It is time to bring osteoporosis back up on my patients’ radar. Are you doing what is necessary to prevent this lifestyle disease? Since 26% of women will experience severe bone loss leading to fractures, it is an important topic. While much of the basic physiology remains the same, I wish to review the recommendations for the prevention and treatment of osteoporosis.
What is osteoporosis? Osteoporosis is an inflammatory condition of the bones in which bone stuff is lost with age making the bones progressively weaker and more prone to breaking. Often the bones will break without any apparent cause. Vertebra in the spine can collapse or hipbones can suddenly break causing you to fall down. You become fragile. Your life becomes very restricted out of fear of doing anything that might cause you to fall and break something. This is what happened to Ellen a few months after her stroke. Her hip spontaneously broke.
The medical profession’s preventative solution is to take calcium – the most abundant element in your bones. This may be important, but if you take a lot of calcium you can actually make your osteoporosis worse. More on this later.
Recently doctors have also started recommending vitamin D as it helps with the absorption of the calcium you eat to get it into the blood stream. It seems many years ago some researcher made a math error and put the decimal point in the wrong place in the results concerning on the amount of vitamin D people need each day. The researcher said we need 400 IU, when in fact the research showed we need 4000 IU – 10 times as much as the government has been telling us for the past 50 years.
The other popular medical approach is of course drug therapy. Your bones are made by two types of cells – one type that lays the raw bone stuff down and another that shapes and carves the stuff into arches to make the bone strong. Biphosphate drugs poison the cells that carve and shape the bone so that none of the bone stuff will be carved away. This makes it look like there is more bone stuff when you take an x-ray of the bone. The problem is that the raw bone stuff is soft like chalk. It is the carvers that make the bone stuff into strong materials that will resist breakage. So the medical approach is to poison the very cells that make your bones strong so they look better on x-ray studies like the Dexa-scan. Biphosphate drugs are now recognized as not able to build bone, only slow down bone loss.
Prolia – a newer osteoporosis drug is a type of antibody that is injected every 6 months. This drug alarms me after reading the side effect profile. Usually a couple dozen negative side effects are reported by a small percentage of people. But one study I read asked the question “How likely is it you will have a significant negative side effect.” The scary result was that the chances of having a negative outcome was 97% and the chance of a serious and possibly life threatening outcome was 62%. So virtually everyone who takes these drugs have negative side effects and almost 2/3rds of the people have serious side effects, sometimes even fatal effects.
A better choice appears to be the newer drug Reclast if you have actual diagnosed osteoporosis, not simply osteopenia. Like all drugs there are possible side effects, some of them serious. But the incidence of serious side effects appears to be quite a bit smaller with this drug than Prolia. The main concern is flu like symptoms for typically 3 days after the injection. I would avoid workouts for those three days as I have had patients that blew out their backs because of the muscle imbalances created during this period. For osteopenia I would adopt lifestyle changes to build stronger bones.
So what natural things can we do to prevent osteoporosis? For years the advice was to exercise by walking. But more modern research has shown that walking does nothing to prevent bone loss. It is not intense enough. Exercise is vital, but it has to be intense enough to cause the bones to flex. That means either you have to lift weights or you have to run hard enough to cause a hard enough heel strike to bend the bones.
In the past I talked about using Whole Body Vibration as studies show that it increases bone mass. It is a painless way to flex your bones by just standing on a vibration plate. Another good way to fight osteoporosis is by wearing a weighted vest while doing your daily activities to increase the pressure on your bones. The general recommendation is to work up to a vest weighing 10% of your body weight for 1 ½ to 2 hours a day while you move about. Your body is smart and a conservationist by nature. If you don’t prove to it that you need stronger bones by lifting heavy things, it decreases your bone size to match your usage. Use it or lose it is the absolute rule in the body. Here is an example vest.
Now what about nutrition? Do we need all that calcium they have been telling us we need? Probably not. In cultures all over the world where calcium consumption is quite low, they still have strong bones – stronger than ours. There are likely several reasons for this. For one, bones are made of over a dozen minerals, not just calcium. If you take massive doses of just one mineral, like calcium, you will suppress the absorption of other needed minerals. So too much calcium will inhibit the absorption of needed magnesium, manganese, strontium, boron, and so on.
Secondly, most of these other cultures I am talking about have very natural diets and generally do not get an excess of calories. This produces very low levels of inflammation in their bodies. Osteoporosis is the result of inflammation in the bones. Nothing contributes to inflammation more than our over-abundant, overly-processed western diet. Thirdly, the lower calorie, more natural diet of these peoples does not stress their ability to digest their food. Our American habit of overeating is destroying our ability to digest. How many people do you know have some sort of digestive complaint by the time they reach their forties and fifties? Poor digestion is rampant and means that we simply can’t absorb the nutrients we need to build strong bones.
So what can we do nutritionally? The primary nutrients for strong bones are vitamin D, vitamin K2, trace minerals, omega 3 fats, good quality proteins, zinc, magnesium, calcium, phytonutrients, and anti-inflammatory and anti-oxidant herbs and foods. To be properly absorbed you need to address any issues like poor stomach acid, low enzyme production, poor liver processing and intestinal health. If you have food sensitivities, they need to be addressed. If you are reactive to grains (and 30% of you are significantly reactive) you need to avoid them. If you have metabolic syndrome due to eating too many carbs and sugars you are kicking up a storm of systemic inflammation, which will increase osteoporosis.
One phytonutrient in particular that should be mentioned is the use of soy isoflavones. These are plant hormones that look similar to estrogen in our body. I don’t recommend soy for young people as estrogen like substances can mess with our natural hormone balance. But in post menopausal women with low estrogen, soy isoflavones are a studied choice for inhibiting bone loss. Additionally, the use of soy isoflavones significantly lowered the risk of women developing an invasive breast cancer.
Sugar is especially responsible for promoting bone loss. There is simply nothing good about sugar. It is a poison when you use more than 4 teaspoons a day. It should be used in quantities just like salt. It is a flavoring agent, not a food. And yet the average American eats almost a half-pound of sugar a day. That is over 50 teaspoons a day! Can you imagine eating a half-pound of salt a day?
A special side note – recent research is discovering that a percentage of osteoporosis is actually due to autoimmune disease. I expect we will be hearing a lot more about this cause in the future. In these cases we have to tackle the problem on a very different level – by putting out the fires of inflammation and making massive lifestyle and diet changes.
Over the last few years loads of research has demonstrated that the bone formation system in the body is directly affected by CBDs – the medically active component of marijuana and hemp. Extracts of CBDs speed the healing of fractures and make the bones stronger. These extracts have the THC, that produces the psychoactive effects of marijuana, removed. We now have CBDs available in the office for pain control and bone strength support. One important note about CBDs – they interfere with the breakdown of certain drugs like blood thinners, so dosage care has to be observed.
So to recap how to treat or avoid osteoporosis:
Exercise with weights or use high impact
Take at least 5000IU of D3 and 180 mcg of K2
Consume a full complement of trace minerals
Consume enough zinc, magnesium, and calcium
Be sure your digestion is good – correct as needed
Eat an anti-inflammatory diet like a paleo diet
Consider herbals like turmeric to improve bone health
Take a controlled amount of CBDs to make bones stronger
This article touches on some of the changes to the field of osteoporosis in the last few years. It is a complex subject with some simple answers. Basically to fight osteoporosis we have to eat less, digest better, exercise more, reduce inflammation, and get the right nutrients. Basically this is the recipe for health for most all parts of the body, not just the bones.