Osteoporosis

elderly woman laughing

Osteoporosis is characterized by a decrease in bone mass and an increase in susceptibility to bone fractures. This disorder affects 28 million Americans and more than 75 million people worldwide. It causes more than 1 million fractures in the U.S. each year. More than 50% of U.S. women over 70 years old (and 25% of men) have some form of osteoporosis, and are deficient in Vitamin D. For seniors, the two leading causes of diminished quality of life are osteoporosis and cognitive decline.

Ten to twenty billion dollars is spent annually just for care of individuals in the hospital with osteoporosis-related fractures. The pharmaceutical industry would have Americans believing that osteoporosis is caused by lack of pharmaceutical drugs. These drugs, while eliciting some bone density gain, may be mainly a cover-up.

In women and men, bone mass peaks at approximately 35 years of age, and then tends to slowly decline at a rate of 1-2% loss per year. Many people do not understand that osteoporosis is one of the most preventable disorders, yet, the medical and social costs of this disorder reach billions of dollars a year. Lifestyle, diet, heredity, hormones, weight, age, stress, and nutritional factors all play an important role in protecting an individual against osteoporosis.

THE FIVE BIGGEST MISCONCEPTIONS ABOUT OSTEOPOROSIS

  1. I’m too young to get osteoporosis.  In fact, every woman starts losing 1 or 2 percent of her bone density after reaching her mid-30’s.
  2. I drink lots of milk to build strong bones. Cow’s milk is not the best way to get calcium. Although milk is an adequate source it contains too much protein, sugar, and phosphoric acid that leaches the calcium out of the system over time. The more animal protein a person eats, the more calcium he or she will need to offset the calcium drain. Simply put, “Milk does not build strong bones!”
  3. Only women get osteoporosis. Mostly postmenopausal women, but 1/3rd of elderly American men have it.
  4. If I take a calcium supplement, I won’t get it. Calcium is important, but one can’t neglect other nutrients, exercise and lifestyle.
  5. Osteoporosis is caused by lack of pharmaceutical drugs.

TYPES

There are two types of osteoporosis: Type 1, Postmenopausal osteoporosis, usually occurs in women; Type 2, Age-related osteoporosis, afflicts both men and women aged 70 or older.

Bone mineral density (BMD) tests are the gold standard to diagnose osteoporosis and assess response to treatment. But BMD may have a reverse relationship to fracture. Since BMD is only one of multiple contributors to fracture reduction and bone strength, it is appropriate to look at other alternative markers to bone health (see prevention below).

GOALS

The goals of therapy for osteoporosis include:

  • Prevention of fractures
  • Maintaining or increasing bone density
  • Prevent complications caused by weakened bone density
  • Improve quality of life
  • Decrease mortality and morbidity

Much of this can be accomplished through patient education. Elderly women also have increased risks of cardiovascular disease, so cardiovascular risk reduction should be incorporated into the management plan. Education of fall prevention should also be included. This should obviously include a review of the patient’s medication record to identify agents that may increase risk of fall (i.e. hypnotics, antipsychotics, antihistamines, antidepressants, and analgesics).

DIET AND PREVENTION

There are numerous opportunities for the improvement and prevention of bone health. These should include: identification of individuals at risk; educational assistance to modify risk factors; monitoring the response to recommendations with affordable tests; eating more fresh whole foods; and. supplementation with calcium and magnesium and vitamin D at a younger age, long before prescription drugs need to be prescribed. To have healthy bones as a senior, one must develop maximal bone mass as an adolescent and young adult so that the accelerated bone loss in the sixth decade of life will not result in osteoporosis.

Recently, more research has been done on the positive link between the beneficial effects of fruits, vegetables, potassium-rich foods, vitamin K, and B-complex vitamins on bone metabolism among both women and men. The importance of pH “buffered” foods (alkaline) can have a significant impact on bone health. Some other important dietary factors are:

  • Acid-Alkaline Balance has a dramatic effect on bone health. The bulk of the diet should be alkalizing vegetables, fruits, lentils, nuts, seeds and spices. 60-80% of foods should be from the alkaline side.
  • Despite what dairy ads imply, milk is not the best source of calcium. Kale, Brussels sprouts, broccoli, great northern beans, tofu and calcium-fortified soy milk or fruit juices, are all excellent sources.
  • Limit animal flesh to 4 ounces daily, limit protein intake to 50-60 grams a day.
  • Maintain a fat intake of no more than 15-20% of total calories.
  • Drink 64 ounces of pure mineral spring water daily.
  • Green foods and green supplements are good buffering (alkaline) mineral sources.
  • Buffer the body with ionized minerals: calcium, magnesium, zinc and potassium. Add L-glutamine and sesame/flaxseeds for first morning urine pH. A pH of 6.5 to 7.5 reflects the existence of adequate buffering mineral reserve.
  • Avoid excessive consumption of salt (sodium causes the body to lose calcium in the urine).
  • Quit smoking. Women who smoke generally have 5-10% less bone density at menopause than women who don’t smoke.
  • A study that appeared in Am Jrl of Clinical Nutrition (Oct 2006) showed that women who drank cola — regular, diet, or decaffeinated — have significantly decreased mineral bone density, putting them at higher risk for bone fracture.

AVOID ACIDIC FOODS – Refined sugars, caffeine, alcohol, soft drinks (new study showing 3-5 times increase in fractures among teenage girls who regularly consume acidic soft drink beverages), high fat and high animal protein all increase the excretion of calcium.

Main Sources of Acidic Load:

  1. Diet: long-chain fatty acids in excess of 15-20% of total dietary calories.
  2. Distress and stress (excess cortisol and adrenaline release).
  3. Delayed immune system reaction.

WHAT ABOUT MILK? Contrary to what the advertisements from the dairy board tell us, milk consumption may not lead to strong bones. Numerous clinical studies have demonstrated that although cow’s milk is a good source of calcium, it is poorly absorbed calcium (because it is acidic with too much sugar, phosphoric acid, protein, steroids, and antibiotics.) According to a Harvard University landmark Nurses’ Health Study, which followed 78,000 women over a 12-year period, found that women who consumed 3-4 glasses of milk a day actually broke more bones than those you drank 0-1 glasses a day. There is no scientific evidence to support a recommendation of daily intake of dairy foods to promote bone health. Drink more soy and rice milk!

FOODS HIGH IN CALCIUM

Dandelion greens, mustard greens, collard greens, kale, turnips, orange, figs, papaya, molasses are all high in calcium.

EXERCISE

Proper weight bearing exercise is critical for maintaining healthy bones. Physical exercise for an hour three times a week has been shown to prevent bone loss and actually increase bone mass in post-menopausal women. One can still build bone density when they are 90 or 100 years old, it just takes longer than when they were 30 or 40 years old.

ESTROGEN THERAPY

As women go through menopause the estrogen produced in the body significantly decreases (up to 60%) which has a negative effect on bone density. Hormone Replacement Therapy (HRT) is the most common form of treatment (or prevention0 recommended by doctors and OB-GYNs. In terms of osteoporosis, estrogen is known to retard bone loss and help prevent the disease from developing (although estrogen does NOT build bone.) Despite some benefits of HRT (decrease in menopausal symptoms, dryness, and a decrease risk of osteoporosis), the therapy does have its detrimental side effects and can increase the odds of developing other diseases. An alternative to HRT might be to have a compounding pharmacist prepare a natural “bio-identical” estrogen cream or capsule (from naturally-derived chemicals), or increase the consumption of phytoestrogens which occur in plants and vegetables. Soy is a favorite source of phytoestrogens, as is dong quai, black cohosh, and red clover. Phytoestrogens are much weaker than the body’s estrogens, however they are capable of binding to a women’s estrogen receptors to carry out the metabolic processes that synthetic estrogen is involved in. It is always best to talk to your doctor and/or a qualified alternative practitioner about HRT.

RISKS & CAUSES

  1. Family history of osteoporosis
  2. Inadequate or lack of exercise
  3. Prescribed medications, i.e., chronic use of steroids, antibiotics and NSAID drugs.
  4. Low body fat, thin body type
  5. Menopause, inadequate calcium uptake caused by poor diet, high protein & phosphorus, sugar and caffeine
  6. Stress and distress (sympathetic hyperactivity)
  7. Heavy metal toxicity with mercury, arsenic, and cadmium can block new bone cell development
  8. Tobacco use
  9. Higher salt intake appears to increase urinary calcium loss.  This appears to be more problematic when eating a “Western” diet.
  10. Thyroid dysfunction and long-term use of thyroid medications (Synthroid).
  11. New studies suggest that Vitamin A may interfere with your body’s absorption of Vitamin D. And Vitamin D is essential for strong, healthy bones. Limit Vitamin A (Retinol form) to 5,000 IU daily. Beta carotene can be taken safely up to 10,000 IU daily.
  12. A government study showed that long-term warfarin (coumadin) use may increase the risk of fractures in men.  In a one-year study, men taking warfarin for more than a year had a 63% more likelihood of suffering osteoporosis-related fractures of the hip, wrist and spine.

SUPPLEMENT PROTOCOL

  1. CALCIUM CITRATE with VITAMIN D
    Combining adequate calcium supplementation with vitamin D reduces fracture risks by 49% versus calcium alone. Although calcium carbonate (oyster-shell) is the most common form, calcium citrate is the better-absorbed form. Even when taking osteoporosis drugs like Fosamax and Actinel, taking those in combination with optimum doses of calcium/magnesium/vitamin D is better than taking either one separately. (Microcrystalline calcium hydroxyapatite [MCHP] is an excellent source of bioavailable calcium. It is derived from whole bone). VITAMIN D grabs calcium and phosphorus out of your intestines and dumps them into your blood stream where they can be absorbed by your bones and keep your skeleton strong. Vitamin D is derived from sunlight. Increased sun exposure (about 10-15 minutes a day) will produce a sufficient amount for younger people. However, many women mistakenly believe that they get enough D from their diet or from sunlight. Dosage: 1,000-1,500 mg daily of calcium and vitamin D doses from 400-1,000 IU daily. [Every woman over 35 years old is losing 1-2 percent of her bone yearly. Start calcium/magnesium/D after this age.]
  2. MAGNESIUM
    This mineral is probably just as important as calcium in the prevention of bone loss and for the treatment of osteoporosis and osteopenia. Magnesium is an important factor in the qualitative changes in bone matrix that determines bone fragility. Magnesium is required to make parathyroid hormone, which regulates bone development as well as the enzymes that deposit calcium in the bone. Thus, low magnesium levels can lead to low calcium levels and resistance to the effects of vitamin D. Magnesium deficiency in common among Americans today, and it has been confirmed that many adolescent girls in America have early osteopenia due to magnesium deficiency. Germans and Israeli scientists recently reported to that magnesium may be vital to keeping bones strong. A 2:1 calcium-to-magnesium ratio is generally accepted as effective. Dosage: 300-800 mg a day helps achieve peak mass. Best foods for magnesium are legumes, almonds and nuts, seeds, whole wheat germ, wheat bran and leafy greens.
  3. ISOFLAVONES and IPRIFLAVONES
    Ipriflavone is a synthetic derivative of naturally occurring isoflavones that is active in bone metabolism. Many studies have found that ipriflavones have a positive effect in reducing bone mineral loss and increasing bone density (increasing the amount of calcium retained in the bones) in postmenopausal women with osteopenia or established osteoporosis. Ipriflavones also help to inhibit the activity of cells that destroy bone while keeping the bones strong and healthy. Studies have shown that long-term treatment with ipriflavones is both safe and effective in halting bone loss in postmenopausal women. Dosage: 400-600 mg a day.
  4. TRACE MINERALS (COLLOIDAL)
    Many trace minerals (also called micro-minerals) are present in bone, which likely play an important role in bone health. These trace minerals include: zinc, copper, manganese, phosphorus, boron, silica, fluoride, vanadium, molybdenum, strontium, and chromium.
  5. NATURAL PROGESTERONE
    According to noted hormone specialist, Dr. John Lee, women reach peak bone mass at 35 then start losing 1% a year. With a decrease in estrogen of 40% at menopause, loss of bone may be 5%, and there is also a loss of progesterone. New bone function can’t keep up with old bone destruction. Progesterone cream was very effective in reversing process without estrogen. It also works to influence the bone building process of osteoblasts. Dosage: Pre-menopausal women 20 mg a day on days 12-26 of cycle; post- menopausal women should use the topical cream 215 days a month, with a five day break.
  6. NATURAL HORMONE REPLACEMENT THERAPY
    Triple bio-identical estrogen (compounded by a qualified pharmacist) from natural chemicals, appears to be a safer choice than conjugated estrogen, but no overwhelming studies exist.  Dosage: As directed by physician and compounding pharmacist.
  7. VITAMIN K
    Although primarily known for its effect on blood clotting, vitamin K is also required to synthesize osteocalcin, a protein found uniquely and in large amounts in bone. Vitamin K is essential for bone formation, bone remodeling and repair. Vitamin K can decrease urinary calcium loss by 18-50% and may be required more after a bone fracture. Found in green leafy vegetables and cabbage, these vegetables supply almost half of the vitamin K for the majority of Americans. Dosage: As directed on label.
  8. DHEA
    DHEA is a steroid hormone produced in the adrenal glands, ovaries and testes. At the time of menopause, DHEA manufactured by the ovaries declines by 60%. Since DHEA is metabolized in part to estrogen and testosterone, both of which help prevent bone loss, there is a possible relationship between DHEA deficiency and osteoporosis. DHEA and/or testosterone are essential for the maintenance of bone mass in post-menopausal women, but also in elderly men. Dosage: 5-50 mg a day. See a qualified practitioner before starting DHEA therapy.
  9. VITAMIN B-COMPLEX, with extra VITAMIN B6 and B12
    The importance of B vitamins for bone health seems to be related to its role in homocysteine metabolism. Vitamin B6 deficient diets may produce osteoporosis. A recent research breakthrough cited that VITAMIN B12 strengthens brittle bones. The study uncovered that a key factor associated with rapid hip bone loss is low levels of VITAMIN B12, especially in older women. Dosage: B-complex 50-100 mg daily, Vitamin B12 1,000-5,000 mcg daily.
  10. BORON
    Appears to play a major role in human nutrition, particularly in relation to bone health. Born supplementation can help to decrease urinary calcium excretion by 44%. Fruits, nuts, and vegetables are the main  dietary sources of boron. Dosage: 1-3 mg daily.
  11. SILICON
    High concentrations of silicon are found at calcification sites in growing bone. The mineral appears to strengthen connective tissue matrix and aids in calcium utilization. Dosage: As directed.
  12. STRONTIUM
    Strontium is a naturally occurring mineral in the diet and like calcium, it is concentrated in bones. Strontium supplementation has recently been shown to increase calcium retention and support a healthy skeletal system. Dosage: 300- 600 mg before meals, and not at the same time as calcium.
  13. VITAMIN C and other ANTI-OXIDANTS
    Vitamin C is needed for the formation of collagen, the tissue that gives support to bones. As an antioxidant, vitamin C may protect bones from free-radical damage (i.e., cigarette smoke, environmental toxins, chemicals, pesticides) and may aid in calcium absorption by creating an acid environment in the stomach. Dosage: 500-1500 mg daily. Best food sources are kiwi, citrus fruits, tomato juice, strawberries, red peppers, broccoli, brussels sprouts, cauliflower, and suma fruit. Other anti-oxidants such as VITAMIN A with mixed CAROTENOIDS, and VITAMIN E are important in retarding the aging process by improving oxygen utilization in the body. Dosage: vitamin A up to 25,000 IU daily; vitamin E 400 IU daily.
  14. GLUCOSAMINE and CHONDROITIN
    Nutrients necessary for the development of bone and connective tissues. Dosage: up to 1,500 mg daily of glucosamine; 500mg of chondroitin.
  15. ZINC
    Is an essential mineral in bone formation. Zinc also enhances the biochemical action of vitamin D. Zinc levels are low in the elderly who have osteopenia or osteoporosis. Dosage: 50mg daily.
  16. COPPER
    Copper is deficient in the elderly with osteoporosis. 2 mg per day may be enough to help inhibit bone re-absorption.
  17. METHYLSULFONYLMETHANE (MSM)
    A natural sulfur compound found in foods and present in body tissues. MSM is used by the body to build healthy bone and cartilage cells. Dosage: 1,000-3,000 mg daily.
  18. PYCNOGENOL and QUERCETIN
    These common but potent bioflavonoids can reduce inflammatory cytokines that break down bone. Dosage: As directed on label.

DRUGS USED FOR OSTEOPOROSIS

  1. BIPHOSPHONATES (FOSAMAX, ACTONEL, BONIVA)
    These are non-hormonal drugs that target the skeleton by binding permanently to the surface of bone and slowing bone loss but not halting it. Approved for treatment and prevention of osteoporosis, should be prescribed for women diagnosed with osteoporosis. Compliance is difficult and patient must follow a strict regimen to prevent serious stomach problems. The manufacturers of these drugs report a 22% reduction in fractures. Both are available in weekly dose. Fosamax (Alendronate sodium) and Actonel (Risedronate sodium) should be taken at least ½ hour before eating or drinking (except water) to improve absorption. Side effects include gastrointestinal problems including flatulence, acid regurgitation, esophagitis ulcer, and abdominal distress. Headaches, rash and dermatitis, and general pain have also been reported. Recent reports have connected Fosamax use with osteonecrosis (a serious oral condition) of the jaw.  This serious condition seems to be more associated with patients receiving I.V. forms of these drugs, and those receiving chemotherapy and radiation in cancer treatment. Discuss these potential problems with your physician before beginning therapy. The newest drug in this class is Boniva (Ibandronate sodium). Boniva is the first and only once-monthly osteoporosis medicine for the management of post-menopausal osteoporosis.NOTE:  These drugs MUST be taken concomitantly with calcium, magnesium and vitamin D in order for them to work effectively.
  2. SELECTED ESTROGEN RECEPTOR MODULATORS (EVISTA- Raloxifene)
    Evista has been approved for prevention of osteoporosis in postmenopausal women. The drug mimics estrogen in the way that it retards bone loss (classified as a selective estrogen receptor modulator SERM drug) but does not increase cancer risk, even though there is some scientific evidence that there may be an increased risk of ovarian cancer). Largely, the benefits and effectiveness of Evista have been disappointing. Side effects are leg cramps, intensified hot flashes and increased risk of blood clots (thrombus). Evista does not relieve menopausal symptoms. Dr. John Lee says the side effects of Evista may outweigh the benefits. Reported side effects include: fluid retention inside uterus; flu symptoms that are difficult to reverse; decrease in the immune system; increase stroke by three-fold.
  3. CALCITONIN (MIACALCIN, CALCIMAR)
    Approved for treatment of women at least 5 years past menopause. Calcitonin, a hormone produced by thyroid cells, is used as an injection or nasal spray. This drug may be effective in relieving back pain. This drug works by blocking cells that cause bone loss. Side effects include nausea, nasal irritation.
  4. ESTROGEN – (Premarin, Estrace, Prempro)
    Premarin’s mechanism is unknown, but estrogen appears to slow the rate of bone loss by replacing the female sex hormone. Estrogen can increase the risk of breast cancer, cause blood clots, weight gain, cardiovascular events and headaches. Extended use of estrogen definitely results in hip-fracture reduction. According to Dr. John Lee, estrogen may inhibit the thyroid hormone, impair blood sugar (use in caution with diabetics), increase varicose veins, add to auto-immune disease enhancement, and cause the body to lose its ability to make progesterone.  ESTRADIOL AND ESTRONE- may lead to higher cancer risk. ESTRIOL- does not cause cancer.

 

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