This week we’re going to be doing a series of posts related to bone health, specifically osteoporosis. This topic is especially pertinent right now as people are becoming more active thanks to the nice weather. For those with weak bones, exertion can equal a recipe for a bad break. This post will talk about the types of osteoporosis, risk factors for developing it, as well as the conventional treatments (and why they aren’t always what they’re cracked up to be – no pun intended).
Osteoporosis: This is “the weakening of bones caused by an imbalance between bone building and bones destruction” (Harvard School of Public Health). The Merck Manual defines it as “a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture”.
Osteopenia: Translated from Latin meaning “bone” (osteon) “poverty” (penia) – it is a “mild thinning of the bone mass, but not as severe as osteoporosis. Osteopenia results when the formation of bone (osteoid synthesis) is not enough to offset normal bone loss (bone lyses). Osteopenia is generally considered the first step along the road to osteoporosis” (MedicineNet.com).
Osteomalacia: Translated from Latin meaning “softening” (malacia) of the bone (osteon) – it is a “softening of bone, particularly in the sense of bone weakened by demineralization (the loss of mineral) and most notably by the depletion of calcium from bone (MedicineNet.com).
- Contrary to popular belief, as you will see in the above definitions, osteoporosis is not a disease of calcium deficiency. Osteomalacia, the softening of the bones, is greatly affected by calcium deficiencies, but osteoporosis is a decrease in bone mineral density, which results in fragile (not soft) bones. Several minerals are required to form the bone’s inner structure (or density) – calcium is only one.
- Osteoporosis is a weakening of the ‘trabecular’ bone (the inner matrix) – most calcium deposit in ‘cortical’ bone (the outer shell).
Who is at Risk of Developing Osteoporosis?
In general, those who fail to attain sufficient bone mass within the first 30 to 35 years of life and those whose bone reabsorption is greater than their bone deposition during their adult life.
- Post-menopausal women.
- Individuals with a small frame and body mass index.
- Individuals with a family history of osteoporosis.
- Individuals with a sedentary, inactive lifestyle.
- Women who have not had children.
- Long term use of corticosteroids (Prednisone etc.) and glucocorticoids.
- Those consuming alcohol.
- Those consuming caffeine (cola as well as coffee) – the famed Framingham Osteoporosis Study found that older women who drink cola every day have lower bone mineral density (Am J Clin Nut 2006; 84: 936-42).
Conventional Options for Osteoporosis Treatment
Hormone Replacement Therapy: Despite the on-going suggestions that HRT will “treat” osteoporosis, consider the following:
- HRT does not build new bone density – it only offers some benefit in slowing down bone loss – and numerous options can do the same, without the serious risks of breast cancer, stroke, heart attack and blood clotting.
- The medical journal Bone (Sep. 29, 2001(3):216-222) stated “conventional HRT acts by preserving bone, but can not restore lost bone in women with established osteoporosis.
- The medical journal Human Reproductive Update (Sep, 2000;6(5)) published a review of ALL trials on HRT and osteoporosis from 1995 – 2000 and concluded “the recommendation to use estrogen for postmenopausal osteoporosis … is not well supported.”
- In 2002 the U.S. government’s National Institutes of Health stopped an 8 year study on HRT after only 5 years because it was deemed too dangerous for the women to stay on HRT given their findings of risks. These risks included a 41 per cent increase in strokes, a 29 per cent increase in heart attacks and a 24 per cent increase in breast cancer” (Journal of the American Medical Association 2002;288:49-66).
Popular Pharmaceuticals: Remember that osteoporosis is an imbalance between new bone development and the breakdown (reabsorption) of existing bone? Well, ALL of the existing drugs for osteoporosis – including bisphosphonates (like Fosamax), S.E.R.M.s (like Evista) and calcitonin (Calcimar) – work only by slowing down the breakdown (reabsorption) of the bone. NONE of them actually increase the body’s ability to build new bone density.
- Bisphosphonates (Fosamax, Actonel, Didronel): bone and joint pain, flu-like symptoms, constipation / diarrhea, fatigue, kidney damage, osteonecrosis of the jaw.
- S.E.R.M.s (Evista): hot flashes, leg cramps, blood clots.
- Heartburn Medication: The popular drugs Prilosec, Nexium and Prevacid were found, in a study published in the Canadian Medical Association Journal (August, 2008), to almost double the risk of a hip fracture – because they decrease the stomach acid required to absorb the needed minerals.
Calcium Supplementation: The Harvard School of Medicine examined their own, as well as several other medical studies, and found no association between calcium intake and fracture risk (Am J Clin Nutr 2007;86:1780-90). Study has shown that only calcium supplements taken with a variety of trace minerals results in improvements in spinal bone loss in post-menopausal women. Calcium alone does not produce significant changes in bone density – it is only one of several minerals inside the bone.
The type of calcium dictates what you absorb and what is excreted Check your supplement label –most use calcium carbonate. This is the worst absorbed form of calcium at about 10% absorption. Calcium citrate has better absorption, but requires adequate stomach acid – and approximately 40% of post-menopausal women have low levels of stomach acid – others are taking antacids like Tums, Prilosec, Nexium, Losec etc. Calcium hydroxyapatite is a synthetic form of calcium and is very poorly absorbed, while ossein microcrystalline hydroxyapatite complex is VERY well absorbed and consider the best form of calcium by far.
The density of the inside of our bones is made up of several minerals – calcium is included, but is NOT the primary. If you want to provide your bones with minerals to slow, prevent and reverse bone loss, you need them all. They include:
- Magnesium: 1/2 of the magnesium in your body is actually inside your bones. One study showed that while magnesium deficiencies were associated with an increased risk of osteoporosis fracture, calcium deficiencies were not (Int J Epidemiol 1995, Aug 24(4):771-82).
- Vitamin D: Most have heard of the critical role this vitamin plays in bone health. The amount is key – 1000 IU per day is required to reduce fracture risks.
- Vitamin K: Low levels are associated with low bone density. Studies show supplementation can reduce hip fractures by 30% to 50% (Nurses Health Study, Framingham Heart Study).
- Zinc: Involved in the formation of osteoblasts (the cells inside bones that MAKE new bone) and enhances the activity of Vitamin D.
- Manganese: Increases the production of mucopolysaccharides – which provide a structure for calcification.
- Boron: Reduces the urinary excretion of calcium and magnesium, increases blood levels of estrogen and testosterone and helps activate Vitamin D.
- Strontium: See below.
N.B.: A multivitamin and / or calcium-magnesium supplement will NOT give you these minerals in the dosages required. You need a specific formulation, for bone health, that focuses on these minerals and vitamins.