Bone & Joint
Osteoporosis – Overview
Osteoporosis refers to a loss of bone mass in which the bones become porous and fragile. Our bones are constantly being remodeled, with bone tissue being broken down and rebuilt on a regular basis. Bone density (the degree of mineralization of the bone matrix) usually increases until about the age of 30, but after that, trouble can begin. Osteoporosis sets in when more bone is lost than can be rebuilt. Eventually, bones become brittle and easily fractured.
There are actually two different types of bone – both of which lose bone mass later in life, but at different times.
- Trabecular bone refers to the inner portion of bone that contains calcium in lattice crystal-like structures. The years that comprise childhood through young adulthood are critical for depositing calcium in trabecular bone, which then provides a reserve of this mineral in later life. Trabecular bone is sensitive to several hormones, including estrogen, which control the amount of calcium deposited and withdrawn. The calcium in trabecular bone is used by the body when blood calcium levels are low. After age 30, a gradual loss in trabecular bone begins to occur.
- Cortical bone is the dense layer that forms the outer shell of bone. While Both types of bone are crucial to bone strength and both contain calcium, cortical bone does not give up its reserves as readily as trabecular bone, and does not begins to decline in mass until after about age 40.
Estrogen plays an important role in maintaining bone mass. Once women reach menopause and estrogen levels decline, bone loss escalates. Rapid bone loss continues for about five years during and after menopause, and can deplete three to four percent of total bone mass. This surge of bone loss eventually tapers off after a few years, and soon equals the amount of bone loss in men of the same age. But the loss of bone minerals continues throughout the rest of a person’s life.
About one out of every three postmenopausal women has osteoporosis to some degree, even mild osteoporosis leads to an increased risk of fractures, particularly of the hip, vertebrae and wrists. Fractures can have serious consequences as well. About 20 percent of elderly women who undergo hip replacement surgery due to a hip fracture die within one year. And half of those who survive will require full-time nursing care.
Causes and Symptoms
Osteoporosis can be influenced by the following risk factors:
- Genetics – Women are more at risk, but anyone of thin build and of Northern European or Asian descent is at higher risk. Studies of mothers and daughters have shown that heredity plays a role in bone density.
- Menopause – Particularly in those not taking hormone replacement therapy.
- Poor intake of calcium – Calcium intake in the diet plays a vital role in bone mineralization during the growth years and is essential to depositing an abundant supply of calcium into the bones. Even after maximum bone mass has been achieved, calcium intake continues to be important to help slow down bone loss later in life. Dairy products are one of the best sources of calcium, but many people choose not to eat them or can’t tolerate them because of lactose intolerance or allergy. Other food sources of calcium are canned sardines, dark green vegetables like broccoli, collard greens and bok choy, as well as tofu and calcium-fortified juices and soy milk. However, a supplement is recommended to ensure you are getting enough.
- Lack of Vitamin D – Vitamin D plays a pivotal role in allowing the body to absorb calcium. Vitamin D is synthesized naturally in the skin when it is exposed to sunlight. It is also available in fortified milk and cereals. However, many people do not produce enough vitamin D or get enough from food. Vitamin D deficiency can be a problem for older people and those who are homebound or bed-ridden.
- Inactivity – Weight-bearing activities such as walking, jogging and weight training help to maintain bone density. A sedentary lifestyle promotes bone loss as well as muscle loss. Conversely, muscle use promotes the building of bone. Regular physical activity strengthens both muscles and bones, slows down bone loss and decreases the risk of injury from falls.
- Smoking – The relationship between bone loss and smoking has been confirmed by numerous studies. However, once you quit smoking, even later in life, the bone loss influenced by this habit can be minimized.
- Excessive alcohol intake – People who drink alcohol to excess are more prone to fractures. This may be partially due to the diuretic effect of alcohol, which induces calcium losses through the urine. Alcohol can also decrease the absorption of calcium from the intestines and cause deficiencies in vitamin D and magnesium – both of which are important to bone health.
- High sodium intake – Several studies have demonstrated the harmful effects of high dietary sodium on bone integrity. Reducing sodium intake can reduce bone loss considerably.
- Coffee – Coffee consumption of more than two cups a day may contribute to accelerated bone loss.
- High consumption of animal protein – Some studies have shown that a diet high in animal protein actually promotes bone loss by leaching calcium from the bones, although the verdict is still out on this issue.
- A high acid-ash diet – Recent research has suggested that eating an acid-ash producing diet (high in animal protein and grains, low in vegetables and fruit) causes an increase in urinary excretion of calcium, leading to bone loss.
- Medications – Certain medications, such as steroids and anticonvulsants, may contribute to bone demineralization.
Certainly men are not immune to osteoporosis. Bone loss is more gradual in men, but once they reach age 70 their risk for osteoporosis increases significantly. Men in this age group are at increased risk for fractures, particularly if they are sedentary and have a diet low in calcium.
The most accurate testing method to measure bone density and diagnose osteoporosis is the DEXA (Dual Energy X-ray Absorptiometry), which uses a computer to scan an image of the hip and spine. Less accurate screening methods are now available in pharmacies and at health fairs. X-rays, which were used in the past, are not sensitive. At least 25 percent of bone loss has to occur before osteoporosis can be diagnosed from a routine X-ray.
Suggested Lifestyle Changes for Osteoporosis Treatment
- Get enough calcium. Choose organic, high quality dairy products such as yogurt and non-fat milk. Eat more sardines (with bones), dark green vegetables like collard greens, bok choy and broccoli, soy products like tofu, and calcium-fortified soy milk and orange juice. Consider taking a calcium supplement for osteoporosis treatment if you are not eating at least three servings of dairy per day and/or calcium-fortified foods, if you are postmenopausal or if you have a family history of osteoporosis.
- Make sure you get enough vitamin D. I recommend supplementing with 2,000 IU daily for adults.
- Decrease your sodium intake. Avoid salty processed foods and fast food. Don’t salt your food before tasting it.
- Eat plenty of vegetables and fruit. Potassium, magnesium, vitamin C and beta carotene (found in fruits and vegetables) have been associated with higher total bone mass. A diet rich in vegetables and fruit and moderate in animal protein and grains may minimize the acid-ash residue of the diet, good for osteoporosis treatment.
- Limit caffeine intake.
- Avoid alcohol or drink only in moderation.
- Increase weight-bearing activities, such as walking, weight training and calisthenics. Try to do at least 30 minutes of exercise most days of the week.
Nutrition and Supplements for Osteoporosis Treatment
In addition to the nutrition information above, research has indicated that magnesium and vitamin K may be helpful in reducing bone loss. Consider incorporating the following into your diet and daily routine:
- Eat calcium-rich foods every day. In addition to the dairy foods already discussed, you’ll find calcium in fortified soymilk, some tofu, sesame seeds and black-eyed peas. Blackstrap molasses, poppy seeds, almonds and figs are also good sources of calcium.
- Eat magnesium-rich foods every day. Our menu plan is rich in these foods which include spinach, tofu, almonds, broccoli and lentils. Pumpkin seeds and sunflower seeds are also good sources of magnesium.
- Eat vitamin K-rich foods every day. The best sources are green leafy vegetables (see the calcium-rich greens listed above), but most vegetables are good sources.
The following are nutrients, botanicals and other compounds that Dr. Weil often recommends for persons diagnosed with osteoporosis, as well as for those who want to help prevent the disease – great for osteoporosis treatment.
- A calcium/magnesium supplement – Although most forms of supplemental calcium are acceptable, calcium citrate appears to be better absorbed, especially in older adults. To ensure maximum absorption, take with meals and limit to 250 mg per dosage. Magnesium is also an important mineral in the bone matrix, and is usually provided with calcium to offset some of its constipating effects.
- Vitamin D – Vitamin D plays a pivotal role in nutrition by facilitating the absorption of calcium, thereby helping to support healthy and strong bones. It also is an important nutrient for promoting bone mineralization in concert with a number of other vitamins, minerals, and hormones.
- Vitamin K – More recently identified as an important nutrient in bone health, vitamin K helps activate certain proteins that are involved in the structuring of bone mass. Talk with your doctor about the effects of vitamin K if you are taking a blood-thinning medication.
Read on to learn about Pilates as an osteoporosis treatment.