Osteoporosis: More Than Calcium Deficiency
By Dr. Millie Lytle, ND, MPH, CNS
For many people, osteoporosis is a reversible condition. I see it all the time in my practice, but what many people don’t realize is that your bones can actually become stronger from year to year instead of weaker. There is so much misunderstanding and misinformation surrounding bone repair. Bones are always actively breaking down and repair in a process called remodeling. It's likely that lifestyle habits and nutrients are involved in the end result, either net loss or net gain of bone.
Let's start with exercise. Weight bearing exercise is the best kind of workout for bones. While any exercise may be helpful, weight-bearing exercise is not synonymous with weight lifting. Weight-lifting increases your muscle strength, which helps stabilize and support your balance. Weight-bearing exercise is a workout that puts good stress on your bones with movements such as walking, jumping, skipping, handstands, standing on one leg and even holding a prolonged plank position in yoga.
Studies show that high-impact exercise involving aerobics and jumping may be even more effective at building bone than calcium supplementation1. Swimming, cycling or using the elliptical machine don't build bones. The best way to care for the bones is to make lifestyle changes to avoid osteoporosis in the first place. You build bone primarily in your youth, so start exercising early. Girls who participate in more sports during their childhood protect their bones in the long run by building more calcium stores in their bones in their youth.
The best methods to prevent Osteoporosis in the long run include interventions duringadolescence and young adult years when the body is naturally building bone towards Peak Bone Mass. Peak bone mass is the amount of bone tissue present at the end of the skeletal maturation and is predictive of osteoporosis later in life. Prevention should include a balanced diet with adequate calcium and vitamin D, exercise and a decreased use of alcohol and cigarette smoking2. Avoiding oral contraceptive use by young women may reduce risk of osteoporosis as well, as the birth control pill has been shown to compromise bone health during a time when mineral is still accruing3. Excessive exercise, bone fractures and eating disorders can erode bone density and predispose towards osteoporosis. Avoid smoking, excessive coffee, excessive alcohol and antacid medications in order to protect your bones. And milk is not your best friend, contrary to popular belief. Milk is not just about Calcium intake – cow's milk and dairy products are rich in calcium, but they are also rich in phosphorus, which actually causes the loss of calcium from the bones. Vegetarian sources of calcium are preferable, because you get the calcium without the phosphorus. Plus, in vegetarian sources you get the added benefits of nutrients, along with calcium that are essential for bone repair, bone building and healing. While calcium is the main bone storage mineral, studies have shown that this mineral is more absorbable in the presence of pre-biotics such as Fructooligosaccharides or FOS4. Look for a calcium product that contains FOS in a powdered form.
Depending on your age, your level of activity, your list of medications and the type and quantity of bone-building nutrients you take, you can reverse osteoporosis. I see people making the changes necessary all the time. Here are the five major nutrients needed to rebuild bone, which can help you go from being osteoporotic to osteopenia and back to normal again. This process takes 2-5 years.
1) Vitamin D3. Not calcium, but Vitamin D, may be the biggest nutrient deficiency that leads to Osteoporosis. If you’re low in Vitamin D, no matter how much calcium you have in your circulation, it won't get absorbed if you're low in Vitamin D. Get your blood checked at the doctor. Aim for Vitamin D levels between 60-100 (D OH 25). The problem is there is not enough Vitamin D in food sources, and most of us tend to avoid direct sunlight. 66% of osteoporotic and osteopenic patients at an endocrine ambulatory care center were deficient or insufficient in Vitamin D. Frequent low vitamin D status was consistent among all ages with bone loss but more common in those over 50 years old5.
2) Magnesium. Not only does it help relax muscles and nervous system, it also helps balance the release of calcium from the bones and helps deposit it into other tissues. Lastly, it also helps to regulate calcitonin and parathyroid response of high circulating magnesium levels. Again, magnesium deficiency is very common, with over 50% of the American population not getting adequate levels in their daily diets. One study showed Magnesium, Calcium and Zinc play important roles in bone breakdown and synthesis rates, with decreased bone levels of Ca, Mg, and Zn in patients with osteoporotic fractures compared to subjects with osteoarthritis6. Lower magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower arm and wrist fractures that are possibly related to more physical activity and falls7.
3) Boron. This is a trace mineral required in small amounts to prevent calcium leaching through the urine, which is absolutely essential for building bones. If your body is getting rid of more calcium than you're storing, you can't possibly build bone. Boron can help you keep calcium in your bones. In a study of osteoporotic and non-osteoporotic post-menopausal women, it was boron and phosphorus (not calcium and magnesium) that differed between the two groups. 8 The study also showed that boron supplementation modestly decreases serum phosphorus levels, thereby conserving calcium and magnesium in the bone. 9
4) K1 and 2. Because Calcium supplementation may cause calcification of unwanted tissues such as bone spurs, arteriosclerosis and breast calcifications, when taking calcium and vitamin D supplements it’s essential to take Vitamin K as well. Vitamin K comes in two forms: K1 is the clotting factor found in spinach that stimulates collagen formation and builds bone matrix, and K2 shuttles calcium out of the arteries and into the bones. It is sourced from nattokinase and other fermented soy and unpasteurized dairy. Although these two Vitamins are related, they both have different mechanisms of action to save your bones. Vitamin K supplementation prevented bone loss in cases of obesity induced by a high-fat diet. Vitamin K Vitamin K1 (phylloquinone) and K2 (menaquinone-4) supplementation reversed the high-fat diet-induced bone deterioration by modulating osteoblast and osteoclast activities and preventing bone loss in a high-fat diet-induced obese mice.10
5) Phytoestrogens. These healthy plant chemicals are often misunderstood. Phytoestrogens are not xenoestrogens, which are synthetic chemical estrogens from pesticides, GMOs soy, corn and canola and medications that promote breast cancer. Phytoestrogens are plant constituents that mimic the strenghtening effects of hormones produced in a younger body (either male or female) and are essential for stimulating bone growth. Instead of taking HRT, take organic soy (miso, tempeh, sprouts), black cohosh, red clover tea, organic flax seeds, beans/lentils and broccoli sprouts. A clinical trial showed that supplementing with phytoestrogens in addition to Vitamin D3, Vitamin K1 and essential fatty acids may help to prevent osteoporosis and reduce fracture risk, at least at the hip, in postmenopausal women. Larger and longer-term clinical trials are warranted. 11
6) Fat. Eating a diet high in healthy fats when you're young may have bone strengthening effects. Conjugated Linoleic Acid (CLA) and other essential omega fatty acids promote weight loss and increased strength, as well as stronger peak bone mass 12. In a mouse study, CLA increased bone mass in both cancellous and cortical bones, and the effects of CLA on bone were not further improved by exercise in pure cortical bone of young male mice. 13 While obesity does not protect bones, excess weight loss is known to be destructive for bones, causing demineralization.
- Welch JM, Turner CH, Devareddy L, Arjmandi BH, Weaver CM. High impact exercise is more beneficial than dietary calcium for building bone strength in the growing rat skeleton. Bone. 2008 Apr;42(4):660-8.
- Ausenhus MK. Osteoporosis: prevention during the adolescent and young adult years. Nurse Pract. 1988 Sep;13(9):42, 45, 48.
- Almstedt Shoepe H, Snow CM. Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporos Int. 2005 Dec;16(12):1538-44.
- Scholz-Ahrens KE, Açil Y, Schrezenmeir J. Effect of oligofructose or dietary calcium on repeated calcium and phosphorus balances, bone mineralization and trabecular structure in ovariectomized rats.Br J Nutr. 2002 Oct;88(4):365-77.
- Kocjan T, Tan TM, Conway GS, Prelevic G. Vitamin D status in patients with osteopenia or osteoporosis--an audit of an endocrine clinic. Int J Vitam Nutr Res. 2006 Sep;76(5):307-13.
- Karaaslan F, Mutlu M, Mermerkaya MU, Karaoğlu S, Saçmaci Ş, Kartal Ş. Comparison of bone tissue trace-element concentrations and mineral density in osteoporotic femoral neck fractures and osteoarthritis. Clin Interv Aging. 2014 Aug 18;9:1375-82.
- Orchard TS, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD.Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study. Am J Clin Nutr. 2014 Apr;99(4):926-33.
- José Ramón V, Mora Mora M, Marino Alarcón O, Hernández G, Josefina Linares L, Urdaneta Romero H, Arévalo González E.[Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis]. Invest Clin. 2012 Mar;53(1):3-15.
- Meacham SL, Taper LJ, Volpe SL. Effect of boron supplementation on blood and urinary calcium, magnesium, and phosphorus, and urinary boronin athletic and sedentary women. Am J Clin Nutr. 1995 Feb;61(2):341-5.
- Kim M, Na W, Sohn C. Vitamin K1 (phylloquinone) and K2 (menaquinone-4) supplementation improves bone formation in a high-fat diet-induced obese mice. J Clin Biochem Nutr. 2013 Sep;53(2):108-13.
- Lappe J, Kunz I, Bendik I, Prudence K, Weber P, Recker R, Heaney RP. Effect of a combination of genistein, polyunsaturated fatty acids and vitamins D3 and K1 on bone mineral density in postmenopausal women: a randomized, placebo-controlled, double-blind pilot study. Eur J Nutr. 2013 Feb;52(1):203-215.
- Malvi P, Piprode V, Chaube B, Pote ST, Mittal M, Chattopadhyay N, Wani MR, Bhat MK. High fat diet promotes achievement of peak bone mass in young rats. Biochem Biophys Res Commun. 2014 Dec 5;455(1-2):133-8.
- Banu J, Bhattacharya A, Rahman M, O'Shea M, and Fernandes G. Effects of conjugated linoleic acid and exercise on bone mass in young male Balb/C mice. Lipids Health Dis. 2006; 5: 7.