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Steps to Prevention: Osteoporosis

What Is Osteoporosis?

Osteoporosis means porous bone. Throughout the early part of your life bone formation outpaces resorption. Around age 35-40 bone breakdown starts to outpace bone formation. Osteoclasts dissolve the bone faster than osteoblasts can build the bone and your bones get holes in them – osteoporosis.

Throughout your lifetime, you constantly lose and gain bone mass. This continuous cycle of formation and breakdown of bone is known as bone remodeling. Osteoclasts dissolve old or damaged parts of the bone in what is called resorption. Resorption dissolves crystallized calcium and other minerals in the bones returning them to the blood. This leaves small spaces in the bone. Cells called osteoblasts create new bone to fill these spaces in. In forming new bone, calcium and other minerals are taken from the blood and crystallized in the bone.

Decline in bone mass after the age of 35-40 (about 2% per year) is greater in women than in men because of lower bone density prior to the age of 40. Postmenopausal osteoporosis is the most common form of osteoporosis. Approximately one in four postmenopausal women have osteoporosis. Osteoporosis affects more than 20 million women and 5 million men in the United States.

Primary Symptoms Of Osteoporosis

• Usually asymptomatic until severe backache
• Most common in postmenopausal white women
• Spontaneous fractures of the hip and vertebra
• Decrease in height
• Demineralization of spine and pelvis as confirmed by x-ray techniques
• Kyphosis or dowager’s hump
• Leg and foot cramps especially at night
• Extreme fatigue
• Large amounts of plaque on the teeth
• Periodontal disease
• Loss of teeth
• Brittle or soft fingernails
• Premature graying
• Heart palpitations

What Causes Osteoporosis?

There is more to osteoporosis than lack of dietary calcium. Osteoporosis involves both the mineral (inorganic) and non-mineral (organic matrix composed primarily of protein) components of bone. In osteoporosis there is a lack of calcium and of other minerals as well as a decrease in the non-mineral framework (organic matrix) of bone.

Osteoporosis involves both the mineral (inorganic) and non-mineral (organic matrix composed primarily of protein) components of bone. In osteoporosis, there is a lack of calcium and of other minerals as well as a decrease in the non-mineral framework (organic matrix) of bone.

Bone is a living tissue and normal bone metabolism is dependent on an intricate interplay of many nutritional and hormonal factors, with the liver and kidneys having a regulatory effect. Over two dozen nutrients are necessary for optimal bone health.

You can develop low bone density in two ways. You can have accelerated loss of bone mass – like women in menopause do. You can also have slowed bone growth – which is harder to correct than accelerated loss of bone. The goal in prevention is to foster the appropriate interrelationship between resorption (breaking down) and formation (making new bone). There are many chemicals in the body that regulate the starting and stopping of resorption and formation including thyroid and parathyroid hormones, growth hormones, estrogen and testosterone, and others. The rate at which bone is made is also affected by how much calcium you ingest and how much calcium is absorbed and how it is utilized in the body (all of which is regulated by a series of hormones). Also, the amount of stress that is placed on the bone through weight bearing exercises influences the growth of bone.

During the course of your life, you go through four phases of bone development. In the first phase - which runs from infancy through adolescence - you build bone. The sex hormones that drive puberty also spur bone growth and half of all bone forms during the teenage years.

In the second phase of bone development, you reach peak bone density - by your mid to late 20s - and stay there for about a decade. Around the age of 35 years you enter the third phase where you begin to experience a slow decline in bone mass (0.5-2%). During the five to ten years after menopause, women will experience an increase in loss of bone mass (3-5% per year) because of the decrease in estrogen and progesterone.

Somewhere around 65 years of age you enter phase four wherein the rate of bone loss slows to about 1 percent per year for the rest of your life. However, in phase four your rate of bone formation starts slowing down in addition to the loss of bone mass. We absorb less calcium and make less vitamin D, have less efficient digestion and lower than optimal levels of hormones. By age 80 women have lost about two-thirds of their skeletons – about 30-40% of their total bone mass (men have lost 20-30%).

After bone loss starts, your risk of fracture increase 1 1/2 times each decade. The younger you are when your bone loss begins or quickens the higher your risk of fracture will be later in life.

What You Can Do To Prevent Osteoporosis

Osteoporosis is a lifestyle disease that begins in childhood. The best way to avoid low bone density is to reach the point where your bones start to lose bone mass with the healthiest, densest bones you can. The only chance you get to create the best bone density you can is when you are very young – from birth to adolescence. Once you are past adolescence, your window of opportunity is closed. After adolescence, you have to take the next best strategy - protecting your bones.

It is never too late to start taking the steps to prevent, protect, and reverse osteoporosis. With a comprehensive program of dietary and lifestyle modifications along with the use of selected herbs, you can make your bones healthy at any age.

Dietary Modifications

Include several servings of high calcium foods a day.

Eat at least 4 cups of vegetables a day. In addition eat 1 cup of green leafy vegetables a day.

Eat more plant foods overall- like grains and legumes.

Eat 35-60 grams of soy protein a day.

Decrease consumption of soda.

Reduce the amount of meat in your diet to below 4 oz daily.

Avoid high protein diets.

Reduce caffeine.

Reduce of salt.

Reduce refined sugar.

Have at least one serving of legumes a day.

Reduce saturated fat.

Avoid heavy alcohol use.

Increase your intake of foods rich in magnesium and vitamin D.

Improve digestion to ensure adequate absorption of nutrients and maintain adequate stomach acid. Take a cup of Carminative Tea and Liver/Bitters Tonic at each meal.

Lifestyle Modifications

Do at least 30-60 minutes of weight bearing exercise three to five times a week.

Strength training.

Yoga, tai chi or qi gong.

Herbal Support

Bone Health Herbal Tonic

• Horsetail - a useful source of minerals, especially silica and calcium in a form that can be easily used by the body in the production and repair of bone and connective tissue.
• Burdock - assists in providing the bones with a rich and pure supply of blood in order to heal.
• Echinacea - has an important healing effect on healing bone and connective tissue by inhibiting the enzyme hyaluronidase; may prevent the pathogenic destruction of connective tissue.
• Dandelion - assists in providing an acid environment for maximum digestibility of calcium.

Calcium Raising Herbal Infusion

• Nettles - a rich source of micronutrients that are vital for flexible bones; source of vitamin K which is crucial for calcium absorption
• Horsetail - helps restore bone density through synergistic mineral action: helps bones thicken and stabilize
• Dandelion - increase hydrochloric acid production to increase absorption of calcium
• Red Clover - calcium rich herb
• Raspberry - calcium rich herb
• Oatstraw - a calcium rich herb which is also magnesium rich; magnesium is needed for calcium absorption.

The above herbal remedies may be ordered from Eventar Herbs.

Supplements That May Help Prevent Osteoporosis

Calcium citrate – 800 –1200 mg/

Vitamin D (as vitamin D3) – 400 IU / d

Magnesium – 400-800 mg/d.

Boron ( as sodium tetrahydraborate) – 3-5 mg/d.

A Note On Hormone Replacement Therapy

The research clearly shows the beneficial effects of hormone replacement therapy with a combination of estrogen and progesterone in maintaining bone health and preventing osteoporosis. The benefits of hormone replacement therapy significantly outweigh its risk in women who are susceptible to osteoporosis and women who have already experienced significant bone loss.

Act now!

The primary goals in the treatment and prevention of osteoporosis are:

• To preserve adequate mineral mass
• To prevent loss of the protein matrix and other structural components of bone
• To assure optimal repair mechanisms to remodel damaged areas of bone.

Do not wait for symptoms. Act now with a detailed plan for prevention.

Act as if you have osteoporosis and start an aggressive prevention program.

Assess your bone density with your doctor.

Test yourself for accelerated bone loss with our simple at home test.

Get a bone density scan.

Get your NTX levels measured.

Have your vitamin D levels checked.

Check your levels of DHEA and testosterone.

Have your levels of thyroid stimulating hormone checked.

Get a parathyroid evaluation done.

Get a serious diet review by a Certified Nutritionist.

Get a knowledgeable assessment of your current fitness and exercise program. Work with a physical trainer. Find out any movement limitations and then work with a trainer to discover ways to exercise your body.

Have a complete physical.

Get a stress test.

The more of these risk factors you have the greater your risk of osteoporosis:

• Age – the older you are the more at risk you are of having already lost bone.
• Postmenopausal
• White or Asian
• Premature menopause
• Positive family history
• Short stature and small bone
• Leanness – women who got heavier after the age of 25 lowered their risks and women who weigh less later in life than they did at age 25 increased their risk
• Low calcium intake
• Inactivity – lack of exercise
• Nulliparity
• If you have experienced any of the following medical conditions:
  • anorexia and other eating disorders
  • amenorrhea
  • high blood sugar levels as in diabetes
  • endocrine diseases such as Cushing’s syndrome
  • hyperparathyroidism
  • hyperthyroidism
  • thyrotoxicosis
  • hypogonadism
  • irritable bowel syndrome
  • celiac disease
  • scoliosis
  • jaundice
  • hypertension
  • rheumatoid arthritis
  • cirrhosis
  • hypercortisolism
  • removal of the small colon
  • chronic lung disease
  • removal of all or part of the stomach
  • gastric or small bowel resection
  • kidney stones
• Receiving your nutrition through a tube or IV
• Anything that gives you impaired balance or coordination
• Dementia
• Smoking
• Heavy alcohol use – too much alcohol interferes with the absorption of calcium and thus with bone growth. Yet people who have a few drinks a week have been shown to have higher bone density than nondrinkers. Moderate alcohol intake boosts estrogen which helps build bone. Ideally, limit alcohol intake to three drinks a week.
• Use of the following medications:
  • steroids (corticosteroids and adrenal corticosteroids)
  • thyroid hormone
  • antacids with aluminum
  • chemotherapy
  • diuretics
  • anticonvulsants including pheytonin and barbituates
  • antibiotics (long term or frequently including tetracycline)
  • Cholestryanmine
  • cyclosporin A
  • Gonadotropin releasing hormones analogues and agonists
  • Methotrexate
  • anticoagulants including heparin and Coumadin
  • lithium
  • benzodiazepines including Valium, Librium, and Xanax
• Early menopause before age 45
• Surgical menopause that occurs from a hysterectomy or removal of the ovaries
• Delayed onset of menstruation
• Interrupted periods

Other factors that increase your risk of developing osteoporosis include:

• Over exercising to the point that your periods stop.
• Pregnancy without taking calcium, vitamin D and other nutritional supplements
• Breastfeeding without taking calcium, vitamin D and other nutritional supplements
• Chemotherapy
• Type I diabetes
• Long term use of antacids containing aluminum
• Taking the new antacid medications such as Zantac, Tagamet, Pepcid and Axid.
• Taking diuretics.
• Long term use of anticoagulants.
• Taking thyroid hormone
• Being bedridden for a week or more at a time.
• Extremely low body fat
• Irregular periods and irregular ovulation.
• Amenorrhea and delayed menstruation.
• Poor diet in childhood, adolescence or young adulthood
• Poor exercise habits through childhood, adolescence or young adulthood
• Drinking more than 1 soda a day – diet, regular, caffeine free (even club soda). Diet sodas have more caffeine than regular sodas, which increases its bone density risk factor. Seltzer is OK because it does not have phosphorous.
• Not eating enough vegetables and fruit (at least 3-4 cups of vegetables a day and 1-3 servings of fruit a day).
• Inefficient digestion. The absorption of calcium is dependent on becoming ionized in the intestines. In order for calcium carbonate (the most common form of calcium) to be absorbed it must first be solubilzied and ionized by stomach acid. About 40% of postmenopausal women are severely deficient in stomach acid. Those with low stomach acid secretion need a form of calcium that is already in a soluble and ionized state such as calcium citrate, calcium lactate, or calcium gluconate.
• Lactose intolerance.
• Long term consumption of more than 12 oz of meat daily
• Eating more than 4 oz of meat daily. For most American women 3-4 ounces of protein a day is adequate. For each ounce of protein that you eat your loss 30-40 grams of calcium. For every gram of meat you eat you loss an average of one milligram of calcium. (4 ounces of meat is approximately 100 milligrams.)
• High caffeine consumption – caffeine is a diuretic and increases the amount of calcium you excrete in urine. To make up for the loss of calcium when drinking one 6-oz cup of coffee you need an additional 40-mg of calcium. The older you get the more calcium caffeine leeches out of your bones.
• Eating a high salt diet. Salt increases the amount of calcium excreted from your body. Every 500-milligram of salt leeches 10 milligrams of calcium out of your bones.
• Eating a high sugar diet. Sugar intervenes in the absorption of calcium and increases the amount of calcium excreted.
• Having high levels of heavy metal toxicity such as lead, cadmium, tin and aluminum.
• High protein weight control plan for more than 1 year
• Current lack of exercise.
• Not getting enough sunlight.
• Your mother broke a hip before she was 80 years of age.
• You had any fracture after the age of 50.
• You are taller than average (or were when you were 25).
• You rate your own health to be fair or poor.
• You can not get up from a chair without using your arms.
• You have poor perception of depth and / or contrast.
• You have a fast resting heart rate (over 80 beats per minute).
• You spend less than four hours a day on your feet.

How Do You Know If You Have Osteoporosis?

The more risk factors you have the more concerned you need to be about getting a test to measure your current bone density and future risks. Available tests can give a detailed and accurate picture of the state of your bones. Low bone density test results are better indicators of future fracture than cholesterol levels are of heart disease. Nearly three quarters of the women who have low bone density do not know that they have it and only 15 percent of women with low bone density are currently taking steps against it. By the age of 40 you should be seriously discussing bone density tests particularly if you:

• Have a history of osteoporosis or of losing height, developing dowager’s hump or hunchback or frequent fractures
• Are slender and of light build
• Are or have been a smoker
• Have decreased sex hormones for any reason
• Have spine abnormalities like scoliosis
• Have an endocrine or metabolic disorder
• Have been treated for long term gastrointestinal problems
• Take thyroid medications, corticosteroids, or anticonvulsants or have taken them over the long term some time in the past.

Osteoporosis is best diagnosed by bone densiometry

The test with the greatest accuracy and popularity is dual energy X-ray absorptiometry (DEXA). It provides the most reliable measurement of bone density, requires the least amount of radiation (less than a chest X-ray, a full set of dental X-rays or a year of living in the world), and takes only 10-20 minutes. The DEXA takes measurements of the wrist, vertebrae, and hip and checks both trabecular and cortical bone. Results are expressed as a T-score comparing you to a healthy 30-year-old at peak bone density and a Z score comparing you to the average for your age, sex and race. But it only measures for bone density not quality of bone. Just having dense bones does not guarantee bone health. Osteoarthritis can make bone density scan results less accurate. If you have osteoarthritis, you should also get your NTX levels to have a second way to monitor your current situation and progress. Using the World Health Organization conservative framework for evaluating your bone density: a T score of –1 to –2.5 compared to peak bone mass means osteopenia or bone loss; below –2.5 means osteoporosis. For each decrease in standard deviation your risk of hip fracture doubles or triples. That means –1 means that you have twice the risk; - 2 means four times the risk; -3 means eight times the risk. You should act to address any amount of bone loss.

Other bone density tests available:

Dual photon absorptiometry (DHA)- an older version of the DEXA

Single –photon absorptiometry (SPA) or single energy absorptiometry (SXA) – checks bone density at the heel and wrist

Computer tomography or quantitative computed tomography (CT or CAT Scan or QCT) –used for bone density measurements only if you are having one for some other reason

Radiographic absorptiometry (RA)- regular X-ray of the hand followed by special analysis

Follow up testing

It is recommended that women get a baseline bone density measurement and then monitor the rate of bone loss through the use of a blood or urine test that measure the breakdown by products of bone (such as cross-linked N-telopeptide of type I collagen or deoxypyridium). The DEXA test can be used to monitor bone density but can take up to 2 years to detect a therapeutic response. Urine tests of bone resorption measure markers of bone formation and loss, can help predict your fracture risk, estimate the quality of your bone and the rate of bone loss and because they provide quicker feedback they can be used to monitor the success or failure of therapeutic interventions.

You want to be as far on the positive side of the range as possible. You should repeat the follow up tests periodically to see if your levels are changing.

N-telopeptide of cross lined type I collagen – NTX – a fast and reliable urine test that measures the rate of one kind of bone metabolism. N-telopeptides are molecules used in forming collagen and are the first things broken down when bone is destroyed. High levels mean a rapid rate of bone destruction likely outpacing formation of new bone. This test can be used to indicate your risk of fracture and the rate of progression of bone loss. If your DEXA indicated that you have density that was on the low side but close to what is expected but your NTX revealed rapid progression and a high fracture risk your intervention should be aggressive.

The normal NTX range is from 0 to 40 or 50. The lower it is the better. You should have your NTX checked twice about 6 months apart.

Other blood tests that might be helpful include:

Calcium blood levels – high levels of calcium in the blood indicate either bone is being broken down or that calcium is getting into the body but not into the bones. Checking your NTX and parathyroid hormone can tell you if bone turnover is causing high calcium levels. Otherwise, your body’s absorption and use of calcium is at issue.

Serum bone specific alkaline phosphate – an enzyme produced by the osteoblasts in building bone. In the blood, it indicates that bone formation is taking place, which is always good.

Serum Vitamin D levels (as 25-hydroxyvitamin D) – it they are too low (under 9 nanograms per milliliter) your body will not be able to use the calcium you ingest. Low levels would indicate that you should have a bone scan.

A blood test to measure procollagen I extension peptides – these peptides result from the making of collagen a crucial ingredient in bone structure.

A blood test to check osteocalcin levels – osteocalcin is a protein in bone matrix involved with bone formation and levels in the blood can indicate the pace of bone building. Osteocalcin levels are a good way to assess bone formation.

Test for monitoring the effects of drug treatment include:

A urine test to check the rate of bone breakdown by measuring levels of hydroxyproline, hydrosylysine, pyridinoline, and deoxypyridinoline. All four are used in creating collagen and one is also used in elastin. These substances are crucial for forming bone, so their presence in urine means that bone is being broken down.

A blood test to measure plasma tartrate resistant acid phosphatase (TRAP) another indicator of bone destruction.

Related Conditions

Osteomalacia, or soft bones, is related to a lack of dietary calcium. In children, the disease is called rickets. Osteomalcia occurs when minerals do not crystallize on the bone matrix properly often due to a lack of vitamin D that is needed to utilize calcium, phosphorus, and magnesium. With osteomalcia, you do not have enough calcium and phosphorous forming into bone. This is not the same as osteoporosis. Osteoporosis involves the lack of other minerals and a decrease in bone matrix. Osteomalcia can be a precursor of osteoporosis.

Osteopenia is another related condition which means low bone mass. In osteopenia, you have density lower than normal but not low enough to lead to fractures. Osteoopenia is a warning that the stage is set for osteoporosis unless you take corrective action. Health Impact of Osteoporosis

The greatest loss of bone mass is likely to occur in the spine, hips and ribs. Since these bones bear a great deal of weight, they are susceptible to pain, deformity and fracture. At least 1.5 million fractures occur each year as a direct result of osteoporosis, including 250.000 hip fractures. Hip fractures is fatal in 12-20% of cases and precipitates long term nursing home care for half of those who survive. Nearly one-third of women and one-sixth of men will fracture their hips in their lifetime.

What More Can You Do To Prevent Osteoporosis?

Osteoporosis is more than just lack of dietary calcium. It is a complex condition involving hormonal, lifestyle, nutritional, and environmental factors. The primary goals in the treatment and prevention of osteoporosis are:

To preserve adequate mineral mass

To prevent loss of the protein matrix and other structural components of bone

To assure optimal repair mechanisms to remodel damaged areas of bone.

Focus on Children

Genetics makes a large impact on determining peak bone mass. But good nutrition, adequate calcium intake and plenty of exercise in childhood and adolescence is the best way to prevent low bone density and for reaching the genetic potential. Children should be taking basically the same steps to prevention as adults but children have some special requirements in regards to their calcium needs. Most kids only get about 75 percent of the RDA for calcium and that along with other dietary habits such as increased soda intake can be very detrimental for growing bones.

For the first six months of life, babies should be getting 400 mg of calcium/d (which is what they will get when drinking breast milk or formula exclusively.

From 6 to 12 months children need 600 mg calcium /d (the equivalent of 3 cups of milk a day).

After the first birthday, they need 800 mg of calcium/d.

At age 6 years, they need 800-1200 mg of calcium/d (the equivalent of about 4 cups of milk a day).

Eleven – 24 year olds need 1200-1500 mg of calcium/d (which is about 5 cups of milk/d.

For girls the period just before puberty demands the highest amount of calcium at any age and bone builds most rapidly through about four years after the first period.

Eating dairy products – high calcium – during childhood is related to greater bone density in adulthood.

Using low fat milk after the age of two years may protect their cardiovascular system and their weight.

If eating enough high calcium foods is difficult, use a calcium supplement. You will need to get more than what is in your typical children’s multivitamin/ mineral.

Avoid or eliminate soda drinking. Soft drink consumption in children poses a significant risk factor for impaired calcification of growing bones. Since there is a strong correlation between maximum bone mineral density and the risk of osteoporosis, the rate of osteoporosis may reach even greater epidemic proportions as these children reach adulthood.

Have kids outside in the sun for at least 30 minutes a day (two hours a day is even better) so that their bodies can make enough vitamin D.

It is time you were taking steps to build strong bones, prevent osteoporosis or correct developing osteoporosis!

Free Osteoporosis Risk Assessment

This is a rare opportunity to receive a personal osteoporosis risk assessment in a free 60 minute session. We will go through a detailed screening assessment to assess your potential risk of developing osteoporosis.
(This is not a diagnosis)

Free with the Purchase of any Functional Health Test

Usual disclaimers apply

© Copyright 1997 - 2008 by Mary Ann Copson and Evenstar. All rights reserved.

About the Author:
Mary Ann Copson is the founder of the Evenstar Mood & Energy Wellness Center for Women. With Master's Degrees in Human Development and Psychology and Counseling, Mary Ann is a Certified Licensed Nutritionist; Certified Holistic Health Practitioner; Brain Chemistry Profile Clinician; and a Health, Wellness and Lifestyle Coach. Reconnect to your physical, emotional, mental, psychological and spiritual natural rhythms at
http://evenstaronline.com

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