Osteoporosis

Osteoporosis, meaning "porous bone," is the degeneration of normal bone mineral density, mass, and strength. This process results in thinner bones and increases their susceptibility to fracture.

An estimated twenty million Americans, primarily older women, have osteoporosis or are at significant risk for it. Good bone health is a life-long process, but osteoporosis is usually prompted by the hormone changes at menopause. Early stages can be without symptoms, but the disease can progress to crippling spinal fractures and broken hips from which many do not survive.

A healthy diet can prevent or mitigate the damage caused by osteoporosis.

Eat more

  • Organically grown fruits and green leafy vegetables
  • Dairy products (if you don’t have sensitivity to milk products)
  • Cold water fish (September 8, 2003)

Avoid coffee, soft drinks, refined sugar and excess salt.

Description

What is Osteoporosis?

An estimated twenty million Americans have osteoporosis or are at significant risk for it. Osteoporosis causes at least 1.5 million fractures each year, including 250,000 hip fractures.

Hip fractures are often devastating. Nearly one-third of all women and one-sixth of all men will fracture their hips in their lifetime. Hip fractures result in death 12-20% of the time, and 50% of those who survive end up in long-term nursing home care.

Osteoporosis, meaning “porous bone,” is the degeneration of normal bone mineral density, mass, and strength. This process results in thinner bones and increases their susceptibility to fracture.

Symptoms

Early symptoms include:
  • Usually none
  • Backache
  • Bone Density Tests showing demineralization of the spine and pelvis
Late symptoms include:
  • Loss of height
  • Deformed spinal column with humps
  • Fractures, especially of the hip, arm or wrist, occurring with minor injury
  • Severe backache
  • Sudden back pain with a cracking sound indicating vertebral (spinal bone) fracture
  • Hip fracture
Bone density tests

The most reliable measurement of bone density at this time is the DEXA (dual energy X-ray absorptiometry) test. It is a safer choice because it produces less radiation exposure than other X-ray procedures for evaluating bone density.

The Osteomark-NXT test measures the levels of cross-linked N-telopeptide of Type I collagen, a compound linked to bone breakdown in urine. The Osteomark-NXT can be used to monitor the rate of bone loss and evaluate the success of therapies.

Disease Process

What causes bone to lose its mineral density? Which areas of the body suffer most from osteoporosis?

Bone is living tissue that is continuously broken down and rebuilt at the cellular level. Conventional medicine has focused on alleviating insufficient dietary calcium and the postmenopausal decline in estrogen in treating and preventing osteoporosis.

However, normal bone metabolism is the complicated interaction of over two dozen nutrients including the vitamins D, K, B6, B12, and folic acid, and the minerals boron, magnesium, and phosphorous as well as calcium.

Estrogen often overshadows the importance of progesterone in treating and preventing osteoporosis. Although estrogen regulates osteoclasts, specialized bone cells that remove dead portions of demineralized bone, progesterone influences the bone-forming cells, called osteoblasts, that use calcium, magnesium, and phosphorous from the blood to replace bone mass.

The combined levels of these nutrients and hormones create a system either promotive or preventative of osteoporosis.

Osteoporosis can develop anywhere in the skeleton, but most bone loss usually occurs in the spine, hips, and ribs. Unfortunately, these structures carry most of the body's load, thereby increasing their vulnerability to pain, deformity, and fracture.

Causes

Bone mass normally decreases 1.5% to 2% per year in both men and women after the age of 40. However, women are at greater risk for osteoporosis since their bone mass is naturally less than men’s due to their smaller size and muscle mass.

Approximately one in four women suffer from osteoporosis after menopause, partly due to the perimenopausal decrease in progesterone and postmenopausal drop in estrogen, both important factors to maintaining bone mass.

Osteoporosis rarely occurs in men, but when it does, it is usually the result of underlying stresses such as long-term alcoholism, use of anticonvulsive or corticosteriod drugs, or hyperthyroidism.

Dietary Causes

Protein is important to a healthy diet, but too much protein intake, as seen in the standard American diet, chemically increases one's vulnerability to osteoporosis. Bones are at their best in a slightly alkaline body, so when a high animal protein diet makes the body acidic, the body buffers the acidity by withdrawing alkaline minerals like calcium from the bones. This means that raising daily protein intake from 47 to 142 grams doubles the excretion of calcium in the urine.

The average American consumes 150 grams of sucrose each day in addition to large quantities of refined simple sugars from processed foods and soft drinks. Refined sugar promotes acidic body chemistry like protein does, and therefore also increases the urinary excretion of calcium.

Soft drinks contain large amounts of phosphates and almost no calcium. High levels of phosphates combined with low levels of calcium result in the body again removing calcium from the bones to restore mineral balance.

A diet deficient in green leafy vegetables is often a diet deficient in the vitamins and minerals necessary for bone health. These include calcium, vitamin K1, and boron.

Vitamin K1, the plant form, activates osteocalcin, the major noncollagen protein in bone. Osteocalcin anchors calcium molecules inside of the bone. Therefore, without enough vitamin K1, osteocalcin levels are inadequate and bone mineralization is impaired.

Too low calcium intake causes the parathyroid hormone to stimulate osteoclasts into breaking down bone to raise the calcium levels in the blood. When calcium levels are too high, calcitonin suppresses osteoclastic activity (removal of dead parts of demineralized bone).

Estrogen and vitamin D are less useful for maintaining bone health if they are not accompanied by sufficient quantities of boron. Without boron, the body can not convert these hormones to their most active forms.

Inadequate consumption of magnesium decreases the serum concentration of the most active form of vitamin D (1,25-(OH)2D3). Magnesium is also required to regulate the body's levels of parathyroid hormone and calcitonin, the two hormones that maintain the proper concentration of calcium in the blood.

Increased homocysteine concentrations found in postmenopausal women interfere with collagen cross-linking and can cause defective bone matrix formation. Homocysteine is the intermediate product of the conversion of amino acid methionine to cysteine caused by inadequate levels of the vitamins B6, B12, and folic acid, or a genetic defect in the enzymes responsible for this conversion.

Inadequate vitamin C consumption decreases the secretion of important intercellular substances by all cells, including those of osteoblasts (cells that build new bone).

Nutrient Needs

Nutrients in Food That May Help Include:

Calcium

Studies have shown that supplementing with calcium increases bone density in perimenopausal women and slows bone degeneration in postmenopausal women by an average of 30 to 50%, which translates to a significant reduction in hip fractures.

There are many calcium forms to choose from, which kind is the best? Calcium bound to citrate or other Krebs-cycle intermediates including fumarate, malate, succinate and aspartate are recommended. The Krebs cycle is a phase of the energy production process in mitochondria, the powerhouses in cells, which uses these intermediate compounds to produce energy.

These forms of calcium are much better absorbed than calcium carbonate because they are already ionized and are soluble. These Krebs-cycle intermediate bound forms are prefered because they are non-toxic, better for the absorption of all minerals, and easier on people with reduced stomach acid (a common problem accompanying aging).

About 45% of the calcium from an oral dose of calcium citrate is absorbed in patients with reduced stomach acid, whereas only 4% of calcium is absorbed from calcium carbonate (once again, in patients with reduced stomach acid). The recommended daily dosage of calcium citrate or other calcium bound Krebs cycle intermediates is 800mg for ages 25-35, 1,000mg for ages 35-50, and 1,500mg for people over 50 (1,200mg if taking HRT). Take your calcium just before or at the beginning of meals.

Sources of calcium that can harm your health are oyster shells, dolomite, and bone meal. Supplements derived from these sources may contain substantial amounts of lead. How critical is it to avoid lead toxicity? Excessive lead intake can damage the brain, kidneys, and the manufacture of red blood cells.

Children are especially susceptible to lead toxicity, which has also been directly linked to a lowered IQ and criminal behavior and proves to be a significant problem in industrialized countries including the U.S.

One of the specific bone meal calcium extracts to avoid is calcium hydroxyapatite. Not only is it a potent lead source, but studies comparing multiple forms of calcium supplementation have shown that it is not absorbed (only 20 % absorption) as well as either calcium carbonate or calcium citrate (both of which had a 30% absorption rate). All of the above studies were conducted with subjects who had normal levels of stomach acid.

Excellent food sources of calcium include dairy products, kelp, bok choy, spinach, greens (collard, mustard, turnip), nuts and seeds (sesame seeds, almonds, chestnuts, walnuts), beans (garbanzo, soy, tofu). Foods from the cabbage family, kale and collards, contain very absorbable calcium. The boiling of foods like spinach in water for a short period of time (3-5 minutes) may slightly reduce their oxalate content.

Vitamin D

Many studies of postmenopausal women using vitamin D, especially in its most active form, D3, have shown that it stimulates the absorption of calcium, increases bone mineral density, and reduces the risk of hip fracture.

Vitamin D is especially helpful for people who don’t get much sun exposure due to living far from the equator, staying indoors most of the time, or being confined to a nursing home. The recommended daily dosage of vitamin D3 is 400 IU(International Units). Don't over do it; higher doses of vitamin D do not offer a clear benefit and may decrease the effectiveness of magnesium.

Very good food sources of vitamin D include shrimp and milk. Sunlight is a great source of vitamin D.

Magnesium

Women with osteoporosis have low bone magnesium content and other signs of magnesium deficiency. A two-year study of magnesium supplementation in postmenopausal women found that those receiving magnesium had a slight improvement in bone density while those receiving the placebo lost some of their bone density.

Without sufficient magnesium, vitamin D is less concentrated in the body and the body can not convert it to its most active form. Magnesium also mediates the secretion of parathyroid hormone and calcitonin, the two hormones that maintain proper calcium concentration in the blood. The recommended daily dosage of magnesium is 400-800 mg.

Chard and spinach are two excellent food sources of magnesium.

Boron

Boron is another trace mineral required to convert estrogen and vitamin D to their most active forms (17-beta-estradiol and 1,25-(OH)2D3 respectively). Studies have shown that boron provides protection against osteoporosis and reproduces many of the positive effects of estrogen therapy in postmenopausal women. Estrogen levels drop after menopause causing osteoclasts to become more sensitive to parathyroid hormone, which signals them to break down bone.

A diet deficient in fruits and vegetables is probably a diet deficient in boron. The U.S. Second National Health and Nutrition Examination survey found that less than 10% of Americans meet the minimum recommendation of 2 fruit and 3 vegetable servings per day, and 51% of Americans eat only one serving of vegetables per day.

The best dietary source of boron is fruits and vegetables, but their boron richness can vary based on the boron content of the soil in which they were grown. Therefore, supplementation is recommended and has been shown effective. One study of postmenopausal women concluded that supplementation with 3 mg of boron per day reduced urinary calcium excretion by 44%. The recommended daily dosage of boron (as sodium tetrahyrdoborate) is 3-5 mg.

Boron is easily consumed through most fruits and vegetables provided that the soil they were grown in was not deficient in boron.

Ipriflavone

Ipriflavone is a drug approved for the treatment and prevention of osteoporosis in Japan, Hungary, and Italy. This semisynthetic flavonoid similar to soy isoflavonoids increases the effects of calcitonin on calcium metabolism. The hormone calcitonin, usally signaled by high levels of calcium in the blood stream, stops osteoclasts from breaking down old bone.

A number of studies of ipriflavone have shown remarkable results. One study of 100 women with osteoporosis found that 200 mg of ipriflavone taken three times daily increased bone density by 2% after 6 months and 5.8% after 12 months. Another one-year study of women with osteoporosis found that 600 mg of ipriflavone per day raised bone density by 6%, while the placebo group lost 0.3%. The recommended daily dosage is 600 mg.

Silicon

Silicon cross-links collagen strands to strengthen the connective tissue matrix of bone. The presence of concentrated silicon at calcification sites in growing bone may indicate that sufficient levels of silicon are required for bone remodeling.

No RDA currently exists for silicon, but the suggested daily requirement falls in the range of 5-20 mg. It may be appropriate for patients with osteoporosis to increase silicon supplementation, but use caution until more is discovered about the role and requirements for silicon.

Vitamin B6, Folic Acid, and Vitamin B12

These three B vitamins, in which the elderly are commonly deficient, are involved in the conversion of the amino acid methionine to cysteine. Defective conversion enzymes, or deficiency in any of these vitamins will increase the levels of the intermediate compound homocysteine. Homocysteine, found in higher levels in postmenopausal women, obstructs collagen cross-linking, which results in poor bone matrix and osteoporosis.

All three of these vitamins interact with the enzymes and chemicals in complex ways to successfully complete the conversion. Yet one study showed that postmenopausal women who were not considered deficient in folic acid lowered their homocysteine levels simply by supplementing with folic acid by itself. The recommended daily dosage is 400 mcg of folic acid, 400 mcg of vitamin B12, and 25-100 mg of vitamin B6.

Excellent sources of vitamin B6 include bell peppers, turnip greens, and spinach. Excellent sources of folate include spinach, parsley, broccoli, beets, turnip greens, asparagus, romaine lettuce, lentils and calf's liver. Excellent food sources of vitamin B12 include calf's liver and snapper.

Attention users of barbituate anticonvulsant drugs: Folic acid and B6 can dampen these drugs thereby increasing the risk of seizures. Supplementation with these B vitamins must be monitored carefully.

Potassium

Potassium appears to counteract the increased urinary calcium loss caused by the high-salt diets typical of most Americans, thus helping to prevent bones from thinning out at a fast rate. A clinical trial of 60 postmenopausal women on high-salt diets found that those whose daily intake of potassium was equal to the amount found in seven to eight servings of fruits and vegetables had a reduced level of calcium loss than those whose diets were not supplemented with potassium. Excellent sources of potassium include spinach, chard, and button mushrooms.

Omega-3 Fatty Acids

New research provides evidence that omega-3 fatty acids can significantly decrease bone turnover rates. In women, these beneficial omega-3 fats work with estrogen to stimulate bone mineral deposits and slow the rate of bone breakdown.

A July 2003 study published in the Journal of Bone Mineral Research found that when fish oil was given to mice whose ovaries had been removed (the mouse equivalent of menopause), the mice produced less osteoclasts (the cells responsible for breaking down bone) and lost less than half the bone of mice given corn oil (which is high in omega 6 fatty acids). Bone mineral density in mice fed corn oil dropped 20% of the femur (the thigh bone) and 22.6% in their lumbar vertebrae (lower spine) while mice given fish oil showed either no bone loss or no more than a 10% loss in bone mineral density.(September 8, 2003)

This study underscorers why , in addition to increasing omega-3 intake, it is also important to decrease consumption of omega-6 fats (i.e., arachidonic acid, which is found in meat and dairy products) in order to more effectively reduces bone turnover. Arachidonic acid is used by the body to produce a type of inflammatory mediator called the Series 2 prostaglandins (PGE2) that can trigger increased activity by osteoclasts, the cells whose job it is to break down or "resorb" old bone. Flaxseeds, walnuts and salmon are excellent sources of omega-3 fatty acids.

Nutrient Excesses

Substances to Avoid

Coffee

Do you drink more than 2 cups of coffee to make it through the day? Unfortunately, staying awake means a greater short-term calcium loss through urine. This may be enough to have a significant impact on older people with already low calcium levels, but can be buffered somewhat by drinking coffee with milk.

Meat

Eating more than 4 oz. of meat on a daily basis may be weakening your bones. High protein diets result in an acidic body chemistry. Since calcium is alkaline, the body pulls it out of the bones to restore the slightly alkaline chemistry needed for most metabolic chemical reactions.

Soft Drinks

Drinking soft drinks regularly: To balance the phosphates in soft drinks, the body leaches calcium from the bones, which is then excreted in the urine.

Salt

Salty foods will cause your kidneys to evacuate additional calcium through urination. Over 90% of the sodium ingested in the typical American diet is excreted from the body, requiring excess calcium excretion. For every 500 mg of sodium excreted, you lose 10 mg of calcium in your urine.

Refined Sugar

Sugar isn't just bad for your teeth; it's bad for all of your bones. Eating too much refined sugar increases urinary calcium loss.

Consume 3 servings of vegetables daily including at least 1 cup of green leafy vegetables: These vegetables contain vitamins and minerals necessary for bone formation.

Recommended Diet

What should you eat to combat or prevent osteoporosis? The medical profession stresses the importance of taking calcium supplements, but don't neglect natural food sources of calcium, or eat too many foods that pull calcium out of your bones and into the sewers. Eat lots of green leafy vegetables, especially kale, collard greens, parsley, and lettuce (excluding iceberg). Leafy greens are rich sources of calcium, vitamin K1, and boron, and are especially important for people who do not consume dairy products.

Soyfoods are also recommended. A double-blind, placebo-controlled study involving 203 postmenopausal Chinese women, aged 48 to 62 years old, suggests that soy isoflavones can help women with low bone mineral content prevent hip fractures in postmenopause years. The trial, reported in the October 2003 issue of the Journal of Clinical Endocrinology and Metabolism, randomly divided women into three treatment groups which received daily either a placebo, a medium dose of isoflavones (40 mg isoflavones) or a high isoflavone dose (80 mg isoflavones). All three groups were also given 500 mg of calcium and 125 IU vitamin D daily. At the beginning of the study and one year later, researchers measured bone mineral density (BMD) and bone mineral content (BMC) of the whole body, spine and hip.

Women receiving the high dose of isoflavones had mild, but a significantly higher improvement in BMC at the total hip and trochanter compared to those in the placebo and mid-dose groups, even after adjustments for potential confounding factors. Further analyses revealed that soy isoflavone supplementation was only beneficial among women who started out with average or lower bone mineral content measurements. The researchers concluded, “… soy isoflavones have a mild, but significant, independent effect on the maintenance of hip BMC in postmenopausal women with low initial bone mass,” —in other words, soy isoflavones improve bone density in women who need it, while having little effect on the bones of those whose bone density is already adequate. The results of this study provide additional support for the findings of a review study published in the September 2003 issue of the American Journal of Clinical Nutrition. In their review, Drs. Kenneth Setchell, one of the foremost researchers in soy’s effects on health, and Eva Lydeking-Olsen examined 17 in vitro studies of cultured bone cells, 24 in vivo animal models for postmenopausal osteoporosis, 15 human observational/epidemiologic studies, and 17 dietary intervention studies. Their conclusions: “the collective data suggest that diets rich in phytoestrogens have bone-sparing effects in the long term, although the magnitude of the effect and the exact mechanism(s) of action are presently elusive or speculative."(December 3, 2003)

Yet again, the favorites of the American diet are the culprits of America's health problems. Avoid salt, sugar, animal protein, soft drinks, alcohol, and coffee because they increase calcium excretion.

Vitamin K-rich foods include dark green leafy vegetables (broccoli, lettuce, cabbage, spinach), and green tea. Other good sources include asparagus, oats, whole wheat, and fresh green peas.

The Condition Specific Meal Planner for Osteoporosis has menus that cover the nutritional needs of this condition over a four day period.

References

  • Chen YM, Ho SC, Lam SS, Ho SS, Woo JL. Soy isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab. 2003 Oct;88(10):4740-7.
  • Sellmeyer DE, Schloetter DE, Schloetter M et al. Potassium citrate prevents urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endo Metab 2002;87(5):2008-12.
  • Setchell KD, Lydeking-Olsen E. Dietary phytoestrogens and their effect on bone: evidence from in vitro and in vivo, human observational, and dietary intervention studies. Am J Clin Nutr. 2003 Sep;78(3 Suppl):593S-609S.
  • Sinclair S. Migraine headaches: nutritional, botanical and other alternative approaches. Altern Med Rev 1999 Apr;4(2):86-95.
  • Sun D, Krishnan A, Zaman K, Lawrence R, Bhattacharya A, Fernandes G. Dietary n-3 fatty acids decrease osteoclastogenesis and loss of bone mass in ovariectomized mice. J Bone Miner Res Jul;18(7):1206-16.
  • Watkins BA, Li Y, Seifert MF. Nutraceutical fatty acids as biochemical and molecular modulators of skeletal biology. Am J Clin Nutr 2001;20(5):410S-420S.

This page was updated on: 2004-11-29 01:05:41
© 2002 The George Mateljan Foundation