Osteoporosis: The Rest of the Story

© 2003-2010 Dale H. Peterson, M.D.

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Are you at risk for osteoporosis? Almost half of all women will suffer a fracture due to osteoporosis during their lifetime. Many men will also sustain osteoporotic fractures. In a recent survey, however, 86 % of women over the age of 50 said that they did not expect to develop osteoporosis. Sadly, 82 % of those who already had symptoms of osteoporosis such as back pain, a stooped posture, and loss of height did not think that they were at high risk for osteoporosis.

The seriousness of osteoporosis is also under appreciated. Osteoporosis is a condition that can dramatically decrease the quality of one’s life. Collapsing vertebrae in the spine can cause severe, persistent back pain. This can also result in a loss of chest size preventing the lungs from fully expanding. The resulting shortness of breath can significantly limit activity. Mobility can be severely restricted by fractures in the hips or feet.

Osteoporosis can also cause an untimely death. Although it is not generally known, more women in the United States die from osteoporotic hip fractures than from breast cancer. These statistics become even more disturbing when it is recognized that osteoporosis is, in most cases, preventable.

Ask someone to explain how to prevent osteoporosis and chances are he or she will say, “Take more calcium,” or “Drink more milk.” This is certainly the message that has been promulgated by the popular media, most physicians and many dieticians. This directive, unfortunately is not very helpful in understanding and forestalling the osteoporotic process.

Some people surveyed may suggest that osteoporosis is caused by a lack of estrogen, citing the frequency at which it occurs in menopausal women. A few might mention that vitamin D and exercise play a role in the prevention of osteoporosis. Almost no one will say, “Eat more fruits and vegetables!”

Osteoporosis cannot be defined simply as a bone calcium deficiency. Lack of calcium, phosphorus and vitamin D causes a problem called osteomalacia, commonly known as rickets. Children who are given insufficient amounts of calcium develop soft bones that have a tendency to bend causing bow-legs, knock-knees and similar deformities. While osteomalacia is most often seen in children, it can occur in adults.

No, osteoporosis is not a simple calcium deficiency nor is it exclusively due to a lack of estrogen, exercise or vitamin D. Osteoporosis is a very complex process. As you gain a better understanding of the factors involved you will be better able to protect yourself from this debilitating and life-threatening disease.

Osteomalacia means “soft bone.” This describes a bone lacking enough mineral content to make it strong and hard. Osteoporosis, on the other hand, means “porous bone” and describes a bone full of holes. The name itself says much about osteoporosis and its prevention.

Osteoporosis is first and foremost a breakdown of the bone matrix, a loss of the structure that holds bone together, and into which minerals are deposited. Forcing more minerals into a bone devoid of a strong matrix will make the bone more dense. One might assume that a denser bone would be a stronger one. Unfortunately this is not the case. When fluoride, for example, is used to increase bone density the bone does not become stronger; it becomes more brittle!

What then, can be done to prevent osteoporosis and help build strong bones? Many things. Just as each piece of a puzzle contributes to forming the complete picture, so each osteoporosis risk factor that is addressed will add to the strength and stability of bone.

Diet - what is consumed and what is not - plays a major role bone health. There are many misconceptions about what is desirable, however. The most common is that people who wish to prevent osteoporosis should drink more milk. Two large studies, one in Australia the other in the United States, have shown the opposite to be the case. Both studies found that as milk consumption increased so did the risk of fracture. Many people find this puzzling and hard to believe.

The findings were not entirely unexpected, however, since diets that are high in animal protein tend to promote osteoporosis. It is true that milk is high in calcium, but it is also extremely high in animal protein. It appears that the net effect of drinking milk is to cause the body to remove calcium from the bone to buffer the acidic ash which results when the body burns dietary protein.

It is best, therefore, to eat a diet that is at most moderate rather than high in animal protein. Plant based protein, such as that derived from soy does not promote osteoporosis, and may even slow its development. Diets high in animal protein, which are currently being promoted, can be expected to accelerate the osteoporotic process and predispose their adherents to other degenerative diseases.

The importance of regularly including fruits and vegetables in the diet cannot be overemphasized. Many studies have shown that a diet high in plant chemicals, or phytonutrients, provides the building blocks needed to maintain the bone matrix. When the matrix is maintained, osteoporosis does not develop. Carbonated beverages are also a major enemy of bone. No woman who cares about bone health should be drinking “cokes” or “sodas”. These place a tremendous drain on the body’s calcium stores.

Cigarette smoking has also been shown to increase the risk of developing osteoporosis. The exact mechanism is uncertain, but this is only one of many reasons to do whatever is necessary to kick the habit.

Weight bearing exercise is also important. Walking is a good example. Low impact aerobic exercise programs are also excellent. This is because when bones are stressed the body works to strengthen them. Bones that are not used atrophy or waste away.

A number of supplements are helpful. The need for calcium is well known, but the fact that calcium sources vary widely in effectiveness is often ignored. Elemental minerals such as calcium carbonate are poorly absorbed and are not utilized well by the body. Chelated minerals are much more efficacious. The forms of calcium which are best absorbed and incorporated into structure of the body are calcium citrate, calcium hydroxy apatite and tricalcium phosphate. Plant based calcium is extremely well absorbed and utilized. The best way to get calcium is the same way cows do . . . from leafy greens.

Calcium taken alone is not used effectively. To be optimally absorbed and utilized other minerals must be present. Magnesium is the major support mineral, but trace minerals including boron, manganese, zinc, copper and perhaps others are also necessary. When the full complement of minerals is present calcium is driven into the bone much more effectively.

I do not believe that there is a magic number regarding the amount of calcium to be taken. A woman who is eating a plant based diet may require very little supplemental calcium whereas one eating a meat based diet may need a great deal. Therefore it is best to begin with a good diet and use the supplements as a safety net. Drinking the juice of 1/4 lemon in a glass of pure water 20 minutes before meals will maximize the absorption of calcium and other minerals from the diet.

Vitamin D may be as important as calcium. It was once believed that people living in the “sun belt” did not require supplemental vitamin D. This has proven to be incorrect for two reasons. The first is that it is rare for an individual over the age of 21 to get enough sun exposure on a daily basis to manufacture the body’s vitamin D requirements. The second is that during the winter months, from roughly October through April, the sun is too low on the horizon to provide the energy needed to generate vitamin D manufacture. It is now believed that half of all hip fractures are the result of an ongoing vitamin D deficiency. I recommend that 400 - 800 units be taken daily.

The question of whether to take hormone replacement therapy (HRT) after menopause must be approached individually. A woman who is a non-smoker, does not drink carbonated beverages, eats a plant based diet high in soy protein, exercises regularly, and takes appropriate supplements is at very low risk for osteoporosis.

There is no question that hormone replacement therapy is capable of slowing the onset and progression of osteoporosis. That does not mean, however, that every woman must take estrogen. While estrogen supplementation tends to slow the rate at which bone loss occurs, it is ineffective in completely stopping the process and it is incapable of helping the body build new bone.

Progesterone, on the other hand, supports the body's ability to build new bone. It is not unusual to see women using progesterone supplements increase their bone density over time.

Bioidentical progesterone (the same substance the body was producing in adequate quantities prior to menopause) should not be confused with synthetic progesterone-like substances called progestins.

Progestins tend to cause fluid retention and weight gain while bioidentical progesterone encourages fluid release and does not cause weight gain. Progestins tend to cause sleep disturbances; progesterone tends to improve sleep quality. Progestins tend to increase the frequency of migraine headaches; progesterone tends to decrease the incidence of migraine.

Most importantly, progestins have been demonstrated to increase a woman's risk of developing breast cancer. Laboratories that monitor hormonal balance are reporting an apparent diminished risk of breast cancer in women who supplement progesterone postmenopausally.

If a woman has experienced menopause at a young age, especially if it was brought on surgically, hormonal replacement becomes even more important. Progesterone should be supplemented to protect the bone and estrogen supplementation given primarily as needed to control menopausal symptoms such as hot flashes.

Urine tests are now available to monitor the rate of bone loss and may be used to assess the adequacy of the chosen regimen.

It is never too soon to take the steps necessary to build and maintain healthy bones. No matter what your age or sex I encourage you to start today. Osteoporosis is a devastating disease in which an ounce of prevention is worth much more than a pound of cure!

Consultation with a physician knowledgeable in diagnosis and treatment of disease should be obtained and the use of any protocol should be discussed in the context of a complete management plan.

The opinions expressed are those of Dr. Peterson and have not been evaluated by the FDA or any other third party. They do not necessarily reflect the recommendations of any supplier of nutritional supplements.

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