Osteoporosis is a disease that weakens bones, causing them to be easily broken. Many people only realize they have osteoporosis after breaking a bone, and a diligent, knowledgeable doctor discovers the issue. However, many early osteoporosis cases are unfortunately not caught when the patient comes to the doctor with a bone fracture (1). Called a "silent" disease, osteoporosis in the early stages rarely has noticeable symptoms, which is why it can be missed. Fortunately, screening is easy, and early prevention can reduce the risks of bone fractures.
Review: Bone is a Story of Building Up & Breaking Down
Bone is alive, a living tissue (2). Old bone is regularly broken down and replaced with newly made bone. Osteoporosis occurs when not enough new bone is created to replace the old bone, weakening the structure (2). In a healthy adult, any bone that is destroyed is replaced with new bone tissue.
An intricate matrix of material makes up the interior of bones. The matrix is similar to a lattice or honeycomb; hard material provides strength, but empty spaces exist. Dense, strong bone has smaller-sized empty spaces. Not only is it strong, but it's rubbery - healthy bone can vibrate from a hard impact but maintain intact. Larger empty spaces create a bone that is brittle, weak, and can be easily snapped in two or shattered. It has no "give." The slowing of bone creation is why the spaces in the bone get larger, causing it to lose strength.
The Estrogen Protection Connection: Male Risk Catches Up to Female
There is an established connection between high levels of estrogen and protection from bone loss. Women, who have higher estrogen levels than men in their younger years, are less likely to have bone loss than men. However, this trend reverses when women have lower estrogen levels due to the natural cessation of reproductive hormones (menopause). After menopause, age-related bone loss accelerates in women (3). Eventually though, both men and women have the same rate of bone loss in their 60s or 70s.
Though osteoporosis is commonly associated with women, men are still at risk for hip fractures due to osteoporosis. “For men, bone loss starts later and progresses more slowly” (4). Six percent of men over the age of 50 have hip fractures, with the root cause identified as osteoporosis (4). Not only that, osteoporosis can shave a few inches off a man's height, caused by osteoporotic fractures (4).
The Vitamin D Deficiency Connection
Vitamin D deficiency in adults can cause a bone to shatter rather than have a clean break. Shattered bone takes a much longer time to heal than a clean break. Vitamin D is crucial to bone maintenance because it regulates other elements involved in bone maintenance, such as calcium and phosphorus (5). Vitamin D helps the body absorb food-derived phosphorus and calcium (6). The "rubbery" quality that allows bone to bounce back from an impact is lost when these vital nutrients are missing.
The Nutrition Deficiency Connection
Bone needs many nutrients to remodel, making new bone tissue to replace old bone tissue. A diet low in nutrients (or nutrients that are eaten but not absorbed) can cause significant deficiencies that negatively affect bone growth. This is partly due to the many nutrients bones require to grow correctly. Here is a partial list of all the nutrients bone needs to be healthy (5, 7-13):
Vitamin D - Assists calcium absorption and regulates calcium and phosphorus.
Vitamin K2 - Aids bone metabolism (helps create bone and reduce breakdown). Through its effect on certain proteins, K2 directs calcium away from soft tissues so it doesn't get deposited in arteries and soft tissues such as hair and joints.
Calcium - Forms bone matrix, together with phosphate and a protein that acts as a glue.
Magnesium - Aids bone metabolism and resides in bone.
Phosphorus - Forms bone matrix with calcium (hydroxyapatite), regulated by the action of vitamin D.
Potassium - Protects bone and increases bone mineral density.
Protein - A vital component of bone tissue.
Nutrition deficiency is the true concern for those who primarily eat fast food or processed foods full of artificial ingredients, as the body needs real food with intact nutrients to maintain bones and tissues. Not only that, the nutrients must be absorbed correctly. Unfortunately, there is a lengthy list of foods that harm the gut lining and affect nutrient absorption. Additionally, many illnesses can prevent the proper absorption of nutrients (Celiac disease, inflammatory bowel disease, etc.). Gut health is so vital to human health that we at the Temecula Center for Integrative Medicine (TCIM) spend considerable time helping people correct their gut issues.
The Weight-Bearing Exercise / Movement Connection
Bone loss associated with osteoporosis can be countered by moving the body in specific ways. Strength training that involves weight-bearing exercise puts pressure on the bones, stimulating them to make more bone (14). Gyms are typically outfitted with many kinds of machines, kettle balls, and free weights that can be used for weight-bearing exercises.
Mechanical vibration is also vital to bone health. Gravity puts healthy stress on the bones. Astronauts who live in weightless environments lose bone mass because they don't have the usual effects of walking in gravity. Researchers found that making astronauts stand on a vibrating plate, simulating the impact of walking in gravity, helped them regain bone loss acquired in space (15)! Walking is a fantastic exercise for whole body health and easy to do regularly, but so is whole body vibration therapy (WBVT). Details about WBVT are listed below.
Symptoms
Unfortunately, osteoporosis can occur without symptoms. By the time symptoms arise, the bones can be severely compromised. Bones weakened by osteoporosis can typically cause the following symptoms (16):
Gradual loss of inches of height
Fractures in the spine that cause back pain
Bent posture
Easily broken bones
Risk Factors
Many factors feed into bone health and acquiring osteoporosis. It's best to have a doctor or health practitioner assess your particular risk. The following populations are typically at a higher risk by varying degrees, and should seek out an assessment (17):
Post-menopausal females
A family history of osteoporosis
Genetic makeup of Hispanic, White, or Asian
Nutritional deficiencies (calcium, vitamin D, etc.)
Lack of exercise, physical movement, or weight-bearing activities
Smokers have higher risks of broken bones, and female smokers often enter menopause earlier, further increasing risk
Have certain health conditions such as Celiac disease, inflammatory bowel disease, diabetes, or premature ovarian failure
Take certain medications that treat arthritis, asthma, lupus, or thyroid disease
Heavy drinkers (high alcohol intake)
Weight under 127 lbs with a small stature and slim frame
Hypothyroidism or Hyperthyroidism
Prevention
1) Get bone density screenings early and often. Women, don't wait until menopause! Men, don't wait until you're in your 70s! Don't wait until you've lost 1 or 2 inches of height! If low bone mass density is detected early, it leaves time to attempt correction before it becomes dangerous.
2) Eat a nutrient-dense diet and use nutritional supplements if necessary
Let food provide your calcium - Allowing food to provide calcium (rather than relying mainly on supplements) keeps the body from getting too much. Too much synthetic calcium can negatively affect bones, cause kidney stones, and cause the heart to race or beat out of time (18). Great sources of calcium are dairy products (milk, unsweetened yogurt, and cheddar, cottage, or ricotta cheeses), black beans, almond milk (unsweetened), sardines, and cooked greens (spinach, collard greens, kale, bok choy) (19).
Animal products such as dairy and animal bones provide higher amounts of calcium than plant sources, so vegans may be more at risk for calcium deficiency unless they consume large amounts of other calcium sources. For those who are inclined, animal bones from salmon, chicken (small bones softened by cooking), sardines, and broths made from cooking bones are excellent sources of bone-building phosphorus, magnesium, strontium, zinc, iron, copper, osteocalcin (a protein hormone), and collagen (10).
Keep Vitamin D in the "normal" ranges - Test your vitamin D and work with your doctor to keep it in the range determined optimal for you. Vitamin D supplementation might be necessary. See details about the strategy for increasing vitamin D in our article on preventing cancer.
Eat more fruits and vegetables - Fruits and vegetables encourage an alkaline internal environment, which helps foster bone health and counters acidity. Green leafy vegetables are also a source of calcium.
Increase vitamins K1 and K2 - Vitamins in the K family are essential to bone health. Vitamin K2, in particular, influences specific proteins that help drive calcium into the bone and away from soft tissues such as joints. The danger of too much calcium from heavy supplementation is that it can go into arteries, hardening them, and get deposited into joints (10), causing them to ache. K2 helps get the calcium into the bone, where it is needed.
Reduce sodium - Sodium affects how much calcium is excreted through urination. Reducing sodium decreases calcium excretion, allowing more calcium tobe used for bones.
Decrease alcohol and caffeine consumption - Alcohol interferes with the ability to absorb vitamin D and calcium, while caffeine causes an increase in calcium leaving the body through urination (19). Consistent, heavy use of alcohol and caffeine is detrimental to bones.
3) Perform weight-bearing exercises - Did you know that walking, climbing stairs, and jogging count as "weight-bearing exercise” (20)? It's not necessary to train for a marathon or even jog. Simply walking several times a week helps build health. (If walking is difficult, read about whole body vibration therapy under the "Potential Osteoporosis Treatments" section below to see if it appeals.) Similarly, it's not necessary to lift heavy weights. Even light exercise with simple hand weights or kettlebells can increase healthy pressure on bones, spurring them to create more bone.
4) If you smoke, consider quitting smoking - Smoking is associated with a higher risk of weakened bones (2). Many great smoking cessation methods exist, including cell phone applications (21), nicotine patches, or other forms. If you are ready to quit smoking, TCIM can support you through medicines, supplements, education, and referrals to other resources.
Diagnosis
Screenings during annual or twice-yearly physicals are the best way to detect asymptomatic osteoporosis. Bone density tests such as a DEXA scan use imaging to assess bone mineral content, bone density, and even body composition (ratios of fat and muscle mass) (22). Based on your health history and genetic factors, TCIM doctors can perform bone assessments during the executive physical, or set an appointment for a future assessment. The executive physical is a two-step process involving an in-depth evaluation of the patient, followed by an appointment covering the results of the exams. During the evaluation, our doctors can assess if other specific tests seem necessary, such as a bone density test. A suspicion of nutrient deficiencies may trigger a suggestion for in-depth nutrient testing, which can be done in-house.
Potential Osteoporosis Treatments
As with many conditions, most osteoporosis prevention measures can also be used as treatments if the disease is mild. Additionally, there are many avenues of treatments that doctors can suggest, considering the patient's individual health history. Below, a few osteoporosis treatments are highlighted.
1) Whole body vibration therapy (WBVT) - This exciting therapy is based on the principle that even minor stressors on the body (and bones) can result in significant gains in different health measures over time. As mentioned above, WBVT has helped astronauts regain bone density after prolonged periods in space. The therapy involves standing on a vibrating platform, causing the body to adjust muscle tension constantly. Constantly expanding and contracting muscles elicit a response from bone that leads to bone creation (15). Two studies have shown that WBVT has improved bone mineral density (BMD) in the femurs and lumbar vertebra of women who started with low BMD (23, 24). For those who have difficulty walking but can stand while holding onto a bar, WBVT may help strengthen bones and improve balance so that walking becomes possible in the future.
2) Nutritional strategies (10):
All the prevention strategies listed in the section "Eat a nutrient-dense diet" can be used as treatments. Testing for nutrient deficiencies might be warranted based on the doctor's evaluation. Therapeutic doses of specific vitamins or minerals may be suggested based on the results of nutrient testing. IV therapy may even be advised to replenish certain nutrients quickly.
3) Conventional treatments - Many medications can help you recover from osteoporosis or slow its progression. Doctors may prescribe hormones for pre- or post-menopausal women, called hormone replacement therapy (HRT), to deliver bone protection through the action of estrogen. Medications that inhibit bone breakdown may be prescribed. Once osteoporosis is diagnosed and the severity assessed, a doctor can select the proper medications to address the need (17).
Retaining or Improving Bone Health Is Possible
Bone testing can be arranged during TCIM's two-part extensive "executive physical" if your medical history, lifestyle habits, or symptoms warrant it. We encourage everyone with osteoporosis risk factors to have a TCIM doctor evaluate bone health. The slow progression of bone disease might often escape notice, but catching osteoporosis early can prevent costly and debilitating broken bones, loss of height, and excruciating back and neck pain. If your bones are in good shape, we can help you reduce remaining risk factors and encourage certain habits so your bones stay healthy. If your bones are compromised, discovering it earlier rather than later will give us time to begin therapies to reduce your odds of a painful or debilitating fracture. If your last physical was long ago, please call TCIM and schedule an appointment soon. It is easy to prevent osteoporosis, given time and thoughtful guidance.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
info@tcimedicine.com
951-383-4333
Sources:
1. LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-2102. doi: 10.1007/s00198-021-05900-y. Epub 2022 Apr 28. Erratum in: Osteoporos Int. 2022 Jul 28;: PMID: 35478046; PMCID: PMC9546973.
2. Osteoporosis [Internet]. U.S. Department of Health and Human Services; [cited 2023 Jun 5]. Available from: https://www.nia.nih.gov/health/osteoporosis
3. Ahlborg HG, Johnell O, Turner CH, Rannevik G, Karlsson MK. Bone loss and bone size after menopause. New England Journal of Medicine. 2003;349(4):327–34. doi:10.1056/nejmoa022464
4. Men: Don’t let osteoporosis weaken your bones [Internet]. Cleveland Clinic; 2022 [cited 2023 Jun 5]. Available from: https://health.clevelandclinic.org/men-dont-let-osteoporosis-weaken-your-bones/
5. Godman H. Essential nutrients your body needs for building bone [Internet]. 2022 [cited 2023 Jun 5]. Available from: https://www.health.harvard.edu/staying-healthy/essential-nutrients-your-body-needs-for-building-bone
6. Rickets [Internet]. Mayo Foundation for Medical Education and Research; 2021 [cited 2023 Jun 5]. Available from: https://www.mayoclinic.org/diseases-conditions/rickets/symptoms-causes/syc-20351943
7. Capozzi A, Scambia G, Lello S. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas. 2020 Oct;140:55-63. doi: 10.1016/j.maturitas.2020.05.020. Epub 2020 May 30. PMID: 32972636.
8. Office of dietary supplements - phosphorus [Internet]. U.S. Department of Health and Human Services; [cited 2023 Jun 5]. Available from: https://ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional/
9. Palermo A, Tuccinardi D, D’Onofrio L, Watanabe M, Maggi D, Maurizi AR, et al. Vitamin K and osteoporosis: Myth or reality? Metabolism. 2017;70:57–71. doi:10.1016/j.metabol.2017.01.032
10. O'Keefe JH, Bergman N, Carrera-Bastos P, Fontes-Villalba M, DiNicolantonio JJ, Cordain L. Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa. Open Heart. 2016 Mar 22;3(1):e000325. doi: 10.1136/openhrt-2015-000325. PMID: 27042317; PMCID: PMC4809188.
11. Office of dietary supplements - magnesium [Internet]. U.S. Department of Health and Human Services; [cited 2023 Jun 5]. Available from: https://ods.od.nih.gov/factsheets/magnesium-HealthProfessional/
12. Office of dietary supplements - potassium [Internet]. U.S. Department of Health and Human Services; [cited 2023 Jun 5]. Available from: https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/
13. Mayo Clinic Q and A: Osteoporosis and a bone-healthy diet - Mayo Clinic News Network [Internet]. Mayo Foundation for Medical Education and Research; 2022 [cited 2023 Jun 5]. Available from: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-osteoporosis-and-a-bone-healthy-diet/
14. Slowing bone loss with weight-bearing exercise [Internet]. 2021 [cited 2023 Jun 5]. Available from: https://www.health.harvard.edu/staying-healthy/slowing-bone-loss-with-weight-bearing-exercise
15. Can whole-body vibration therapy help with osteoporosis? [Internet]. MediLexicon International; [cited 2023 Jun 5]. Available from: https://www.medicalnewstoday.com/articles/can-whole-body-vibration-therapy-help-osteoporosis
16. Osteoporosis [Internet]. Mayo Foundation for Medical Education and Research; 2021 [cited 2023 Jun 5]. Available from: https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
17. Osteoporosis [Internet]. [cited 2023 Jun 5]. Available from: https://www.womenshealth.gov/a-z-topics/osteoporosis
(18) Hypercalcemia [Internet]. Mayo Foundation for Medical Education and Research; 2023 [cited 2023 Jun 5]. Available from: https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523
19. Bigleyj. 22 calcium-rich foods to try right now [Internet]. Cleveland Clinic; 2023 [cited 2023 Jun 5]. Available from: https://health.clevelandclinic.org/calcium-rich-foods/
20. How to keep your bones healthy [Internet]. Mayo Foundation for Medical Education and Research; 2022 [cited 2023 Jun 5]. Available from: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060
21. Create my quit plan [Internet]. [cited 2023 Jun 5]. Available from: https://60plus.smokefree.gov/tools-tips-60plus/mobile-tools
22. Dexa Scan (DXA): Bone Density Test, what is it & how it’s done [Internet]. [cited 2023 Jun 5]. Available from: https://my.clevelandclinic.org/health/diagnostics/10683-dexa-dxa-scan-bone-density-test
23. ElDeeb AM, Abdel-Aziem AA. Effect of whole-body vibration exercise on power profile and bone mineral density in postmenopausal women with osteoporosis: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2020;43(4):384–93. doi:10.1016/j.jmpt.2019.12.003
24. Marín-Cascales E, Alcaraz PE, Ramos-Campo DJ, Martinez-Rodriguez A, Chung LH, Rubio-Arias JÁ. Whole-body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Aug;97(34):e11918. doi: 10.1097/MD.0000000000011918. PMID: 30142802; PMCID: PMC6112924.