Osteoporosis, a condition that weakens bones and increases the risk of fractures, is an almost inevitable problem affecting post-menopausal women. Approximately 1 in 3 women over the age of 50 will experience a fracture due to osteoporosis. The dramatic drop in estrogen levels significantly accelerates bone loss. It is a silent disease. You may not have any symptoms or know you have the disease until you break a bone. Osteoporosis related fractures are very expensive and cause substantial disability, reduced quality of life and even mortality.
Standard recommendations to take calcium supplements and use prescription drugs are not good for your health and may not even help. Adding back in estrogen is definitely not an option when you have uterine cancer. Read this post to learn all about osteoporosis, what the risk factors are, how to test for it, natural ways to keep your bones strong and why bisphosphonates are not helpful.
WHAT IS OSTEOPOROSIS?
Osteoporosis is a disease that develops when bone mineral density and bone mass decrease and the structure and strength of the bones change. Bone is a very dynamic tissue that is constantly undergoing remodeling. There is a delicate balance in our bodies between bone resorption (breakdown) and new bone formation. Estrogen plays a crucial role in maintaining this balance, which is why menopause is a major risk factor for osteoporosis.
Estrogen directly suppresses the formation, activity and lifespan of osteoclasts, the cells responsible for breaking down bone. It indirectly stimulates osteoblasts, which are the cells responsible for producing new bone. Not only that, but estrogen helps with the absorption of calcium in the gut, which is a vital mineral for bone density.
Without estrogen, osteoclast activity goes unchecked, leading to excessive bone resorption, while osteoblast activity may not be able to keep up with new bone production. The net result is a loss of bone mass, making the bones porous, brittle and prone to fractures, especially in the spine, hips and wrists. Sometimes the bone is so weakened that even mild stresses like coughing or bending over can lead to fractures.
- Primary osteoporosis is associated with aging and menopause
- Secondary osteoporosis is caused by a medical condition or certain medications
RISK FACTORS FOR OSTEOPOROSIS
- Menopause
- Advancing age
- Smoking
- Anemia
- Being caucasian or asian
- Low vitamin D levels
- A slender body type with thin bones
- Poor protein intake
- Having other medical conditions such as hyperthyroidism, diabetes, rheumatoid arthritis, gastrointestinal disease or hyperparathyroidism
- Cancer treatments including chemotherapy, radiation and hormone therapies
- Medications such as steroids, selective serotonin re-uptake inhibitors to treat depression and proton pump inhibitors to reduce stomach acid
- Being sedentary
- A vegan diet
- Early menopause
- Excessive alcohol consumption
- Certain genetic factors
TESTS FOR OSTEOPOROSIS
DEXA SCAN
DEXA stands for dual energy x-ray absorptiometry. This is considered the gold standard for measuring bone mineral density (BMD). It uses low-dose x-rays to scan specific areas of the body. The scan is quick and non-invasive and the radiation exposure is much less than a standard chest x-ray so that is good.
- Central DEXA measures BMD in the lumbar spine and hips
- Peripheral DEXA measures BMD in the forearm, wrist, finger or heel
- Whole body DEXA measures bone density of the entire body
The DEXA scan allows for precise measurement of bone mineral content and BMD. The results are usually presented as T-scores and Z-scores.
T-Score: This compares your BMD to the average BMD of healthy young adults of the same sex at their peak bone mass.
- >1.0 is normal
- -1.0 to -2.5 indicates osteopenia (low bone mass)
- < -2.5 or lower indicates osteoporosis
Z-Score: This compares your BMD to the average BMD of individuals of the same age, sex, weight and ethnicity. It is more often used in younger premenopausal women, younger men and children.
QUANTITATIVE ULTRASOUND
This is a portable technique that uses sound waves to assess bone density and structure, typically at the heel. The benefits of this are that it does not use x-rays and can be a cost-effective screening tool for fracture risk assessment. However, it does not directly measure BMD and is not as established for diagnosing and monitoring osteoporosis as the DEXA scan. Abnormal results often require confirmation with a central DEXA scan.
VERTEBRAL FRACTURE ASSESSMENT
This is an imaging technique using the same DEXA machine. They image the thoracic and lumbar spine from the side to identify vertebral fractures, which are a hallmark of osteoporosis. Many times these fractures can be asymptomatic, but they lead to loss of height and curvature of the spine. Vertebral fractures may increase the risk for future fractures.
FRACTURE RISK ASSESSMENT TOOL (FRAX)
This was developed by the World Health Organization and estimates the 10-year probability of major osteoporosis fractures of the hip, spine, forearm and shoulder. It can be calculated with or without BMD values. It is calculated based on factors like age, weight, height and lifestyle habits. Here is a link to the calculator. FRAX
NATURAL WAYS TO STRENGTHEN BONE
The main goals of treating osteoporosis are to increase bone mass, decrease bone loss and strengthen the bones. Here are ways to achieve these goals without medications.
EXERCISE
As we all know, exercise is very important to strengthen bones and build bone mass. Bones respond to stress. Without stress or weight bearing, bones will weaken. However, the types of exercises are key. Some exercises can create too much stress on the bones and increase the risk of fractures so you should avoid them.
GOOD EXERCISES
Strength training, walking, dancing, low-impact aerobics, elliptical training machines, stair climbing, hill climbing, gardening and balancing exercises. Swimming or water aerobics are excellent. Cycling, tai chi, gentle stretching and certain yoga poses. Bodyweight exercises like planks, squats, lunges and push-ups build core strength. Using resistance bands is another great form of exercise. Consider “rucking”, which is wearing a weighted vest while walking. The weight of the vest adds stress to the bones, which can increase bone density and strength.
EXERCISES TO AVOID
Any exercises that involve excessive bending, twisting, jumping or high impact should be avoided. These include, sit-ups and crunches, touching your toes, golf, tennis and jogging. Do not lift heavy objects or weights overhead or lean and reach to lift anything heavy. Avoid rapid, jerky movements. Certain yoga poses can be a risk, especially those that involve excessive bending of the spine.
It’s crucial to avoid things that increase the risk of falling or injury, such as equestrian sports, soccer, skiing and snowboarding. A fracture can be extremely debilitating, so it’s not worth the risk. If you have osteoporosis you need exercise, but make sure it’s safe and doesn’t put too much strain on your bones, ligaments and joints. Start slow and gradually build strength so you can do more.
SUPPLEMENTS
SAY NO TO CALCIUM
First off, do not take calcium supplements for osteoporosis. This is what doctors and mainstream media will tell you to do. It is best to get calcium from food instead. Here are reasons why calcium supplements are not helpful.
- The majority of women do not have a calcium deficiency. In fact, many have excess calcium in the body. However, the calcium may not be getting into the bone for various reasons.
- Bone is not just made up of calcium. In fact, it is made up of 12 minerals and 64 trace minerals. Phosphorous is as important as calcium in supporting bone growth and maintenance.
- Taking high-dose calcium supplements that consist of carbonate or citrate salts may bind all the phosphorous you are getting from foods making it unavailable for absorption.
- Calcium supplementation does not improve bone strength and fractures can still occur.
- When you take calcium, you get too much and this signals the body to hold onto magnesium to try to get the calcium balance back. This causes the kidneys to release potassium and sodium, leading to huge imbalances of your electrolytes.
- Excess calcium deposits into soft tissues, joints and the kidneys leading to kidney stones, hardening of the arteries and arthritis. Studies have shown that women supplementing calcium had a higher risk for cardiovascular disease, heart attacks and strokes.
- Calcium can cause constipation.
REFERENCES
In this study with 23,980 participants, aged 35-64, users of calcium only supplements had a 70% increased risk for a heart attack. Read More
Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Read More
Calcium intake and risk of fracture: systematic review. Read More
VITAMINS AND MINERALS YOU SHOULD SUPPLEMENT
Here are the vitamins and minerals you should supplement to strengthen your bones. Vitamin D3, vitamin K2, magnesium, zinc, selenium and a good trace mineral supplement that contains boron, chromium and manganese. These are all components of bone and support many other processes in the body. Most women with uterine cancer are very deficient in these vitamins and minerals so supplementing them is important.
MAGNESIUM
- Magnesium is an essential mineral and approximately 60% of the body’s magnesium is found in the bones. Studies have shown that individuals with higher dietary intake or supplementation of magnesium have better bone mineral density.
- Magnesium is vital for calcium homeostasis. It influences the parathyroid hormone, which regulates calcium levels in the blood. Proper magnesium levels help prevent excessive calcium release from bones, which can weaken them.
- You need magnesium to be able to metabolize vitamin D into its active form (calcitriol). Without sufficient magnesium, vitamin D may not be fully effective in its role in calcium absorption and bone health.
- Magnesium can inhibit osteoclasts and stimulate osteoblast differentiation, helping maintain a healthy balance of bone remodeling.
VITAMIN D3
- Vitamin D3 (cholecalciferol) is a fat-soluble vitamin that is necessary for calcium absorption in the gut. Without sufficient vitamin D3, the body can only absorb a limited amount of dietary calcium.
- Like magnesium, vitamin D3 influences bone remodeling by interacting with osteoblasts and osteoclasts. It helps ensure a balanced turnover of old bone tissue and formation of new healthy bone.
- When vitamin D3 levels are low, this increases parathyroid hormone release, which leads to increased bone resorption and reduced bone mineral density. Adequate vitamin D3 helps maintain calcium balance and prevent excessive parathyroid hormone secretion.
- Both magnesium and vitamin D3 play vital roles in muscle function. Adequate levels of these can help maintain muscle strength and thus reduce the risk of falls.
VITAMIN K2
- Vitamin K2 (menaquinone) is another fat-soluble vitamin important for calcium metabolism and bone health.
- Vitamin K2 activates osteocalcin, which is a protein produced by osteoblasts. When activated, osteocalcin binds calcium and helps incorporate it into the bone matrix, thereby increasing BMD and bone strength. Without adequate vitamin K2, osteocalcin remains largely inactive. Therefore calcium cannot be effectively deposited into the bones.
- K2 also activates a protein called matrix Gla protein. This protein inhibits calcium deposits in soft tissues, including blood vessels. This ensures that calcium is deposited into the bones where it is needed and not into soft tissues like arteries, which can contribute to cardiovascular disease.
- Some studies suggest vitamin K2 may promote osteoblast proliferation and inhibit osteoclast formation.
- Vitamin K2 deficiency can lead to cardiovascular disease and osteoporosis. Deficiency is often found in the elderly and people with diabetes or kidney disease.
These three supplements in particular work synergistically to support bone health.
HEALTHY DIET
- Eat a diet of real, whole foods that are high in fat, low in carbohydrates and moderate protein.
- Protein is very important for bone health. Make sure you are getting adequate, but not excessive amounts. A general rule of thumb is to consume 1.0-1.2 grams of protein per kilogram of body weight per day. To get your weight in kilograms, take your weight in pounds and divide it by 2.2. i.e. 130 pounds is 59 kilograms.
- Here are some foods rich in calcium that are good on a ketogenic diet. Whole sardines with the bones, leafy green vegetables like kale and watercress, broccoli, full-fat milk, hard cheeses, salmon, full-fat unflavored yogurt or kefir. These foods also contain other important vitamins and minerals like selenium, magnesium and vitamin B12.
- Eat foods rich in phosphorous. Phosphorous is extremely important for bone health. Foods rich in phosphorous include milk, cheese, yogurt, beef, chicken and fish.
- Avoid alcohol as even two drinks can reduce the absorption of calcium and vitamin D in the intestines.
- Excess salt can increase calcium loss through the kidneys so avoid processed foods filled with high sodium. Salt is good and important, but be mindful of it.
- Avoid phytates (found in grains, legumes and soy products) and oxalates (spinach, sweet potatoes, almonds, soy products and legumes). These plant compounds bind to calcium and reduce its absorption in the gut. Not only that, but oxalates can bind with calcium forming crystals that lodge in the kidneys (stones) or in joints causing pain, inflammation and arthritis.
TAKE CARE OF YOUR GUT
Did you know that 90% of calcium is absorbed in the gut? Our bodies cannot make calcium so we need to get it from the foods we eat. If your gut health is compromised you may not be able to absorb calcium, or other important vitamins and minerals necessary for bone health.
- Certain bacteria ferment dietary fibers, producing short chain fatty acids (SCFAs). These SCFAs make the colon more acidic. This acidic environment enhances the absorption of minerals including calcium, phosphorus and iron.
- Other gut bacteria synthesize vitamin K2, which is essential for bone and heart health. A diverse and healthy gut microbiome can contribute to adequate vitamin K2 production.
- Gut dysbiosis can negatively impact vitamin D absorption and metabolism.
- Probiotics isolated from fermented dairy products like cheese and kefir are capable of breaking down phytates. Phytates are anti-nutrients found in many plants that bind to minerals, reducing their absorption. Breaking down the phytates improves mineral uptake.
- Calcium has to be ionized in the acidic environment of the stomach before it can be absorbed in the small intestines. If a person has low stomach acid, this process becomes impaired. Betaine HCL supplement improves stomach acidity. Avoid the use of antacids.
- Digestive enzymes may improve the absorption of key vitamins and minerals for women with poor gut health and secondarily help with osteoporosis.
BISPHOSPHONATES, DO THEY REALLY HELP?
Bisphosphonates are a class of medications used to prevent the loss of bone density and they are commonly prescribed to treat osteoporosis. Examples include Fosamax, Boniva and Zometa.
Groups such as the National Osteoporosis Society (UK), Osteoporosis Australia and The National Osteoporosis Foundation (USA) receive up to 25% of their funding from pharmaceutical companies. These drugs net pharmaceutical companies billions of dollars in profit. Is it any wonder they are pushing these drugs on us?
They will tell you bisphosphonates reduce the risk of vertebral fractures by 50%. That is the absolute risk reduction. The relative risk reduction is only 1.4%. That means 71 patients would need to be treated to prevent one woman from getting a vertebral fracture. Not only that, but most vertebral fractures are over diagnosed and completely asymptomatic.
The most harmful fractures are hip fractures. Studies have shown absolutely no benefit of using bisphosphonates to prevent hip fractures. Even for women who had a prior major fracture due to osteoporosis, the use of a bisphosphonate only reduced their risk of a second fracture by 1%.
Hip fractures in the elderly can often lead to mortality. However, this is usually due to other co-morbidities and not the fracture alone. A meta-analysis of 38 randomized controlled trials of drug therapies (particularly bisphosphonates) for 101,642 patients with osteoporosis, found that these therapies were not associated with reduced overall mortality rates. Read More
These drugs carry a lot of serious side effects. Please do your research and due diligence before agreeing to the use of these drugs to treat osteoporosis.
Many are the afflictions of the righteous: but the Lord delivereth him out of them all. ~ Psalm 34:19