147 patients who were compared to 2,381 normal controls. The authors examined two abnormal genes which reduce estrogen activity. These are the genes for the Aromatase Enzyme, and gene for the estrogen receptor (ER-Alpha, estrogen receptor alpha), and their association with severe osteoarthritis of the lower limbs.
Women with unfavourable genotypes had 60% increased risk for knee osteoarthritis. The authors conclude, “Common genetic variations of the aromatase and ER genes are associated with the risk of severe osteoarthritisof the large joints of the lower limb in a sex-specific manner. These results are consistent with the hypothesis that estrogen activity may influence the development of large-joint osteoarthritis.” Thus, the genetic studies also indicate the importance of estrogen in preserving joints and preventing osteoarthritis.
Cellular Mechanisms of Estrogen on Cartilage
Dr Tanko from Denmark summarized three decades of medical research in an article published in 2008 in Climacteric entitled, “Review of cellular mechanisms conferring the indirect and direct effects of estrogen on articular cartilage.” The authors state, ” Estrogen receptors have been identified in articular chondrocytes from various animals and humans.” They conclude: “The effects of estrogen on articular cartilage further corroborate the due consideration of estrogen therapy for maintaining not only bone but also cartilage health in postmenopausal women.”
Dr Dach has also reported on a number of studies that have looked at the effects of estrogen replacement therapy on osteoarthritis including work on monkeys, mice, sheep and pigs. These studies have taken place in the USA, Denmark, Germany, Australia and China and have consistently shown long-term estrogen replacement significantly reduces the severity of osteoarthritis.
In 2008, Dr Sniekers of the Netherlands summarized all preceding animal studies in a report published in Osteoarthritis Cartilage, entitled,” Animal models for osteoarthritis: the effect of ovariectomy and estrogen treatment – a systematic approach.”
The author noted that the prevalence of osteoarthritis increases dramatically in women after the age of 50 with onset of menopausal estrogen deficiency. Animal models are useful to evaluate this. The author found eleven out of 14 animal studies showed that ovarectomy (surgically induced estrogen deficiency) resulted in cartilage damage, indicating considerable evidence for a relation between cartilage degeneration and estrogen deficiency in animals.
The animal and human studies now provide overwhelming evidence for the importance of estrogen replacement after menopause for the prevention, and/or reversal of osteoarthritis.
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For maximum protection against both osteoporosis and osteoarthritis a combination cream with both bioidentical natural progesterone and natural oestrogens would seem to be an ideal solution for women at risk. This will provide oestrogen in a bioidentical and safe form, and supported by progesterone to oppose any possible oestrogen dominance.