Bone-Related Hormones & Skeletal Health

Supporting bone-related hormonal balance is essential for optimal bone and overall health. In addition to aging, menopause, male hypogonadism, and some medications, a range of chronic diseases may also contribute to osteoporosis or reduced bone quality, including inflammatory bowel disease,¹ liver and kidney diseases,^2,3 celiac disease,⁴ and diabetes.⁵ The functional medicine model approaches bone health by considering the multiple influential factors. This includes addressing potential bone-related hormone dysfunction. 

Hormones operate within a web of interconnection impacted by many factors, with the balance ultimately affecting the function and health of body systems. The skeletal system is no exception, as multiple hormones modulate and support bone health. This complex network of regulatory hormones responds to changes in blood calcium and phosphorous levels and affects the formation and turnover of bone throughout the life stages. What modifiable lifestyle factors and other foundational functional medicine approaches support the skeletal system and bone-related hormones?

Bone Hormones: A Complex Web

Regulatory hormones play a critical role in the lifelong bone remodeling process. The following are some of those hormones, with a brief description of their complex roles in supplying necessary minerals for bone development, monitoring mineral blood levels, and maintaining or influencing bone homeostasis: 

• Parathyroid hormone (PTH): This calcium-regulating hormone controls the level of calcium in the blood and stimulates both resorption and formation of bone.⁶
• Calcitriol (1,25 dihydroxy vitamin D): Also a noted calcium-regulating hormone, calcitriol is produced from vitamin D and is required for calcium absorption.⁶
• Calcitonin: A third calcium-regulating hormone, calcitonin protects against excessive blood calcium levels.⁶
• Sex hormones: Estrogen is a key regulator of bone remodeling in women and men and acts on both osteoclasts and osteoblasts. Testosterone is important for skeletal growth and is also a source of estrogen in the body.^6,7
• Growth hormones: Growth hormone and its production of the insulin-like growth factor (IGF-1) influences bone formation.⁶
• Thyroid hormones: These hormones are required for skeletal maturation and influence adult bone maintenance.^6,8
• Cortisol: Large amounts of this adrenal gland hormone block bone growth. Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis.^6,9
• Insulin: Important for bone growth, insulin signaling regulates both bone formation and bone resorption.^6,10
• Leptin: This circulating hormone has direct and indirect influences on bone metabolism that research continues to elucidate.^6,11

Bone Hormones: Lifestyle-Based Support

A foundational principle for the assessment and treatment of all hormonal imbalances is IFM’s “PTSD” mnemonic, which identifies points of leverage where personalized interventions help to restore hormonal balance through the improvement of production, transport, sensitivity, and detoxification of hormones. These tailored treatments may include a range of lifestyle-based approaches. Recent studies continue to indicate that anti-inflammatory Mediterranean-style diets,¹² weight-bearing and resistance-based exercise,^13,14 and mind-body interventions including stress reduction^15-17 help tosupport bone health overall. In addition to a nutrient-dense diet, specific vitamins, minerals, and nutraceuticals help to positively impact bone density and quality. Calcium, vitamin D, vitamin K, isoflavones (abundant in soybeans and other legumes), and omega-3 fatty acids are several examples.^18-22

Specific to supporting those hormones that regulate bone homeostasis, nutrition and other modifiable lifestyle factors may also play a role. For example:

• Mindfulness-based stress reduction interventions may improve regulation of both the sympathetic nervous system and the hypothalamic-pituitary-adrenal system impacting cortisol levels.²³ 
• A 2019 randomized controlled trial that included overweight/obese adults with metabolic syndrome reported that compared to controls, those participants receiving the 12-month intervention (energy-restricted Mediterranean diet, physical activity promotion, and behavioral support) had reduced circulating levels of leptin and significantly improved insulin sensitivity.²⁴ 
• Compelling results from a 2020 animal study suggested that the short-chain fatty acid butyrate was required for PTH to stimulate bone formation and increase bone mass.²⁵ This study highlights the developing research on the relationship between maintaining a healthy gut microbiome and optimizing bone health.^26,27

Conclusion

A team of hormones regulates bone metabolism and works to maintain bone homeostasis. Lifestyle-based interventions from nutrition to stress management help to support their function and maintain skeletal integrity. At IFM’s Hormone Advanced Practice Module (APM), learn from functional medicine experts about the complex interplay of hormones and how you can use IFM tools to determine the most appropriate treatments for your patients.

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