| Osteoporosis-
Avoidable or Inevitable??
By Dr. Deborah Ardolf, ND
Osteoporosis
affects 25 million people in the United States
and causes 1.5 million fractures annually. Of
all hip and spine fractures in white American
women aged 65 to 84, 90% occurred as a result
of osteoporosis. Osteoporosis has been defined
as not only low bone density but also deterioration
of the bone micro architecture leading to bone
fragility and susceptibility to fractures.
Why
is osteoperosis such a common occurrence? Female
hormones, especially estrogen, have a significant
impact on maintaining bone health. After menopause
the rate at which bone is lost intensifies.
Despite how astronomically high these numbers
are, there is great concern the numbers will
climb even higher in the next decade with the
potential to affect millions more due largely
in part to our poor diet and high stress lifestyles.
Natural treatment approaches to prevent and
minimize the risk of developing a severe form
of osteoporosis, when used consistently can
slow bone loss, improve bone density, bone strength,
and bone architecture.
The
gold standard for the diagnosis of Osteopenia
or Osteoporosis is the DEXA scan (Dual energy
X-ray absorptiometry). It is more accurate than
other techniques, delivers a lower dose of radiation,
and has a shorter examination time. Currently,
the standard of care is not to order a DEXA
scan until you are over 65 years of age unless
you have one of the following risk factors;
1) a fracture after menopause, or a hip fracture
in either parent, 2) weigh less than 127 lbs
or a BMI less than 21, or 3) are a current smoker.
A diagnosis of osteopenia will be given if the
bone mineral density (BMD) falls between 1 and
2.5 standard deviations from the mean. Osteoporosis
on the other hand is a BMD greater than 2.5
SD below the mean. If you have recently learned
of your DEXA scan results or are anxious about
having the test administered, a consultation
with your physician will help to clear up any
questions or concerns.
Usually
osteoporosis is thought of as a disease of retirement
age. However, research has pointed to a new
generation of young adults with significant
loss of bone. In a healthy growing adult, peak
bone density is reached between 30-35 years
of age. However, the American lifestyle has
moved away from many of the factors that help
to optimize bone growth. Now, younger adults
are being diagnosed with osteopenia and osteoporosis
at earlier ages than ever before. Lifestyle
choices leading to increased risk tend to include
one or more of the following:
1)
Diet. Females who chronically consume insufficient
calories on a daily basis such as in anorexia
nervosa or bulimia have been shown to become
osteoporetic much earlier on in life. The Pepsi
Generation: Carbonated beverages contain a high
amount of phosphorus and approx 7 teaspoons
of sugar per serving, both of which have a negative
impact on calcium levels. In a study of 228
children, of the 57 who had low blood calcium
levels, 67% of them consumed more than 4 cans
of soft drinks per week. Only 28 percent of
those children with normal blood calcium levels
consumed the equivalent amount of soda per week.
Refined grains and flours may also play a part
in the development of osteoporosis due to the
removal of the nutrient rich portion of the
grain. The refining process removes trace minerals
such as manganese, copper, and zinc as well
as vitamin B6, calcium, and magnesium, all of
which play a role in bone development and maintenance.
A
high animal protein diet has also been linked
to bone loss. Metabolically, calcium is released
from the bone to buffer the acidic breakdown
products of animal protein and is therefore
excreted in the urine. The amino acid methionine
which has the highest concentration in animal
meats, dairy products, and eggs is converted
to homocysteine. High homocysteine levels may
cause bone loss as well as increase your risk
of stroke, heart attack, and dementia.
2)
Malabsorption syndromes, such as IBS, Celiac,
Crohn’s disease.
3) Smoking: Smokers lose bone more rapidly than
nonsmokers and reach menopause two years earlier
than nonsmokers.
4)
Alcohol consumption: consuming two alcoholic
beverages per day significantly increases the
risk of bone fractures. The good news is that
a small amount of alcohol consumption i.e.,
one to two ounces per week, is associated with
a higher bone mineral density in women over
65 years of age, and a decreased risk of hip
fracture.
5)
Insufficient exercise: Bones need to be stressed
by weight in order to increase bone mass therefore
jumping in the backyard pool for exercise or
walking to the mailbox and back will do nothing
to increase bone density. Weight bearing exercises
such as jogging, running, gymnastics, basketball,
and weight lifting will increase bone density
if done consistently. Recker and associates
demonstrated the more college age women exercised,
the greater BMD they achieved. Reportedly to
achieve these benefits weight training as little
as two times a week coupled with a healthy diet
could increase and maintain BMD throughout their
life.
6)
Hereditary: In 1989, the New England Journal
of Medicine published a research study by Seeman
et al, revealing reduced bone mass for their
age in daughters of women with osteoporosis.
It concluded that 80-90% of women with a family
history of osteoporosis and especially hip fractures
are at the highest risk of developing the condition.
Their risk can be minimized by optimizing their
calcium and other crucial minerals stores.
Women
can help reduce their risk and incidence of
acquiring a diagnosis of osteoprosis by making
a few changes in the choices you make on a daily
basis. Remember that osteopenia and osteoporosis
are very treatable if caught early.
TRADITIONAL TREATMENT APPROACHES
1) Calcitonin
Has not been shown to reduce the risk of hip
or wrist fractures. May reduce the risk of spine
fractures in women with osteoporosis.
2) Raloxifene
Reported in JAMA in 1999 to reduce the risk
of spinal fractures in women with osteoporosis
but has not been demonstrated to reduce the
risk of hip or wrist fractures. Also carries
the unfortunate side effects of hot flashes,
leg cramps, and possibly the formation of blood
clots most commonly found in the lower leg.
3)Bisphosphonates
Has been studied the most extensively to show
a reduced risk of spine and hip fractures in
women with osteoporosis. However, in order to
take this drug, you must do so on an empty stomach,
stay sitting up right for a minimum of 30 minutes,
and do not eat for 30 minutes after taking the
pill. It also is advised to take your calcium
and Vitamin D supplement at a different time
of day. The unpleasant side effects include
bone and muscle pain, and throat, stomach, and/or
intestinal irritation.
NATUROPATHIC
TREATMENT
1) Weight bearing exercise 2-3x/week at a minimum.
2) Vegetarian diet is associated with a lower
risk of osteoporosis, according to a study published
by Ellis et al in 1972 in The American Journal
of Clinical Nutrition. By not eating animal
protein, and instead an increased amount of
fresh fruits and vegetables, soy, nuts, and
seeds, the probability of calcium going to the
bone and staying in the bone is much greater.
3) Soybeans: Soy appears to have a pro-estrogen
effect on bone according to a University of
Illinois study. Menopausal women had an increase
in mineral levels and lumbar spine bone density
after taking 55 to 90 mg of isoflavones for
six months! A soy protein diet seems to have
more of an effect on trabecular bone (spine)
than on cortical bone (hip).
4) Calcium: Soy is also a good source of calcium.
Other foods high in calcium include kelp, collard,
turnip, and dandelion greens, parsley, broccoli,
spinach, molasses, almonds, Brazil nuts, walnuts,
Swiss, cheddar, and cottage cheese.
SUPPLEMENTATION:
1) Calcium, 1,000mg/day in women aged 31 -50,
and 1,200-1,500 mg/day in women 51 and over
are recommended EXCEPT if you have a history
of kidney stones. Calcium citrate is one of
the best forms as it is less likely to cause
constipation, can be taken on an empty or full
stomach, and does not contain high levels of
lead found in bone meal, unrefined calcium carbonate,
and dolomite. Calcium carbonate is unique in
that it needs to be chemically altered by stomach
acid in order to be absorbed. This maybe a problem
in people with insufficient stomach acid, especially
the elderly and Type A blood type.
2) Vitamin D, 1,000 mg/day for 25-50 years of
age, 1,200-1,500 for 51 years and older. Vitamin
D is really a hormone synthesized in the skin
with the help of sunlight. Most of us have been
forewarned of sun exposure and the risk of cancer
as a result, many of us are vitamin D deficient.
This is detrimental to our health as vitamin
D helps with the absorption of calcium, phosphate
absorption in the intestines, and calcium reabsorption
in the kidneys. Vitamin D also helps to maintain
normal parathyroid function, is an important
immune system modulator, and is important for
muscle strength.
3) Magnesium 500-750 mg/day. In a two year study
by Stendeg et al, of osteoporetic menopausal
women, magnesium supplementation resulted in
a significant increase in bone mass density
and a decrease fracture incidence.
4) Manganese 15-30 mg per day. Considered one
of the most important trace nutrients in the
treatment of osteoporosis. Manganese stimulates
the production of mucopolysaccharides that provides
a structure on which calcification can take
place in the bone.
5) Boron 3 mg/day. In a study published in 1988
by Dr. Nielson, results indicated boron supplementation
reduced the urinary excretion of calcium by
44 percent, reduced urinary magnesium excretion,
and increased serum concentrations of 17 beta
estradiol and testosterone, thereby preventing
bone loss.
6) Zinc 15-20 mg/day. Is essential for normal
bone formation, has the bio-chemical ability
to enhance the effectiveness of vitamin D. Low
levels found in the elderly and people already
diagnosed with osteoporosis.
7) Copper, 1.5 – 3 mg/day. A deficiency
in this trace mineral has been linked to abnormal
bone formation. Maybe one of the causative factors
of osteoporosis.
8) Folic Acid, 400 – 800 mcg per day.
Linked to high homocysteine levels which results
in increased bone loss in menopausal women and
twice the risk of osteoporetic fractures of
the hip and wrist in women.
9) Vitamin B6, 50-100 mg/day has been shown
to reduce homocysteine levels. Vitamin B6 deficiencies
have been linked to increased fracture healing
time, impaired growth of cartilage, defective
bone formation, and therefore more rapid development
of osteoporosis.
10) Vitamin C, 1000 mg/day. Promotes formation
and cross linking of some of the structural
proteins in bone.
11) Vitamin K 45 mg per day. A required vitamin
for the production of osteocalcin which is a
protein matrix on which mineralization occurs.
Osteocalcin has been shown to attract calcium
to bone tissue.
12) EFA’s 1 gm/day of EPA and DHA. They
are called Essential Fatty Acids for a reason,
known to work as an anti-inflammatory, especially
to joints.
BOTANICAL
MEDICINE
1) Trifolium pretense (Red Clover)
In a study of 50 postmenopausal women given
Red Clover daily, bone mass density (BMD) increased
by 4% and as an added benefit a 21% increase
in HDL.
2) Urtica dioica (Stinging Nettles)
Is a plant rich in calcium, magnesium, and silicic
acid, a form of silicon the body can readily
use.
3) Cimicifuga racemosa (Black Cohosh)
Study published in Menopause, 2006 suggested
a correlation between Black Cohosh and the stimulation
of bone building cells.
4) Matricaria recutita (Chamomile)
Contains alpha bisabolol and chamazulene which
are anti-inflammatory in nature via inhibition
of arachadonic acid metabolism.
5) Equisetum arvense (Horsetail)
Known to increase connective tissue tone and
resistance, act as a diuretic without altering
the electrolyte balance, and helps heal tissue.
Horsetail is one of the richest plant sources
of silicon, and contains other crucial trace
minerals such as, potassium, manganese, and
flavonoids.
6) Taraxacun officinalis (Dandelion greens)
Best known as a liver and gall bladder detoxifier,
dandelion contains approx 1 mg of boron and
200 mg of calcium in just 10 gms of dried dandelion
shoots. It also contains sterols which have
an anti-inflammatory effect on the body and
will play a role in hormone balancing.
If
you’re feeling overwhelmed by the thought
of taking all these pills on a daily basis,
don’t be. There are several highly reputable
companies that have taken the available data
and combined the above list into 1-2 different
products. So instead of taking 12 different
supplements you may obtain nearly all the above
list in one product which is often prescribed
as 2 pills, taken 2-3 x/day. These products
are available only through a licensed naturopathic
physician. We also carry these products in our
own medicinary. So stop by to begin caring for
the bones that carry you everywhere every day.
The effort put forth now will reward you with
great strength and mobility for many, many years
to come.
If
you need help designing a treatment plan specific
to you, call the office at (480) 767-7119 and
make an appointment with Dr. Ardolf.
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