Osteoporosis has become a very widespread health concern. Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million U.S. women and men aged 50 and older. It is linked to 1.5 million bone fractures annually with the most common fractures being those of the hip, spine, and wrist. For the year 2000, there were an estimated 9 million new osteoporotic fractures, of which 1.6 million were at the hip, 1.7 million were at the forearm and 1.4 million were clinical vertebral fractures. Europe and the Americas accounted for 51% of all these fractures, while most of the remainder occurred in the Western Pacific region and Southeast Asia.
What is Osteoporosis?
Osteoporosis literally means “porous bones.” It occurs when bones lose so much of their mass and strength that they become weak, brittle, and very susceptible to fractures. Osteoporosis is sometimes called the “silent disease” because many patients are not even aware they have it until they experience a bone fracture. Sometimes a minor movement such as a sneeze or a cough can cause a bone fracture in folks with advanced osteoporosis. The condition is found most often in post-menopausal women, but from age 75 and beyond, it is equally common amongst men and women.
Many of the hip and wrist injuries are the result of a fall. Broken hips require major surgery and can be very risky for senior citizens. Spinal fractures can lead to loss of height as the vertebrae collapse on themselves. This is the cause of the hunchbacked appearance of some elderly folks, especially women. Sometimes this condition is called “widow’s hump” or “dowager’s hump.”
Bones are composed of a dynamic living tissue that is constantly changing. In a process known as remodeling or bone turnover, old bone tissue is broken down (resorption) and new bone is produced to replace it (formation). These cycles repeat every 2-3 months. Resorption utilizes specialized cells calledosteoclasts, and formation involves cells called osteoblasts. During childhood and the young adult years, more bone is produced than removed, and the body reaches maximum bone density and strength at about the age of 35. After that, the process begins to reverse itself, and the body slowly loses bone mass faster than it gains it. This is part of the aging process, but most osteoporosis occurs when this process happens faster than normal. This is known as primary osteoporosis. When osteoporosis occurs due to other health conditions it is called secondary osteoporosis.
What Are the Risk Factors for Osteoporosis?
There are quite a few factors that can increase one’s chances of developing osteoporosis. Let’s discuss the most common factors.
Gender. Women are five times more likely than men to suffer from osteoporosis, and twice as likely to experience a bone fracture from osteoporosis. The reasons behind this are:
- Women generally have smaller, thinner bones than men.
- Most females live longer than males, and therefore have more time to develop osteoporosis.
- After menopause, usually around the age of 50, women lose bone density faster than men. This is due to a significant drop in estrogen and progesterone production at this point in their lives. Both estrogen and progesterone plays an important role in protecting the bones. Women may lose up to 20% of their total bone mass during the first 5-7 years after menopause. However, research also tells us that bone loss actually begins in the 30’s.
- Statistically, women will lose more bone mass (30-50%) over their lifetimes than men (20-33%).
- After the age of 75, males and females both tend to lose bone mass at equal rates. As men are living longer, osteoporosis is becoming more of a health concern for them.
- Age. The bones naturally weaken with age. All other factors aside, the older you get, the more your risk for osteoporosis increases.
Race. Caucasians and Asians have the highest incidence of all races. African Americans and Hispanics are still susceptible to osteoporosis, but their risk is less.
Frame Size. If you are thin and small-boned, your risk is higher because you have less bone mass to begin with. Shorter people also have a greater risk for the same reason.
Family History. Researchers are not quite sure of why, but if you have a parent or sibling with osteoporosis, you have a better chance of getting it than if you do not. Another interesting statistic is that if you also have a family history of bone fractures, your risk for osteoporosis is even greater.
Exposure to Estrogen. The more a woman is naturally exposed to estrogen, the lower her risk is. For example, if she begins to menstruate earlier than normal or has a later than normal menopause, her risk is decreased.
Other Disorders. There are a number of other medical conditions that can increase the risk for secondary osteoporosis:
- Eating Disorders. Individuals with anorexia nervosa or bulimia mayhave an increased risk due to a lack of critical nutrients, especially calcium, in their bodies. They are particularly susceptible to lower back and hip problems because of low bone densities in these areas.
- Thyroid Disorders. An excess of thyroid hormones can cause bone loss and increased risk for osteoporosis. This can occur from an overactive thyroid (hyperthyroidism) or from the medication given to treat an under active thyroid (hypothyroidism).
- Alcoholism. Chronic alcoholics are at increased risk. Heavy drinking impairs bone formation and lessens the body’s ability to absorb calcium.
- Depression. Chronic depression has been linked to increased bone loss. The reason for this is not fully understood.
- Breast Cancer. Women who have a history of breast cancer and have been treated with certain chemotherapy drugs have increased risk. These include estrogen suppressors such as anastrozole, letrozole, and exemestane.
- Other Medications. If you have a condition that has been treated with certain types of drugs your risk may be increased. These include: heparin (a blood thinner), diuretics (causing the kidneys to excrete abnormal amounts of calcium in the urine), steroid medications (used for treating arthritis, psoriasis, and asthma), and some anti-seizure medications.
- Antacids. This drug deserves special mention. Antacids that contain aluminum can contribute to bone loss. Be especially careful of these. Many people take these for heartburn, and think they are also getting extra calcium to help conditions like osteoporosis. The drug companies have done a great job of marketing this, but it is a misrepresentation. They don’t tell you about the risk from aluminum. They also don’t tell you that this form of calcium is not absorbed readily by the body and therefore cannot help fight osteoporosis, and may even worsen it. I have known some people who take these antacids on a daily basis whether they have heartburn or not, just for the calcium. This is a mistake. Stay away from these drugs.
Osteoporosis – Hormone Balance Matters
The beginning of oesteoporosis correlates with hormone imbalance in women and also in men. Osteoporosis is usually referenced as a disease of estrogen deficiency, and is usually treated as a disease that mainly occurs at menopause.
What is not usually pointed out is that a woman’s bone loss actually begins in her mid thirties when estrogen levels are high indicating that estrogen does not totally prevent bone loss. What estrogen usually does is slow the rate of bone loss by slightly poisoning the ‘osteoclasts’ thereby slowing down resorption, but it DOES NOT reverse it.
The correlation? Progesterone Levels. When a woman reaches her mid thirties she may fail to ovulate every period (anovulatory cycle), leading to a decline in progesterone production.
Osteoporosis actually begins to set in 10 to 15 years before menopause, around the time a woman begins to experience a deficiency in progesterone. Therefore, the most important factor in osteoporosis is the lack of progesterone, which then causes a decrease in new bone formation.
Evidence suggests that progesterone receptors are present in osteoblasts and that adding progesterone will actively increase bone mass and density and can reverse osteoporosis. Some doctors prescribe conventional HRT in the form of combination estrogen and artificial progestins, or even estrogen alone (if you no longer have an intact uterus).
We know that estrogen can retard bone resorption, however, the accumulated old bone is not good bone and can result in an increase in hip fracture. A marked decline in estrogen levels at menopause can accelerate bone loss initially then, after a few years, this will plateau out again.
Given that many women are making adequate estrogen via their fat cells, muscle cells, and skin, bioidentical progesterone alone may be sufficient to prevent and/or reverse osteoporosis.
Artificial progestins used in conventional HRT are not identical to the progesterone made by a woman’s ovary, and therefore do not do the same work in bone building. In fact, artificial progestins may prevent any real progesterone that may be circulating in the body from occupying bone-building receptors, negating any bone-building benefits as both compete for the same receptor site.
- Smoking. Research indicates that tobacco use weakens bone tissues. The details of how are not exactly understood, but the bone mass of smokers is generally lower than that of non-smokers.
- Drinking. Heavy drinking interferes with calcium absorption. Either give up alcohol altogether, or limit it to no more than two drinks per day to minimize your risk.
- Soft Drinks. These are a no-no for several reasons. First off, many soft drinks contain high levels of phosphoric acid (phosphates), which contributes to calcium loss. When phosphate levels are high and calcium levels drop, the body draws out calcium from the bones to compensate, causing them to weaken. Secondly, foods high in refined sugar, such as soda pop, stimulate the body to excrete more calcium in the urine. Again the body will try to compensate by pulling calcium from the bones. The third concern about soft drinks is that most of them are high in caffeine. Caffeine acts as a diuretic, and can cause the body to excrete abnormal amounts of minerals, such as calcium, in the urine. This is true for other caffeinated drinks as well, such as coffee or tea.
- Exercise. A sedentary lifestyle is bad for your overall health, and can significantly increase risks for osteoporosis. Teach children while they are young how to get consistent daily exercise. This life long habit is one of the best defenses against osteoporosis. Cardiovascular exercise is always good for the body, but when we are looking specifically at osteoporosis, weight-bearing exercise is critical. This type of activity helps to build muscles and bones in the parts of the body that support the bulk of our weight: legs, hips, and lower spine. Jumping exercises are thought to be especially helpful, such as skipping, jumping rope, or bouncing on a trampoline. Combining these with strength-training exercises using weights is a great one-two punch against osteoporosis.
- Diet. Diet is of critical importance in good health and especially when one receives a diagnosis of osteoporosis.
- One of the things you want to avoid is getting too much protein. Excess protein stimulates the body to rid itself of more calcium. One study showed that high protein diets can double the amount of calcium excreted. Plant-based and vegetarian diets are thought to be an excellent choice. Studies have shown that vegetarians have a higher bone mass later in life than omnivores. This is thought to be due to decreased bone loss over the course of their lifetimes. Be careful though. Too little protein can be a risk factor for osteoporosis as well. Another reason a diet with little or no free-range meat or organic dairy foods might be beneficial is because most vegetables and fruits are more alkaline than acid. High acidity in the body causes it to excrete more calcium in the urine as well.
- Loading up on certain kinds of foods that are high in Vitamin K1 is also a good choice. K1 is involved in converting a bone protein called osteocalcin into a useful form. Most foods high in K1 are also rich in many important nutrients that affect bone health. These foods include organic green leafy vegetables from the cabbage family such as kale, collard greens, broccoli, and Brussels sprouts. Organic green tea is also rich in K1.
- The best sources of calcium are found in foods. Some suggestions are green leafy veggies, shellfish, sardines, Brazil nuts, and almonds. Milk will not give you enough calcium to fend off osteoporosis, despite what the advertising would have us believe. Even drinking milk from a young age does not protect against future fracture risk but actually increases it. Shattering the “savings account” calcium theory, Cumming and Klineberg report their study findings as follows: “Consumption of dairy products, particularly at age 20 years, was associated with an increased risk of hip fracture in old age. (“Case-Control Study of Risk Factors for Hip Fractures in the Elderly”. American Journal of Epidemiology. Vol. 139, No. 5, 1994). Other research indicates that drinking too much milk can actually increase your risk of osteoporosis. Amy Lanou Ph.D., nutrition director for the Physicians Committee for Responsible Medicine in Washington, D.C., who states that:“The countries with the highest rates of osteoporosis are the ones where people drink the most milk and have the most calcium in their diets. The connection between calcium consumption and bone health is actually very weak, and the connection between dairy consumption and bone health is almost nonexistent.”
- Be careful with calcium supplements. If calcium is to be absorbed effectively it must be combined with magnesium. They are actually a pigeon pair. And calcium alone can actually cause phosphorous levels to drop, which can contribute to osteoporosis. I personally use and recommend Calcium Orotate with Magnesium. It has been well established that calcium supplements can work as preventative measures against bone loss and osteoporosis. While many forms of calcium supplement may aid in the prevention of this loss, Hans A. Nieper’s studies showed that calcium orotate gave the bones more usable calcium per milligram consumed. Orotates are able to penetrate cell membranes which enables the effective delivery of the calcium ion to the inner-most layers of the cellular mitochondria and nucleus. Other forms of calcium supplements, such as calcium carbonates, citrates, gluconates, lactates, malates and phosphates, are not capable to penetrate deep into the membranes.
Research and Resources
Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726.
Dören M, Nilsson J-A, Johnell O. Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women: a meta-analysis. Human Reprod 2003; 18(8):1737-1746.
Liang M, Liao EY, Xu X, Luo XH, Xiao XH. Effects of progesterone and 18-methyl levonorgestrel on osteoblastic cells. Endocr Res . 2003 Nov;29(4):483-501.
The authors evaluated in this study the effects of progesterone (P4) and levonorgestrel (LNG) on markers of bone growth, utilizing normal human osteoblasts as well as the osteosarcoma cell line, MG-63. Their study found that, compared with placebo, both P4 and LNG increased the proliferation and differentiation of human osteoblasts through osteocalcin gene transcription.
Sowers M, Randolph JF Jr, Crutchfield M, Jannausch ML, Shapiro B, Zhang B, La Pietra M. Urinary ovarian and gonadotropin hormone levels in premenopausal women with low bone mass. J Bone Miner Res 1998; 13(7):1191-202.
Prior JC, Vigna Y, Alojado N. Progesterone and the prevention of osteoporosis. Canadian Journal of Obstetrics/Gynecology and Women’s Health Care 1991; 3(4):178-84.
In this review article, the authors propose that cyclic progesterone both prevents bone loss and acts as a bone-builder. The studies discussed focus on abnormal menstrual cycles as an important risk factor for osteoporotic fractures. Their conclusion is that the first step in preventing osteoporosis is treating ovulation disorders.
Prior JC, Vigna YM, Schecter MI, Burgess AE. Spinal bone loss and ovulatory disturbances. New England Journal of Medicine 1990; 323(18):1221-7.A review of the available data indicates that progesterone acts to promote bone metabolism. It appears to be independent of estrogen by either acting directly at progesterone receptors, or indirectly through competition at glucocorticoid receptors in the osteoblasts.
Prior JC. Progesterone as a bone-trophic hormone. Endocr Rev 1990; 11(2):386-98.
Lee JR. Osteoporosis reversal; the role of progesterone. International Clinical Nutrition Review 1990;10(3):384-91. Transdermal progesterone supplementation with and without conjugated estrogens was evaluated in a clinical setting using 100 women aged 38 to 83 years. The average time from onset of menopause was 16 years. 63 women were followed for three years with dual photon absorptiometry. Treatment also included dietary changes, nutritional supplements, and exercise. All individuals followed showed an increase in bone mineral density over the three years, with the greatest increase occurring in the first year. There was no difference noted between estrogen/progesterone and progesterone only groups. Subjective changes included increased libido, diminished hot flushes, reduced joint pain, and increased mobility and energy. No side effects were noted during treatment protocol.