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Healthy

  Osteoporosis / Risk  
 
Search treatments and conditions
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations

 

"The silent crippler", as osteoporosis is often called, sneaks up on its victims and, without any pain, gradually causes bones to become more porous and fragile. One day you grab your coat and your wrist snaps; or a friend hugs you and cracks your rib; or you step off a curb and break your hip... Osteoporosis is the chronic loss of bone mass and strength which afflicts over 8 million Americans - one and a half million are subjected to life threatening fractures every year. Of those who endure hip fractures, some 20% die from complications within a year; 60% become dependant on constant help in their daily lives.

It is not strictly a women's disease, though 85% of victims are women. As you age, the need for absorbable calcium, in conjunction with other essential minerals and vitamins, can be increased.

A 2000 statement by an expert panel of National Institutes of Health asserted "Osteoporosis, once thought to be a natural part of aging among women, is no longer considered... gender-dependent." Men start with higher bone density and lose calcium at a slower rate than women, which is why their risk is far lower. Nevertheless, after age 50, bone loss increases, and, according to one 2000 study, more rapidly than previously thought. Men have a 6% risk for hip fracture and between 16% and 25% risk for any fractures related to osteoporosis. And the actual numbers of osteoporosis and fractures in men is bound to grow as baby boomers age. Some risk factors include the following:

Surprisingly, a survey found that even among women with early symptoms of bone loss, including back pain, loss of height, and stooped posture, 82% thought they were not likely to ever suffer the consequences of progressive bone loss. Contradicting these assumptions, most statistics show that nearly 50% of women will suffer an osteoporosis-related fracture sometime during their lives.

Bone mass does not increase beyond a "peak density" after age 35. The loss of bone mass can be slowed and lost bone mass regained somewhat with the right treatments. Dairy product consumption is not an appropriate treatment to accomplish this, as it will ultimately accelerate bone loss. However, this fact is ignored by marketing experts in the milk industry who make certain that women this age and older are targeted consumers for milk and dairy products. Within 5 years of the initial onset of menopause, there is an accelerated rate of loss of bone, particularly from the spine. During this period of time, estrogen replacement is somewhat effective in preventing bone breakdown, but progesterone is needed for creating new bone.

Things to avoid for better bone health

  • Avoiding factors that encourage bone loss can be as just as important as calcium intake. Diets high in protein, salt, refined sugar, caffeine, and phosphorous contained in soft drinks, all promote calcium excretion in urine.
  • A diet low in green leafy vegetables can be low in vitamin K. Vegetarians may have greater bone mass than meat eaters, but some studies have not found this correlation.
  • Other habits to curtail include heavy smoking, excess alcohol consumption, and limited sunshine exposure or vitamin D intake.
  • Prescription drugs can increase bone loss. These include cortisone, blood thinners, antacids containing aluminum, chemotherapy, lithium, and certain antibiotics.
Things to do for better bone health
  • Reduce animal protein consumption.
  • You can reverse bone loss and regain bone mass with calcium, magnesium, vitamin D, and vitamin K. Minimum doses should be in the following ranges: calcium (1200mg), magnesium (400-800mg) vitamin D (400 IU - consider supplementing in the winter months in females), and vitamin K (80mcg). Calcium comes in many forms, so use those which are more absorbable such as hydroxyapatite, citrate, gluconate, and others. Some special preparations have been shown to increase bone density without the use of any other nutrients.
  • Building and maintaining bone early in life (up until the 40s) will delay or prevent the appearance of bone loss problems.
  • Exercise strengthens bones.
  • Estrogen and progesterone are known to provide benefit. The natural forms are best to use for many reasons. As explained below, and when appropriate, they should be used in combination. A recent study, however, has contested the benefit of estrogen use in preventing fractures. Most agree that estrogen does reduce fractures (at several fracture sites) by halting the reduction in bone density. More recent studies have shown that women who start using estrogen in their 70s still have a benefit in their 80s, and that maybe half of the dose of estrogen will do the same job. Estrogens decrease bone resorption, but also decrease bone formation, with an overall effect of reducing loss without substantially increasing bone mass. Natural progesterone, on the other hand, stimulates new bone tissue growth. A three year study of 63 post-menopausal women using progesterone cream for osteoporosis found an average of 7-8% bone mass density increase the first year, 4-5% the second year and 3-4% the third year.
  • Trace minerals (zinc, copper, manganese, and boron) are required for strong bone formation.
  • There is some evidence that the use of statins is associated with a significantly reduced fracture risk compared with the non-use of these lipid-lowering agents. Further study needs to confirm this.
Monitoring bone health
A bone scan can indicate what your current bone mineral density is. Repeated scans (a year or two apart) can tell if you are gaining, losing or just maintaining bone.

A new urine test utilizes the two most specific markers of bone resorption - the collagen crosslinks pyridinium/pyridinoline (PYD) and deoxypyridinium/deoxypyridinoline (DPYD or DPD) - to identify elevated levels of bone loss before excessive damage occurs. This profile enables regular testing of women for resorption rates, allowing treatment intervention at its most effective - before bone loss has occurred. It also allows easy and rapid monitoring of treatment effectiveness. As valuable as bone scan results can be in the definitive diagnosis of osteoporosis, the evaluation cannot be performed often enough for patients who are losing bone at a fast rate.
 

 
 

Signs, symptoms & indicators of Osteoporosis / Risk:
 
 
Lab Values - Hormones  Low TSH

Symptoms - Skeletal

  (Possible) bone pain
 
 

Conditions that suggest Osteoporosis / Risk:
 
 
Autoimmune  Crohn's Disease
 Getting enough calcium and protecting against bone loss is a challenge for those with Crohn's Disease.

Any digestive disorder carries the threat of nutritional deficiency, and Crohn's is particularly tricky. First, the chronic diarrhea and other symptoms of the disease can make it tough to get adequate nutrition from even the healthiest diet. Then, Crohn's patients are often on corticosteroids for long periods of time to relieve the intestinal inflammation. These medications further deplete the system of calcium. These factors explain why, next to the intestinal aspects of the disease, degenerative bone disorders top the list of Crohn's disease complications.

Lab Values - Scans

  Bone loss continuing or bone loss being controlled or bone loss advanced / rapid

Counter-indicators:
  Normal bone density

Musculo-Skeletal

  Rheumatoid Arthritis
 According to researchers, women with rheumatoid arthritis have up to double the risk of developing osteoporosis and those who use steroid drugs to help control the arthritis are at an even higher risk of bone loss. [Arthritis and Rheumatism, March 2000]

Skin-Hair-Nails

  Premature Hair Graying
 Is premature graying of hair associated with other features of accelerated aging - faster bone loss, for example? A study of 293 postmenopausal women has confirmed that early hair graying and greater bone loss tend to occur together. The lower bone density was especially apparent in the hip region.

The authors found that when they adjusted bone mineral density for age and weight, there was a clear connection between the age of onset of hair graying and bone density. "Age- and weight-adjusted bone mineral density (BMD) was significantly lower in those with the majority of their hair graying during their thirties compared with those in whom it occurred in their forties." Premature hair graying before the age of 40 was associated with a lower BMD at most skeletal sites. Also, women who started graying extremely early in life, already in their twenties, had lower bone density than those who started graying in their thirties. [J Clin Endo Metab 1997; 82: pp.3580-83]
 
 

Risk factors for Osteoporosis / Risk:
 
 
Aging  Premature/Signs of Aging

Autoimmune

  Gluten Sensitivity / Celiac Disease
 A study concluded that reduced mineralization occurs even in asymptomatic celiac patients, and that early diagnosis and treatment can prevent bone demineralization. [Am J Gastroenterol 1994;89: pp.2130-4]

  Ulcerative Colitis
 Scientists believe osteoporosis may occur when the immune system triggers inflammation in other parts of the body. These problems are usually mild and go away when the colitis is treated.

Cell Salts

  Cell Salt, Calc Phos Need

Circulation

  Anemia, Megaloblastic
 March 3, 2004 – Older women with low levels of vitamin B-12 are more likely to experience rapid bone loss, according to new research published in The Journal of Clinical Endocrinology & Metabolism. The new findings help to establish the importance of vitamin B-12 in the bone health of women as they age.

  Thrombocytosis

Diet

  Excess Protein Consumption
 It has been commonly thought that high protein intakes may contribute to a loss of calcium, leading in turn to the development of osteoporosis. This may not be the case. In 2004, scientists from the Bone Metabolism Laboratory at Tufts University reported that men and women who increased their dietary protein by an average of 58 grams a day had 25% higher levels of bone growth factor and lower levels of a marker of bone resorption compared with a control group. Two other studies have demonstrated similar results suggesting that a higher protein diet does not increase the risk of osteoporosis.

Digestion

  Atrophic Gastritis
 Stomach acid is required to enhance the absorption of minerals such as calcium. Reduced calcium absorption encourages bone loss.

Hormones

  Low Testosterone Level
 Osteoporosis is hasteded by hormonal deficiencies, including both testosterone and estrogen, which occur in older men (although much more slowly than in women). Estrogen deficiencies may also a play a major role in osteoporosis in older men. Some 30% of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men with testosterone deficiency have subnormal bone density that puts them at risk of fractures.

  Hyperparathyroidism

Lab Values

  Elevated Homocysteine Levels
 Elevated homocysteine levels disrupt collagen-forming processes in the body and raise the likelihood of developing osteoporosis.

  Elevated Cortisol Levels
 If a woman is not ovulating she may have lower estrogen and progesterone levels. Low estrogen levels can increase the activity of osteoclasts (bone breakdown cells) while low progesterone has been shown to increase PMS symptoms and slow bone deposition. Also, to provide the extra calcium needed when faced with intense stress situation, cortisol can directly stimulate bone breakdown cells. Unchecked over a long period of time, high cortisol levels can cause you to lose bone faster than you can rebuild it.

Metabolic

  Acidosis
 Acidic diets (high in protein and refined food) will cause bone calcium leaching in order to maintain your blood pH balance. Chronic leeching of calcium from the bones increases the likelihood of osteoporosis. [Am. J. Clin. Nutr. 2001: 73, pp.118-122, Lancet 1968:1, pp.958-959]

  Anorexia / Starvation Tendency
 The common medical complications of anorexia/starvation include osteoporosis.

Nutrients

  Manganese Requirement
 Individuals with osteoporosis sometimes have low blood levels of manganese. [Raloff J. Reasons for boning up on manganese. Science Sep 1986, 199 [review]]

  Vitamin A Requirement

Supplements and Medications

  (Past) PPI antacid use
 Use of the drugs proton pump inhibitors (PPIs) for the treatment of acid-related diseases such as gastro esophageal reflux disease (GERD) is associated with a greater risk of hip fracture, according to a study in the December 27, 2006 issue of JAMA.

  History of using Fosamax
  History of Evista use
  Taking no/taking minimal calcium supplement
  Using high dose T4
  Desiccated thyroid use
  Using synthetic T3

Counter-indicators:
  Using Evista for over/using Evista for less than a year
  Using Fosamax
  Taking calcium supplement

Symptoms - Cancer

  History of testicular cancer
 Medical conditions that can reduce testosterone levels, which increases the risk of osteoporosis, includes prostate cancer treatments, testicular surgery, and mumps.

Symptoms - Food - Beverages

  Sugared soft drink consumption
 A study of 460 teenage girls carried out by a researcher from Harvard Medical School in Boston, Mass. found a significant link between the quantities of cola and other carbonated drinks they consumed and bone fractures, which increased when the girls were very physically active.

Grace Wyshak reports in the medical journal Archives of Pediatrics and Adsolescent Medicine that nearly 80% of the girls consumed carbonated drinks. Approximately 20% of them had suffered bone fractures and the fizzy drink lovers were three times more likely to have a fracture than the rest. Those who reported a high level of physical activity and drank carbonated drinks had nearly five times the risk of fracture.

The study suggests that the changed patterns in drinking and eating of recent decades may be having an effect on the bone structure of young girls which could persist into later life. Dr. Wyshak speculates that the phosphorous contained in carbonated drinks may have a damaging effect on the bone, by altering the phosphorous-calcium ratio. However, the cola theory is undercut by the fact that phosphorus is so plentiful in the diet. Many foods contain more phosphorus than colas.

Soft drinks often contain caffeine, phosphoric acid and sugar, all of which can have a negative effect on calcium balance. Sugar intake increases calcium loss in the urine. It would be best to avoid the use of such drinks, even though the mechanism of action has not yet been fully explained.

Would carbonated mineral water have a negative effect on calcium balance? Possibly, because carbonation makes the drink more acidic, but definitely not to the degree of a soft drink containing sugar, phosphoric acid, and caffeine.

  Caffeinated soft drink consumption
 Regular consumption of caffeinated carbonated beverages has been associated with increased risk of bone fracture both earlier and later in life, yet the contributions of the individual components of these beverages to calcium loss is unclear. The per capita consumption of carbonated beverages has risen dramatically, making them the preferred beverage of women 20-40 years old, many of whom already have an inadequate daily intake of calcium.

The effect of caffeinated and noncaffeinated beverages on urinary calcium excretion was measured in a group of 30 women with an average age of 31 years. The subjects habitually drank from two to seven 12-ounce cans of carbonated beverages daily; 27 drank predominantly colas.

Though the caffeine in the drinks was primarily responsible for excess calcium excretion, previous studies of the effect of caffeine have shown a compensatory drop in calcium excretion over the 24-hour period following ingestion. The fact that the small calcium loss from carbonated beverages was offset by reduced excretion later in the day, and the habituation of the subjects to frequent consumption, lead the authors to conclude that the main cause of calcium loss from carbonated beverages was their lack of nutrients needed for bone health. [Heaney, Rafferty; Am. J of Clin. Nutr., August 2001]

  Low-calorie soft drink consumption

Counter-indicators:
  High/moderate alcohol consumption
 ASN Spokesperson Stephanie Atkinson, PhD, explained the study which looked at the effects of alcohol on bone mineral density in older people, and said that "moderate alcohol consumption was shown to contribute to stronger bones (measured as hip and spine bone mineral density). The positive effect on bone was most notable at 1-3 glasses of beer in men and more than 2 glasses of wine or liquor (but not beer) for women. The bone preserving ingredients may be the silicon in beer and resveratrol in wine in addition to the alcohol. Such positive effects on bone must be balanced against the risk of falls and bone fractures caused by consuming excessive alcohol." [16 Mar 2009]

Symptoms - Food - Intake

  (High) dairy product consumption
 One study, funded by the National Dairy Council (NDC), involved giving a group of postmenopausal women three 8-ounce glasses of skim milk per day for two years and comparing their bones to those of a control group of women not given the milk. The dairy group consumed 1,400mg of calcium per day and lost bone at twice the rate of the control group. The adverse effect of increases in animal protein intake (such as cow's milk) on calcium balance has been reported from many studies. This effect is probably less pronounced in younger people.

Needless to say, this study was not published by the NDC.

Symptoms - Skeletal

Counter-indicators:
  Absence of osteoporosis

Uro-Genital

  Amenorrhea
 Amenorrhea associated with reduced estrogen levels increases the risk for osteoporosis (loss of bone density). This is may be particularly dangerous from amenorrhea that occurs in young female athletes and those with eating disorders. Because bone growth is at its peak in adolescence and young adulthood, losing bone density at that time is very dangerous, and early diagnosis and treatment is essential for long-term health.

  Postmenopausal Status / Issues
 
 

Osteoporosis / Risk suggests the following may be present:
 
 
Aging  Premature/Signs of Aging

Cell Salts

  Cell Salt, Calc Phos Need

Circulation

  Thrombocytosis

Metabolic

  Anorexia / Starvation Tendency
 The common medical complications of anorexia/starvation include osteoporosis.

Musculo-Skeletal

  Rheumatoid Arthritis
 According to researchers, women with rheumatoid arthritis have up to double the risk of developing osteoporosis and those who use steroid drugs to help control the arthritis are at an even higher risk of bone loss. [Arthritis and Rheumatism, March 2000]
 
 

Recommendations for Osteoporosis / Risk:
 
 
Botanical  Horsetail Grass (Equisetum arvense)
 Horsetail contains silicon, and it has been suggested as a possible natural treatment for osteoporosis. One study has examined horsetail for osteoporosis. In that study, 122 Italian women took horsetail dry extract or Osteosil calcium 270 mg twice daily (a horsetail-calcium combination used in Italy for osteoporosis and fractures). Although both groups who took horsetail did improve bone density, the study was poorly designed.

  Green / Oolong / BlackTea (Camellia sinensis)
 Drinking regular tea was associated with a small improvement in bone mineral density, but was not associated with the risk of hip or forearm/wrist fractures. This study was done in the United States using 4,979 women over 50 years old who were followed for an average of 4years. [Am J Epidemiol 2003;158(8): pp.772-81]

Diet

  Dairy Products Avoidance
 Harvard University's landmark Nurses' Health Study, which followed 78,000 women over a 12-year period, found that the women who consumed the most calcium from dairy foods broke more bones than those who rarely drank milk. Summarizing this study, the Lunar Osteoporosis Update (November 1997) explained: "This increased risk of hip fracture was associated with dairy calcium. If this were any agent other than milk, which has been so aggressively marketed by dairy interests, it undoubtedly would be considered a major risk factor."

A study published in the January, 2001 edition of the American Journal of Clinical Nutrition examined the diets of 1,035 women, particularly focusing on the protein intake from animal and vegetable products. Deborah Sellmeyer, M.D., found that animal protein increases bone loss. In her study, women with a high animal-to-vegetable protein ratio experienced an increased rate of femoral neck bone loss. A high animal-to-vegetable protein ratio was also associated with an increased risk of hip fracture. Dr. Sellmeyer states: "Sulfur-containing amino acids in protein-containing foods are metabolized to sulfuric acid. Animal foods provide predominantly acid precursors. Acidosis stimulates osteoclastic activity and inhibits osteoblast activity."

Milk has been called "liquid meat". The average American eats five ounces of animal protein each day in the form of red meat and chicken, at the same time consuming nearly six times that amount (29.2 ounces) per day of milk and dairy products. How ironic it is that the dairy industry continues to promote the cause of bone disease as the cure!

Many foods naturally contain an abundance of calcium. One must wonder why Asians traditionally did not get bone-crippling osteoporosis... that is, until they adopted the "American Diet", a diet of milk and dairy products.

  Sugars Avoidance / Reduction
  Caffeine/Coffee Avoidance
  Vegetarian/Vegan Diet
 Calcium loss is reduced with a vegetarian type diet.

A study published in the January, 2001 edition of the American Journal of Clinical Nutrition examined the diets of 1,035 women, particularly focusing on the protein intake from animal and vegetable products. Deborah Sellmeyer, M.D., found that animal protein increases bone loss. In her study, women with a high animal-to-vegetable protein ratio experienced an increased rate of femoral neck bone loss. A high animal-to-vegetable protein ratio was also associated with an increased risk of hip fracture. Dr. Sellmeyer states: "Sulfur-containing amino acids in protein-containing foods are metabolized to sulfuric acid. Animal foods provide predominantly acid precursors. Acidosis stimulates osteoclastic activity and inhibits osteoblast activity."

A 1994 report in the American Journal of Clinical Nutrition showed that when volunteers are switched from a typical American diet to a diet eliminating animal proteins, calcium losses were reduced to less than half of baseline values. [Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am Clin Nutr 1994;59:1356-61]

Higher consumption of fruits, vegetables and cereals was associated with greater femoral bone mineral density (in men) in a study of 907 older adults. [Am J Clin Nutr 2002;76(1): pp.245-252]

  Alcohol Avoidance
 Alcohol is toxic to the cells that form bones and inhibits the absorption of calcium.

  Alcohol Consumption
 ASN Spokesperson Stephanie Atkinson, PhD, explained the study which looked at the effects of alcohol on bone mineral density in older people, and said that "moderate alcohol consumption was shown to contribute to stronger bones (measured as hip and spine bone mineral density). The positive effect on bone was most notable at 1-3 glasses of beer in men and more than 2 glasses of wine or liquor (but not beer) for women. The bone preserving ingredients may be the silicon in beer and resveratrol in wine in addition to the alcohol. Such positive effects on bone must be balanced against the risk of falls and bone fractures caused by consuming excessive alcohol." [16 Mar 2009]

  Soy Isoflavones (genistein, daidzein)
 Higher intake of dietary phytoestrogens (isoflavones) was associated with higher lumbar spine and hip bone mineral
densities in a study of 357 postmenopausal southern Chinese women. [J Clin Endocrinol Metab 2001;86(11): pp.5217-5221]

One month of treatment with a soy isoflavone extract reduced the excretion of bone resorption markers, in a placebo-controlled study of 23 healthy perimenopausal women. [J Am Coll Nutr 2002;21(2): pp.97-102]

Another showed that postmenopausal women with the highest level of isoflavone consumption had greater bone mineral density at the spine. [J Women's Health Gender-Based Med, 2002;11(1): pp.69-78]

If using soy products to reduce osteoporosis risks, consider taking 80mg or more per day of soy isoflavones. One year of supplementation with a soy extract containing 80mg isoflavones in addition to calcium (500mg) and vitamin D3 (125IU) modestly improved hip and trochanter bone mineral density among women with low initial bone mass, compared with placebo OR a lower dose of soy extract containing only 40mg isoflavones with calcium and vitamin D3. This was the conclusion from a well-controlled study of 203 Chinese postmenopausal women. [ J Clin Endocrinol Metab 2003;88(10): pp.4740-7]

Ipriflavone (7-isopropoxyisoflavone) is a synthetic derivative of naturally occuring isoflavones, flavonoid compounds found in soybeans and other plants.

For some time, postmenopausal women in Europe and Japan have taken ipriflavone supplements to maintain the density and strength of their bones and to guard against fractures and other complications associated with the bone-thinning disease known as osteoporosis.

In the United States, ipriflavone supplements have recently become available. Ipriflavone's bone-strengthening effect is enhanced by taking both vitamin D and calcium along with it.

Because ipriflavone does not have direct estrogenic effects, it may be suitable for use in aging men with bone loss, as well as in women.

However, in 2006, a separate analysis of isoflavones, a component of soy, was also carried out. Dr. Frank Sacks, a professor of nutrition at the Harvard School of Public Health in Boston. According to Dr. Sacks, there are is no evidence that it could reduce symptoms of menopause like 'hot flashes' or even osteoporosis.


Not recommended:
  High/Increased Protein Diet
 After looking at 34 published studies in 16 countries, researchers at Yale University found that countries with the highest rates of osteoporosis including the United States, Sweden, and Finland are those in which people consume the most meat, milk, and other animal foods. They also found that African Americans, who consume on average more than 1,000mg of calcium per day, are nine times more likely to experience hip fractures than are South African blacks, whose daily calcium intake is only 196mg. On a nation-by-nation basis, people who consume the most calcium have the weakest bones and the highest rates of osteoporosis. Only in those places where calcium and protein are eaten in relatively high quantities does a deficiency of bone calcium exist, due to an excess of animal protein. The association between the intake of animal protein
and fracture rates appears to be as strong as the association between cigarette smoking and lung cancer.

HOWEVER, it was found that although protein intake in the presence of a low-calcium diet may increase net calcium spill in the urine and aggravate bone loss, adequate protein (average 80gm per day from all sources) and calcium intake (along with vitamin D) taken together act synergistically to reduce bone loss and have improved hip fracture healing and lessened the recurrence of hip fracture. [Am J Clin Nutr, 2002; 75:pp. 609-610, 773-779]

So if you have osteoporosis and prefer a higher protein diet, just make sure you are getting enough or the right kind of calcium and vitamin D.

Drug

  Conventional Drugs / Information
 Servier, a leading independent French research-based pharmaceutical company, discovered and developed Protelos. Protelos has been recently licensed across Europe in the treatment of postmenopausal osteoporosis to reduce the risk of vertebral and hip fractures. It is the first agent of its kind with a dual action on bone metabolism, simultaneously increasing bone formation and decreasing bone resorption. This action rebalances bone turnover in favour of the formation of new and strong bone.

The results of two large-scale phase III clinical trials have shown that Protelos is effective at reducing the risk of vertebral and hip fractures in postmenopausal osteoporotic women. Results published in the New England Journal of Medicine from the first major clinical trial show that in women with existing vertebral fractures the risk of new vertebral fractures is halved within a year and in the longer-term. This efficacy has also been confirmed in patients without fracture at baseline. Recent results from the second major clinical study show that Protelos also significantly reduces the risk of hip fracture in postmenopausal osteoporotic patients . These results show the efficacy of Protelos whatever the severity of the disease and the site of fracture. Throughout its development Protelos was shown to be safe and well tolerated. Protelos is easy for patients to take; one sachet daily diluted in water taken at bed time.

Although Evista is frequently recommended for osteoporosis, a study indicated that calcium and vitamin D alone may produce the same benefit.

Two years of treatment with calcium at 500mg per day and vitamin D3 at 400-600IU per day plus placebo increased iliac crest bone mineral density similarly to calcium and vitamin D3 plus raloxifene (Evista; 60 mg/d or 120 mg/d) in a randomized, three-arm study of 54 postmenopausal women with osteoporosis. Compared to baseline, all treatments shifted the mean degree of bone mineralization to closely resemble that of premenopausal bone. [ J Clin Endocrinol Metab 2003;88(9):4199-4205]

A long-term study of the most widely used osteoporosis drug has found that many women can discontinue the drug after five years without increasing their fracture risk for as long as five more years.

The study on alendronate (fosamax) was led by researchers at the University of California, San Francisco, and findings are published in the December 27, 2006 issue of the "Journal of the American Medical Association." The research also showed that women at very high risk of painful spine fractures might be better-off continuing treatment.

"This has important implications as it has not been known whether treatment of osteoporosis should be continued indefinitely," said lead author Dennis Black, PhD, professor in the UCSF Department of Epidemiology and Biostatistics. "Because women with osteoporosis, particularly older post-menopausal women, often need to take multiple drugs, this would be welcome news for this group."

Fosamax Once Weekly (alendronate sodium) increased bone mineral density (BMD) more than Actonel Once-a-Week (risedronate) with similar tolerability, according to results of the Fosamax Actonel Comparison Trial (FACT). This is the first U.S. head-to-head study comparing FDA approved once weekly osteoporosis treatments in postmenopausal women with osteoporosis. In this study, Fosamax provided greater increases in BMD at all sites measured as early as six months, and lowered levels of biochemical markers of bone turnover further within the normal pre-menopausal range than Actonel within three months. Reducing and stabilizing bone turnover, which leads to increased bone density, are important factors in improving bone strength in patients with osteoporosis.

However, Merck, maker of osteoporosis drug Fosamax, may have “seriously under reported” the risks of "jawbone death" related to the drug, according to the American Association of Oral and Maxillofacial Surgeons. A class-action lawsuit has been filed claiming that Merck knew about the risk of jawbone death but hid it from the public.

"Jawbone death" is associated with the use of a bisphosphonate class of drugs (to which Fosamax belongs). Also known as Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ), is a serious side effect that destroys the bone in the jaw, and is difficult to treat.

BRONJ was reported by oral surgeons, who noticed the condition among patients treated with intravenous forms of bisphosphonates in 2003. A broader warning of BRONJ was issued for the entire class of drugs in 2005.

Fosamax is prescribed to about 10 million men and women -- mostly postmenopausal women -- each year to help increase bone density, with annual sales of $3 billion. Over 190 million prescriptions for oral bisphosphonate drugs have been dispensed worldwide. [LawyersAndSettlements.com July 19, 2007]

Habits

  Aerobic Exercise
 Physical activity may help reduce fracture risk by enhancing bone strength and improving bone quality.

Please read the following study summary carefully. It demonstrates the value of exercise.

Twelve months of supplementation with calcium citrate (800mg) plus exercise (aerobic, weight-bearing and weight-lifting exercise three times per week) increased trochanteric bone mineral density among women who did not use hormone replacement therapy (HRT) in a study of 320 healthy, non-smoking postmenopausal women who did or did not use HRT. HRT users who exercised and took calcium experienced increased femoral neck, trochanteric and lumbar spine BMD, while women who used HRT and calcium but did not exercise had no change in BMD. [Osteoporos Int 2003;14(8):637-43]

  Sunlight / Light Exposure
  Tobacco Avoidance
 Studies have shown that women who smoke one pack of cigarettes per day have on average 5-10% less bone density at menopause than do nonsmokers.

Lab Tests/Rule-Outs

  Test for Bone Resorption

Mineral

  Calcium
 A study found that a supplement containing calcium, manganese, zinc and copper prevented bone loss in postmenopausal women, whereas calcium alone was ineffective. Calcium supplements for osteoporosis should contain other minerals as well, or the form of calcium used should have been proven to be of benefit.

Intake of supplemental calcium (1000mg per day or more) and vitamin D was associated with reduced tooth loss (due to bone loss) over a five year period in a study of 145 healthy subjects aged 65 years and older who completed a 3-year trial of the effect of calcium and vitamin D supplementation on bone loss from the hip, as well as a 2-year follow-up study after discontinuation of the study supplements. [Am J Med 2001;111(6): pp.452-56]

The recommended daily intake levels for prepubertal children (ages 4-8 years) is 800 mg/day; adolescents (ages 9-18 years), 1300 mg/d; pregnant or lactating women (18 years), women and men (ages 19-50 years), 1000 mg/d;
women and men over 50 years, 1500 mg/d.

Another study concluded: "The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance. It may be appropriate to explore alternative nutritional interventions, such as increasing vitamin D concentrations and intake of fruit and vegetables." [BMJ Sept 2006]

These results with calcium are not that encouraging. However, there are products using compounds of calcium which have been proven to reverse osteoporosis. Examples are AdvaCAL, 3A Calcium (Active Absorbable Algal) and a new one - AlgaeCal Plus.

All 400 participants have now completed the first 6 months of the AlgaeCal Bone Health Program, and results are exceeding expectations by reversing bone loss, and increasing bone mineral density in post menopausal women.

C.E.O. of AlgaeCal International Dean Neuls says "we are very excited with these results because our natural osteoporosis treatment is accomplishing what no other calcium supplement has been able to do; we are actually reversing bone loss."

AlgaeCal International and Integrative Health Technologies Inc (IHTI) launched an independent clinical trial to study the effectiveness of the AlgaeCal Bone Health Program. The program is a natural osteoporosis treatment that consists of a plant based calcium supplement, a strontium citrate supplement and an exercise program.

Kaats, adds "Although only a few subjects have now completed the one-year tests, analysis of the 6-month test results revealed that instead of the expected decline in bone mineral density, over two-thirds of women over 50 years of age increased their bone densities. Subjects in the 50+ adult group achieved an annualized increase in bone density of over 1% instead of the expected 1% decline for people of this age." Kaats goes on to say "The most dramatic improvement was found in a 64-year old woman who improved her bone density at a 10% a year rate and a cancer patient being treated with chemotherapy who also improved his bone density." Here is a link to the AlgaeCal home page, where these products can be ordered.

  Magnesium
 A high percentage of the American population is considered to have some degree of magnesium deficiency [JAMA 1990, 263: 3063]. In a study, magnesium supplements were given to 19 postmenopausal women on estrogen replacement therapy with low bone density. After 1 year of magnesium supplementation 12 of the women no longer had low bone density [J Reprod Med 1990, 35: p.503]. Magnesium supplementation has been associated with a 1 - 8% increase in bone density [Magnesium Research 1993, 6: p.155].

  Salt Intake Reduction
 Sodium (salt) tends to leach calcium out of the bones.

Vitamins

  Vitamin K1/K2
 In a 3 year study of postmenopausal women, vitamin D, minerals and vitamin K were used to determine vitamin K's effect on bone loss. The use of vitamin K, along with other nutrients, reduced femoral neck bone loss, but not lumbar spine bone loss when compared to a similar supplement list without vitamin K. [Calcif Tissue Int 2003;73(1): pp.21-6]

Numerous studies published in 2008 have shown that vitamin K not only helps regulate calcium balance in the body to ensure calcium remains in the bones and away from heart valves and arteries, but it has demonstrated numerous other health benefits. In addition, scientists have been able to develop a form of the nutrient that stays in the body longer than previous forms and is more cost effective to purchase.

Maintaining consistent levels of calcium is essential, especially as we age. Studies have shown that a vitamin K2 deficiency can lead to brittle bones and hardening of the arteries. Conversely, a new study shows that restoring the nutrient can actually reverse the normal aging process of arterial calcification. Another study published in 2008 demonstrated that postmenopausal women in Japan who took both Fosamax and vitamin K2 for one year had a greater increase in neck bone density than women who only took Fosamax. And an in vitro study published in January 2008 led doctors to conclude that taking a combination of vitamins D3 and K1 can offer a "low-cost strategy for laying down new bone material."

"Clinically, vitamin K2 sustains the lumbar bone mineral density (BMD) and prevents osteoporotic fractures in patients with age-related osteoporosis, prevents vertebral fractures in patients with glucocorticoid-induced osteoporosis, increases the metacarpal BMD in the paralytic upper extremities of patients with cerebrovascular disease, and sustains the lumbar BMD in patients with liver-dysfunction-induced osteoporosis. Vitamin K deficiency, as indicated by an increased circulating level of undercarboxylated osteocalcin, may contribute to osteoporotic fractures. Even though the effect of vitamin K2 on the BMD is quite modest, this vitamin may have the potential to regulate bone metabolism and play a role in reducing the risk of osteoporotic fractures." [Iwamoto J, Takeda T, Sato Y. Curr Pharm Des 2004; 10:pp. 2557-2576.]

So for osteoporosis prevention and treatment, vitamin D, vitamin K2, and calcium, used in combination should result in the desired effect.


Not recommended:
  Vitamin A
 In a study of 72,337 women aged 34-77 years, there were 603 incidences of hip fracture. Women taking a vitamin A supplement had a 40% increased risk of hip fracture. This risk was increased among those who consumed at least 3,000 mcg/day of retinol equivalents of vitamin A from the diet. [JAMA January 2, 2002;287(l): pp.47-54]

Animal, human, and laboratory research suggest an association between greater vitamin A intake and weaker bones. Researchers have also noticed that worldwide, the highest incidence of osteoporosis occurs in northern Europe, a population with a high intake of vitamin A. However, decreased biosynthesis of vitamin D associated with lower levels of sun exposure in this population may also contribute to this finding.

To further test the association between excess dietary intake of vitamin A and increased risk for hip fracture, researchers in Sweden compared bone mineral density and retinol intake in approximately 250 women with a first hip fracture to 875 age-matched controls. They found that a dietary retinol intake greater than 1,500 mcg/day (more than twice the recommended daily intake for women) was associated with reduced bone mineral density and increased risk of hip fracture as compared to women who consumed less than 500 mcg per day. [Ann Intern Med. 1998;129: pp.770-778]

If osteoporosis is present, and vitamin A treatment is indicated for other reasons, it would be wise to limit the duration of high dose vitamin A use.

There is no evidence of an association between beta-carotene intake and increased risk of osteoporosis. Current evidence points to a positive osteoporosis risk in postmenopausal women who are consuming increased amounts of food or supplemental vitamin A in its retinol form only.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Anorexia Nervosa:  An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.

Antacid:  Neutralizes acid in the stomach, esophagus, or first part of the duodenum.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Asymptomatic:  Not showing symptoms.

Boron:  A mineral that may play a role in maintaining strong bones, affecting calcium and magnesium metabolism and proper membrane function.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Chemotherapy:  A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cobalamin:  Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Colitis:  Inflammation of the colon.

Collagen:  The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.

Copper:  An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Diarrhea:  Excessive discharge of contents of bowel.

Esophagus:  Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.

Estrogen:  One of the female sex hormones produced by the ovaries.

Gastric Reflux Disease:  Gastro-Esophageal Reflux Disease (GERD). A common relapsing condition affecting approximately 10% of the U.S. population and caused by an abnormal exposure of the lower esophagus to refluxed gastric contents, causing irritation and injury to the esophageal tissues. GERD develops as a result of relaxations of the transient lower esophageal sphincter. Typical presenting symptoms are heartburn, an epigastric burning sensation and acid regurgitation. However, some patients may present with atypical symptoms such as chest pain, shortness of breath, wheezing, and coughing.

Gram:  (gm): A metric unit of weight, there being approximately 28 grams in one ounce.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

IU:  International Units. One IU is 1/40th (0.025) of a microgram (mcg).

Magnesium:  An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.

Manganese:  An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.

Menopause:  The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Microgram:  (mcg): 1/1,000 of a milligram in weight.

Milligram:  (mg): 1/1,000 of a gram by weight.

Mineral:  Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.

Osteoporosis:  A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

pH:  A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.

Phosphorus:  The second most abundant mineral in the body found in every living cell. It is involved in the proper functioning of both muscles and nerves. It is needed for metabolic processes of all cells, to activate many other nutrients, and to form energy-storage and energy-releasing compounds. The phosphorus content of the body is approximately one percent of total body weight. Phosphorus combines with fats to form phospholipids.

Postmenopause:  The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.

Premenstrual Syndrome:  PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.

Prostate:  The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Refined Sugar:  The term 'refined sugar' includes not only the “sugar” listed in ingredient listings, but also brown sugar, glucose, fructose and dextrose. Obvious sources include jams and jellies; hidden sources are often mayonnaise, ketchup, salad dressings and other condiments.

Rheumatism:  General term applied to conditions of pain, or inability to articulate, various elements of the musculoskeletal system.

Rheumatoid Arthritis:  A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

Silicon:  A non-essential mineral. Tissues such as arteries, tendons, skin, connective tissue, cornea and sclera (white of the eye) contain relatively large amounts of silicon. Collagen, the protein glue that holds us together, contains silicon in silanolate form. While vitamin C functions only as a catalyst in the formation of collagen, silicon is actually a structural part of collagen. Silicon containing substances are found in all cartilage and in the material binding cells together. Silicon may be needed for proper bone structure and growth.

Steroid:  Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Testosterone:  The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.

Vitamin D:  A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.

Vitamin K:  Helps the blood clot when the body is injured.

Zinc:  An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.