Osteoporosis

Osteoporosis, which literally means ‘porous bone’ is a progressive reduction in normal bone mineral density, mass, and strength resulting in marked bone thinning and vulnerability to fracture.  Although bone mass normally declines by 1.5 – 2% per year in both sexes after the age of 40, women are at greater risk since their peak bone mass is naturally less than that of men due to their smaller size and muscle mass.  Osteoporosis is uncommon in men and is typically due to some underlying cause such as longterm use of anti-convulsants or steroid drugs, alcoholism or thyroid problems.  In women, osteoporosis is quite common, occurring in approximately one in four women after the menopause and is due, in part, to the drop in progesterone and oestrogen – both of which play important roles in maintaining bone mass.  Osteoporosis may affect the entire skeleton, but bone loss is usually greatest in the spine, hips, and ribs as these bear a great deal of weight and are susceptible to pain, deformity or fracture.

• Usually none
• Backache
• Bone density test showing demineralisation of the spine and pelvis.

• Loss of height
• Deformed spinal column with humps
• Fractures, especially of the hip, arm, wrist, occurring with minor injury
• Severe backache
• Sudden back pain with a cracking sound indicating vertebral (spinal bone) fracture
• Hip fracture

• Longterm use of steroid or anti-convulsant drugs
• Hyperthyroidism (over-active thyroid)
• Increased parathormone hormone levels
• Alcoholism
• Crohn’s disease
• Cystic fibrosis
• Hormonal deficiencies

• Inadequate stomach acid – in order for calcium to be absorbed in the intestines it must first be made soluble and ionised by stomach acid.  Sufferers with inadequate stomach acid absorb only about 4% of an oral dose of calcium carbonate (the most widely utilised form of calcium for nutritional supplements, being neither soluble or ionised – even people with normal stomach acid absorb only 22% of an oral dose of this form of calcium).
• Inability to convert vitamin D to its most active form – the form that stimulates the absorption of calcium and which is made in the body.  The enzyme need to convert this active form of vitamin D is affected by oestrogen, magnesium and boron and a deficiency in any of these will inhibit conversion.
• Low levels of oestrogen and progesterone after menopause.  When oestrogen levels drop during the 3-5 year period around menopause, the osteoclasts (the cells that remove dead portions of demineralised bone) become more sensitive to parathormone hormone – this hormone signals osteoclasts to increase their activity.  In addition, the drop in oestrogen that occurs during menopause triggers the inflammatory mediator interleukin-6 which stimulates the growth of additional osteoclasts, thus increasing bone loss.  Progesterone stimulates osteoblasts (the cells that pull calcium, magnesium and phosphorus from the lood to build bone mass)
• Lifestyle factors – coffee, alcohol, smoking, all cause a negative calcium balance – more calcium being lost than is taken in.  Lack of exercise, especially weight-bearing exercise, stimulates osteoblasts to build more bone.  In contrast, inactivity double the rate of urinary and faecal calcium excretion.  Lack of sun exposure – sunlight is the first step in the body’s production of the active form of vitamin D, which controls calcium absorption.
• Dietary factors include:

1. Soft and fizzy drinks – these drinks contain a large amount of phosphates and virtually no calcium.  When phosphate levels are high, calcium levels are low as calcium is pulled out of the bones to balance things up.
2. High protein diets – these foods are acidic in the body and a slightly alkaline body chemistry is required for good bone health.
3. Refined sugar – promotes acidic body chemistry.  Following sugar intake, the urinary excretion of calcium increases.
4. Inadequate intake of leafy green vegetables – these provide a broad range of vitamins and minerals necessary for bone health, including vitamin K and boron.
5. Inadequate consumption of magnesium – when magnesium levels are insufficient, a decrease occurs in the active form of vitamin D.  Also, magnesium is needed for the proper balance of the hormones responsible for proper calcium concentration levels in the blood.
6. Inadequate consumption of vitamins B6, B12 and folic acid – low levels of these vitamins lead to a build up of homocysteine – which has been demonstrated in menopausal women to interfere with the collagen cross linking leading to defective bone matrix.
7. Inadequate consumption of vitamin C – necessary for secretion of intercellular substances by all cells, including the formation of osteoid (a cartilage-like material in which calcium is deposited) by the osteoblasts.

• Regular weight-bearing exercise – jogging, trampoline, brisk walking, dancing etc.
• Don’t smoke
• Limit alcohol consumption to less than three servings per week.
• Don’t drink fizzy or soft drinks.
• Don’t drink more than two cups of coffer per day.
• Enjoy some sunshine – to ensure vitamin D production, a 40-year-old women should spend 10-15 minutes twice each weak in direct sunlight.  After age 65, sun exposure should be increased to 30-60 minutes two or three times a week.
• Avoid processed foods.  Their high salt and sugar content make them a bad choice for bone health.
• Consume a nutrient dense, primarily vegetarian diet, rich in whole, unprocessed, preferably organic foods, especially  plant foods (leafy green and other vegetables, fruits, beans, wholegrains, seeds and nuts), and cold-water fish.