By Phillip Steele, MD RMSK, CAQ Sports Medicine and
Buzz Walton, MD, CAQ Sports Medicine
Performance Injury Care & Sports Medicine
One of the basic concepts of regenerative medicine and “Anti-Aging Medicine” is that hormonal decline as we age can lead to the onset of degenerative joint diseases. Osteoarthritis (OA), a form of progressive joint disease is secondary to both a hormonal decline as we age and from years of wear and tear. Recent medical research shows that menopausal estrogen deficiency is a causative factor in developing degeneration of the joints.
In an attempt to slow the progression of degenerative joint disease we are now using stem cell, platelet rich plasma and concentrations of A2M to slow the steady march of osteoarthritis. Regenerative medicine and Anti-Aging Medicine should be intertwined with the idea that hormonal replacement is beneficial for preventing the destructive joint degeneration of osteoarthritis. Bioidentical hormone supplementation can not only slow the progression of degenerative joint disease, it can also reduce over-all mortality.
Traditional mainstream medicine practiced here in the U.S. teaches physicians that we “normally have a decline in hormonal levels as we age”. As more and more evidence becomes available that this basic tenet is false, we must reconsider our more traditional mainstream beliefs and look to new solutions to the aging problem. By using Bio-identical hormones to slow the progression of degenerative joint disease we can also impact the quality of life as we age.
Osteoarthritis and Estrogen Replacement
Osteoarthritis prevalence increases dramatically in women after menopause suggesting a link to estrogen deficiency and the 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 study suggests a role for estrogen supplements for prevention of osteoarthritis in women after age 50. In a review article published in 2009, Seminars in Arthritis and Rheumatism several factors were concluded that increase the risk for OA.
- menopause-related Estrogen deficiency
In 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 they concluded that Estrogen Replacement Reduces Osteoarthritis of the HIP by 43%. They further concluded that ” Postmenopausal estrogen replacement therapy may protect against Osteoarthritis of the hip.”
Framingham Study – Arthritis of the Knee Reduced by 60%
In another study on knee arthritis “The Framingham Study on Arthritis of the Knee” published in Arthritis and Rheum in 1998, they evaluated whether estrogen replacement therapy prevents worsening of radiographic knee osteoarthritis in elderly women. They followed 551 post-menopausal women greater than 8 years with serial weight bearing AP knee X-Rays, looking for worsening of osteoarthritis over time. The authors found a 60% decrease in osteoarthritis in the estrogen users compared to non-users.
A study from Denmark summarized three decades of medical research in an article titled “Review of cellular mechanisms conferring the indirect and direct effects of estrogen on articular cartilage.” published in 2008. They found estrogen receptors in articular chondrocytes (cells) from various animals and humans.” They further concluded that “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.”
Although I have provided just a few examples of research showing the importance of maintaining levels of estrogen in women for prevention of osteoarthritis, many more such articles confirming the important role of estrogen in osteoarthritis are available. With many other considerations for Bioidentical hormone supplementation consider discussing this issue with one of our physicians.
The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician.