Osteoporosis

Osteoporosis_1

Do You Have Osteoporosis?

The Orthopedic Association President of New Zealand, Professor Geoffrey Horne, said the predicted burden of osteoporosis on the health system generated by the over 60’s was alarming indeed. The numbers of people affected by osteoporosis in New Zealand will increase by an amazing 201 percent in the next 50 years, and this figure will no doubt be similar in many other developed nations. And it is the women who have a four-time greater risk of developing osteoporosis than men, with post-menopausal women at greatest risk. Let’s take a look at this common health problem that in many cases is preventable.

Osteoporosis is the most common metabolic bone disease. One in four women and one in eight men over the age of 50 of Caucasian or Asian descent will eventually develop osteoporosis. Taking into account our increasing population, the incidence of hip fractures has increased three-fold from 1950 to 1987. Furthermore, it is estimated that 40 per cent of women and 13 per cent of men over 65 will experience a fracture with the inevitable impairment to quality of life. Almost one third of elderly women in many countries will end up in a hospital due to a hip fracture. Between 12 and 20% of hip fracture victims die shortly after fracture, usually from complications related to either the fracture or surgery.

Early Warning Signs Of Osteoporosis

Osteoporosis is what we call an end-stage disease, caused by a chronic disruption of skeletal-bone metabolism. It takes time to develop, and like going bankrupt, it doesn’t tend to happen overnight. Significant contributors to this degenerative process include nutritional, hormonal, physical, lifestyle, but also no doubt genetic and environmental factors.
In osteoporosis, just like in high cholesterol and blood pressure, there is a long, quiet, symptomless period before clinical symptoms appear. Although the entire skeleton may be involved in osteoporosis, bone loss is usually greatest in the spine, hips and ribs. Since these bones bear a great deal of weight, they can become susceptible to pain, deformity and fracture. My mother complained of a low grade nagging back and neck pain in her late 60’s. Early warning signs include spinal bone pain, chronic low-grade back and leg pain, bone fractures from trivial injuries such as minor falls, bone loss in the jaw and tooth sockets (bone draws away from teeth, causing them to loosen or even fall out), tooth pain, facial tics, some vision problems including poor depth perception, and excessive loss of height or noticeable decline in posture with increasing age.

Eric_and_Mum

Eric and his Mom

My mother suffered with osteoporosis in her advancing years, and by the time she was in her late sixties her bone density was not the best at all. Mum’s condition was caused by her diet and her lifestyle to a degree (she smoked for many years); she absolutely loved coffee and would drink between five to seven cups of strong coffee a day as many Dutch people do. Her diet was devoid of sufficient calcium as she drank no milk because it caused her to develop too much catarrh and mucus, no doubt caused by her lifelong habit of smoking. Mum went on a brief holiday and at a caravan park tripped over a small tree root resulting in two broken ribs and a broken wrist. I have seen patients who break ribs just by coughing or laughing, and that is no laughing matter. The writing was on the wall, but unfortunately any suggestions for mum to reduce her coffee fell on deaf ears.

At 78 years of age, mum had a fall as she went from her hospital bed to the bathroom. This resulted in a broken hip, something which too many elderly people succumb to in many developed countries around the world. Mum did survive the operation but unfortunately passed away with a second stroke not long after.
I don’t believe that mum’s lifestyle was at fault; after all she would go to the gym several times a week for many years and lead a very active life, more active than most in fact. She understood the concept of weight-bearing exercise to ward off osteoporosis but could not stop that regular cup of coffee. The percolator was always on in her house, just like it did in my grandparent’s house as well; both my grandparents drank too many cups on short black daily. My grandmother passed away with a hip fracture at 80. Mum’s diet was good, I had taught her the value of good nutrition over twenty years ago.
I believe mum’s problems stemmed from her genetics, her hyperthyroidism and all those endless cups of coffee, a beverage which is acidic. Acid forming foods and drinks tend to cause bone loss by way of stimulating a higher bone turn over. Calcium is released regularly to “buffer” or reduce the acidity of the blood. This results in time to a lower bone density, regardless of how much calcium you consume. Kidney stones are also caused this way, and my grandfather had many kidney stones removed. Osteoporosis is best prevented by ensuring the person has a diet rich in all the minerals and trace elements and has a diet which is more on the alkaline rather than acid side.

Most Common Osteoporosis Risk Factors

Nutritional

  • High animal protein intake
  • High caffeine and drinking soft-drinks (phosphate containing drinks are “bad to the bone”
  • High salt and sugar intake
  • Low mineral intake (Magnesium, Calcium, Vitamin D, Boron, Manganese, Copper, & many others)

 Drugs

  • Steroid medications
  • Thyroid replacement drugs
  • Lithium, Heparin
  • Chemotherapy
  • Extended Tetracycline (antibiotic) use
  • Aluminium containing antacids such as Mylanta or Gavascon
  • Some diuretic drugs which increase calcium urine excretion

Lifestyle Factors

  • Smoking
  • Excess alcohol intake
  • Being inactive
  • Poor sunlight exposure
  • Not having had any children

 Genetic Factors

  • White or Asian ethnicity
  • Female sex
  • Small body frame
  • Positive family history

Medical Problems

  • Hyperthyroidism, Hyperparathyroidism
  • High homocysteine (get this checked!)
  • Cushing’s syndrome, Type I Diabetes
  • Rheumatoid arthritis, Ankylosing spondylitis
  • Connective tissue disorders
  • Malabsorption, Early menopause
  • Poor adrenal function
  • Liver disease, Kidney disease
  • Amenorrhea (no periods)
  • Oophorectomy (Ovaries removed)
  • Anorexia nervosa, Bone marrow problems, tumours

The Conventional Approach                                                                                                            

The current mainstream medical approach of osteoporosis prevention and management is limited to the use of HRT, and the very poorly absorbed calcium carbonate form of calcium (Doctors, what about the other minerals and trace elements?). Other options include medications such as estrogens and anti-absorptive drugs such Alendronate (Fosomax), Etidronate (Etidrate) and Calcitriol (Rocalcitrol). Long term drug safety has not been established, although extensive studies are on-going. While these prescriptions may be clinically useful for some, their safety and efficacy is highly questionable, and they never address each woman’s unique and often complex cause for osteoporosis in the first place. Mum took Fosomax for over ten years, believing it would save her, it did nothing. Her GP would have been better off getting her to understand the real causative factors here, because osteoporosis does not really exist in the undeveloped nations.

Diet and Bone  Health

Diet has a significant effect on bone health. In the book, “Paleolithic Nutrition,” the author demonstrated that the diet of the hunter-gatherer populations of 40,000 years ago contributed to their quite massive bone density. This diet was about 35% meat and 65% vegetables and fruit. Sorry folks, no flat-whites, fish and chips, cold-beer, or typical Kiwi fare in those days. There was little or no cereal grain consumption and absolutely zero dairy food, and a cow never stood still long enough to be milked before it was eaten! The diet was naturally low in sodium (690 mg) and high in calcium (1580 mg). High dietary intakes of salt and sugar, common in the standard NZ diet, cause increased urinary calcium excretion and should be reduced. I have always wondered why the countries with the highest milk consumption are also the countries with the highest rates of osteoporosis.  Forget the cow folks, do you still think that without milk your bones will crumble?                                                                                                                            The goal in my clinic is to counsel patients to eat a nutrient-dense diet so that supplementation is kept as minimal as possible. Teaching concepts of a whole foods diet, with particular emphasis on increasing the intake of non-starchy vegetables, fresh fruits, nuts and seeds, introducing people to sea vegetables, and reducing their intake of refined carbohydrates and grains will reduce their need for supplements as well as improve their overall health.

Exercise and Bone Health                                                                                                                            

Exercise has a central role in the prevention and treatment of osteoporosis. No drug, hormone or mineral such as calcium, can cause a skeleton to be heavier or sturdier than required by the uses to which the owner puts it. Peak bone mass is achieved both by adequate bone-building nutrients and by mechanically loading the skeleton. In order for exercise to be effective it must be continued throughout life. Simply put, inactivity leads to bone loss. In a study of 200 individuals 70 years of age or older doing Tai Chi, there was a 47.5% reduction of risk of multiple falls!  Mum was into Tai Chi and practiced this wonderful “meditation in motion” for over twenty years. But – because she didn’t get involved in the “complete package” of adopting the correct lifestyle and diet, it didn’t have the desired effect. Range of motion in the lower extremities showed significant improvement, and lower blood pressure was observed following Tai Chi participation. What I like about Tai Chi is that improves the coordination, muscle strength and flexibility, so that a slip does not become a fall and a fall does not become a fracture. Exercise also reduces the older person’s need for many different medications that can alter balance and coordination and result in a fall. The elderly shouldn’t have to be pill poppers as too many are.
Some folk say that the best exercise program of all to maintain bone density however is yoga. It is weight bearing, and in the various yoga postures the muscles pull on the bone, thus stimulating additional bone remodeling.

Vitamin D 

We all know the dangers of too much sun. But are we aware of the health effects of too little?
People living in NZ may be at increased risk of vitamin D insufficiency and its associated risk of fractures caused by osteoporosis because they are not exposed to enough sunshine – a source of vitamin D.   Short exposures to the sun (15 minutes) per day will also do the trick, as will consumption of vitamin D-rich foods such as eggs, chicken livers, fish oil, and fish like salmon, sardines, herring, mackerel, and halibut. Vitamin D is one of the most important hormone nutrients affecting bone, with its role in regulating intestinal and renal absorption of calcium. Vitamin D deficiency has been found in 25% of elderly patients presenting with hip fracture.Several studies suggest a daily supplement of 1000 units a day of vitamin D, at least during the winter. A recent article in the Medical Journal reminds readers that cod liver oil, (very rich source of vitamin-D), has been a reliable remedy for rickets since the 1600s.

Nutrients and Bone Health

Calcium

The benefits of calcium supplementation on osteoporosis have received considerable attention, and unfortunately these supplements are considered to be a cure-all by many. It must always be remembered that calcium is an integral part of any comprehensive approach to osteoporosis, but calcium alone is not the answer to osteoporosis. There are many forms of calcium available for supplementation, but the benefit of supplementation is closely related to its absorbability. When compared with an equal dose of elemental calcium from calcium carbonate, 500 mg elemental calcium from calcium citrate was the most effective at increasing bone density in post-menopausal women. Recent studies have shown that it may be dangerous to give calcium unopposed by magnesium to women who are postmenopausal as it may increase the risk of a heart attack considerably.

Magnesium

Sixteen of nineteen osteoporotic women demonstrated low bone magnesium and abnormal crystalline structure of the bone.Magnesium supplementation (250-750 mg/day) appears to significantly increase bone density and reduce the incidence of fracture. The appropriate intake ratio of calcium to magnesium is controversial, with some authors supporting the current 2:1 ratio and others recommending a 1:1 ratio.

Vitamin K

Vitamin K is important to the maintenance of healthy bone. Because 90% of the vitamin K in the human liver is made by the intestinal flora, impaired vitamin K status should always be considered in anyone with frequent or long-term antibiotic treatment. Vitamin K is fat soluble and can be mal-absorbed in those with chronic digestive problems or with malabsorption. Vitamin K is found in green leafy vegetables, and legumes.

Boron

Many human studies suggest that boron interacts with other nutrients and plays an important regulatory role in bone metabolism. In post-menopausal women, boron supplementation at 3 mg per day significantly reduced the urinary excretion of calcium and magnesium.

Trace Minerals

Several trace minerals, especially copper, zinc, and manganese, are essential in bone metabolism as co-factors of specific enzymes in bone development and mineralisation. In a study of 59 post-menopausal women, the effects of calcium supplementation (as calcium citrate, 1000 mg elemental Ca/day) with and without the addition of zinc (15.0 mg/day), manganese (5.0 mg/day) and copper (2.5 mg/day) on the lumbar spine was evaluated over two years. Bone loss was arrested the most in the-calcium-plus-trace-minerals group.

Hormones             

Estrogen inhibits bone breaking down activity as well as stimulating calcium absorption by the intestine, and facilitates the synthesis of vitamin D. It is well documented that estrogen replacement therapy decreases bone resorption and helps to stabilise bone mass, but confers only a 2% increase in bone density at best, and must be taken for ten or more years to reduce fracture incidence. Unfortunately, this approach subjects women to a long-term therapy that poses an unacceptable increasing risk of breast cancer, blood clots, strokes, uterine cancer and many other side effects. Progesterone, the much safer option, is also active in bone metabolism and appears to promote bone formation. Some researchers state that post-menopausal osteoporosis may in fact be in part a disease of progesterone deficiency. In a study of 100 post-menopausal women followed for three years, Dr. John Lee reported the significant benefit of progesterone which was independent of supplemental estrogen.The treatment of osteoporosis with progesterone appears quite encouraging and deserves significantly more research.

Lifestyle and Bone Health

Alcohol & coffee consumption and cigarette smoking are associated with osteoporosis. Alcohol inhibits absorption and increases excretion of calcium, magnesium, ascorbic acid, zinc and copper. Caffeine in average daily doses of two to three cups accelerates bone loss from the spine and total body in women with calcium intakes below 800 mg/day. Cigarette smoking depletes the body of vitamin C and exposes it to a number of toxins, such as cadmium and lead, which directly damage bone and interfere with calcium absorption. Modification of these habits is essential to any bone-building program. Do you smoke and drink alcohol regularly and have three or more cups of coffee a day and expect great bone density as you age? Self delusion is the worst form of delusion I’ve been told.

Conclusion                                                                                                                                         

I’d like you to always remember this, that the health of your skeleton is a reflection of the total health of your body. Osteoporosis can be prevented, but one must start early! Osteoporosis prevention and treatment is an opportunity not only to address skeletal concerns, but also to make a positive impact on your total health and well-being. So typical, like many chronic complex illnesses, the current medical idea of osteoporosis prevention and treatment fails to address both main causes and the chronic systemic dysfunctions that lead to osteoporosis in the first place. Do you have an elderly relation who is frail, who has low bone density and has broken bones in the past very easily? I’d like you to make sure that you aware that she is like a “candle in the wind” and can easily succumb to a broken hip all too easily. Make every day count with your loved one.
The only really practical and common sense approach to osteoporosis is a preventative and restorative program that includes educating a person in the correct diet, exercise and lifestyle factors which enhance and maintain bone density, and include additional nutrients when needed as required.   An approach like this will improve overall health, reducing needless hospitalisation whilst sparing a person from misery and a potentially-hazardous drug-induced therapy. It wasn’t nice seeing my own mother suffer with osteoporosis in her later years, and if this article can help just one younger person to grasp the full significance of the prevention of osteoporosis it will have been worth the time and effort I put into researching and writing it.

References
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3. Wolf, SL, Barnhart HX, Kutner NG, et al. Reducing frailty and falls in older persons: an  investigation of Tai Chi and computerized balance training. Journal American Geriatric Society 1996;44:489-497.
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9. Cohen L, Kitzes R. Infrared spectroscopy and magnesium content of bone mineral in osteoporotic women. Israel Journal of Medical Science 1981;17:1123-1125.
10. Sojka JE, Weaver CM. Magnesium supplementations and osteoporosis. Nutritional Review 1995;53:71-74.
11. Abraham GE, Grewal H. A total dietary program emphasizing magnesium instead of calcium. Journal of Reproductive Medicine 1990;35:503-507.
12. Shearer MJ. Vitamin K. Lancet 1995;345:229-234.
13. Pizzorno J, Murray M. Osteoporosis. Textbook of Natural Medicine. Seattle, WA: Bastyr Books; 1989.
14. Naghii MR, Samman S. The role of boron in nutrition and metabolism. Progressive Foods Nutritional Science 1993;17:331-349.
15. Strause L, Saltman P, Smith KT, et al. Spinal bone loss in post-menopausal women supplemented with calcium and trace minerals. Journal of Nutrition 1994;124:1060-1064.
16. Harris SS, Dawson-Hughes B. Caffeine and bone loss in healthy post-menopausal women. American Journal of Clininical Nutrition 1994;60:573-578.

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