According to the U.S. Department of Health and Human Services, around 10 million people over 50 have osteoporosis. (1) An additional 43 million have low bone mineral density, putting them at risk for full-blown osteoporosis. This is a concerning number of people who have compromised skeletal health, as osteoporosis increases your risk of major fractures. Spotting the Signs and Symptoms of Osteoporosis Osteoporosis is called the “silent disease” because it often is not detected until there are overt signs. – Decreasing height – Rounded shoulders – Humped back – The head begins to protrude forward – Intermittent or constant upper, middle, and lower back pain – Rigidity in movement Doctors typically recommend a bone density scan after the age of 50 years. Unfortunately, most are women, but men can get osteoporosis too! The most common scan is a DEXA scan which measures bone density. Often the ankle, wrists and lower back are scanned. What causes silent disease in the first place? Lack of weight-bearing exercise, long-term low vitamin D, K, calcium, and trace minerals, hormonal changes, and medications. When a doctor confirms an osteoporosis diagnosis, the standard treatment is a prescription for bisphosphonates (Fosamax or Actonel are common drugs.) | |
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The Problem with Osteoporosis Drugs My last semester in school I had to do a research project and I chose osteoporosis. This was twenty-five years ago and we were just starting to use the bisphosphonate drugs, Fosomax being one of the first. Twenty-five years ago we hadn’t fully grasped the importance of testing regularly for vitamin D. Even now, you have to “ask” for it to be on your annual labs. We also didn’t know how important ALL the minerals were in keeping healthy bone density. The focus was on calcium, calcium, calcium! What do these bisphosphonate drugs do? Our body has a remarkable system of “remodeling” bone throughout our life. Bone is a “living” organism just like any of our cells. We have cells called osteoblasts that help grow new bone, and we have cells called osteoclasts which eat up and remove old bone. It’s a constant process going on our whole life. The bisphosphonate drugs inhibit the osteoclast cells from breaking down old bone. While the intention is good, there are some problems with this. • Bisphosphonates will disrupt your body’s bone-building process, resulting in the preservation of “old bone” rather than promoting healthy bone formation through natural methods. • Bisphosphonates have side effects, such as severe musculoskeletal pain. If you are taking bisphosphonate drugs you will see an improvement on your DEXA scan. Of course, you will be excited to see that, but, you are not building new bone, you are just preventing the old bone from being gobbled up by the osteoclast cells. After 3 years (more or less) the old bone (because it is old) becomes just as brittle as the osteoporotic bone that you had in the first place, and your risk of fracture is high again! The results of a DEXA scan are compared to the average bone density of a 30-year-old, producing a T-score. Medical students learn that a T-score of 0 to -1 is normal, -1 to -2.5 indicates osteopenia, and -2.5 or worse signifies osteoporosis, prompting urgent treatment. However, considering natural age-related bone density loss, most individuals will have lower bone density than a 30-year-old! We can’t expect to have the bone density of a 30-year-old at age 50,60,70 years old. Of course we are going to have some loss of bone, just like we have loss of muscle as we age. Does this mean we need to take a bisphosponate drug? | |
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It’s Never to Late to Support Bone Health There are many co-factors involved in building bone density. We have heard of the “big” ones like calcium and vitamin D, but let’s look at some additional minerals and vitamins that need to be present to have healthy bones. Magnesium and Vitamin K2 Rounding out the nutrients needed to combat osteoporosis are magnesium and vitamin K2. Research has shown that magnesium deficiency leads to brittle, fragile bones that lead to microfractures. Moreover, magnesium is needed to stimulate osteoblastic activity, and it influences skeletal homeostasis regulators — parathyroid hormone and vitamin D. (2) As for vitamin K2, studies have shown that it promotes osteogenic differentiation. In other words, it directs your body to promote more healthy bone formation instead of failure. It also promotes osteoclastic resorption by suppressing osteoclast activity. The best dietary sources for magnesium are vegetables, such as spinach, broccoli and carrots. Your leafy greens are one of the highest sources of magnesium. Meanwhile, vitamin K2 is found in fermented foods such as sauerkraut, kefir, cheese and yogurt. Trace Minerals If you were to take a chicken drumstick, cut the meat away from the bone, and then put the drumstick into a jar of vinegar for 30 days – when you removed it on day 31 it would be very elastic. The vinegar leaches all of the minerals out of the bone, leaving a cartilage matrix behind. Every bone in the body is composed of a cartilage matrix upon which minerals have been laid. When we are attempting to strengthen bone tissue, not only do we give minerals, but we also give nutrients to support healthy cartilage formation (see below.) There are many trace minerals that the body needs to build and maintain healthy bones, tissues, ligaments, tendons, etc. etc. It’s best to eat a wide variety of mineral rich fruits, vegetables, and organ meats. If you decide to supplement, use a broad spectrum mineral complex that includes trace minerals then add in some extra calcium and magnesium. | |
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Bones Need Protein, Specifically Collagen Adequate collagen provides your bones “cushion,” helping them bend and yield to external forces instead of fracturing. As noted in a study published in the Journal of Frailty, Sarcopenia & Falls: “Collagen and a variety of noncollagenous proteins form the organic matrix of bone, so an adequate dietary protein intake would seem to be essential for optimal acquisition and maintenance of adult bone mass.” (3) It’s been my experience as people age they eat less protein. We start to loose 8% of our skeletal muscle each decade after the age of 40 years. We should pay close attention to our protein intake as we age for muscle and skeletal strength! However, don’t just focus on red meat for your protein needs. You need a balance of muscle meats and collagen. I recommend you get one-third of your protein intake from collagen or gelatin because solely focusing on meat alone will have a negative effect on your bone health as it is acidic and that can actually cause loss of bone as the body try’s to alkalinize your blood by pulling calcium from your bones. The best way to get more collagen into your diet is by making bone broth from organic grass-fed animal bones. Slow-cooking or pressure-cooking more gelatinous cuts of meat are another option, as are collagen and gelatin supplements. Making crock-pot meals with “bone in” meats gives you dinner AND collagen! Weight Bearing Exercise Exercise is foundational for strengthening your bones. Specifically, the impact felt by your bones causes them to adapt, remodel and strengthen themselves. Resistance training and aerobic exercise such as brisk walking and fitness classes put a “load” on the body that can generate forces that will have a strong and consistent positive effect on bone development. | |
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Hormones? There is much debate about whether hormone replacement therapy is beneficial for maintaining bone mass. One side feels it works and is worth the risk, and the other side feels we shouldn’t take a chance. With the advent of Bio-identical hormone therapy and new tests, such as saliva hormone testing, we can better pinpoint an individual’s needs when it comes to hormones. One size does NOT fit all! Work closely with a health practitioner who is experienced in these types of tests and can give you a better understanding of what is right for you. Osteoporosis is a serious decline in bone density. But as mentioned above, we shouldn’t compare ourselves at sixty to our thirty-year-old self. We are going to see some decline in bone density and muscle as we age but the side effects of the bisphosphonate drugs need to be considered given that they really are not “building” new bone. Start early, and don’t quit when it comes to supporting your bone health! In health, Chris Mckee Certified Nutritionist at Achieve Integrative Health P.S. For our nutritional supplement top picks check out our Full Scripts online dispensary… | |
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References: 1. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014 Nov;29(11):2520-6. doi: 10.1002/jbmr.2269. PMID: 24771492; PMCID: PMC4757905. 2. Castiglioni S, Cazzaniga A, Albisetti W, Maier JA. Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients. 2013 Jul 31;5(8):3022-33. doi: 10.3390/nu5083022. PMID: 23912329; PMCID: PMC3775240. 3. Tsagari A. Dietary protein intake and bone health. J Frailty Sarcopenia Falls. 2020 Mar 1;5(1):1-5. doi: 10.22540/JFSF-05-001. PMID: 32300728; PMCID: PMC7155358. |
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