DHEA: The Missing Link to Long-term Bone Metabolism and Health
The past decade has seen renewed interest in the rise of specific disorders related to deteriorating musculoskeletal health. Musculoskeletal disorders—like osteoporosis, weak bones, arthritis, and other bone diseases—account for more than 50 percent of the chronic conditions afflicting Americans over the age of 50. In fact, one in four Americans suffers from some form of bone and/or joint disorder.
Causes of bone loss
Disorders related to bone health and bone density are expected to escalate in the coming years. This rise is a direct result of an increased aging population and inappropriate lifestyle factors. Earlier studies and education focused on maintaining bone health and density through exercise combined with adequate calcium and vitamin D3 intake. (D3 improves calcium absorption.) Contemporary studies are focusing on the synergistic effects of other nutrients like magnesium, vitamin K2, boron, and phosphorus on bone health.
New information about bone health has researchers focused on ways to reduce the physiological processes that inhibit bone remodeling—if bone remodeling is inhibited, bone deterioration is accelerated and density suffers. Italian researchers found that chronic low-grade inflammation in the body inhibits osteoblast activity (cells responsible for bone formation) but accelerates osteoclast activity (cells that break down bone). These researchers found that a suppressed immune system leads to increased levels of pro-inflammatory agents called cytokines that have a negative impact on metabolism, bone density, and strength.
These progressive physiological changes seem to explain how aging fosters decline, and to explain the body’s struggle to stay robust in the midst of increasing frailty. This new research found increased frailty in the bone matrix as a direct result of declining levels of the hormone DHEA during the aging process.
But there’s good news: Proper levels of DHEA actually increase bone density in aging individuals by modulating key regulatory activities within the bone matrix.
The DHEA story
DHEA is one of the most abundant hormones found in the human body. Sometimes referred to as the mother hormone, it is a precursor to male and female sex hormones, including estrogen, progesterone, and testosterone, as well as the stress hormones cortisol and norepinephrine.
Commonly used as an anti-aging supplement, DHEA has been linked to improving immune function and antioxidant profiles, and it destroys various harmful brain chemicals associated with Alzheimer’s disease and dementia. Its use as an anticancer, anti-atherosclerosis, antiobesity, and antidiabetic agent has been well documented. Low DHEA levels have been conclusively linked with increased rates of mortality and decreased functional limitations in both men and women. Though DHEA is the most abundant hormone in the human body, levels tend to decline at an accelerated rate starting in the mid-30s. In fact, by age 65 blood levels can drop to 10 to 20 percent of optimal levels (those of individuals aged 25 to 35). By age 80, blood levels can drop to less than five percent of optimal levels.
How DHEA outsmarts osteoporosis
In a 2006 study appearing in Clinical Calcium and a related 2006 study in Cellular and Molecular Immunology, researchers described how reduced activity levels of DHEA in aging females could be considered a precursor to osteoporosis. Japanese researchers studying the role of DHEA in relationship to bone metabolism found androgen receptor sites (DHEA is an androgen) in osteoblast, osteoclast, and in bone marrow stromal cells. Growth agents like DHEA have demonstrated the ability to regulate the expression and activity of many different cytokines and growth factors, while modulating the maintenance and repair activities within the bone matrix. These researchers found that postmenopausal women benefit from DHEA as a bone restoration agent due to its regulatory actions within osteoblasts.
As mentioned earlier, DHEA is a precursor to estrogen, progesterone, and testosterone, all of which deter bone loss as a direct result of their physiological interactions with DHEA. Bone cells also convert DHEA into estrone with the help of D3. Estrone is the form of estrogen responsible for accelerating the activity of the bone-building osteoblasts.
Based on data collected from a recent study, researchers found a positive correlation between DHEA levels and increased bone density in women over 50. The higher a woman’s DHEA levels were at menopause, the greater the density of the bones. This study also clarifies how skeletal health is dependent upon the delicate balance between bone formation and bone breakdown. Bone loss often occurs as a result of an imbalance between these two processes. While bone deterioration, fragility, and fractures are associated with many factors—like genetics, environmental, nutritional, and chronic disease—the correlation to hormonal activity is still an important factor to consider. Raising DHEA levels in aging men, and even more so for women, reduces the incidences of osteoporotic fractures.
A related study, also conducted by Japanese researchers, testing bone mineral density and DHEA levels in 120 postmenopausal women aged 51 to 99 found a definitive link to increased DHEA levels and stronger bones. These researchers concluded that DHEA’s conversion to estrone in osteoblast cells is an important factor in maintaining bone mineral density as estrogen levels decline following menopause.
DHEA increases bone mineral density
In a study appearing in the Townsend Letter for Doctors and Patients, 70 women and 70 men aged 60 to 88 were randomly administered 50 mg a day of DHEA or a placebo for a year. The mean bone mineral density (BMD) increased in the DHEA group by 1 percent in the hip compared to 0.05 percent in the placebo group. In the femoral shaft bone mineralization increased by 1.2 percent versus 0.06 percent in the placebo group. Women in the study also showed a BMD increase in the lumbar spine of 2.2 percent as compared to 0.04 percent in the placebo group.
Results of this study indicate that markers of bone breakdown appear to be a better predictor of future bone loss than markers of bone formation. The link appears to be stronger in older women than young women.
DHEA and anorexia
Recently researchers at Harvard Medical School conducted a study of 15 anorexic young women to assess how well dosages of 50 mg, 100 mg, and 200 mg a day of DHEA improved bone mineral density. These researchers reported that all of the subjects receiving each dose range had dramatic decreases in markers for bone breakdown and had significant increases in markers related to bone formation. These results have far-reaching implications for preserving bone health in young women with anorexia. Women with anorexia tend to exhibit low levels of DHEA and estrogen which studies suggest causes the bone loss seen in these individuals.
Researchers at Boston Children’s Hospital compared the effects of a one-year course of oral DHEA treatment versus that of conventional hormone replacement therapy (HRT) in young women with anorexia. In this trial 61 young women were randomly administered 50 mg/d of DHEA or 20 micrograms of the HRT drug ethinyl estradio and 0.1 mg levonorgestrel.
Body measurements and nutritional and exercise data were recorded over a three-month period. Bone mineral density and body composition changes were measured at six months and one year.
While both therapies in this study significantly decreased bone loss, hip bone density in the DHEA group went up with increases in insulin growth factor (IGF-1) bone formation markers and bone-specific alkaline phosphatase (bone ALP), a test used to measure active bone formation. The increase in insulin-like growth factors (IGF-1) associated with DHEA intake is also of great significance here as IGF-1 plays a critical role in bone metabolism.
The IGF-1 connection
While a decline of the hormone IGF-1 is seen in aging women and men, it is also seen in young women suffering from anorexia nervosa. In the aforementioned study DHEA had clearly superior growth effects on the bone matrix as compared to HRT.
Furthermore, Mexican researchers have noted that a major complication of eating disorders—especially anorexia nervosa—is bone mass loss. The mechanisms implied in bone deterioration are declining estrogen levels, elevated cortisol levels, and decreases in IGF-1 in these individuals. According to these researchers, the first line of treatment to recover bone mass in these cases is nutritional rehabilitation, weight gain, and hormonal replacement therapy combined with an anabolic method that can positively manipulate restorative activities within the bone matrix.
The cortisol connection
A mounting body of scientific data suggest that DHEA’s ability to reduce cortisol is a major factor in the improvement it creates in bone repair and building activities. Elevated cortisol levels due to physical and mental stress trigger the fight-or-flight response. To deal with a perceived stress, the body quickly reroutes energy sources and micronutrients destined for bone building activities to muscle tissue.
According to scientists at the University of Naples in Italy, glucocorticoid-induced osteoporosis is one of the most frequent causes of secondary osteoporosis. This is caused by taking glucocorticoid medicines like hydrocortisone (which is cortisol), cortisone, prednisone, and so on. These researchers found that increasing DHEA levels minimized the risk of vertebrae fractures associated with excessive cortisol. They concluded that the lumbar spine bone mass density is directly related to cortisol-to-DHEA ratio, and that it is actually a very good predictor of impending vertebral fractures.
Suggested dose of DHEA
Based on a large body of scientific evidence, 50 mg to 200 mg of DHEA a day is needed to maintain blood levels of 200 to 300 mcg/dl for women and 300 to 400 mcg/dl for men. The ideal is to restore the person taking DHEA to a typical DHEA level for a healthy 30-year-old of their gender.
Many physicians check DHEA blood levels and adjust dosages to maintain levels optimal for maintaining bone health.
There is now considerable evidence that restoring DHEA levels in the aging population enhances bone mineral density—this is especially important for women. Current data suggest that improvements in bone mineral density in response to DHEA supplementation are due to suppressing bone loss and, more importantly, stimulating bone formation. In practical terms, women over 35 should strongly consider supplementing with DHEA as an addition to current supplementation and other modes of osteoporosis prevention.
This consideration should be discussed with your healthcare professional, as DHEA is the only hormone that can stop bone breakdown while stimulating bone formation.
Editor’s Note: DHEA is a potent hormone and supplementation can result in undesired effects. Consult with your practitioner who can recommend personalized dosages and monitor your blood levels, guiding you toward the desired results.
George L Redmond, PhD, ND, is a graduate of the Clayton College of Natural Health (ND), the American Holistic College of Nutrition (PhD), and received a PhD in Administration and Management from Walden University. For 20 years he has specialized in vitamins and holistic healthcare and he has served as a regional and national education director for one of the largest retailers of vitamins in the United States. He is a popular guest on many syndicated radio health programs and his articles have appeared in numerous magazines.