You’ve seen them: little elderly ladies, hunched over, their backs shaped almost like a camel’s hump. You might be someone who has this problem, or someone who fears that this problem is something you will have and can do nothing about. Let’s look at what we know about bone health. By the end of this article, you should be feeling quite positive about your options.
Let’s talk about the various functions that bones have in our bodies. First of all, they provide the structural framework for our body shape. They also provide an attachment for tendons so the muscles can cause movement in our joints and limbs. Fortunately, bones also protect internal organs. The skull protects the brain; the rib cage shields the heart, lungs and kidneys. The bones serve as a storage and shipping depot for minerals. In the bone marrow is the production of red blood cells, white blood cells, and platelets. As you can see, our bones are critical for proper functioning of our bodies.
How a Normal Bone Is Formed
I recently finished our basement. This incredibly lengthy and challenging project involved a number of steps that affected the outcome: smooth finished walls with consistent color and shape. It might be helpful for me to liken that process to how the elements in our bodies combine to create bone health.
The first step, other than the planning process, involved creating a framework. In fact, folks who do construction for a living call those who create a framework “framers.” This framing involved in construction is similar to the “matrix” that forms the framework for bone tissue. On the framework, my son and I laid drywall, followed by joint compound to fill in the gaps and create a consistent, smooth surface. In order to make the finished walls smooth, we taped over the gaps between sheetrock, and we sanded and mudded and sanded and mudded over and over again. At the end, we did a final sanding, primed the walls, and then painted. This reworking of the wall, with the breakdown of mud and building up in order to create a finished product could be likened to the breakdown and building activity in the body to make a finished healthy bone.
It is important to understand that bone is very much an alive tissue. There are cells that break down the protein and mineral components of bone through digestive acids and enzymes. These cells are called “osteoclasts,” and they facilitate normal development, growth, maintenance, and repair of bone. A different cell type builds the matrix of bone tissue by making and secreting collagen fibers, upon which the initiation of mineralization, or calcification, takes place. I’ve likened the collagen fibers to both frame and sheetrock. These cells are called “osteoblasts.” The “sanding” in our analogy is the osteoclast’s job, and the “mudding” is what the osteoblasts do. The hardness in bones depends upon crystallized minerals: primarily calcium, magnesium and phosphorus. Flexibility in bones depends on collagen fibers that resist being stretched or torn apart.
In childhood, the osteoblasts are more active than the osteoclasts. That is why bone growth occurs in children and they grow taller. The bones are constantly remodeling based on the stresses and stimuli placed upon them during activity. Somewhere in the 20s, osteoblasts and osteoclasts are about equally active. As we age, osteoclast activity increases relative to osteoblast activity. This means there is a natural decrease in mineral content in the bones as we age.
During adulthood, bones need constant renewing or remodeling. The remodeling of adult bones heals injured bones, and redistributes the bone matrix along lines of stress. This remodeling process can also renew bone before it starts to deteriorate. Osteoclasts carve out small tunnels of old bone tissue so that osteoblasts can move in and rebuild bone in that area. This process usually takes from two to three months. If an imbalance exists in the system, problems occur. Too much osteoblastic activity (buildup) may lead to bones that are thick and heavy, or may even develop bone spurs. Too much osteoclastic (breakdown) activity causes osteopenia or osteoporosis (bone thinning) and weak bones.
Other Elements that Make Up Bone Health
This is a continuation of Physiology 101. If you are bored with the science, you may skip ahead.
Calcium is carefully regulated in the bloodstream because of its critical role in nerve cell transmission. It is also a cofactor for many enzymes. Muscles would not contract or relax without this critical mineral, and neither would blood clotting occur without it. When calcium levels decrease in the blood, parathyroid hormone (PTH) is released, which increases osteoclastic activity. This releases calcium (and phosphates) from bone into the bloodstream. When blood calcium levels are too high, another hormone called calcitonin is released, which inhibits osteoclast activity and increases calcium uptake into bones. Additional functions of the parathyroid hormone are that it decreases the loss of calcium and magnesium from the kidneys, while increasing the loss of phosphates in the kidneys. Parathyroid hormone also promotes the formation of activated vitamin D, which increases the intestinal absorption of calcium, magnesium, and phosphate.
Thyroid hormone is required for normal bone remodeling to take place. If thyroid hormone is deficient, old bone that is not as strong and is abnormally thick tends to accumulate. Excessive thyroid hormone may cause osteoporosis.
Insulin and insulin-like growth factors (IGF-1) stimulate osteoblasts to synthesize and secret collagen fibers and other components needed to build the bone tissue. Growth hormone stimulates the local release of IGF-1 from bone.
Vitamins, Minerals, and other Good-for-You Stuff
Vitamin C is needed for the synthesis of collagen, and critical cross-linking of bone proteins. Its deficiency causes osteoporosis.
Vitamin A stimulates activity of osteoblasts.
Vitamin B6 and folic acid reduce homocysteine levels. Homocysteine contributes to osteoporosis, in addition to vascular disease and Alzheimers.
Vitamin K is required for production of osteocalcin, the protein matrix upon which mineralization occurs in bones. Without it, our bones would be like chalk.
Vitamin D, which is really more like a hormone, improves absorption of calcium, magnesium and phosphorus from the intestinal tract (as I mentioned earlier). Studies of vitamin D supplementation demonstrate increased bone density and decreased fracture risk.
DHEA levels are higher in women without osteoporosis, compared to those with osteoporosis. The specific mechanism is unknown.
Magnesium deficiency is associated with osteoporosis, possibly because of its being a co-factor for vitamin D activation, or its ability to mediate parathyroid hormone and calcitonin excretion.
Manganese stimulates the production of mucopolysaccharides, compounds that provide structure for mineralization to take place.
Zinc enhances the action of vitamin D. It is also required for the formation of osteoblasts and osteoclasts, and for synthesis of bone tissue proteins.
Strontium (not the radioactive strontium-90) increases bone mass in 78% of patients with bone pain. Biopsy samples showed a 172% increase in bone formation after strontium use.
Copper deficiency in animals showed reduced bone mineral content and reduced bone strength.
Silicon is involved in the early calcification of bone. Brown rice is a good source of this mineral.
Hormonal Considerations in Post-Menopausal Women
Estrogen prevents excessive bone breakdown, thus reducing fractures by 50% for about 3-5 years after menopause. Unfortunately, this may result in inactive bone that is not remodeling and repairing itself; hence, it becomes weaker. This may explain why there is no reduction in hip fractures in women on estrogen after the age of 65.
Progesterone binds to osteoblasts, resulting in new bone formation. This will actually reverse osteoporosis.
Follicle-stimulating hormone (FSH) increases in many women after menopause. During the premenopausal years, FSH helps to regulate progesterone/estrogen levels. When the ovaries no longer produce adequate levels of progesterone and estrogen, FSH levels will rise. Unfortunately, high FSH levels cause immature osteoclasts to mature, thus causing more bone breakdown (osteoporosis).
Exercise and Attitude
Both weight-bearing exercise and swimming improve bone mineral content by about 40%. So it pays to get out there and move! Swimming has an added benefit of providing you with a gravity-minimized workout area, so there is less stress on the joints and more freedom of movement. If you haven’t tried aerobic water exercise, you might benefit from the experience. You don’t have to be a swimmer to enjoy it.
There is much to be said for how the mind and the spirit affect the body. “As a man [or woman] thinketh in his [or her] heart, so is he [or she]” (Proverbs 23:7). In the book Feelings Buried Alive Never Die, author Karol Truman shares a rather startling but thought-provoking idea that those who have dowager’s humps have “carried the weight of the world on their shoulders.” I have observed it to be true countless times in my practice, that people are able to affect their disease state through their mental and spiritual efforts.
Adverse Effects on Bone Health
Dietary phosphate intake from soft drinks and meat proteins must be matched in the body by calcium. Since 99% of the calcium in the body is in the bones, it will be taken from the bones. Of the other 1% that is in the body, dietary sugar and caffeine increase calcium loss from kidneys. Excessive alcohol ingestion also interferes with bone health.
Frequent antibiotic use may interfere with the normal intestinal flora that makes vitamin K.
Aluminum in bone interferes with new bone formation and accelerates bone resorption.
Lead increases the number of osteoclasts, thus increasing bone resorption. Vitamin and mineral deficiencies (especially those critical for bone health) increase the toxicity of lead in the body.
Cadmium and tin accumulate in bone in proportion to their intake, and both interfere with zinc and calcium.
Fluoride deposition in bone produces low-quality bone, even though fluoride is a stimulator of bone formation. This topic will be explored more completely when we talk about tooth health and toxins.
There are several things that interfere with nutrient absorption. In order for complete breakdown of food for proper absorption, adequate gastric acid in the stomach and enzymes in the pancreas are necessary. Antacids and anti-ulcer drugs decrease gastric acid, causing difficulty with food breakdown. Intestinal malabsorption from food allergies or celiac disease certainly interferes with vitamin and mineral absorption.
Bisphosphonates (Fosamax, Actonel) bind to crystals in the bone and inhibit bone resorption; that is, they interfere with osteoclastic activity. They do increase bone mass in the spine and hip by about 4%, with an initial reduction in fracture risk. This, however, represents a very tunnel-visioned approach to a complex biologic and biochemical issue. My long-term concern with Fosamax and Actonel is that we may learn in the future that appropriate bone remodeling and healing do not take place, and that there will be ultimate deterioration of bone strength in those who use those drugs. How refreshing it is to know that there are safer and more effective ways than drugs to assist bone health and avoid osteoporosis.
Diagnostic Considerations
A bone densiometer x-ray or DEXA-scan gives a score relative to maximal bone density at age 26. It does not account for the normal decrease in bone density with age. Neither does it give a totally accurate assessment of the quality of the bone matrix and bone strength. Since my interest is in total bone health, I do not rely on this diagnostic device to provide me with a reliable source of information.
Urine deoxypyridium measures the breakdown products of bone. If the levels are high, aggressive management, using the subsequent recommendations, typically brings down the high levels of breakdown products.
A gastric analysis performed with a swallowable transmitter can assess the gastric acid pH and subsequent neutralization of the acid by pancreatic juices. This is an accurate measurement of the function of these two organs. Both the stomach’s and the pancreas’ performance can be modified by supplementation.
I have found that a valuable measuring tool for toxic metal exposure is urine and hair analysis. These toxins manifest in the growth of hair and the excreted urine. Also, excretions patterns of minerals can be seen in the urine assessment, which tells me if the minerals are too low or too high, based on their excretion patterns.
Blood tests can be obtained for the following substances: homocysteine, ionized or free calcium and magnesium, phosphorus, vitamin D, DHEA, estradiol, progesterone, and IGF-1.
Prevention and Treatment of Osteoporosis
- Diet is important. Avoid a high phosphate diet by lowering protein (meat) intake and eliminating all soft drinks. Avoid refined sugar nd caffeine. Eat green leafy vegetables, which are a rich source of nutrients, including calcium, Vitamin K and boron, and brown rice – a good source of silicon.
- Stop smoking.
- Exercise.
- Supplements: a. Vitamin C – 2000-4000 mg/dayb. Vitamin A – individual assessment neededc. Vitamin B6 – 50 mg/dayd. Vitamin D – 400 or more IU/day (more if you live in northern climates or have little sun exposure/ heavy sunscreen use).e. Vitamin K – individual assessment neededf. Folic acid – 400-1000 mcg/dayg. Calcium – 500-750 mg/dayh. Magnesium – 600 mg/dayi. Zinc – 10-30 mg/dayj. Copper – 1-2 mg/dayk. Manganese – 5-20 mg/dayl. Boron – 1-3 mg/daym. Strontium – 1-2 gm/dayn. Silicon – brown rice consumption
- Only if indicated:a. DHEA – 5-25 mg/dayb. Progesterone – 10-25 mg/day or on days 16-26 of cyclec. Estrogen to reduce FSH levels (progesterone may reduce it adequately)d. DMSA chelation for metal removale. IV EDTA chelation as a stimulant for bone remodeling. This is a little known and little used function for IV EDTA chelation. During chelation, a small drop in calcium occurs in the blood (the loss over a three hour chelation is about the same as the normal kidney loses in a 24 hour period), which triggers PTH releasing initial osteoclastic stimulation followed by osteoblast building of bone. The net effect of this stimulation is reversal of osteoporosis over a 2-3 month period.