Information » Diseases » Osteoporosis
Everyone knows that our bones get weaker as we get older. There is no shortage of information out there about the risks of osteoporosis but there is more to the message. Most people at risk have already taken some steps towards keeping their bones healthy and to prevent osteoporosis, but very few people are getting the best protection they can.
Some of the key foods that have been linked to stronger bones and fewer fractures will surprise you. Would you have guessed that green tea is important? Turns out that Japanese men who drink a lot of green tea get a lot fewer broken hips. What about soy? It contains genistein, which has increased bone density in several studies. It is very important to avoid carbonated soda, because the phosphate in the bubbles leeches calcium from bones. Drink less alcohol and quit smoking too.
What you do is just as important as what you eat. Weight lifting, running or other sports that require jumping all subject your bones to stresses that force them to become stronger. Tai chi and yoga improve balance and coordination, which are proven to prevent falls. What better way to prevent a broken hip than to avoid falling in the first place?
This is an old story - but it is evolving. There has been a lot of debate over the dozens of clinical trials looking at whether or not calcium and vitamin D actually improve bone density and prevent fractures. The answer in both cases is that they do. What you need to know is that it is best to take at least 1200mg of calcium between meals.
As for vitamin D, experts recommend 800 units or more but a wiser approach is to find out how much you need with a 25-OH vitamin D blood test. Most Canadians suffer from vitamin D deficiency which increases their risk of cancer, heart disease and other problems. Vitamin D makes bones stronger, but it also improves nerve and muscle function. This improves balance and coordination, making falls less likely.
There are some medications that increase the risk of osteoporosis and hip fracture. The most publicized of these is prednisone and the other corticosteroids, but they are not the only culprits. A newly recognized risk is the family of acid-suppressing drugs called proton-pump inhibitors. Many large studies have linked use of these pills to an increased risk of hip fracture, and in the largest one, high doses were linked to almost triple the risk. Other drugs that increase the risk of osteoporosis are SSRI antidepressants and thiazide diuretics.
Poor gut health can also increase your risk by affecting calcium absorption. This is known to be a problem for people with celiac disease or inflammatory bowel disease, but a much more common cause of calcium malabsorption is lack of stomach acid. This declines with age, making older women especially vulnerable.
This may be the most important therapy to consider. It is a trace mineral that is normally found in the human body. It is consumed in tiny amounts in food and the average person has about 300mg of it, mostly in bones and teeth. It was discovered in Strontian, Scotland in 1808 and first studied in the treatment of bone pain at the Mayo Clinic in the 1950s.
The research establishing strontium for bone health is truly world-class. In the largest trial to date, 1649 women with osteoporosis were given two grams of strontium ranelate or placebo every day for three years. The women who got strontium increased their bone density by 14% and cut their fracture risk in half. That is a much bigger improvement than has ever been found in trials of conventional drugs and has been confirmed by several other trials. It is truly astounding that this has not made headlines around the world, but every woman should take strontium. Perhaps men should too - since it seems to prevent cavities as well.
You may have thought that your bones were just made of the hard white stuff you see in skeletons that white stuff is called hydroxyapatite. It is a strong material, but on its own it is not strong enough. It is reinforced by a mesh-like matrix that is made of protein just as steel reinforces concrete. The body cannot make this steel without vitamin K. A bone density test measures the quantity of bone, but it does not measure its quality. As a comparison, consider that a thin metal rod is much stronger than a thick piece of chalk.
Vitamin K deficiency is a common problem, especially among the elderly who eat less vitamin K-rich food and absorb less of what they eat. In a large French study, 7598 elderly women were followed for 22 months. The 104 women in this group who broke a hip during this time were compared with 255 women who did not break their hips but had the same bone density scores. Those with vitamin K deficiency had almost double the risk of hip fracture. The women with low bone density AND vitamin K deficiency were at 5.5 times the risk of hip fracture.
In a systematic review of 7 randomized, double-blind studies in women with osteoporosis, those who used vitamin K2 had an incredible 81% lower risk of nonvertebral bone fracture.1
One caution: If you are taking coumadin as a blood thinner, you will need to increase your dose when you start taking vitamin K. This is easy and safe, but your doctor should monitor your INR test until you have found the right dose to account for the vitamin K you are taking. An added bonus is that vitamin K is associated with lower risk of heart disease.
Millions of women stopped using HRT when the Women's Health Initiative Study results went public. In this very public trial, women taking synthetic drugs similar to estrogen and progesterone were at increased risk of stroke. Many women have come to realize that the culprit - provera - is not progesterone at all. It is medroxyprogesterone acetate, a molecule that looks similar but is different enough that it can be patented and sold for profit. While there is no evidence proving it is safer, some women have chosen to take bio-identical hormones instead. These hormones are identical to the ones your body used to make, so it makes sense to think that they would not pose the same risks.
There are no clinical trials proving that bio-identical hormones work and are safe, but many of our patients are very satisfied with them. In addition to their effect on bone, they also improve many of the symptoms of menopause.
These options should be considered by anyone who wants to improve the strength of their bones and prevent thin, brittle bones from breaking later in life. This is an easy problem to treat, so there is no reason for you to join the rising number of people who suffer from osteoporosis.
Arch Intern Med 2006;166:1256