Osteoporosis

Ever wonder why osteoporosis seems to happen more often in post-menopausal women? Estrogen actually protects against bone loss (so does testosterone, by the way), and when hormones decline, so does bone density.  Men experience similar bone loss with age, but they’ve generally got more bone to begin with, so they can usually afford to lose more of it than women can.  But menopause alone doesn’t have to lead to osteoporosis – there are other factors involved.

A staggering 51% of fractures worldwide occur in Europe and the Americas, which suggests that osteoporosis is a disease of Westernized cultures.  Why is that?  Most of the staples of the Standard American Diet (SAD – love that acronym) include acidic foods, such as sugar, meat, coffee, alcohol, white flours or grains in general.  Your body buffers excess acid with a molecule called calcium bicarbonate (calcium that might otherwise be used to build bone).  Another culprit is soda, which leeches phosphate from the bones.  High salt diets are also a poor choice, and one common to Westernized cultures.  The kidneys are forced to eliminate the excess salt, and this may increase the loss of other minerals as well.

Other causes include Vitamin D deficiency, since the primary function of Vitamin D in the body is to maintain calcium levels in the blood.  Even in Arizona, a staggering number of my patients are Vitamin D deficient according to labs.  I’m not really sure why this is, but I suspect it has to do with a decrease in consumption of Vitamin D- containing foods, and perhaps increased use of sunscreen.

Certain medications and lifestyle choices also impair the absorption of key nutrients necessary for bone formation.  These include smoking, high alcohol consumption, proton pump inhibitors (such as omeprazole – these are incredibly common medications for reflux), corticosteroids (such as prednisone), coffee (back to the acidic discussion), eating disorders, or just a poor diet devoid of nutrients.

Weight-bearing exercise is also quite important – this encourages not only new bone formation, but muscle formation as well.  And it’s no secret that Western cultures tend to be sedentary.

Finally, there are more serious conditions can result in poor nutrient absorption or nutrient loss, including malabsorption syndromes, kidney disease, and any number of inflammatory conditions.  These need to be ruled out.

DEXA scans (bone mineral density testing) are standard.  However, a bone resorption urine assay is also available to indicate the amount of calcium you lose on a daily basis.  This helps to determine whether osteoporosis (or osteopenia) treatments are working before the time comes for the next DEXA – and protocols can be tweaked accordingly.  Other blood tests may also be necessary in order to rule out other causes, and I test everybody for Vitamin D status.

Most doctors now recommend supplementing with those nutrients necessary to produce new bone, such as calcium, magnesium, and Vitamin D, as well as weight-bearing exercise to stimulate new bone growth.

The most common class of osteoporosis medications inhibits the breakdown of bone.  However, these can cause bone, muscle or joint pain, and digestive disorders such as abdominal pain, constipation, diarrhea, stomach upset, gas and bloating, and nausea.

Another common drug is similar to a common chemo agent for breast cancer, and it has hormonal effects on the body.  Not surprisingly, side effects for this one involve hot flashes, as well as joint pain, and sometimes clotting, among others.  These are the most effective and least dangerous of the current pharmaceutical options.

Although there may be many factors leading to osteoporosis, one of the first things I consider is the pH of the patient’s diet (mentioned above).  So I start by cleaning up the diet, and increasing those foods high in calcium (especially dark leafy greens!  Dairy is a source of calcium, but it’s actually more absorbable in veggies!)

Supplementation is also a great idea, but not all supplements are created equal.  It’s important to get absorbable forms of calcium, and Vitamin D supplementation should follow blood testing to make sure supplementation is adequate but not excessive.  We should also supplement a number of other minerals for bone formation.  The protocol will also be specific to the patient, addressing relevant complications such as poor nutrient absorption, inflammation, or perhaps the reason for the corticosteroids or proton pump inhibitors (so that hopefully we can eliminate the offending medication once the reason for it has been resolved).

Last but not least- weight bearing exercise is very effective preventatively, although it’s important to make sure you choose an exercise protocol that is safe, given your level of physical activity and condition.

Ready to address your root cause, build some bone, and get healthier along the way? Set up an appointment!