Bioidentical Hormones Prevent and Reverse Osteoarthritis by Jeffrey Dach MD

Hormonal Decline Leads to Degenerative Disease

One of the basic concepts of “Anti-Aging Medicine” is that hormonal decline leads to the onset of degenerative diseases. On the top on 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.

Xray of knee showing early osteoarthritis courtesy of wikimedia commons.

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 osteo-arthritis. 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 is a Vending Machine and a Mouthpiece for the Drug Industry

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 osteo-arthritis.

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.

Typical changes of osteoarthritis of the finger joints, courtesy of wikimedia commons.

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. (15)

A nice summary article by Dr. Herrero- Beaumont from Spain came out in the 2009 Seminars in Arthritis and Rheumatism. (1) This author reviewed the medical literature from 1952 to 2008 and found three causes for osteoarthritis :

1) genetic
2) menopause-related Estrogen deficiency
3) aging

In another publication in 2009 Arthritis Research and Therapy, Dr Herrero Beaumont says: “There is now increasing evidence that estrogens influence the activity of joint tissues through complex molecular pathways that act at multiple levels.”(2)

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.(3) 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 (OA) of the hip. Women who used Estrogen for 10 years or longer had a 43% reduction in OA of the hip. The authors concluded that ” Postmenopausal estrogen replacement therapy may protect against OsteoArthritis (OA) of the hip.” (3)

Framingham Study – Arthritis of the Knee Reduced by 60%

Hip replacement could be prevented by Estrogen Replacement, image courtesy of wikimedia commons.

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. ” (4) Their study examined whether estrogen replacement therapy (ERT) prevents worsening of radiographic knee osteoarthritis (OA) 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.(4)

Women’s Health Initiative WHI- Lower Incidence of Joint Replacements

Published in 2006, the WHI data showed that women receiving Premarin (oral estrogen alone) had 12% lower rates for joint replacement for osteoarthritis.(5)

Genetic Causes of Arthritis

GENETIC CAUSES OF Osteoarthritis- Disturbed Estrogen Metabolism

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.” (6)

The authors explored the association of genetic abnormalities with severe osteoarthritis (OA) in 3147 patient 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 (OA) of the lower limbs.

Women with unfavourable genotypes had 60% increased risk for knee OA. The authors conclude, “Common genetic variations of the aromatase and ER genes are associated with the risk of severe OA of 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 OA.”(6) 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.” (8) 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.” . (8)

Animal Studies

Estrogen Replacement in Monkeys Prevents OA

A study published in Arthritis Rheumatism 2002 entitled,”Effects of long-term estrogen replacement therapy on osteoarthritis severity in monkeys”, by Dr Ham from the University of Minnesota, examined estrogen replacement therapy (ERT) on the severity of osteoarthritis (OA) of the knee joint in postmenopausal female monkeys (after surgical removal of the ovaries).(7)

After three years of estrogen treatment, using Premarin, the monkeys were sacrificed and knee joints examined histologically. The authors found that cartilage lesions of osteoarthritis (OA) were significantly less severe in the animals given estrogen replacement (ERT) compared with those in the control group. The authors concluded,” These results demonstrate that long-term estrogen replacement (ERT) significantly reduces the severity of osteoarthritis (OA).(7)

Ovarectomized Mice Treated with Estrogen

A 2006 study by Tanko from Denmark published in Arthritis Rheumatism found that estrogen prevented joint and cartilage degradation in an animal model with mice. This article was entitled,”Effects of ovariectomy and estrogen therapy on type II collagen degradation and structural integrity of articular cartilage in rats: implications of the time of initiation.”(9) The authors found that “treatment of the animals with estrogen counters the acceleration of type-two collagen degradation and these benefits can be maximized by early initiation after menopause. The protective effect of estrogen seems to involve direct inhibition of the catabolic function of chondrocytes.” (9)

Pig Studies

Similarly in pigs, researchers found estrogen prevents cartilage degradation. This study was published by Claassen from Germany in 2002 Annals of Anatomy, entitleded, ” The effect of estrogens and dietary calcium deficiency on the extracellular matrix of articular cartilage in Göttingen miniature pigs.” (10) Their study investigated how estrogen deficiency affects the articular cartilage . They found that in animals with estrogen deficiency, the articular cartilage underwent degradation, i.e. similar changes to those observed in physiologically aging cartilage.(10)

Electron Microscope Study of Estrogen Deficiency Induced Arthritis in the Guinea Pig

A guinea pig study by Dr Dai from China was published in the Chinese medical Literature, in 2005, entitled,”The relationship of the expression of estrogen receptor in cartilage cell and osteoarthritis induced by bilateral ovariectomy in guinea pig.” (11)

The authors used the scanning electron microscope (SEM) and transmission electron microscope (TEM) to analyze cartilage degeneration in joints after ovariectomy, which produces estrogen deficiency in the animals. The authors looked at estrogen receptors and serum levels of estrogen. They indeed found estrogen receptors (ER) in the cartilage of the guinea pigs. They also found Joint Cartilage degeneration detected by electron microscopy at 6 weeks, with severe degenerative lesions at 12 weeks after removal of ovaries compared to the control group. The author concludes that , “bilateral ovariectomy in the guinea pig leads to severe osteoarthritis “.(11)

Ovarectomized Sheep Treated With Estradiol Implants

Published in 1997 in Osteoarthritis Cartilage, a study entitled,” Biochemical effects of estrogen on articular cartilage in ovariectomized sheep” by Dr AS Turner from Colorado State University, looked at estrogen replacement with estradiol implants in ovarectomized sheep.(12) After twelve months, the articular cartilage from the knee joints were carefully evaluated. Ovarectomy, with its attendant estrogen deficiency had a significant deleterious effect on articular cartilage. Treatment with estradiol, a bioidentical hormone, reversed these deleterious effects, and maintained structural integrity of the joints. (12)

Another sheep study published in 2005 in Osteoarthritis Cartilage, entitled, “Ovariectomy alters the structural and biomechanical properties of ovine femoro-tibial articular cartilage and increases cartilage iNOS”, by Dr MA Cake MA from Australia examined the effect of estrogen depletion (ovariectomy) on articular cartilage of the joints, and the production nitric oxide synthase (iNOS). (13)

At 26 weeks after removal of the ovaries, the joints were studied histologicaly, and amounts for nitric oxide (NO) studied. In the estrogen deficient animals, cartilage thickness was reduced, along with arthritic changes and upregulated nitric oxide production. (13) The authors conclude, “estrogen depletion caused regional thinning of femoro-tibial cartilage, with biomechanical and histological changes suggestive of a disturbance in proteoglycan and collagen.”(13)

Animal Model Summary Paper

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.” (14)

The author noted that the prevalence of osteoarthritis (OA) 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 (ovarectomy) in animals. (14)

Conclusion

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.

Articles with related interest:

Menopausal Arthritis

Articles on Bioidentical Hormones By Jeffrey Dach MD

Articles from Bioidentical Hormones 101

Jeffrey Dach MD
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