With the “Baby Boomer” generation graying osteoporosis has become a growing concern. If you are at risk for osteoporosis knowing what you can do about it is critical.
There are two types of osteoporosis: What determines the existence of either type is the amount of calcium left in the skeleton and whether it places a person at risk for fracture.
The Two Types of Osteoporosis:
1. Primary osteoporosis can consist of high- and low-turnover osteoporosis. High-turnover osteoporosis (sometimes called type I) occurs in 5 to 20 percent of women, most often between the ages of 50 and 75. This is associated with vertebral fractures and fractures of the hip, wrist or forearm caused by falls or minor accidents. Women have a higher risk for type I osteoporosis than men. Low-turnover osteoporosis (also known as type II or age-related, senile osteoporosis) results when the process of re-absorption and formation of bone are no longer coordinated. Bone breakdown then overcomes bone building.
2. Secondary osteoporosis is caused by conditions and medications such as:
a. Corticosteroids used by more than 30 million Americans (also called glucocorticoids or steroids).
b. Diuretics, which are used to treat high blood pressure (hypertension), have different effects on osteoporosis, depending on the type. Diuretics, such as furosemide (Lasix), increase the kidneys’ excretion of calcium. Thiazide diuretics protect against bone loss, but this protective effect ends after use is discontinued.
c. Contraceptives that use progestin without estrogen (such as Depo-Provera injection or other progestin-based [synthetic progesterone] contraceptives) can cause loss of bone density.
d. Other medications: such as anti-seizure drugs, can increase the risk for bone loss, as can the blood thinning drug heparin, and hormonal drugs that suppress estrogen. Proton pump inhibitors (examples: Omeprazole [Prilosec], Prevacid, Nexium, Protonix & others) and Aluminum-containing antacids which are used to treat gastroesophageal reflux disease (heartburn), may also increase the risk for bone loss and hip fractures. Cancer chemotherapeutic drugs, Thyroid hormones in excess and a number of other common drugs may contribute to bone loss.
e. Medical conditions including alcoholism, diabetes, hyperthyroidism (over active thyroid), epilepsy, chronic liver or kidney disease, Crohn’s disease, celiac disease, scurvy, rheumatoid arthritis, leukemia, cirrhosis, gastrointestinal diseases, vitamin D deficiency, lymphoma, perparathyroidism, and rare genetic disorders such as Marfan and Ehlers-Danlo’s syndrome all increase the risk for bone loss.
All too often, osteoporosis becomes apparent in dramatic fashion: A fracture of a vertebra, hip, forearm or any bony site if sufficient bone mass is lost. These fractures frequently occur after minor trauma, such as bending, lifting, jumping or falling. Pain, disfigurement and debilitation are common in the latter stages of the disease. Early spinal compression fractures may go undetected for a long time, but after a large percentage of calcium has been lost, the vertebrae in the spine start to collapse, gradually causing a stooped posture called kyphosis, or a “dowager’s hump.” Although this is usually painless, patients may lose as much as six inches in height.
There are a number of factors that predispose a person to osteoporosis:
• Gender: 70 percent of people with osteoporosis are women.
• Age: Aging causes bones to thin and weaken. According to a report from the Surgeon General’s office, half of all Americans over age 50 could be at risk for this condition by 2020.
• Ethnicity: Although adults from all ethnic groups are susceptible to developing osteoporosis,Caucasians and Asians face a comparatively greater risk.
• Body type: Osteoporosis is more common in people who have a small, thin body frame and bone structure.
• Family history: People whose parents had a history of fractures may be more likely to have osteoporosis.
• Hormonal deficiencies: In women, estrogen deficiency is a primary risk factor. In men, a low level of testosterone increases risk. Certain medical conditions (hypogonadism) and treatments (prostate cancer androgen deprivation) can cause testosterone deficiency.
• Lifestyle factors: These include dietary factors, exercise, smoking and alcohol use.
Diagnosing the Condition
Because osteoporosis can occur with few symptoms, testing is important. Bone density testing is recommended where there is long term use of medications; history of treatment for prostate cancer or breast cancer; history of medical conditions such as diabetes, thyroid imbalances, estrogen or testosterone deficiencies, early menopause, anorexia nervosa, rheumatoid arthritis; significant loss of height; and significant recent weight loss or low body mass index. The standard technique for determining bone density is a form of bone densitometry called dualenergy X-ray absorptiometry (DXA). DXA is simple and painless and takes 2 to 4 minutes.
The results of this test are usually reported as a “T score” and “Z score.” The T score compares bone density with that of healthy young women, while the Z score compares bone density with that of other people of similar age, gender and race. In either score, a negative number means thinner bones than the standard. A T score below -2.5 indicates osteoporosis.
Weight-bearing exercises, both high and low impact, can be beneficial in delaying the complications from loss of bone density. While high-impact exercises are best for building bones, low-impact exercises can also help avert bone loss and are safer for people who cannot do high-impact exercises. Walking can be one of the best options. Agriculture Department scientists found that women who walked more than 7.5 miles a week can delay complications from loss of bone density better than non-walkers. In addition, resistance and strengthening exercises including using weight or resistance against gravity can be beneficial as can nonimpact activities, such as wobble boards, yoga and dancing.
a) Calcium: Calcium is a mineral that is important for healthy bones. It is a building block of bone.
b) Vitamin D: Vitamin D is important because it helps your body use calcium. If you don’t get enough vitamin D or if your body does not absorb it well, you are at much greater risk for bone loss and osteoporosis.
c) Phosphorous: Like calcium, phosphorous is a part of the bones. Because this mineral is naturally present in many foods, most people get enough phosphorus. It is sometimes added to processed foods and soft drinks in the form of phosphate or phosphoric acid. Some experts say that Americans may be getting too much phosphorous and could contribute to bone loss especially if not balanced with calcium.
d) Other Minerals and Vitamins: Magnesium, vitamin K, vitamin B6 and vitamin B12 are some of the many minerals and vitamins that are important for bone health. If you eat a well-balanced diet, you should be getting enough of these nutrients. Most experts recommend multivitamins or supplements for people who do not get what they need from foods.
e) Protein: Eating foods that supply protein is important for your health. But a very high protein diet, particularly animal protein, causes a loss of calcium through the kidneys. You can make up for this calcium loss by getting enough calcium to meet your body’s needs.
f) Caffeine: Found naturally in coffee and tea, caffeine is often added to soft drinks. Caffeine may decrease calcium absorption. One study suggests that drinking 330 mg of caffeine, or about four cups of coffee, daily increases the risk of fractures. To protect your bones, try not to have too many drinks with caffeine each day. You can also offset the calcium lost from drinking caffeine but increasing your calcium intake.
g) Soft Drinks: Some people are concerned that the phosphorous and/or caffeine in certain soft drinks may harm bone health. Other experts suggest the harm to bone is caused by people substituting soft drinks for milk and calcium fortified juices. In other words, when soft drinks take the place of milk and other sources of calcium, bone health may be affected.
h) Sodium (salt): Eating foods that have a lot of sodium may decrease your body’s ability to retain calcium. Eating too much sodium is bad for your bones and can cause bone loss. Try cooking without adding extra salt, and limit the salty snacks and processed foods that you eat.
i) Spinach: Spinach contains high levels of oxalate. Oxalate prevents the body from absorbing calcium from spinach. The body can absorb calcium found in most other green vegetables such as broccoli and kale. Although spinach can be part of a healthy diet, it just can’t be counted as a source of calcium. It does not affect calcium absorption from other foods.
j) Wheat Bran: 100% wheat bran is the only food that appears to reduce the absorption of calcium in other foods that are eaten at the same time. If you are taking calcium supplements, you may want to take your supplement two or more hours before or after eating any foods with 100% wheat bran. Although wheat bran may interfere with calcium absorption, foods with wheat bran are still considered a part of a healthy diet.
k) Remember to Balance Calcium with Magnesium: Magnesium is needed for the absorption of calcium. The National Academy of Sciences recommends a bare minimum of 1,000 milligrams per day of calcium, although because of limited absorption, twice as much can be taken. The recommended daily amount of magnesium is around 400 milligrams. For equilibrium, the body needs a ratio of 2:1 of calcium to magnesium. Green leafy vegetables are one of the best sources of calcium and magnesium. Calcium is also found in dairy, oats, and soy. Magnesium is found in many foods – in nuts, seafood, meat, avocados, bananas, soy, peaches, figs, brown rice, and garlic. The benefits of these two minerals comes not only from their specific roles in the body, but from the balance with each other.
Since there are as many or more treatment approaches as causes of osteoporosis any successful treatment approach should be individualized to the specific patient. There are both drug and natural approaches to improving osteoporosis and combinations of both. This article is not all inclusive. If you are concerned about osteoporosis then make an appointment to see your doctor today. Your Maitland Chiropractor is familiar with nutritional aids and advice that may help improve osteoporosis and/or reduce risk factors for developing it. Call for today to see what natural approaches may be appropriate for you.
•Examiner, NCMIC Summer 2010, Pammer, JC, DC, DACBR.
•The National Osteoporosis Foundation (NOF) is the nation’s leading resource for people seeking up-to-date, medically sound information on the causes, prevention, detection and treatment of osteoporosis. http://www.nof.org /