My mom has osteoporosis.
So do about 52 million men and women over the age of 50. That’s over half of the over 50 population in the United States! And, as population ages, the numbers go up, according to the National Osteoporosis Foundation. It’s clear there is something very wrong with our diet and lifestyle choices.
Osteoporosis is characterized by reduced and weaker bone mass, which leads to an increased susceptibility to fractures. Bone strength is genetically determined, but other factors (nutritional, environmental and lifestyle) can determine whether a person actually gets the disease or not.
Approximately 80–90% of bone mineral content is made up of calcium and phosphorus. Other dietary components, such as protein, magnesium, strontium, zinc, copper, iron, fluoride, vitamins D, A, C, and K are required for proper bone structure and function, and other non- nutrient dietary components (caffeine, alcohol, phytoestrogens) may also impact bone health.
In addition other lifestyle factors such as stress, exercise, and medications may also impact bone health.
The interactions of nutrients and lifestyle is one of the reasons for the confusion as to the real cause or lack of nutrients that lead to osteoporosis.
Many people believe osteoporosis is a normal part of aging, but it is not. Bones can be strong throughout a lifetime with the right combination of nutrition, exercise and lifestyle changes.
Although there is a common misconception that bones are a static part of the body, the human skeleton is actually a living, growing, changing structure over the course of a lifetime.
Children and teens form new bone faster than they lose old bone. In fact, even after they stop growing, young people continue to make more bone than they lose. This means bones get denser, until they reach peak bone mass somewhere around the age of 18-25. For teens who participate in sports, bones generally are even denser and harder. This period of bone building is like putting money in the bank for later.
Both male and female hormones have a tremendous impact on bone health this become very clear in postmenopausal women. The reduction of estrogen in women at menopause and the loss of testosterone for men, contributes to accelerated bone loss. If untreated, women can lose up to 20-30% of bone after the age of 50 and for men it is slightly less.
Think of your bones as a savings account. There is only as much bone density in your account as you deposit, and the critical years for building bone density begin in the pre-teen years and last until your mid-20s. This gain in bone density during the first few decades of life translates to lower risk of fracture later in life. For both men and women, participating in athletics or physical activities help to increase bone mass during the critical early adult years.
After you reach peak bone mass, the balance between bone formation and bone loss may begin to change as you can lose more bone than your body is building. Other factors that affect the amount of bone lost are:
• Age–Osteoporosis can affect people of all ages, but it is far more common in older people than younger people. All of us lose some bone density as we age, but some of us lose more bone or lose it faster. It is not true that every older person gets osteoporosis, but it does become more common with age. One factor having to do with age, may be the drastic decrease in physical activity, which then impacts bone strength.
• Sex–About one in two women over the age of 50 will break a bone because of osteoporosis. A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined. Women have lighter, thinner bones than men. Menopause speeds up the process of bone loss due to the loss of estrogen. However, osteoporosis isn’t just a woman’s disease. Up to one in four men over the age of 50 will break a bone because of osteoporosis. A man older than age 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.
• Family History–Research suggests that heredity and genetics play a major role in osteoporosis and broken bones. If either of your parents had osteoporosis or a history of broken bones, you are more likely to break a bone.
• Small Body Frame–Women and men with small bones are more likely than larger people to have osteoporosis. But that doesn’t mean heavier or larger people can’t get it.
• Sedentary Lifestyle—Putting mild stress on the bones with exercise throughout a lifetime can have a very positive effect on bone strength and the ability to retain it as you age. Conversely a lifestyle lacking in exercise will deplete the strength and mineral content of the bones.
• Not Eating Enough Fruits and Vegetables–Eating a well-balanced diet, rich in fruits and vegetables, is important for healthy bones. In addition to calcium and vitamin D, magnesium, potassium and vitamin K are a few of the many minerals and vitamins that are important for bone health. Experts recommend multivitamins or supplements for people who do not get enough minerals and vitamins from foods or those with any type of GI disorder like gluten intolerance, or those on proton pump inhibitors.
· Medication—Certain medications such as steroids will deplete the bones and can lead to stress fractures and early osteoporosis. Some medicines can be harmful to your bones, even if you need to take these medicines for another condition. Bone loss is usually greater if you take them in high doses or for a long time.
Do not stop any treatment or change the dose of your medicines unless your healthcare provider says it’s safe to do so. If you need to take a medicine that causes bone loss, work with your healthcare provider to take the lowest possible dose to control your symptoms.
Below is a list of medicines that may cause bone loss:
· Aluminum-containing antacids
· Anti-seizure medicines such as Dilantin® or Phenobarbital
· Aromatase inhibitors such as Arimidex®, Aromasin® and Femara®
· Cancer chemotherapy drugs
· Cyclosporine A and FK506 (Tacrolimus)
· Gonadotropin releasing hormone (GnRH) such as Lupron® and Zoladex®
· Medroxyprogesterone acetate for contraception (Depo-Provera®)
· Proton pump inhibitors (PPIs) such as Nexium®, Prevacid® and Prilosec®
· Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft®
· Steroids (glucocorticoids) such as cortisone and prednisone
· Tamoxifen® (premenopausal use)
· Thiazolidinediones such as Actos® and Avandia®
· Thyroid hormones in excess
· Other Lifestyle Factors—Smoking, excessive caffeine intake and alcohol consumption will also contribute to the chances of getting osteoporosis.
Obviously drug companies have captured the rising tide of osteoporosis and are pushing medications that are purported to help strengthen bones. These medications are of dubious help in developing real bone strength with many serious side effects. Long-term usage and effects are really not known either. The primary osteoporosis drugs such as: Fosomax, Evista, Boneva, Reclast, and Atonel all belong to a group of drugs called biophosphonates.
Since 2003, annual sales of osteoporosis drugs have about doubled to $8.3 billion, and $3 billion of that was from Fosamax alone.
Some of the serious adverse effects from Fosamax alone include idiopathic femur breaks in women on the drug more than 5 years, and necrosis (death) of the jawbone.
Essentially, the condition causes your jawbone to rot and decay—quite ironic considering the drugs are primarily taken by people looking to strengthen their bones.
Bisphosphate drugs have also been associated with:
· Eye inflammation and potential blindness
· Atrial fibrillation
· Esophageal ulcers, stomach ulcers and esophageal cancer
· Renal failure
· Skin reactions
· Liver damage
· Hypocalcemia (blood calcium levels are too low)
Bisphosphonate drugs like Fosamax, Actonel and Boniva are problematic because they stay in the bone indefinitely and disrupt the normal bone regeneration process. Healthy bones maintain their strength from a continual process of bone breakdown and bone rebuilding. Osteoclasts are the cells that break down your bone, and osteoblasts are the cells that rebuild it. Fosamax and similar drugs put a halt to the osteoclasts, permanently killing them, so that the normal bone repair process is halted. So although bones get denser with these drugs, they actually become brittle, which is the part the drug companies don’t tell you. In fact, bones become weakened and more prone to fracture.
Why does this happen? Bone is a dynamic structure that requires the removal of unhealthy bone and replacement with new bone to stay strong. Fosamax does NOT build any new bone. It only kills the cells that break bone down, so your bone is not benefitting from its natural regenerative process.
However supplementation, proper nutrition and lifestyle can help you avoid the use of these controversial drugs.
Bone is composed of at least a dozen minerals, and if you focus exclusively on calcium supplementation you are likely going to worsen your bone density and actually increase your risk of osteoporosis. Overconsumption of calcium creates other mineral deficiencies and imbalances, which then increase your risk of heart disease, kidney stones, gallstones, osteoarthritis, hypothyroidism, obesity, opportunistic infections and type 2 diabetes.
The myth that eating a high protein diet will cause calcium loss through the urine is simply false. Consuming plenty of high quality protein, like free-range eggs and grass-fed meats, ensures that you’ll have the amino acids your body needs to form a strong bone matrix.
Specific nutrients essential for bone health—
Calcium–The adult human body contains about 1000-1500 g of Calcium—depending on size gender and race. 99% of that is found in the bones. Dietary amounts of necessary calcium intake are determined by the rate of excretion of calcium, so adding in more calcium when the rate of dietary threshold has been reached will not likely improve bone mass. In general the upper limits of 2500mg/day (including diet and supplements) should not be exceeded for a prolonger period of time. The interaction of calcium with other essential bone minerals and the ratios is delicate but very important in looking at dosages for best efficiency in preventing osteoporosis or rebuilding bones.
Phosphorus–Second in abundance to calcium in the human body is phosphorus with about 85% of phosphorus bound to the skeleton. Although phosphorus is an essential nutrient there is concern that excessive amounts may be detrimental to bone. Phosphorus works in tandem with Calcium. Generally a rise in dietary phosphorus results in a transient fall in serum calcium. This mineral is found in foods such as meat, poultry, fish, eggs, dairy products, nuts, legumes, and cereals and grains. Soda also contains a type of phosphorus in the form of phosphoric acid.
A frequent cause of excess phosphorus is soft drinks. Studies have shown decreased bone mass and elevated fracture rates with the consumption of carbonated beverages, however a possible explanation for this could be the resulting acid load caused by phosphoric acid or just the displacement of milk and calcium from the diet.
Magnesium–The human body contains about 25 grams of magnesium–two thirds of which are in the skeleton. Magnesium plays an important role in bone metabolism. Magnesium deficiency alters calcium metabolism, result in low calcium, vitamin D abnormality, and neuromuscular hyperxciteability. Studies have shown that Mg deficiency results in decreased bone strength and volume, and poor bone development. Numerous population studies demonstrate a positive associate between magnesium intake and bone mineral density. Good sources of mg are dark green leafy vegetables and other vegetables, meat, nuts, seed and dark chocolate.
Omega 3 fats–Omega-3 fatty acids aid bone health. Scientists from Sweden have found that an intake of omega-3 fats, and in particular, docosahexaenoic acid (DHA) is associated with bone mineral density, and peak bone mineral density in young men.
Omega 3 fats found in both grass fed meats and wild caught fatty fish, as well as walnuts and flaxseed, promote bone health by helping to prevent excessive bone turnover, especially when consumption of foods rich in this omega 3 fat results in a lower ratio of omega 6 to omega 3 fats in the diet.
Other studies have shown that diets rich in the omega 3 from animal sources (high in DHA and EPA), which also naturally result in a lowered ratio of omega 6 to omega 3 fats, reduce bone loss.
Zinc–The human body has about 90% of zinc in muscle, bone, skin and hair. Zinc plays and important role in connective tissue metabolism, acting as a cofactor for several enzymes necessary for bone mineralization and collagen. The role of zinc in bone formation is well documented in studies, and low levels of zinc and excessive urinary excretion are related to osteoporosis in humans. Supplements of zinc have been observed to be very beneficial in vertebral and femoral bone mass.
Zinc is found abundantly in red meat—especially grass fed meat, poultry, oysters, eggs and milk.
Vitamin D3–Influences calcium metabolism by helping calcium absorption in the intestines. Vitamin D is also involved in bone turnover. Vitamin D status tends to decline with age due to lower exposure to sun, decreased ability to activate skin metabolism of sunlight into vitamin D, reduced dietary intake and taking steroid drugs. It is thought that most of the population of the US is deficient in Vitamin D.
Foods that contain vitamin D are butter, liver and eggs. Calcium supplements should always be accompanied by vitamin D.
Vitamin K2—Proven to increase bone density and reduce fractures. Vitamin K2 has been shown to be essential for bone health. However it is primarily the K2 (not the K1 form) form that is especially helpful in building bones. Adequate dietary fat is essential for optimal for K2 absorption. K2 has remarkable synergy with vitamins A and D and it was found to be especially effective for degenerative bone diseases. K2 has been shown to build strong bones through multiple mechanisms. It protects osteoblasts, the cells that build new bone, from dying.
While many of today’s commercial foods are sadly lacking in K2, you can still find it specifically in grass fed meat, grass fed dairy, cheeses and butter from grass fed cows.
Strontium–Closely related to calcium, strontium is believed to stimulate bone cells to build new bone tissue, while inhibiting cells that break down bone tissue. In fact, one form of strontium may lower risk fractures and increase bone density.
Other forms of strontium have rave reviews, too. Anti-aging expert Ward Dean, M.D., says strontium “appears to be one of the most effective substances since calcium and vitamin D for bone health.” Alan Gaby, M.D., author and specialist in nutrition and preventive medicine, agrees. “The evidence is clear that strontium supplementation can build better bone density,” he writes.
Simply put, strontium stimulates bone cells called osteoblasts, while inhibiting the cells that break down bone tissue called osteoclasts. Strontium can be found in many plant foods, dairy foods and Brazil nuts. It’s important to note, however, that most experts agree that food sources of strontium fall way short for supporting bone health.
They recommend supplementation for those looking to add more strontium to their diet. When supplementing, strontium should accompany calcium, although not at the same time. Take calcium in the morning and strontium in the evening or vice-versa. Either way, however, strontium is making quite a name for itself in bone health.
Boron–In humans, the highest concentration of boron is found in the bones of healthy individuals, indicating one of boron’s potential benefits, the ability to protect us from osteoporosis. The role boron plays may be one of coordinating the major nutrients involved in bone health: vitamin D, calcium, magnesium and phosphorus.
However, the real benefit of boron appears to be that it lessens the effect of deficiencies in both vitamin D and magnesium. Adequate boron intake decreases the amount of calcium and magnesium lost in urine. Studies of postmenopausal women have shown this same decrease in urinary excretion of calcium and magnesium, an effect similar to that of estrogen.
Boron is available in fruits, vegetables, nuts and legumes. Some of the richest sources of boron are in dried fruits such as raisins, prunes and nuts. These foods have nearly a full day’s supply in just one serving.
Protein–It used to be thought that high protein intake was associated with more loss of calcium, but now it is found that especially for the elderly, a higher protein intake (in the presence of fresh vegetables and fruits) is essential for bone health. Good sources of protein include grass fed meats, wild caught fatty fishes (both high in bone building omega 3’s as well), eggs, and poultry.
These simple guidelines will help you maintain or increase your bone strength safely and naturally, without the use of drugs:
· Increase your consumption of vegetables. If you find it difficult to eat the recommended amount of vegetables you need daily, you can also try vegetable juicing. Make sure your veggies are fresh, organic, locally grown vegetables that are not genetically modified.
· Consume a large amount of animal based omega 3’s from grass fed meat, or cold water wild caught fish. Reduce or eliminate the amount of processed vegetable oils such as corn, canola, safflower, and soy.
· Avoid gluten, a grain protein that has been shown to decrease bone density and the ability to absorb nutrients from foods and supplements. Gluten is found in wheat, barley, rye, oats and spelt.
· Avoid soda and sugar, which deplete your bones of calcium.
· Avoid steroids, especially if you have asthma or any other autoimmune disease. Steroids increase your risk for osteoporosis.
· Consider supplementing with K2 as it if difficult to get appropriate amounts from food alone. Vitamin K2 serves as the biological “glue” that helps plug the calcium into your bone matrix.
· Get plenty of vitamin D, ideally from proper amounts of sun exposure. Vitamin D builds your bone density by helping your body absorb calcium.
· Exercise! Studies show that exercise is just as important to your bone health as eating a calcium-rich diet. Strength building exercises like weight training and impact exercises such as walking, running, dancing, and jumping are especially helpful.
· Natural progesterone for women can increase bone strength. It does this by serving as a growth promoter for the osteoblasts (the cells that build bone). Be sure to get natural progesterone, not the synthetic kind.
With more careful monitoring of diet, lifestyle and overall nutrition, many of us can enjoy healthy bones well into old age and avoid the dangerous drugs that are often prescribed for osteoporosis.
Cathy Wong,About.com, Alternative Medicine, Osteoporosis Prevention, Osteoporosis Prevention, January 13, 2008.
Dr. Mercola, Warning! Don’t Take Another Drug Until You Read How You’re Being Conned…Mercola.com, January 28 2010.
Jasminka Z. Ilich, PhD, RD and Jane E. Kerstetter, PhD, RD
Nutrition in Bone Health Revisited: A Story Beyond Calcium
Journal of the American College of Nutrition, Vol. 19, No. 6, 715-737 2000.
National Osteoporosis Foundation, “America’s Bone Health; The State of Osteoporosis and Bone Health”, 2010.