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The Way Up Newsletter
12/01/08
Volume 40

BONE HEALTH

 

I bet you don't give much thought to your bones. Bones are somewhat of a dry subject, so to speak. But dem dry bones are the most important support system you can ever hope to have. The major functions of bones are to protect your vital organs, to help you to stay upright, to help you move and to create blood cells. Without bones upon which to hang your body, you would be a blob of protoplasm.

 

Bone health should not be dismissed as a problem of later age. It has even been said that "osteoporosis is a pediatric disease". This is because a high peak bone mass in youth is one of the most important contributors to maintaining strong bones and good bone mass in later life. It makes sense that the stronger your bones are to begin with, the less are the consequences from some degree of later bone loss. Starting as early as childhood and adolescence , it is best to supplement with a good all purpose multivitamin mineral and a calcium/magnesium combination supplement daily.

 

Peak bone mass is determined by nutritional status, activity level, hormone production, and genetics. Bones become stronger with weight bearing activity and exercise such as walking and various sports, but swimming or cycling does not have the same effect because of the lack of weight bearing. It is important for children to be physically active to help build peak bone mass.

An early and lifelong bone health program is preferable, but any positive attention given to your bones at any age is better than none at all.

We build bones in our body from infancy until about 30 years of age. This results in a steady accumulation of bone mass to a peak level for each person. After peak bone mass is achieved a gradual loss of bone takes place in everyone. Therefore the two most important preventive approaches are maximizing peak bone mass in the formative years and minimizing bone loss with aging. Overall studies have suggested insufficient calcium nutrition in early life may account for a 5-10% lower peak bone mass. This small difference can then potentially contribute to more than 50% of the hip fracture rates in later life.

 

Bone strength is a combination of bone mineral density (BMD) and bone quality. Without strong healthy bones you are vulnerable to breaks from minor falls or even from no fall at all. These are called spontaneous fractures and can occur with everyday simple movement in those whose bones have thinned to a dangerous level.

 

Bones are constantly being built and broken down in a process called remodeling, so that most adult bone is replaced every 10 years. Cells called osteoblasts work to build bone by laying down minerals and collagen. Cells called osteoclasts work to remove bone by dissolving minerals and matrix. This removal process is called resorption.

 

The building process needs to stay even with or ahead of the breakdown process, or ultimate osteoporosis can be the result.

Osteoblasts are stimulated by progesterone, estrogen, testosterone, parathyroid hormone and DHEA. Parathyroid hormone from the parathyroid gland ,which sits on top of your thyroid, also acts indirectly to signal the osteoclasts to pull calcium from your bones and break them down. Estrogen has an inhibitory action on the osteoclasts.

 

Calcitonin is a hormone made in your thyroid gland which inhibits osteoclast formation and bone resorption It also helps your body to absorb calcium and phosphorus in to your bones. Those who have had their thyroid surgically removed need to be given calcitonin to help prevent the development of osteoporosis. Calcitonin is available as a prescription nasal spray for the treatment of osteoporosis.

Bone is a composite of minerals, and structural proteins. The average adult has 1-1.5 kilograms of calcium in the skeleton as a complex with phosphorus which is called calcium hydroxyapatite. Other minerals found in the bones are magnesium, boron, chromium, copper, iron, zinc, manganese, strontium, silica, and sulfur. The proteins are fibrous proteins such as collagen, elastin, actin and tubulin. All body proteins are formed from dietary amino acids which compose dietary protein.

Bone health depends upon a whole range of nutrients. A prolonged deficiency or excess of any one or a combination of nutrients may contribute to loss of bone density. Dietary and supplemental calcium requires magnesium, vitamin D3, boron, manganese, strontium, and adequate stomach acid for proper absorption. Zinc, copper, silicon, vitamin C, vitamin K, vitamin B6, vitamin B12, folic acid, vitamin A, and dietary protein are also important. To further complicate the picture, most nutrient absorption declines with age.

 

FIRST OF ALL, TAKING CALCIUM SUPPLEMENTS ALONE IS NOT THE ANSWER AND IS NOT RECOMMENDED! THIS IS A GROSS MISTAKE WIDELY PERPETRATED WHEN ADDRESSING BONE HEALTH!

 

Multiple nutrients and hormones work together to build bone and multiple nutrients need to be used to support bone. Environmental, genetic and lifestyle factors also make their contribution.

 

Calcium is what you hear about the most. Yet, many calcium supplements are not well absorbed. Those using poor quality products may have a false sense of security about their calcium intake. Do not supplement your calcium using the cheaper bone meal, dolomite, oyster shell products as the calcium is poorly absorbed from these sources and they can contain significant amount of lead.

The most easily absorbed calcium supplements are listed in order of priority as the amino acid chelates calcium glycinate, malate, citrate, lactate; then calcium carbonate, and calcium phosphate. Calcium hydroxyapatite is also important to add to a treatment program because it maintains more available phosphorus for the bones than do other calcium products. No one form of calcium meets every potential benefit, so it is best to use a combination of the amino acid chelated calcium and the hydroxyapatite form.

 

Most Americans are only getting one third to one half the calcium needed to maintain good health. Food sources of calcium are milk, yogurt, cheese, cream, salmon, tofu, green leafy vegetables, beans, cauliflower, chard, egg yolk, kale, molasses, rhubarb, almonds, beets, bran, cabbage, carrots, celery, lemons, chocolate, dates, figs, lettuce, oatmeal, oranges, oysters, shell fish, parsnips, pineapples, raspberries, spinach, turnips, walnuts and watercress.

 

Less than 1 in 10 women under 70 years of age is getting adequate amounts of calcium from diet alone. Less than 1 in 100 women over 70 years old are getting their calcium needs supplied by diet. Supplementation is usually needed. In premenopausal women the ideal daily dose of calcium is 1000-1200mg. Postmenopausal women need 1500-1800mg daily.

As previously stressed, multiple nutrients and hormones work together to build bone. Calcium supplementation without sufficient magnesium is a dangerous and common mistake which can actually add to loss of bone density. So taking calcium alone can actually harm your bones.

 

Magnesium is critical for bone health. Even a mild magnesium deficiency has been reported to be a common risk factor for osteoporosis. Magnesium regulates calcium transport throughout your body. There are approximately 25 grams of magnesium in your body, and two thirds of this is in your bones. Magnesium is a vital cofactor for almost all the reactions involving calcium absorption and bone formation. Lack of magnesium alters calcium metabolism causing calcium to be pulled from your bones. Magnesium stimulates the hormone that tells your body to put calcium in your bones and suppresses the hormone that tells your body to take calcium from your bones.

The ideal balance of calcium magnesium supplementation ranges between 2 times as much calcium to magnesium and equal amounts of both. Equal is preferable, but magnesium may be quite laxative and this can often limit the dose. Magnesium depletion may cause low blood calcium levels, may interfere with the secretion of parathyroid hormone (calcium and bone metabolism regulating hormone), and may cause low blood levels of Vitamin D3. Blood tests which are usually done for magnesium are the serum magnesium which does not give an accurate report of magnesium in the cells where it has critical functions. A more accurate Red Blood Cell Magnesium test needs to be ordered if this mineral is being checked.

 

FOOD SOURCES OF MAGNESIUM are brown rice, beef, barley, cod fish, cocoa, citrus fruits, oatmeal, peaches, halibut, roast poultry, fresh and boiled vegetables, whole wheat, soy flour, meats, seafood, green vegetables.

VITAMIN D3 facilitates calcium absorption in the intestines and calcium transport to the bones, modulates bone turnover, and improves bone strength. Because it is a fat soluble vitamin and can therefore store in the body, it was previously assumed a daily supplement of 400-800 units was adequate. It was also assumed that those who live in sunny climates and go out in the sun for half hour daily would have plenty of vitamin D. A few years ago I started routinely ordering blood tests for vitamin D3 (25 hydroxy), the active form of D. I have continued to be amazed that at least half of the people I test are vitamin D deficient, and we live in the desert! Some of the deficiencies have taken months of high dosing to resolve with the doses ranging from 2400-10,000 units daily.

 

A University of Pittsburgh study showed more than half of pregnant women studied did not have enough vitamin D, even those using prenatal vitamins.

 

It is important you have this blood test done because vitamin D is not only critical for bone health, but higher levels of D are associated with lower cancer risk in several studies. This is especially so for breast and prostate cancer, but likely all cancers because Vitamin D regulates cell differentiation and cell proliferation. Vitamin D also helps prevent depression, diabetes, and heart disease. If your Dr will not order the vitamin D3 blood test, you can order it yourself from http://www.lef.org/

 

An excellent web site for extensive vitamin D research and information is http://www.vitamindcouncil.org/

 

Foods high in vitamin D are butter, margarine, liver, and eggs.

STRONTIUM is a mineral which is closely related to calcium and metabolized in the body in similar ways.  For this reason, strontium and calcium should be supplemented at different times of the day because they compete for absorption.  Almost all of the 300-350mg of strontium found in your body is in your bones or teeth.  We usually get about 2mg daily in our food such as spices, seafood, whole grains, root and leafy vegetables, and legumes.

 

Strontium stimulates new bone growth by improving bone turnover rather than inhibiting it as do many of the osteoporosis medications. It does this by stimulating osteoblast formation (the bone building cells) and inhibiting osteoclast activity (the bone breakdown cells). There have been several clinical double-blind placebo-controlled trials evaluating the effectiveness of strontium in supporting bone growth. Strontium Ranelate, a particular salt form of strontium is available by prescription in Europe and the UK. The results of a larger clinical trial were published in 2004 in the New England Journal of Medicine. The study evaluated the progress of 1649 postmenopausal women with osteoporosis.

 

The treatment group received 2 grams daily of Strontium Ranelate plus calcium and vitamin D. After 3 years those taking the strontium had increases in bone density of 14.4% in the lumbar spine, 8.3% in the femoral neck of the hip, and 9.8% in the total hip. Also, those taking strontium had 41% fewer spine fractures over the 3 years than those in the control group. Other studies have reported benefits with a 1 gram daily dose. Some have concluded 1 gram daily as ideal for prevention and 2 grams daily for the treatment of osteoporosis.

 

Many forms of dietary supplement strontium are now available such as carbonates, citrates, chlorides and so on. Though all act similarly regarding bone metabolism, no studies have been done comparing them.

 

VITAMIN K inhibits the loss of calcium from bones, and is needed to get calcium in to bones. Vitamin K is needed to form the protein osteocalcin which helps attach calcium to bones. Low vitamin K interferes with the utilization of calcitonin so that not enough calcium gets in to the bones. Vitamin K regulates calcium helping to keep it in the bones, rather than in the soft tissue such as in the arteries as with atherosclerosis.

 

Studies show vitamin K significantly reduces bone loss in osteoporotic women. Low dietary levels of vitamin K are associated with low bone density and increased fractures. Another symptom of vitamin K deficiency is easy bruising. Vitamin K comes from foods and also is made in the intestines from bacteria. High vitamin K foods are green vegetables, especially broccoli, cabbage, spinach, brussel sprouts, turnip greens and lettuce.

 

VITAMIN C promotes the formation and cross linking of the structural proteins in bones.

 

VITAMIN A is important in the bone remodeling process as both the osteoblasts and the osteoclasts contain receptors for vitamin A. Too high or too low levels are damaging to bone. Animal products and red, orange and yellow vegetables are good dietary sources of vitamin A.

 

IRON acts as a cofactor for enzymes involved in collagen formation. Collagen is a factor in bone strength. Iron deficient rats have greater bone fragility. I have extensively written about the symptoms of iron deficiency in my newsletter. A blood test called serum ferritin is the best method for evaluating total body iron status ....and yes I see a great deal of iron deficiency in my patients.

 

ZINC is essential for normal bone formation.

 

MANGANESE deficiency causes a reduction in the amount of calcium laid down in the bone.

 

COPPER 3mg daily has been shown to inhibit bone resorption. It also influences collagen maturation and so affects bone composition and structure from that perspective.

 

BORON 3 mg daily reduces the urinary excretion of calcium and magnesium. It also increases blood levels of 17-beta estradiol which is beneficial to bone health. Boron is a trace mineral found mostly in plant foods such as apples, carrots, grapes, leafy vegetables, nuts, pears, and grains.

 

MOLYBDENUM is a trace mineral which also participates in bone formation.

 

FOLIC ACID, VITAMIN B6, and VITAMIN B12 are necessary for adequate breakdown and metabolism of homocysteine and are related to bone health via this mechanism. Articles in the New England Journal of Medicine linked increasing levels of the blood chemical homocysteine with increasing risk for osteoporosis. You can see my newsletter on Vitamin B12, Folic Acid and Homocysteine for more information on this important subject.

 

Animal studies show vitamin B6 deficiencies are associated with delayed fracture healing, impaired growth of cartilage, defective bone formation, and more rapid development of osteoporosis.

 

SILICON DIOXIDE, also known as silica, is the second most common element in the earth's crust. Therefore it is no surprise to learn it is the 3rd most abundant trace element in your body. The average human body contains 7 grams of silicon. Any parts of your body needing strength and elasticity require silicon. It is an essential nutrient for the formation of bone, skin, nails, ligaments, tendons, blood vessels, collagen, cartilage, and elastin. The average daily dietary intake in the U.S. is 25 mg. All dietary silicon must be dissolved in the stomach to form orthosilicic acid in order to be metabolized and used. A high silica source is the horsetail plant. Silica is also found in green beans, cereal and cereal products such as beer, barley, chickweed, cucumbers, parsley, stinging nettle, walnuts, Brazil nuts, pistachio nuts, and turnips. Bio-Sil is a supplemental form of orthosilicic acid.

 

FLUORIDE is a naturally occurring constituent of minerals in rocks and soil. Though it can help build bone, there is controversy about the quality of the bone built suggesting it may be too fragile. Most water supplies are fluoride treated and fluorides are also in toothpaste. I suggest not adding extra fluoride because of the unresolved controversy.

 

LYSINE is an amino acid which enhances intestinal absorption of calcium and reduces the excretion of calcium in the urine. It is important in the formation of collagen which forms the matrix of your bones, cartilage, and connective tissue.

 

L-CYSTEINE is an amino acid which is positively associated with bone density. Smoking depletes the body of cysteine. In a study of 328 postmenopausal women, lower levels of cysteine were associated with lower bone density.

 

LACTOFERRIN is an iron binding glycoprotein found in human breast milk, cow's milk and colostrums and is also available as a supplement. Lactoferrin can promote bone growth by stimulating the proliferation and differentiation of osteoblasts and inhibiting the formation of osteoclasts.

 

CURCUMIN (turmeric) may help prevent osteoporosis by inhibiting excessive osteoclast formation.

 

IPRIFLAVONE is a soy derived isoflavone which has been shown to improve the availability of calcium in the body for bone building. Many positive studies have shown 600 mg daily to be helpful in preventing bone density loss. Though 1 study differed in conclusions, the overwhelming balance of evidence suggests ipriflavone is effective in preventing bone density loss.

 

NATTOKINASE, a fermented soy derivative has been found to help strengthen bones.

 

DHA is a fatty acid component of fish oil. It helps to maintain normal bone strength. New Zealand researchers reported that fish derived DHA (docosahexaenoic acid) increases the bioavailability, absorption, bone deposition and integration of dietary calcium. In animal studies higher levels of DHA in red blood cell membranes were significantly correlated with higher bone density and bone calcium content.

 

DHEA is the most abundant of more than 150 hormones produced by the adrenal gland. It has many critical functions including increasing bone formation & reducing bone breakdown by affecting both osteoblasts and osteoclasts. Researchers have found DHEA to be significantly lower in those with osteoporosis than those without the disease.

 

BIO-IDENTICAL ESTROGEN, NATURAL PROGESTERONE and TESTOSTERONE replacement in those who are hormone deficient. See my newsletters about Menopause and Hormone Replacement Therapy. Exciting new updated information on testosterone replacement in men is now available in the book Testosterone for Life by Harvard-based Dr Abraham Morgentaler.

It takes 1-2 years to detect changes in bone density on a bone density test and to thus evaluate the success of treatment. Fortunately, there are ways to measure whether a program to build bone may be helping without having to wait 1-2 years for new bone density test results.

 

The Bone Resorption Assessment test is available from Genova Diagnostics. This is a simple urine test which can be done at home and shipped to the lab in the mailing package which comes with the test kit. It is useful in measuring whether bone is currently being lost or is building and is therefore beneficial in evaluating whether a bone support program is working or needs to be modified. I usually have a patient take this test 2-3 months after a change in their treatment program, to be sure we are getting results.

 

Genova also has an OsteoGenomic Profile test which evaluates genes which modulate bone formation and breakdown, regulatory mechanisms affecting vitamin D3 and calcium metabolism, and inflammatory patterns which may be involved in bone breakdown. This is particularly useful when there is an early onset of bone loss or a family history of osteoporosis suggesting the need for aggressive early prevention. These test kits can be ordered from Genova by your Dr or you can call Genova to ask for a Dr in your area who uses these tests.

 

Osteoporosis is a disease of decreased bone mass and structural deterioration of bone tissue leading to the risk of increased bone fractures, especially of the hip, spine, and wrist. It is responsible for millions of fractures yearly. Osteoporosis conservatively costs the U.S. $47 million daily.

 

The surgeon general recently announced that one half of women and twenty five percent of men over 50 years old are at risk for broken bones caused by osteoporosis. Contrary to popular belief, OSTEOPOROSIS IS A DISEASE OF BOTH MEN AND WOMEN. Approximately 10 million Americans are diagnosed with osteoporosis, and 34 million are considered at risk but not yet diagnosed because they have not started breaking bones or had a bone density test.

 

The bones simply deteriorate and weaken to the point where they can break with minimal or no traumatic cause. What are called spontaneous fractures can occur. These may particularly occur in the spine, sometimes going undiagnosed because there is no clear contributing "accident". This can be a cause of chronic debilitating back pain.

 

A broken bone in older age is not as simple as in youth. The sometimes associated surgery, anesthesia, rehab time, and so on can lead to complications and usher in a general health decline. Believe me, I have seen this in many , and have been shocked by their general deterioration after a fracture, never to return to their former selves. When I have seen this suffering, pain, and decline, I am sorry there is not more awareness and education as to how to prevent, or even to reverse bone loss.

 

Hip fracture contributes to mortality with half of the people who suffer a hip fracture dying within 5 years. Older people fall more and falls account for 95% of hip fractures.

The DEXA (Dual Energy X-ray Absorptiometry) is the best method for evaluating bone density. When a bone density is performed a statistical calculation known as a T score is produced. The T score represents the number of standard deviations the density of the bone is above or below the peak bone mass of a 20 year old healthy gender- matched control.

 

When the T score is -2.50 or less a diagnosis of osteoporosis is made. When the T score is -1.00- to-2.49 a diagnosis of osteopenia is made. Osteopenia indicates an increasing risk for the eventual development of osteoporosis.

 

Bone density needs to be measured in at least 3 areas of the body, the hip, spine and wrist because results from the different areas can vary and proper diagnosis can be missed. Often only 1 or 2 of these areas are measured. When you get this test request all 3 areas are evaluated.

• A high soft drink intake is acid forming in your body. Your body uses calcium to neutralize the acid and will pull calcium from your bones to do this.
  
  A 7 year study reported in the American Journal of Nutrition showed those with chronic acid overload are at greater risk for bone loss than those with normal acidity (pH).
  
  A prolonged hyperacidic environment also increases general inflammation in your body and contributes to chronic illness as well as bone demineralization. Refined foods, sugars and excess protein also form extra acid in your body.
  
  Anything which makes your body fluids too acidic will stimulate this release of calcium from your bones which acts to help raise the pH back to an ideal level. More on the acid/alkaline balance issue.
  
  
• Excessive meat protein stimulates an increased excretion of calcium in your urine. Calcium is mobilized from your bones to buffer the acidic breakdown products of protein. Raising protein intake from 50 to 150 grams daily doubled the urinary loss of calcium. Women who consume more than 95 grams of protein daily have twice the risk of forearm fracture than those consuming less than 68grams.
  
  
• The RDA for protein is about .8 grams of protein per 2.2 pounds of body weight daily. I suggest 0.6-1.4gms per 2.2 pounds depending upon your activity level and the intensity of the activity. Protein intake should increase by 30 grams daily during pregnancy, and 20 grams daily during lactation. Infants in first 6 month of life need 2.2 grams of protein per 2.2 pound of weight and 2 grams per 2.2 pounds in the second 6 months of life. Growing children need 1-1.8 grams of protein per 2.2 pounds of body weight. The American Heart Association and the National Institutes of Health believe Americans eat too much protein, and we only need to multiply our ideal weight by 0.36 to find our daily dietary protein need. You can see the matter is not entirely settled, but the point is to avoid extremes.
  
  
• Insufficient dietary protein is also associated with decreased bone density. Too much or too little protein is equally a problem.
  
  
• Excessive intake of milk and dairy products unless you take extra magnesium. Milk products have 10 times more calcium than magnesium and studies have shown a high dairy intake to be associated with a greater risk for osteoporosis.
  
  
• Intestinal malabsorption leading to various nutrient deficiencies.
  
  
• Smoking
  
  
• High alcohol intake
  
  
• Excessive sugar intake which increases the urinary excretion of calcium.
  
  
• Excessive caffeine intake beyond 2 cups daily increases calcium loss in your urine and alters hormones influencing bone metabolism.
  
  
• Excess dietary sodium
  
  
• Thin frail body type
  
  
• Early menopause or complete hysterectomy, or early loss of periods for more than one year.
  
  
• Decreased estrogen and testosterone production in women at menopause
  
  
• Decreased progesterone in women starting at about age 35
  
  
• Decreased testosterone production in men
  
  
• Decreased growth hormone and DHEA production with aging
  
  
• Decreased pituitary functioning
  
  
• Overactive parathyroid gland
  
  
• Use of antacids or other causes of low stomach acidity because minerals require an acid environment in the stomach for proper absorption.
  
  
• Steroid medications or excess steroid production caused by various illnesses are notorious inducers of osteoporosis in at least 50% of those with long term steroid overexposure. Excess steroids decrease the number of osteoblasts and inhibit bone building. Even chronic use of steroid inhalants have been linked to up to 1 point decrease in BMD for T scores. Severe bone demineralization is even possible with very short term steroid treatment.
  
  
• A high stress life style which is associated with excessive cortisol (steroid) production.
  
  
• An underactive or overactive thyroid, or excessive thyroid treatment dosage. Too much thyroid causes loss of calcium and phosphorus in the urine and stools resulting in loss of bone mineral. There is controversy whether excessive thyroid supplementation may aggravate bone loss as seen at http://www.thyroid-info.com/articles/osteoporosis.htm
  
  
• Lead toxicity
  
  
• A family history of osteoporosis.
  
  
• Northern European or Asian ancestry
  
  
• Sedentary lifestyle, spending less than 4 hours daily on ones feet.
  
  
• Excessive exercise
  
  
• Celiac Disease
  
  
• Inflammatory bowel disease
  
  
• Cystic Fibrosis
  
  
• Use of diuretics
  
  
• Excess aluminum in the body
  
  
• No pregnancies
  
  
• Depo provera birth control shot
  
  
• The use of numerous medications, such as the blood thinners Heparin and Coumadin, some anticonvulsants, proton pump inhibitors, aromatase inhibitors, cytotoxic drugs such as Methotrexate, and numerous others. It is best to look up your medication in google, putting in the name of your med, followed by +then the word osteoporosis.
  

Priscilla Slagle M.D.

“Today I focus my attention on each present moment. I allow time to bring with it healing, success, abundance, creativity. I live a life of purposeful activities and inspired action. Just to be is a blessing. Just to live is holy”
Rabbi Abraham Joshua Heschel

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