In this age of information technology we are bombarded with misinformation. Take Osteoporosis, for instance. The word Osteoporosis has a Greek origin. Osteo means "bone" and poros means “porous,” so osteoporosis is a condition in which the bones become more porous, brittle and fragile. I like to think of Osteoporosis or Osteopenia as a condition, not a disease. Therefore, it is reversible, treatable, and preventable, but also dangerous if we choose to ignore it. The skeleton makes our body stand, and without good bones and good muscle mass we will crumble. The good news about maintaining good bone health is that not only will it allow keep us upright, but higher bone density is also associated with improved cardiovascular health. (1) I don’t know about you, but if youthful bone mass allows me to stand straight and offers less cardiovascular mortality, sign me up.
It is well known that Osteoporosis affects elderly populations, but let’s see who really is at risk by taking a look at the many risk factors that can contribute to osteoporosis.
Vitamin D Deficiency
Vitamin D deficiency is rampant among many people living north of the equator, but even below the equator, people are at risk if they always stay indoors. Those with low levels of vitamin D should supplement with vitamin D3 (the active form) and maintaining good Vitamin D levels of 60 to 80 can help decrease risk not only of osteoporosis, but of several cancers.
Bone Density Tests
When I see patients for the first time I measure their height and ask how that compares with the height in previous years. Loss of height results from compression fractures in the spine due to osteoporotic bone that cannot support the body weight. One contributing factor can be osteoporosis in the spine or eating a mono-diet (my name for always eating the same food) or an eating disorder that can hamper bone mass growth.
The density of the affected bones can be tested by a DEXA scan. When the scan registers between 1.0 and 2.5, the patient has osteopenia. When the scan registers more than 2.5, the patient has Osteoporosis. But DEXA scans are a less than perfect way to detect bone loss, as they only test samples from a wrist, four sections of the lumbar spine, and the left or right hip, then make an estimate. However, if you had two osteopenic vertebra and only one osteoporotic vertebra, the scan will read it as osteopenia- giving you a false sense of security by not declaring you at risk of a hip fracture. The second qualm I have with the study is that Insurance companies and Medicare only allow you to take one every 2 years. So, let’s say your reading was very close to osteoporosis but did not meet criteria (-2.5 on the DEXA scan). As a doctor, after putting in place all necessary remedies, I would not want you to wait two years to see if those treatment plans are working. Even if you have Osteoporosis, they will only pay for the study every 2 years if you can show that you have a significant risk. Since we know that many so-called fragility fractures go undiagnosed, we should consider a DEXA scan and blood test that measures bone turnover and bone remodeling if that is indicated. Being proactive can help prevent the risk of future fractures.
We need minerals, vitamins, and a neutral blood PH for good bones. Without getting too complicated, let’s mention Vitamin D, Vitamin C, Vitamin A, B12, and Vitamin K2. Minerals, Calcium, Magnesium, Bicarbonate, and sodium. All of these play a role in bone health. Unfortunately, the hype of low body weight and diets that seem healthy but are not has led to a rampant mineral, vitamin and nutritional deficiencies across the board. Not only do I order a Bone Density analysis in Postmenopausal women but also in young women who have had a history of sub-optimal nutrition, whether due to bulimia, anorexia, or overuse of nutrients due to anorexia athletica, compulsive exercise, or if they have been on fad or mono-diets.
The bone is a living organ that is constantly remodeling itself by using minerals such as calcium, phosphorous, magnesium, sodium. This process is influenced by different hormones, starting from Vitamin D and the intestinal absorption of calcium, to vitamin K2 and the adequate utilization and deposition of calcium. When an acidic PH in the blood leaches calcium out of the bone, it can cause a loss of bone density. A sedentary life or immobility of the bone (such as using a collar neck support all day long) can also cause similar results.
Old habits die-hard, and I still see many women and men taking calcium tablets, and data suggests that 50% of elderly men and 70 % of elderly women consume calcium supplements. Let’s just say too much of a good thing may be bad for us. We know that if we are low in vitamin K2, the calcium we consume finds its way to the arteries and forms plaques instead of going to the bones. Large AARP studies and other studies have found that a high calcium diet increases cardiovascular mortality. Studies have also found higher prostate cancer risk in men who consumed excess calcium. I advise my patients to get their calcium intake from leafy green veggies. Green vegetables will also help alkalinize the body and thus prevent the leaching of calcium from the bones.
Coffee- Good or Bad for Bones?
Coffee had been cited as a risk factor for osteoporosis due to its acidity, but there are inconsistent results regarding association of hip fracture except in some women? also in pregnant women consumption of coffee was associated with low birth weight. However, many studies have vindicated coffee, as in the Grosso and Colleagues Meta-analysis studies, which showed that drinking 3 cups a day may offer a 10% lower risk of all causes of mortality, less Parkinson’s disease, less cognitive decline and Alzheimer’s, and lower depression. I think I will stick to my one cup of coffee a day and enjoy it!
I also like to discuss activity habits with my patients. A healthy, active lifestyle does not necessarily mean treadmills or weights. Simple activities like gardening, doing house chores, and dancing can help your bones and muscle mass. Additionally, getting out in the sun will help increase your vitamin D levels.
Many hormones are involved in calcium homeostasis and one of the important ones is a gluco-corticoid produced in the adrenal glands as a response to stress. Therefore, chronic stress can be linked to osteoporosis and patients that are taking prednisone or other corticosteroids may also be at risk for osteoporosis.
Heavy Metal Exposure
One of the important causes of loss of bone mineral density leading to osteoporosis, is Heavy Metal exposure. In particular, metals such as lead, cadmium and arsenic can disrupt bone metabolism, and have a very long half life. This is of particular concern to Baby Boomers. If you are a Baby Boomer you may want to know not only if you have osteopenia or osteoporosis, but how high is your burden of Heavy Metals? A tenet of functional medicine is to test for underlying factors (e.g. Heavy Metals) which affect health status.
The good news is that we can prevent and reverse osteoporosis and not necessarily with potentially dangerous medication. A functional medicine individualized plan is required for each person, using all of the above-mentioned nutrients, lifestyle suggestions and electromagnetic frequencies such as PEMF or Ondamed (specific frequencies have been shown to increase bone density) as an adjunctive treatment for improvement of bone density and/or reversal of osteoporosis.
After examining the facts, the message is clear: not only do we have to make sure that our bone density is normal, but we must guard ourselves and our children against lifestyle habits that may result in losing bone mass. Better yet, we can take charge of our own health and guide our loved ones towards healthier habits for the long haul.
1 International Journal Cardiology, 2013 June 20, 166(2) 385-393.
Margarita Kullick MD is a functional and anti-aging medical physician who is board certified in Internal Medicine. Her areas of interest include holistic primary care, chronic disease management and prevention (diabetes, kidney disease, chronic fatigue, osteoporosis), heavy metal detoxification, hormone replacement therapy, depression/anxiety, brain health and memory loss, and testing of the markers of aging. Dr. Kullick is bilingual in English and Spanish and has contributed as a medical writer for a Hispanic community publication.
1 (Int. J Cardiol, 2013 June 20, 166(2) 385-393.)