We have treated both men and women successfully with osteoporosis (weakened bone strength) and osteopenia (pre-osteoporosis). In children, poor bone health is more often seen as frequent cavities and dental decay, but this can be seen in adults as well. We all might immediately think "Calcium" is the key, but several nutritional factors are essential for healthy bones and teeth throughout our lives.
Diagnosis of osteoporosis and osteopenia is often made with the use of what is called a DEXA scan (Dual Energy X-Ray Absorbiometry), which gives us a couple markers for bone strength. These scans are generally limited to adults after age 65, as this is when osteoporosis and osteopenia tend to appear in those without a family history, and change in bone mineral density are very slow. A normal X-Ray can also find signs of decreased calcification of the bones and point to a diagnosis of osteoporosis. Some patients have been diagnosed after having surgery to repair a bone fracture, as the surgeon can see that the bones are not stable and as strong as they should be while repairing the injury.
What do the DEXA results mean?
The BMD gives your bone mineral density, which is the number of grams per centimeter of bone. Numbers of +1.0 or above are good.
Diagnosis of osteoporosis is made when the T-Score is less than -2.5, and osteopenia is diagnosed when the score is between -1.5 and -2.5. This score shows how your bone mineral density compares to someone in their thirties, when bone density is generally at its strongest. We want this score to be between +1 and -1.
The Z-Score compares your bone mineral density with others of the same age. This is less helpful as you may have better bone density than others your age, but may still be at a higher risk of bone fracture, which is what we want to avoid!
Other Helpful Tests (1, 2):
Urine testing of cross-linked N or C telopeptides can also tell us a lot about what the bone is doing in terms of remineralization and takes a more functional approach to treatment. When starting a treatment protocol, can let us know within a few months if the plan is working or needs adjusting.
DEXA scans can only be completed at most every two years, and it can take that long to see significant changes (or at least stabilization) in the bone density.
Using the urine testing helps us evaluate how well the treatment plan is working after just a few months, rather than waiting a full year or two for DEXA scan changes to show. Blood labs such as calcium and total protein can sometimes also help indicate if we're moving in the right direction if they were abnormal. Read about DiagnosTech's Bone Health Panel.
Medications you are taking play a BIG role in your bone health! (3)
Steroids: Chronic steroid use is well documented in reducing bone and teeth mineralization, weakening them and putting you at risk of osteoporosis even earlier in life. If you are taking chronic or frequent doses of prednisone, hydrocortisone or similar to manage chronic autoimmune disease or asthma, this should be addressed with the goal of no longer needing the steroid medication, or even just reducing the frequency of needing the medication.
Heartburn medications: Especially proton-pump inhibitors such as Prilosec, Prevacid, Nexium and Protonix, decrease stomach acid production by as much as 99%. Why is stomach acid important? Because without a proper low pH in the stomach, we cannot absorb our essential minerals such as calcium and zinc. This alterating of the stomach pH seems to also have an effect on systemic pH levels. Systemic pH levels are very tightly controlled by the body, and when even slightly too acidic, the body will pull calcium from the bones to help buffer (increase) the systemic pH to keep it in tight range. If you are taking chronic heartburn medication, your risk of osteoporosis or osteopenia later in life is greatly increased, getting off these medications is possible, and we help patients accomplish this regularly. Aluminum containing antacids such as Maalox, Mylanta and Rolaids seem to also impair bone mineralization.
Depo-Provera: This is an injectable form of progestone, often used for contraception. Most bone loss is reversible after the medication is stopped, so one may consider a different form of contraception.
Thyroid Hormone: One of the most commonly prescribed medications, this is one reason we monitor patient's blood hormone levels when on thyroid replacement therapy, as too high a dose of these medications can cause increased bone loss.
Diuretics are often used to help control blood pressure and lead to increased loss of calcium in the urine. They have been associated with reduced bone mineral density at the hips and an increased risk of hip fracture.
Anti-Seizure and Mood Altering Drugs: Such as Tegretol and Dilantin can decrease intestinal absorption of calcium and contribute to low vitamin D levels.
Some cancer medications and chemotherapy drugs alter normal estrogen or testosterone levels, which then leads to loss of bone density.
Ensuring you bones and teeth have what they need (4-7):
Proper nutrition is essential here. Sufficient amounts of protein and essential fats, calcium, magnesium, zinc, vitamin D3, vitamin A, vitamin E and K2 are often used therapeutically to help improve bone mineralization and if deficient, contribute to the development of osteoporosis and osteopenia. The form of calcium you are taking makes a difference, and so does the health of your digestive system, especially the stomach and stomach acidity.
Strontium is a mineral which can also help strengthen bones, and should be taken away from any calcium or other mineral supplements as they compete for absorption. Taking too much can weaken the bones, so be sure to work with your physician on dosing. Also be aware that any X-Rays taken while on strontium will make the bones appear to have more calcium (brighter white) and then can't be used to detect possible osteoporosis. DEXA scans will have to be used to assess bone strength (8,9).
One of the most essential of these nutrients is vitamin K. This vitamin helps form decarboxylated osteocalcin, which is the glue that calcium sticks to in the bones and teeth.
Deficiency of this vitamin can cause calcium to bind to other tissues, such as in the kidneys and the blood vessels, contributing to chronic stone formation and arterial plaques. Vitamin K is naturally found in green, leafy veggies and made by bacteria in the digestive system. This nutrient would not be safe for someone taking the drug Warfarin, which is a vitamin K antagonist (lowering) drug used to decrease the blood from clotting in those who have suffered from an inappropriate blood clot (such as in the brain or lungs).
Healthy hormone balance also help keep our bones strong. Deficiencies in estrogen or testosterone can slowly decrease bone mineral density. Hormone replacement therapy may be indicated and helpful for stabilizing and reversing bone mineral loss.
Weight bearing exercise is also essential. If you're not using it, you'll lose it!
Nature is always adapting to the current environment, and if our environment doesn't require strong bones, then why put the effort in maintaining strong bones?
Show your body you still need those bones to be healthy and strong. Hiking with a weighted vest or backpack can help improve lumbar spine strength (even putting a few heavy books in a backpack works!). An easy exercise that has been shown to increase hip and femur (thigh-bone) density is the flamingo stand.
Flamingo Stand: While supporting your balance next to a table, chair or counter, put all your weight onto one leg by curling the other up like a flamingo. Do this for 2 minutes on each leg, three times daily (10).
Are you concerned about your bone or teeth health? Demineralization of the teeth is often the first sign of trouble, and this can be reversed when caught early enough, especially in children with recurring cavities. For adults, often getting off medications altering bone strength and optimizing digestive function are the initial steps to promote healthy bones. Schedule a complimentary consultation today to see how we can help.
References:
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Szulc P. Bone turnover: Biology and assessment tools.Best Pract Res Clin Endocrinol Metab. 2018;32(5):725-738. doi:10.1016/j.beem.2018.05.003
MEDICATIONS THAT CAN CAUSE BONE LOSS, FALLS AND/OR FRACTURES, osteoporosis.ca
Rizzoli R, Bischoff-Ferrari H, Dawson-Hughes B, Weaver C. Nutrition and bone health in women after the menopause.Womens Health (Lond). 2014;10(6):599-608. doi:10.2217/whe.14.40
Weaver CM, Alexander DD, Boushey CJ, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation [published correction appears in Osteoporos Int. 2016 Aug;27(8):2643-6].Osteoporos Int. 2016;27(1):367-376. doi:10.1007/s00198-015-3386-5
Schwalfenberg GK. Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health.J Nutr Metab. 2017;2017:6254836. doi:10.1155/2017/6254836
Vitamin K, Linus Pauling Institute, https://lpi.oregonstate.edu/mic/vitamins/vitamin-K
Pilmane M, Salma-Ancane K, Loca D, Locs J, Berzina-Cimdina L. Strontium and strontium ranelate: Historical review of some of their functions.Mater Sci Eng C Mater Biol Appl. 2017;78:1222-1230. doi:10.1016/j.msec.2017.05.042
Khajuria DK, Vasireddi R, Trebbin M, Karasik D, Razdan R. Novel therapeutic intervention for osteoporosis prepared with strontium hydroxyapatite and zoledronic acid: In vitro and pharmacodynamic evaluation.Mater Sci Eng C Mater Biol Appl. 2017;71:698-708. doi:10.1016/j.msec.2016.10.066
Sakamoto K.Clin Calcium. 2008;18(11):1594-1599.
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