by Kirti M. Kalidas, M.D., N.D.
As the population ages and we have longer life spans, reduced bone density and more stress fractures are a growing concern. Diet and lifestyle factors as well as specific natural agents have major impacts on preserving bone mass and preventing osteoporosis. This condition, most common among post-menopausal women, combines a thinning of bones with increasing brittleness.
Our bones are composed of a calcium-based mineral complex and an organic material known as collagen, a flexible fibrous protein which appears to be a key component in the ability of bones to withstand sudden impact. The quantity and health of collagen determines bone “toughness” while the mineral content determines strength and stiffness.
Osteoporosis is usually documented through DEXA (bone density scanning) routinely ordered after the age of 50:
Normal: Bone Mass Density (BMD) not more than 1 standard deviation (SD) below the young adult mean (T-score above -1)
Osteopenia: BMD between 1 to 2.5 SD below the young adult mean (T-score between -1 and -2.5)
Osteoporosis: BMD (more than 2.5 SD below the young adult mean (T-score at or below -2.5)
Severe osteoporosis (or established osteoporosis): BMD 2.5 SD or more below the young adult mean in the presence of one or more fragility fractures
Urine excretion of N-Telopeptide (bio-chemical marker of bone metabolism related to bone turnover and loss of calcium)
Statistics Regarding Osteoporosis and Fractures
According to The National Osteoporosis Foundation estimates: 44 million Americans—55% of people 50 years of age and older—face the risk of osteoporosis. Ten million—80% of which are female—are estimated to already have the disease. The other 34 million have low bone mass and are at an increased risk. Osteoporosis is responsible for more than 1.5 million fractures annually, with approximately 300,000 hip fractures, 250,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures of other bones. In 2002 the combined healthcare cost of fracture management and bone-health problems was an astonishing $18 billion!
Risk Factors for Osteoporosis
Risk factors are of two types: those over which we have no control and those subject to change.
Non-Modifiable Risk Factors: Personal history of fracture after age 50, Family history of Osteoporosis or related fracture in a first-degree relative, Advanced Age, Female, Caucasian and Asian ethnicity (although African Americans and Hispanic Americans remain at significant risk as well), Menopause/early menopause (prior to 45), surgically or medically-induced menopause (eg: hysterectomy) which may be modifiable with appropriate bone-building treatment.
Modifiable Factors: Low Body Mass/thin frame (less than 127 pounds), Amenorrhea (absence of a menstrual period) lasting longer than one year, Current low bone mass, Anorexia Nervosa, Inadequate calcium intake, Vitamin D deficiency, Certain prescription medications which decrease calcium buildup in bones, Low testosterone levels in men, Sedentary lifestyle, Cigarette smoking, Excessive alcohol intake, Certain endocrine diseases, Certain cancers (including myeloma, lymphoma, leukemia), Other chronic diseases, including chronic liver and kidney disease.
Prevention and Treatment of Osteoporosis
A good bone-building formula should include:
Calcium: Calcium is absolutely vital. Current recommendations are 1000mg for patients <50 years of age or up to 1500mg of Calcium in a chelated form, either as citrate or malate. Certain forms of calcium are not well absorbed, including Calcium Carbonate. The intake of Calcium is closely correlated with the intake of Phosphorus. If there is a high intake of associated phosphorus from sodas and foods, the availability of calcium is minimized for bone formation.
Vitamin D: Previous recommendations have been as low as 800 units. Recently, there has been a move to raise it as high as 8,000–10,000 units, based on reaching an optimal level of Vitamin D. Vitamin D can also be attained from 20 minutes of sun exposure, which will provide approximately 10,000 units. Vitamin D should not be looked at as simply a vitamin, but also as a hormone influential in regulating the immune system. It also serves an important role in overall cancer prevention, the prevention of colon polyps and the rebuilding of bones.
Trace minerals: Magnesium plays an important role in bone absorption and bone formation.
Strontium: In 2002 a study showed that Strontium use for 1-2 years improved bone health and demonstrated a 3-6% increase in bone density, especially in the spine and hip. In addition, alkaline phosphatase, a marker for bone growth, was increased. Strontium also decreased the release of calcium from the urine.
Manganese: Doses of 15-30mg of Manganese have also been shown to improve bone health.
Vitamin K1 and K2: Vitamin K1 is found especially in green vegetables, and vitamin K2 compounds are found in fermented foods, such as natto (a Japanese food made of soybeans and rich in vegetable protein). They are both essential for making osteocalcin (a bone-building protein).
Zinc 25mg and Zinc Carnosine: 25 mg of Zinc and zinc carnosine improve bone building capability.
Ipriflavone: 200mg, 3 times a day of synthetic isoflavone is important for inhibiting bone resorption and enhancing osteoblast (bone-making cell) function, thus increasing bone density. Bone health studies have shown that testosterone, DHEA (a natural steroid hormone), Estrogen and Progesterone play a pivotal role in maintaining bone health. The appropriate management and support of these hormones needs to be part of a bone support program.
MCHC (Microcrystalline Hydroxyapatite Concentrate): This is a bone source containing a crystalline calcium and phosphorus matrix with trace elements.
Silicon: Orthosilicic acid is the form predominantly absorbed by humans and is found in numerous tissues including bone, tendons, aorta, liver and kidney. Deficiency induces deformities in skull and peripheral bones, poorly-formed joints, reduced contents of cartilage, collagen, and disruption of mineral balance in the femur and vertebrae.
Dieting Factor and Exercise
For patients without underlying conditions requiring higher protein diets, a diet low in animal protein and high in plant-based proteins from a wide variety of legumes and whole grains is recommended. High-protein diets deplete calcium due to the diuretic action of excess urea, as urea is formed from the nitrogenous waste products of protein breakdown. Patients should avoid soft drink consumption, as the high levels of phosphates/phosphoric acid found in carbonated drinks increase the overall acidity in the body, and the bones sacrifice calcium and other minerals to buffer the acid.
Patients should consume soy, dark leafy greens, legumes, nuts and seeds (for phytoestrogen content). A low acid diet and calcium-fortified foods are recommended. This can be achieved with high-quality fats, plant-based oils and fish. As for exercise: walking, strength training, jogging, running, gymnastics, dancing, yoga and other active impact sports provide the weight-bearing stimulus necessary for building as much bone density as possible in prime years and maintaining bone density in later years.
In summary these are essential to bone health:
Combination of Hormones
Appropriate Vitamin D Supplementation
Mineral and Multi-Vitamin supplementations
Add this caveat to the seriousness of osteoporosis: There is a clear-cut correlation between decreased bone density and an increased prevalence of Alzheimer’s Disease. In essence: a weak body can result in a weak mind. Let’s do all we can to avoid this dangerous combination.
I am Kirti Kalidas M.D., N.D., Board Certified in Internal Medicine and a Licensed Naturopathic Physician. I have been in medical practice for more than 25 years. I earned my medical degree in South Africa and completed my residency with the Georgetown program in Washington D.C.
I practiced as an Internist at my successful, busy internal medicine/family practice office for more than 15 years in the Orlando area. However, I started becoming concerned about contradictory health claims and pharmaceutical side-effects. I was sincerely interested in addressing the root cause, instead of merely masking the symptoms.
Center for Natural & Integrative Medicine – 6651 Vineland Rd, Ste 150 Orlando, FL 32819 — 407-355-9246