I read an article in the Washington Post Health and Science section about Osteoporosis that really caught my attention (Oct. 5, 2015). This article stated that of people 50 and older, about half of all older women and a fourth of older men will break a bone because of osteoporosis, a thinning and weakening of the bones. So I reached out to one of our service providers, Susan Brady, to write an article about it –the first in a series we will run about Osteoporosis. -Sandra

Osteoporosis is an increasing health issue facing our aging population. Osteoporosis is defined as a chronic progressive bone disease characterized by a deterioration of bone tissue resulting in bones that are weak and fragile, leaving them at an increased risk for fractures. Currently in the United States 54 million people have osteoporosis resulting in about one in two women and one in four men over the age of 50 breaking a bone due to weakened bones. Worldwide, the incidence of hip fracture is projected to increase by 240% in women and 310% in men by 2050. There is a strong misconception that osteoporosis is an inevitable result of the aging process and cannot be avoided. However, there are many risk factors, both uncontrollable and controllable, that contribute to osteoporosis. By identifying and addressing your risk factors, osteoporosis is a disease that can be prevented.

To prevent bone loss, it is important to understand the how bone maintains strength and density through the remodeling process. Bone is a dynamic living tissue that is able to rebuild and replenish itself. It does this through the workings of two key bone cells called: osteoblasts and osteoclasts. Osteoclasts help to break down and reabsorb old bones cells while osteoblasts generate new bone cells to replace the old. In order to maintain strong and healthy bones, you need a balanced interaction between these two types of bones cells, so that old bone can be sloughed off and replaced with newer, stronger bone cells. Osteoporosis occurs when the old bones cells are being broken down faster than they are being replaced, leaving bones weak and fragile. Therefore, osteoporosis can occur when you excessively break down and lose too much bone, don’t make enough new bone, or both. Because there are many things that affect the bone remodeling process, it is important to understand all the factors that may be putting you at risk for bone loss and osteoporosis.

It is common to hear about osteoporosis in older women and it is true that just being a women puts you at a higher risk of losing bone. Female hormones play a vital role in the bone remodeling process. Estrogen prevents excessive break down by the osteoclasts and progesterone is required by the osteoblasts to build new bone. The decline in these hormones as a woman ages results in an increase in bone resorption and a decrease in new bone formation resulting in an increased risk for osteoporosis. Women have an additional risk factor because they have less bone mass to start with, due to their smaller frame size.

Compounding this problem can be a failure to build critical bone mass earlier in life, during the childhood and teenage years. During these years, the body makes more bone than it loses, not only allowing an individual to grow taller but also to achieve what experts call peak bone mass. Peak bone mass refers the greatest mass, strength and density your bones can accumulate. By the age of 20, most women have reached their peak bone mass. Poor diet, excessive weight loss and inadequate or excessive physical activity can result in a failure to achieve peak bone mass in young women, leaving them at greater risk for osteoporosis as an adult. Although being a female does increase your risk for osteoporosis, there are many other risk factors that contribute to bone loss which leave men susceptible to osteoporosis, as well.

Most people believe that if you eat dairy and exercise, you are not at risk of developing osteoporosis. However, osteoporosis is different from other diseases or conditions because there is not a single, underlying cause. In fact, the overall health of a person’s bones depend on many factors, both uncontrollable as well as those that we can control. Being female and of small frame size is one uncontrollable risk factor.

Other uncontrollable risk factors include:

  • Being over age 50
  • Menopause/andropause
  • Family history of osteoporosis
  • Autoimmune diseases such as rheumatoid arthritis
  • Endocrine disorders such as hyperthyroidism or hyperparathyroidism

Certain medications such as antidepressants, steroid and seizure medication, and cancer chemotherapeutic drugs can be harmful to your bones as well. The higher the dose and the longer the medication is taken, the greater the risk for bone loss.

Though these factors may be out of our control, it is important to recognize these risks, not succumb to them. Prevention strategies aimed at maintaining or improving bone health are key before the deterioration of bone mass occurs.

There are also commonly known controllable risk factors for osteoporosis:

  • Smoking
  • Alcohol consumption of more than 2 drinks per day
  • Sedentary lifestyle
  • Lack of calcium and vitamin D in our diets (though, these minerals are only a fraction of the minerals needed to maintain strong bones)

These factors are known to cause osteoporosis through increasing bone loss and diminishing bone repair and renewal. However, there are several other risk factors, rarely acknowledged, that negatively affect bone density as well.

Other controllable risk factors for osteoporosis:

  • Poor dietary habits can increase one’s risk of developing osteoporosis. Apart from a diet lacking in calcium and vitamin D, a diet without enough vitamins K, C and B, and other key minerals such as magnesium, zinc, and boron, can contribute to weak bones and osteoporosis. Excessive intake of sugar and processed food can cause calcium excretion in the urine. Daily soda drinking depletes calcium levels as well and may increase the risk of bone fractures. Dieting, especially during the peak bone building years of one’s life, can result in nutrient deficiencies that lead to weakened bones. Studies have shown that people with anorexia nervosa are at a greater risk for osteoporosis because of their severely restricted diet and lack of nutrient intake.
  • Inadequate digestion can decrease the absorption of the key nutrients needed to build strong bones. Every day millions of people suffer from some form of digestive issue: heartburn, acid reflux, GERD, irritable bowel syndrome, indigestion constipation, diarrhea, abdominal pain. To relieve these symptoms people turn to Tums, Rolaids, Zantac, Tagamet, or the more dangerous, Proton Pump Inhibitors (PPIs) Nexium, Prevacid, Prilosec, and Protonics. These medication inhibit or decrease the production of stomach acid that is needed to absorb minerals like calcium, which is essential to healthy bones. One study showed that people over the age of 50 taking PPI for more than one year had a 44% increased risk of breaking a hip. Addressing digestive issues with natural remedies will help to improve digestion and absorption of bone building nutrients.
  • Chronic inflammation has been correlated with an increased risk of a variety of conditions associated with aging such as cardiovascular disease, diabetes, dementia and cancer, and now increasingly being associated with osteoporosis. Systemic inflammation is characterized by an increased levels of inflammatory cytokines which affect bone metabolism. Studies have found that individuals with the highest levels of inflammatory markers are up to three times more likely to experience fractures, especially hip fractures. Poor lifestyle choices, gastrointestinal distress, unhealthy diet choices, toxicity and stress can all lead to inflammation. Identifying inflammation as a risk factor is another important tool needed for reducing bone loss.
  • Stress not only contributes to chronic inflammation, but also causes a release of the hormone cortisol, which stimulates the release of calcium from our bones. Increased levels of cortisol cause an imbalance in the body’s pH and in response, calcium is released from the bones to help neutralize and restore the pH balance. Although eating calcium rich foods can replace the calcium lost from the bones, if stress becomes chronic, our diets cannot replace the calcium depletion fast enough leaving our bones fragile. Chronic stress can also lead to depression. Depression reduces hormones that aid bone growth and even mild depression may significantly increase a woman’s risk for developing osteoporosis. Stress and depression need to be recognized as another risk factor for bone loss and addressed.

Perhaps osteoporosis is on the rise and becoming more common than it should be because we overlook these additional factors that put our bones at risk. To compound the problem, the current osteoporosis screening guidelines to determine who is at risk for developing osteoporosis are inadequate. Understanding your risk factors is the first step to preventing and treating osteoporosis. Once you have recognized the factors that put you at risk, you can take the necessary steps to protect and enhance the health of your bones.   A nutrient rich diet, exercise and good lifestyle habits can go a long way to protect your bones and avert osteoporosis, no matter what risk factors you may have.

Up Next: When should someone be tested for osteoporosis?

Susan Brady is a Physical Therapist, Doctor of Integrative Medicine and holds a Post Master’s Certificate in Nutrition and Integrative Health. Practicing in the healthcare field for over 25 years, her background give hers a unique perspective in treating bone disorders.  By providing a comprehensive approach, Susan can evaluate your risk factors and address all avenues for strengthening your bones. For more information on Susan and her practice visit http://nurturedbones.com.

To get a better understanding of your risk for bone loss, take Susan’s comprehensive bone loss quiz: http://nurturedbones.com/quiz/

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