Osteoporosis,, which means "porous bone," is a progressive bone-thinning disease that affects over 200 million people worldwide. It is often referred to as a "silent disease" because it develops slowly over many decades with few or no warning signs. The most worrisome outcome of osteoporosis is fractures. It is estimated that osteoporosis causes approximately 1.6 million hip fractures every year. Common symptoms include decreased height, low back pain, gum disease or tooth decay, brittle nails, and compression or stress fractures. While the condition itself is not fatal, it makes bones more susceptible to fractures and can make moving around increasingly difficult. It is important to note that osteoporosis is not merely a loss of calcium from the bone. Osteoporotic bone is losing not only inorganic (calcium mineral) density but also organic bone matrix, which is made up primarily of collagen and specific proteins.
Bone is dynamic living and growing tissue that is constantly being remodeled. Bone metabolism involves the removal of old bone from the skeletal system and the addition of new bone. This process controls the healing and remodeling of bone during growth and following injuries or trauma. Throughout our lifetime, bones steadily grow in length and density until late teens—after this time, bones continue to increase in density but at a much slower rate. When you reach your 20s, bones achieve what is called “peak mass.” This means that they stop building density and natural bone loss begins. After achieving a peak bone mass around age 28, women slowly lose an average of 0.4% of bone mass in the neck of the femur (the long bone of the leg) each year.
A woman’s risk of osteoporosis greatly increases after menopause because her production of the sex hormone estrogen dramatically drops off at her peak of maturity. In the first 5 to 10 years of menopause the rate of bone loss is an average of 2 percent. Other common risk factors for osteoporosis include a sedentary lifestyle, heavy alcohol and tobacco use, eating disorders, long-term corticosteroid use (prednisone or cortisone), celiac/Crohn’s disease, nulliparity (never having been pregnant), and a high-protein diet.
Diet and Lifestyle Tips to Prevent Bone Loss
Something that many physicians do not address is the digestive system to make sure that adequate stomach acid is produced for vitamin and mineral (especially calcium) absorption. As we age, our stomach acid and absorption capability decrease, making us very vulnerable to vitamin and mineral deficiencies. In fact, decreased stomach acid is seen in as many as 40 percent of postmenopausal women. When supplementing, the form of calcium is critical. Avoid calcium carbonate, as it is the most difficult to absorb. A common recommendation by many medical doctors is calcium in the form of Tums; however, Tums will actually slow down the absorption of calcium by blocking stomach acid and therefore is a very poor choice. Choose calcium citrate or malate instead. Along with calcium, it is also important to include magnesium in a 2:1 ratio of calcium to magnesium. Supplement with magnesium or eat foods rich in magnesium like kelp, millet, tofu, beet greens, swiss chard, buckwheat, brown rice, walnuts, and kidney beans.
Milk and dairy products are often promoted as foods good for bone to prevent osteoporosis because of their high calcium content. However, the results from long-term studies may be surprising. These studies have shown conflicting results between milk consumption and strong, healthy bones. In other words, high calcium intake doesn’t actually appear to lower a person’s risk for osteoporosis.
For example, a large Harvard study of male and female health professionals found that those individuals who drank one glass of milk (or less) per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week. When researchers combined the data from the Harvard studies with other large prospective studies, they still found no association between calcium and fracture risk. There was even the suggestion that calcium supplementation taken without vitamin D might increase the risk of hip fractures.
Another observation reported by many complementary health care practitioners is that their patients have allergies to casein, the milk protein. The chronic consumption of dairy can also cause intestinal inflammation, potentially leading to malabsorption and nutritional deficiencies that would negatively affect bone health. There are plenty of non-dairy calcium-rich foods, which include:
- Greens—kale, collard greens, spinach, swiss chard, and turnip greens
- Salmon and sardines
- Sesame seeds
- Navy beans
- Brazil nuts
- Seaweeds—kelp, nori, and dulse
- Tempeh (fermented tofu)—organic whenever possible
Studies have also shown that a diet high in animal protein may promote bone loss. This can often cause calcium excretion through the urine. Certain animal protein such as red meat and pork can acidify the blood, causing calcium and other minerals to be leached from the bones to buffer the acidity in the body. Healthy protein sources should include chicken, turkey, fish, legumes, organic soy products, nuts and seeds, and eggs. Choose organic, hormone- and antibiotic-free lean meats.
Another offender in osteoporosis are high-phosphorus drinks, such as carbonated beverages and soft drinks. Serum phosphates compete with calcium in the blood for cellular absorption.
Additional nutritional factors that speed up calcium loss from the bones and contribute to osteoporosis include:
- High salt
- Refined sugars
- Refined grains
- Excess caffeine in coffee, black tea, and chocolate
- Excess alcohol
A regular exercise program is as important as a nutrient-dense diet and supplementation for preventing osteoporosis. Weight-bearing exercises stimulate osteoblasts (our bone builders) to deposit in stressed areas of the bone as well as increase the secretion of calcitonin, a thyroid hormone that inhibits osteoclasts (our bone breakers). An exercise program for bone-building should include weight-bearing activities (jogging, walking, stair-climbing, hiking) at least 40 to 60 minutes five days a week and strength-training activities (weight-training, yoga, or Pilates) at least three times weekly.
Why Calcium is Not Enough
During bone growth and the early phases of bone calcification, silicon plays an essential role in the formation of the cross-links between collagen. Bone is in fact made up of 30 percent collagen! The collagen in bone also helps attract more calcium deposits through calcium-binding sites on the collagen fibers. Increasing collagen will increase calcium deposits in the bone, creating healthy, strong bones.
A highly bioavailable form of silicon (choline-stabilized orthosilicic acid, sold under the brand name BioSil) shows impressive clinical results in a double-blind study in postmenopausal women with low bone density. Compared with a control group who received only calcium and vitamin D, the addition of BioSil (6 mg per day) increased the collagen content of bone by 22 percent and increased bone mineral density at the hip by 2 percent in the first year. This demonstrates that BioSil helps to produce greater bone strength and flexibility, thereby increasing resistance to fractures.
Calcium is a key component for the prevention of osteoporosis as well as maintenance of good bone health. However, calcium alone may not necessarily protect against bone fractures. A combination of key bone builders is fundamental in any healthy bone program. It is also important to outline dietary calcium before deciding on how much calcium is needed in supplement form. Dosages of 1,000–1,500 mg daily, including food sources, are recommended.
Magnesium, which is involved in bone mineralization, is also an essential mineral for bone health. Magnesium deficiency can lead to the cessation of bone growth, osteopenia (early bone loss), and bone fragility. A daily dosage of 500–700 mg in the form of magnesium citrate, malate or bisglycinate, is recommended.
Vitamin D3 is crucial when it comes to bone health, as it promotes calcium absorption and utilization in the body. Vitamin D3 increases calcium absorption by as much as 30 to 80 percent. I recommend a minimum of 2,000 IU of vitamin D3 to all my patients—for bone health, chronic inflammation, increased energy, and improved mood.
Vitamin K2 is also an important component of bone formation and remodeling. Vitamin K2 works in combination with vitamin D3 to keep calcium in the bone rather than in other areas of the body (such as in the arteries) to help keep bones strong, flexible, and resilient to fractures. Other important bone builders include:
- Vitamin C
- Vitamins B6 and B12, and folic acid
A Word on Bisphosphonates
The most widely prescribed medications for osteoporosis are bisphosphonates. These drugs include Alendronate (Fosamax), Risedronate (Actonel, Atelvia), Ibandronate (Boniva), and Zoledronic acid (Reclast, Zometa). Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. What many people don't realize is that these medications reduce osteoclastic activity (bone breakdown) and increase mineralization of old bone tissue, which, in some cases, will actually cause bones to become more brittle. Because this risk for brittle bones may be associated with long-term use, bisphosphonate drugs are limited to five years at most.
A natural approach for preventing and treating osteoporosis is a comprehensive plan that involves regular weight-bearing exercise, supplementation, and eating foods rich in bone-building minerals—especially calcium, magnesium, and vitamin D. This will ensure stronger, healthier bones for life.
Marita Schauch, BSc, ND, is a graduate of the Canadian College of Naturopathic Medicine, Canada's premier institute for education and research in naturopathic medicine. She currently resides and has her clinical practice on Vancouver Island in Sidney, B.C., where she has a special interest in women's health.
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