What Is Osteoporosis?
Osteoporosis is a silent, slowly developing disease in which your bones become progressively less calcified and therefore, more fragile and more likely to break.
Osteoporosis is a silent, slowly developing disease in which your bones become progressively less calcified and therefore, more fragile and more likely to break.
This is most particularly dangerous when the bones involved are the bones of your spine and larger bones of your hips. If these bones are fractured, you can become seriously debilitated and commonly in need of hospitalization and major surgery. These fractures can further impair your ability to walk unassisted and may cause prolonged or permanent disability or even death.
Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. The sad fact is often osteoporosis progresses quietly and painlessly to the point where it is finally diagnosed only after a fracture occurs.
You Can Prevent Osteoporosis.
The good news about osteoporosis is that it can be prevented and, at the very least, diagnosed early before any fractures occur. Begin early by learning the risk factors for osteoporosis and changing the ones you can change.
You Can Prevent Osteoporosis.
The good news about osteoporosis is that it can be prevented and, at the very least, diagnosed early before any fractures occur. Begin early by learning the risk factors for osteoporosis and changing the ones you can change.
There are a number of risk factors for Osteoporosis that you can change and others which you can’t change. A few examples:
- Women are four times more likely to develop Osteoporosis than men.
- People with a sedentary lifestyle are at higher risk than their active counterparts.
While you can’t change being a woman, you can change your activity levels. Below I've listed risk factors which you can change and risk factors which you cannot change:
Risk Factors You CAN Change
Risk Factors You CAN Change
Low Calcium Intake
Dexa Scan and Weight-bearing Exercise |
Low calcium intake leads to poorly formed and calcified bones. Only 50-60% of adults and only 10-25% of adolescents in the United States get the recommended amount of calcium. Nearly 90% of a person’s bone mass is built by the age of 20. So, starting early to make sure you and your children are getting enough calcium to build those bones and then maintain that bone mass is recommended.
How to change it: Since the body's calcium needs change with age, calcium intake should be adjusted as necessary. Depending on age, an appropriate daily calcium intake is generally between 1000 and 1300 milligrams (mg) a day with 800 to 1300 mg. daily from ages 4 to 18 and 1000 to 1200 mg. daily for adults.
The best way to assure adequate calcium intake is to supplement. The best forms of calcium for supplementation are calcium citrate (40% more absorbable than calcium carbonate from Tums) and microcrystalline hydroxyapatite concentrate (“MCHC”).
How to change it: Since the body's calcium needs change with age, calcium intake should be adjusted as necessary. Depending on age, an appropriate daily calcium intake is generally between 1000 and 1300 milligrams (mg) a day with 800 to 1300 mg. daily from ages 4 to 18 and 1000 to 1200 mg. daily for adults.
The best way to assure adequate calcium intake is to supplement. The best forms of calcium for supplementation are calcium citrate (40% more absorbable than calcium carbonate from Tums) and microcrystalline hydroxyapatite concentrate (“MCHC”).
Low vitamin D levels
Vitamin D is a hormone in our bodies that helps regulate calcium absorption and utilization. Low levels cause calcium to not be put into bones. Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive. Our bodies manufacture vitamin D on exposure to sunshine. However, sufficient levels of sun exposure are needed to assure adequate levels. In many areas of the world such as the northern latitudes, adequate exposure to sunlight is so lacking during the winter months that our body makes no vitamin D at all. We must then rely on dietary supplements and fortified foods to boost intakes of vitamin D.
How to change it: We doctors in the pacific northwest commonly find many of our patients' vitamin D (25 OH) levels below the normal range of 32.0 - 100.0 and actively replete these low levels with oral doses of vitamin D3 in the range of 1,000 IU - 5,000 IU daily and then recheck levels in 8 - 12 weeks. Vitamin D3 is the best absorbed and utilized form of oral vitamin D. We STRONGLY suggest vitamin D supplementation over 1,000 IU daily be done under the guidance of a licensed health care provider. We also suggest vitamin D levels be checked once or twice yearly depending on what part of the world you live in and your sun exposure.
How to change it: We doctors in the pacific northwest commonly find many of our patients' vitamin D (25 OH) levels below the normal range of 32.0 - 100.0 and actively replete these low levels with oral doses of vitamin D3 in the range of 1,000 IU - 5,000 IU daily and then recheck levels in 8 - 12 weeks. Vitamin D3 is the best absorbed and utilized form of oral vitamin D. We STRONGLY suggest vitamin D supplementation over 1,000 IU daily be done under the guidance of a licensed health care provider. We also suggest vitamin D levels be checked once or twice yearly depending on what part of the world you live in and your sun exposure.
Low intake of bone-supporting nutrients.
Numerous micronutrients help with the absorption and utilization of calcium. These include magnesium, silica, vitamin K2, boron and fluoride to name a few. The optimal daily intake of these micronutrients is commonly deficient in most people throughout the world especially those eating a standard, western diet and fast foods.
How to change it: Supplementing with a calcium product that includes these micronutrients is important. Two of the most important of these micronutrients for maximizing bone health is water-soluble silica and vitamin K2.
Water-soluble silica is present in surface and well water. It is the form predominantly absorbed by humans and is found in numerous tissues including bone, collagen and connective tissues, tendons, aorta, liver, and kidney. Although no Recommended Daily Allowance (RDA) has been set for silica, compelling scientific evidence suggests it is essential for health with a myriad of beneficial effects being discovered. Deficiencies cause bone deformities; brittle nails; thin, brittle hair that lacks luster; damaged, early aging of skin with reduced elasticity and wrinkling; poorly formed joints; reduced levels of collagen and cartilage; and disruption of mineral balance in the femur and vertebrae. In clinical studies, supplementing calcium and vitamin D3 with water-soluble silica (choline-stabilized orthosilicic acid) improved bone calcification and density far better than just supplementing calcium and vitamin D3 alone. Although vitamin K is not deficient in most diets, its form of vitamin K2 has been shown to markedly improve calcium incorporation into bone while slowing the breakdown of bone.
How to change it: Supplementing with a calcium product that includes these micronutrients is important. Two of the most important of these micronutrients for maximizing bone health is water-soluble silica and vitamin K2.
Water-soluble silica is present in surface and well water. It is the form predominantly absorbed by humans and is found in numerous tissues including bone, collagen and connective tissues, tendons, aorta, liver, and kidney. Although no Recommended Daily Allowance (RDA) has been set for silica, compelling scientific evidence suggests it is essential for health with a myriad of beneficial effects being discovered. Deficiencies cause bone deformities; brittle nails; thin, brittle hair that lacks luster; damaged, early aging of skin with reduced elasticity and wrinkling; poorly formed joints; reduced levels of collagen and cartilage; and disruption of mineral balance in the femur and vertebrae. In clinical studies, supplementing calcium and vitamin D3 with water-soluble silica (choline-stabilized orthosilicic acid) improved bone calcification and density far better than just supplementing calcium and vitamin D3 alone. Although vitamin K is not deficient in most diets, its form of vitamin K2 has been shown to markedly improve calcium incorporation into bone while slowing the breakdown of bone.
Tobacco Use
The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
How to change it: Don’t smoke!
How to change it: Don’t smoke!
Eating Disorders
Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density. This is usually due to nutritional deficiencies that occur as a result of those eating disorders and the stress it puts upon their bodies and the resultant lessened body mass.
Hoe to change it: If you or someone in your family has an eating disorder, get them into treatment with an eating disorder clinic and or therapist.
Hoe to change it: If you or someone in your family has an eating disorder, get them into treatment with an eating disorder clinic and or therapist.
Sedentary Lifestyle
People who spend a lot of time sitting have a higher risk of osteoporosis than their more-active counterparts. Too much computer work at a desk, playing video games, watching TV, etc. can contribute to this.
How to change it: When you stress your bones they get the message to put more calcium in and build more bone. Active, weight-bearing exercise is most essential to counterbalance a sedentary life style. Weight-bearing is beneficial for your bones. Walking; running; jumping; dancing; weightlifting and many aerobic, outdoor sports seem particularly helpful for building and maintaining strong bones. So, get active and stay active.
How to change it: When you stress your bones they get the message to put more calcium in and build more bone. Active, weight-bearing exercise is most essential to counterbalance a sedentary life style. Weight-bearing is beneficial for your bones. Walking; running; jumping; dancing; weightlifting and many aerobic, outdoor sports seem particularly helpful for building and maintaining strong bones. So, get active and stay active.
Excessive alcohol consumption
Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.
How to change it: Keep your alcohol intake to a minimum of two drinks a day or less. When you do drink, try not to drink “harder” alcohols and stick to red wine and beer as these can be healthier than harder alcohols.
How to change it: Keep your alcohol intake to a minimum of two drinks a day or less. When you do drink, try not to drink “harder” alcohols and stick to red wine and beer as these can be healthier than harder alcohols.
Use of Corticosteroid and other medications.
Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic inflammatory conditions, such as asthma, rheumatoid arthritis, lupus, inflammatory bowel disease and other autoimmune disorders. Long-term use of aromatase inhibitors to treat breast cancer, the antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton pump inhibitors and aluminum-containing antacids are all associated with an increased risk of osteoporosis.
How to change it: If you cannot reduce your dependence or need for any of these medications, your doctor should monitor your bone density (using a DEXA scan) and your vitamin D and calcium levels and recommend therapeutic medications other than the ones listed to treat those conditions whenever possible. You should certainly maintain optimal doses of calcium, vitamin D3 and the other supportive nutrients as mentioned above while taking these medications. Also using drugs such as Fosamax to help prevent bone loss is quite reasonable if these medications must be continued and you are developing osteoporosis.
How to change it: If you cannot reduce your dependence or need for any of these medications, your doctor should monitor your bone density (using a DEXA scan) and your vitamin D and calcium levels and recommend therapeutic medications other than the ones listed to treat those conditions whenever possible. You should certainly maintain optimal doses of calcium, vitamin D3 and the other supportive nutrients as mentioned above while taking these medications. Also using drugs such as Fosamax to help prevent bone loss is quite reasonable if these medications must be continued and you are developing osteoporosis.
Risk Factors You CAN”T Change
Being a woman.
Fractures from osteoporosis are almost twice as common in women as they are in men. But you can lessen this risk if you change the risk factors above that can be changed.
Getting older.
The older you get, the greater your risk of osteoporosis. But you can lessen this risk if you change the risk factors above that can be changed.
Race.
You're at greatest risk of osteoporosis if you're white or of Asian descent.
Family history.
Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures. But this can also be due to some degree to a learned family pattern of eating habits and sedentary living that puts you at risk. That piece can be changed.
Frame size.
Men and women who are exceptionally thin (with a body mass index of 19 or less) or have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.
Thyroid hormone.
Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism). If you have thyroid disease, your Thyroid Stimulating Hormone (TSH) should be measured and monitored regularly by your doctor. The best and safest levels to maintain are between 1.0 and 2.0.
Medical conditions and procedures that affect bone health.
Stomach surgery (gastrectomy), some intestinal surgery (partial removal of small intestines) and weight-loss surgery can affect your body's ability to absorb calcium. Disorders associated with malabsorption such as Crohn's disease and celiac disease can cause osteoporosis by limiting absorption of calcium and other nutrients. As a matter of fact, all patients with osteoporosis should be screened for celiac disease. Hyperparathyroidism and Cushing's disease are two other disorders that can cause osteoporosis.
How is Osteoporosis Diagnosed?
Reviewing all of your risk factors both personal and familial and an initial physical exam is the first step. Most importantly, however, is predicting your chances of future fracture, as this is your greatest health risk. Various x-rays to detect skeletal problems can be done and laboratory tests that reveal important information about the metabolic process of bone breakdown and formation can be done including vitamin D and calcium levels. Ultimately, a bone density test called a DEXA scan is done to detect if there is low bone density.
How is Osteoporosis Treated?
The best treatment for osteoporosis is prevention. That means following all of the guidelines for changing your risk factors as listed above. Even if you have been diagnosed with osteoporosis or osteopenia (mild loss of bone density), you should institute the guidelines given above for prevention. With this done, you may want to consider treatment with low-dose testosterone and or the hormone DHEA. These hormones must be prescribed by a knowledgeable, licensed, healthcare practitioner who should also monitor your progress.
You may also want to consider treatment with various prescription, bisphosphonate medications such as Fosamax. However, these medications come with risks of their-own. These risks include: ulcers of the esophagus and stomach; gastritis (stomach irritation); irregular heartbeat; fractures of the femur; low calcium in the blood; skin rash; joint, bone, and muscle pain; jaw bone decay (osteonecrosis) and, rarely, ncreased parathyroid hormone (PTH).
Take-aways...Monitoring and Prevention
By far, the best treatment for osteoporosis is prevention. For the most part, it is a preventable disease. The choice is in your hands. You can start today by monitoring and making the necessary changes to your calcium intake, Vitamin D levels, bone supporting nutrients, tobacco use, eating disorders, activity levels, alcohol consumption, and use of medications.
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There's More to Learn About Osteoporosis
Calcium is NOT Made in the Body | How Osteoporosis Affects All of Us |
Ways to Prevent Osteoporosis | Thinning Bone |
Photo: http://freedigitalphotos.net
Dr. Donovan is a Naturopathic Physician, author, educator, and a professor of clinical medicine at Bastyr University's Natural Health Clinic. In 2010 he was voted by his professional peers as one of Seattle’s Top Doctors in the Seattle Metropolitan Magazine. Dr. Donovan writes and lectures on the transformational process of healing and believes a person’s healing journey is ultimately a quest for his/her identity, purpose and meaning. He has more than 35 years of patient care experience as a Registered Nurse (RN) and a Naturopathic Physician (ND), representing a wide range of clinical settings from hospital-based surgical and intensive care as a registered nurse to outpatient primary care as a physician.
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