About Osteoporosis
   by James Occhiogrosso, N.D.

Health Naturally - Home Page

Osteoporosis is a condition caused by an imbalance in the body's bone-building mechanism. It typically occurs in women after menopause, but can occur earlier in both men and women that are nutritionally deficient or who have severe hormone imbalances.

The normal bone-building cycle begins when we are young and continues throughout life. It is driven by the action of two kinds of cells lodged in living bone that are called osteoclasts and osteoblasts. The osteoclasts destroy old bone in the body while the osteoblasts build new bone.

An easy way to remember which does what is by the single different letter in each cells name. OsteoClasts "cut" away old bone and the osteoBlasts "build" new bone. Thus, our bodies are constantly breaking down old bone (a process called resorbing) and replacing it with new bone. When osteoclasts remove old bone, they essentially leave a hole in the bone that the osteoblasts detect and then fill in.

Up to about the age of 30 to 35, our bones are still developing, and we gain bone strength by building more bone then we lose, providing that our bodies get the proper nutrition. In a healthy, well nourished adult that is not deficient in calcium and vitamin D, all bone in the entire skeleton is replaced in less than 10 years. The process of recycling bone usually stays in balance throughout adulthood, so that the amount of bone removed is roughly equal to the amount replaced.

Normal aging, use of certain prescription medications, hormone imbalances, and poor nutrition can disturb this balance and cause us to lose bone faster than it is replaced. This begins the process of osteoporosis, where the holes in the bones left from removal of old bone by the osteoclasts are not quickly filled in by the osteoblasts, leaving the bones more porous, weaker, and more subject to fracture.

There are many factors that initiate osteoporosis. As women approach menopause their bodies begin to produce less of the hormones estrogen, progesterone and testosterone. Much has been written about the effect of the drop in estrogen, but it is only one player in this complex symphony. The hormone progesterone is even more critical in preventing bone loss. Aging also results in lower testosterone levels, which effects bone health. In women, it is primarily the drop in estrogen and progesterone that causes osteoporosis, but in men it is more often related to a drop in testosterone levels.

Menopause, and the male equivalent andropause, are common triggers for osteoporosis in aging men and women, but bone loss can also be caused by surgery (complete hysterectomy) in women and treatment for prostate cancer (androgen deprivation therapy) in men. Essentially, any surgery or medication that effects hormone production can cause problems. Steroid medications used to control conditions like chronic cholitis, lupus, asthma, arthritis, and other conditions can also cause severe osteoporosis if they are taken on a long-term basis.

The consequences of osteoporosis are quite grim. Because the bones gradually become weaker and weaker, small fractures occur in the spine which can gradually accumulate. As a result of these many small, and usually unnoticed spinal fractures, people can actually loss height and become shorter. Unfortunately, many people do not understand that becoming a little shorter often means they have developed osteoporosis. In time this will likely result in more serious fractures of the spine and possibly the classic observable symptom of a protruding, deformed back known as "Dowager's hump". In simple terms, the porous unsupported bone easily collapses under very little stress.

Osteoporosis also increases the possibility of fractures to other bones in the body. Common fractures are to bones in the feet and wrist, as well as more serious fractures to the hip. People with osteoporosis can fracture ankle and wrist bones quite easily, sometimes without even realizing the problem until the pain of the fracture hits them. Fractures of the hip are also common, especially when someone falls. In all cases, the weak bone heals slower, and such fractures, especially those of the hip, can result in severe infirmity, especially to the elderly. These fractures frequently result in permanent disability.

Taking Biphosphonate Drugs to Prevent Osteoporosis

Modern medicine often uses words like "clinically proven", "evidence based", and "scientifically proven" to add credibility to their wares. Listening to the T.V. commercials by some well-known celebrities and movie stars, you might get the impression that all you need do to prevent osteoporosis is simply take a pill! Unfortunately, this is an area where financial interests by manufacturers of drugs in the biphosphonate family, (Boniva, Fosamax, Reclast, etc.) are promoted far beyond their usefulness. Often the studies are designed by the drug companies to provide the result they want. Studies that don't provide the desired result are simply not published. Thus, drug companies have created their own system of "clinically proven, evidence based science" when in actuality the process is designed to deceive patients, and often, their doctors too. Biphosphonate drugs are a classic example of this deception.

Doctors order bone density tests to determine if someone has osteoporosis or its precursor, osteopenia. These tests are useful in helping to diagnose osteoporosis or osteopenia in the early stages before broken bones occur. If there is evidence of bone density below an established reference level, the doctor will usually prescribe a biphosphonate drug.

Biphosphonate drugs work by inhibiting the action of the osteoclast cells described above. This reduces the removal of old, defective or dead bone while leaving intact the process of building new bone. This will often result in increased bone density on subsequent tests repeated over time. But though a bone scan may show increased bone density, it is very misleading.

Inhibiting the removal of old, dead bone, while allowing building of new bone, does not mean the bone is actually stronger. In fact, the denser bone can actually be weaker!

For a good analogy to this, consider refurbishing a brick building whose foundation is deteriorating rapidly. Simply adding more bricks on top of the crumbling ones does not increase the overall strength of the building, and, it may in fact, even make the building weaker. One of the largest and strongest bones in the body is the femur, the large bone connecting the hip to the knee. Recent reports have isolated atypical fractures of the femur in people that have been taking biphosphonate drugs on a long term basis. Thus, long-term inhibition of removal of dead bone appears to have resulted in bone that is weaker and much more likely to fracture. Like the analogy above, adding new brick (or bone) to a crumbling foundation does not strengthen the overall structure.

A fracture of the shaft of the very strong femur bone is a severe injury that is typically related to intense sports injuries, high-speed automotive collisions and other events that cause serious bodily injury. In other words, it generally takes the force of a serious impact event to fracture the femur shaft.

Biphosphonate drugs have been on the market for about 10 years, and serious femoral shaft fractures are appearing in people using them. [1] These are "atypical" fractures, not caused by the severe stress of an accident or similar external impact, but by simply twisting the wrong way, or a minor stumble. Thus, it is obvious that these drugs, while building more dense bone, are simultaneously allowing the living bone to become significantly weaker.

One theory of why this occurs is that the long-term use of such drugs inhibits repair of micro-damage to the bones, which in turn contributes to a buildup of such damage, eventually weakening the entire bone structure.

Thus, in summary, an increased bone density on a bone scan after taking biphosphonate drugs does not necessarily relate to increased bone strength. In fact, quite the opposite may be true, particularly for the large bones in the body after long-term use of these drugs.

Preventing Osteoporosis Naturally

In our society today, many people have been led to believe that osteoporosis is an inevitable part of aging. After all, wasn't Grandma stooped over in her later years? Contributing to this is the "take a pill for everything" attitude that has come about from constant commercial messages coming from every corner of life. And, of course, the pharmaceutical manufacturers very much want to continue this paradigm, keeping the public paying high prices for drugs that are of dubious benefit and, in many cases, cause significant harm.

Osteoporosis can be prevented. If you already have osteoporosis, it can be managed, and with proper supplementation, nutrition, and lifestyle changes, it may even be reversed.

Calcium is one of the most important minerals for the prevention of osteoporosis. However, it is important to get your calcium from the correct sources. Many multivitamins (according to the manufacturer) provide "an entire days supply" of calcium. In most cases, the form of the calcium supplied is not absorbable by the human body. Calcium citrate or calcium gluconate are the more absorbable forms, but they have large molecules and a full day's dose cannot typically be packed into a standard "One-a-day" kind of vitamin. Thus, while a multi-vitamin is definitely of value to provide a broad range of nutrients, separate calcium supplementation is also needed. You should aim to get at least 1000mg of calcium daily from both food and supplements. Many books are available that list the calcium content of various foods.

An optimal vitamin D level is essential for assimilating calcium in the body. Recent studies recommend 2,000 to 4,000 IU daily of this vitamin for preventative purposes. Studies show that women with osteoporosis often absorb calcium less efficiently than women that do not have osteoporosis. This inability to absorb calcium is often due to a vitamin D deficiency. When there is insufficient vitamin D in the body, parathyroid hormone secreted from the parathyroid glands increases, causing an increase in calcium to be absorbed from your intestines. However, this process is dependent on a sufficient level of vitamin D. If you are deficient in vitamin D, you cannot absorb sufficient calcium from your diet and thus, the calcium needed for your body to function is then leeched from your bones. A recent study also indicated that taking a DHEA supplement combined with vitamin D and calcium can significantly improve spinal bone density in older women. [2]

Dietary habits also have a strong effect on calcium levels in the body. Several studies have shown that calcium is excreted in the urine in direct proportion to the amount of carbonated beverages ingested. Thus, a lifetime heavy soda drinker is setting herself up for severe osteoporosis sometime in her future. This is especially true when the carbonated beverage consumed is artificially sweetened. Artificial sweeteners also increase the amount of excreted calcium. Women that have had poor childhood nutritional habits are at particular risk for developing osteoporosis since most calcium is stored in the bones at an early age.

Hormone balance is particularly important for calcium absorption and bone growth. Deficiencies in estrogen, progesterone and testosterone in both men and women cause a decrease in bone strength. Hormone imbalances typically occur with aging, but can also be accelerated by procedures like a hysterectomy in a women, androgen deprivation treatment for a man, and numerous prescription medications. Many men and women can improve bone health by using natural bio-identical progesterone on a regular basis.

Lifestyle issues like smoking and alcohol consumption are also of significance. Studies have shown that both tend to interfere with calcium absorption and hormone balance thus interfering with the action of vitamin D. Some studies also suggest that smoking and alcohol consumption inhibit bone-building osteoblasts.

Lastly, weight-bearing exercises like brisk walking, running, various sports, and low-impact aerobics can go a long way to improving bone strength. Studies show that even a small amount of regular weight bearing exercise can help build stronger bones and significantly reduce the risk of bone fractures.

Women that have a family history of osteoporosis, an early menopause, poor childhood nutrition, a total hysterectomy, smoke, use excessive alcohol, or have used steroid medications (especially long-term use of prednisone) are particularly at risk for osteoporosis and should take steps as early as possible to prevent it.

In summary, to beat osteoporosis you should make sure your calcium and vitamin D levels are adequate, eat a good, calcium rich diet, test your hormone levels for proper balance, get at least a few minutes of weight bearing exercise daily, and avoid carbonated beverages and certain prescription drugs that effect calcium absorption. It is always best to consult a good, holistic doctor or natural health practitioner who can analyze your situation and make appropriate recommendations specific for your situation.

References:
[1] Researchers Puzzled by Role of Osteoporosis Drug in Rare Thighbone Fractures, NY Times, 3/24/10
[2] DHEA supplement combined with vitamin D and calcium significantly improves spinal bone density in older women, News-Medical.net, 3/12/09