Misconceptions abound when it comes to osteoporosis, a dreaded disease marked by porous, brittle bones and hunched backs. Most people think of osteoporosis as a women's disease, but it's more than that. While eight million American women have been diagnosed with osteoporosis, more than two million men also are affected by it.
OSTEOPOROSIS: A SILENT PROBLEM
Osteoporosis can develop because, starting at about age 35, our bone cells do not make new bone as fast as it is broken down. Our bones become more frail and fracture more easily. Fractures, especially of the hip, spine and wrist, are more likely to occur, even without trauma. Osteoporosis has no symptoms until a bone is fractured. Many people go for decades without a diagnosis of osteoporosis—until they fall and an X-ray reveals porous bones.
Bone density can be measured with a dual energy X-ray absorptiometry (DEXA) scan, but many people don't get this test. I recommend a baseline DEXA scan by age 50, and if results are normal, follow-ups every three to five years.
The most worrisome risk for a person with osteoporosis is a hip fracture. According to the National Osteoporosis Foundation (www.nof.org), an average of 24% of hip-fracture patients age 50 or older die in the year following their fractures, often as a result of long-term immobilization that leads to blood clots or infection. Six months after a hip fracture, only 15% of patients can walk unaided across a room.
Virtually every person with osteoporosis who has come to my clinic is confused about the best way to promote bone health. Conventional doctors typically prescribe osteoporosis medication, such as alendronate (Fosamax) and ibandronate (Boniva). However, these drugs can cause side effects, such as digestive upset and blood clots, and they don't address the underlying nutritional deficiencies that promote bone loss.
The natural protocol I recommend includes a healthful diet (rich in vegetables, fruit and fish and low in refined-sugar products and red meat)...weight-bearing exercise (such as walking and stair-climbing)...and good hormone balance (deficiencies of some hormones, such as testosterone, accelerate bone loss). I also suggest certain bone-protecting supplements.
Caution: People with kidney disease should not take supplements without consulting a doctor. With kidney disease, the kidneys cannot process high doses of nutrients.
My recommendations: To help prevent osteoporosis, take the first three supplements listed below. If you have osteoporosis or osteopenia (mild bone loss that can be diagnosed with a DEXA scan), take the first three supplements listed and as many of the others as you're willing to try, in the dosages recommended…
SUPER TRIO PREVENTS AND TREATS OSTEOPOROSIS
- Calcium is the most prevalent mineral in bone tissue. Taking supplements helps prevent a deficiency. Most studies have found that calcium slows bone loss but does not increase bone density when used alone. Women with osteoporosis should take 500 mg of calcium twice daily with meals. It should be a well-absorbed form, such as citrate, citrate-malate, amino acid chelate or hydroxyapatite. To boost absorption, take no more than 500 mg per dose. Calcium carbonate, which is widely used, is not well-absorbed. For osteoporosis prevention, men and women, as well as boys and girls starting atage 13, should take 500 mg daily.
Calcium supplementation for men with osteoporosis is more complicated. Some recent research has identified a link between high calcium intake (from dairy products) and increased prostate cancer risk. A meta-analysis in the Journal of the National Cancer Institute that reviewed 12 studies on this association concluded, "High intake of dairy products and calcium may be associated with an increased risk for prostate cancer, although the increase appears to be small." A recent study found that calcium intake exceeding 1,500 mg a day (from food and supplements) may be associated with a higher risk of advanced, and potentially fatal, prostate cancer. The saturated fat in dairy products may raise prostate cancer risk.
Until there is more definitive information, I recommend that men who have osteoporosis, regardless of whether they have eliminated calcium- rich foods from their diets, take no more than a 500-mg calcium supplement daily. Men with prostate cancer should consult their doctors before using calcium supplements.
- Vitamin D promotes absorption of calcium. Deficiencies of this vitamin are more common in Americans over age 50 than in younger adults. Sun exposure prompts the body to produce vitamin D, and the kidneys help convert it to its active form. As we age, our skin cannot synthesize vitamin D as effectively from sunlight, and our kidneys become less efficient. People with darker skin, those with digestive problems (due to malabsorption conditions, such as Crohn's disease) and those with limited exposure to sunlight are also at greater risk for vitamin D deficiency. Preliminary studies indicate that an inadequate intake of vitamin D is associated with an increased risk of fractures.
For the prevention of osteoporosis, I recommend 600 IU to 800 IU of vitamin D daily. People with osteoporosis should take 800 IU to 1,200 IU daily. Vitamin D is fat soluble, meaning it is better absorbed when taken with meals (containing small amounts of fat).
For many patients with low vitamin D levels, I recommend 2,000 IU of vitamin D daily. To ensure that vitamin D levels are optimal, I monitor blood levels once or twice a year. Overdosing can lead to heart arrhythmia, anorexia, nausea and other ill effects.
- Magnesium, an important constituent of bone crystals, is crucial for the proper metabolism of calcium. A deficiency of magnesium impairs bone-building cells known as osteoblasts. Like calcium, magnesium requires vitamin D for absorption.
Researchers at Tel Aviv University in Israel looked at the effect of magnesium supplementation on bone density in 31 postmenopausal women with osteoporosis. This two-year, open, controlled trial (both the researchers and patients knew who was receiving the placebo or the supplement) involved giving the participants 250 mg to 750 mg of magnesium daily for six months and 250 mg for another 18 months. Twenty-two patients (71%) experienced a one percent to eight percent increase in bone density. The mean bone density of all treated patients increased significantly after one year and remained at that level after two years. Among an additional 23 postmenopausal women not receiving magnesium, mean bone density decreased significantly.
For osteoporosis prevention, take 400 mg to 500 mg of magnesium daily...for osteoporosis, take 500 mg to 750 mg daily. In both cases, take in divided doses.
IF YOU HAVE BONE-LOSS DISEASE
- Vitamin K has received attention in recent years for its role in treating osteoporosis. It activates osteocalcin, a bone protein that regulates calcium metabolism in the bones and helps calcium bind to the tissues that make up the bone. It also has been shown to inhibit inflammatory chemicals that cause bone breakdown.
Studies have shown that low vitamin K intake and blood levels are associated with reduced bone density and fractures in people who have osteoporosis. A recent meta-analysis published in the American Medical Association's Archives of Internal Medicine found that vitamin K supplements were associated with a consistent reduction in all types of fractures. Leafy, green vegetables, such as spinach, kale, collard greens and broccoli, are the best sources of vitamin K, yet many people do not consume these vitamin K-rich foods on a regular basis. High-dose vitamin K (above 2 mg) should be used only under the supervision of a doctor, because excess vitamin K may increase blood clotting. Vitamin K supplements should not be used by people who take blood-thinning medication, such as warfarin (Coumadin) or heparin, orby pregnant women or nursing mothers. I typically recommend 2 mg to 10 mg daily of vitamin K for people who have osteoporosis to help increase their bone density.
- Essential fatty acids (EFAs) have been shown to improve bone density in older women andare believed also to promote bone health in men. Many researchers theorize that osteoporosis develops because of chronic inflammation of bone tissue (due to stress, toxins, poor diet and infection). EFAs, especially those found in fish oil, reduce inflammation. Some studies show that EFAs also improve calcium absorption. I recommend that people with osteoporosis take fish oil daily (containing about 480 mg of EPA and 320 mg of DHA), along with 3,000 mg of evening primrose oil, which contains inflammation-fighting gamma-linolenic acid (GLA). Because EFAs have a blood-thinning effect, check with your doctor if you are taking a blood thinner.
- Strontium is a mineral that doesn't get much attention, because it is not regarded as essential for the human body. However, 99% of the total amount of strontium found in the body is located in the teeth and bones. Supplemental strontium is not the radioactive type that you may have heard about in relation to nuclear facilities. Strontium is a valuable mineral for people with osteoporosis, and I often recommend it.
A clinical trial in The New England Journal of Medicine found that strontium prevents vertebral fractures and increases bone density. The most common supplemental forms are strontium chloride and strontium citrate. I suggest a supplement that contains 680 mg of elemental strontium daily (similar to the dose used in most studies). Because calcium inhibits strontium absorption, strontium should be taken at least four hours before or after calcium is taken. Strontium should not be taken if you are pregnant or nursing. It is not available at most health-food stores, but you can buy it from Vitacost (800-381-0759, www.vitacost.com). A one-month supply costs about $20.
- Soy, as a supplement and/or food, has been shown in several studies to improve bone density. Soy contains isoflavones, estrogen-like constituents that support bone mass and relieve menopausal symptoms in women,'Women and men with osteoporosis or osteopenia should take 125 mg of soy isoflavones daily in soy protein powder or supplement form and consume three to five servings of soy foods weekly. (One serving equals one-half cup of tofu...one-half cup of soy beans...or one cup of soy milk.)
Caution: Soy supplements are not well studied in women who have had breast cancer, so they should avoid supplements and non-fermented soy products.
- Vitamin C is required for the production of the protein collagen, a component of bone tissue. I recommend that people with osteoporosis take 1,000 mg twice daily. Reduce the dosage if loose stools develop.
- Silicon is a trace mineral required for bone formation. I recommend 2 mg to 5 mg daily.