Osteoporosis is found frequently in women due to the loss of estrogen after menopause. Testosterone somewhat protects men against osteoporosis. Osteoporosis means porous bones, which are brittle and easily broken, especially in the hip, spine and wrist. Mineral density of the bones also decreases further contributing to bone weakness. It is possible to reduce the risk of osteoporosis through lifestyle changes, diet and nutrition because the body has the capacity to rebuild healthy bone at any age.
Bone density is evaluated through the bone matrix. Bone tissue is made up of widely separated bone cells surrounded by large amounts of "matrix" which is composed of collagen, calcium carbonate and various salts.44 Activity within bone tissue consists of both removal and replacement of components at the same time at the same location. This process is called remodeling. It serves to repair stresses and damage, replace old bone, and store calcium and phosphorus. Bone loss occurs when removal occurs more rapidly than replacement.45.
What you can do
- Stop smoking: Smoking leads to increased bone loss.
- Exercise: Exercise is known to help protect against bone loss. Walking is a good weight-bearing exercise for premenopausal women.
- Avoid unnecessary weight loss: People on extreme weight loss regimes experience bone loss.
- Eat vegetarian?While consumption of large amounts of animal protein are tied to more fractures, vegetarianism is not necessarily the best answer.
- Restrict salt consumption: Short-term increases in dietary salt cause more calcium to be lost in urine. This suggests that, over time, salt consumption may cause significant bone loss.
- Avoid caffeine: Caffeine has been linked to fracture of the hip. Caffeine also causes calcium to be lost from urine. Caffeine sources include black tea, coffee, cola drinks, and some prescription and over-the-counter medications.
- Avoid soft drinks: The relationship between soft drinks and bone mass is controversial. The adverse effect of soft drinks, if there is one, may be due to phosphoric acid, a substance found in many soft drinks. Avoiding drinks filled with sugar and phosphoric acid may reduce urinary loss of calcium.
- Eat soy: In animal studies, soy isoflavones have been reported to slow bone loss. Soy foods including tofu, roasted soy beans, soy milk, and soy extract powders (whole soy, not soy isolate), may be helpful in preventing osteoporosis.
Learn more about diet and lifestyle changes, and key nutritional factors
Women (or men) may not notice osteoporosis until they break a bone. Typical signs of osteoporosis, however, can include loss of height, more rounded shoulders, and the classic "dowager's hump." The patient might also notice back or neck pain.
Causes of Osteoporosis
Ten million Americans have osteoporosis, and 8 million of them are women. About 34 million more have osteopenia. This means they don't have osteoporosis yet, but have lost enough bone to make them more likely to get it. One in two women and one in eight men over age 50 will have an osteoporosis-related fracture during their lives. White and Asian women are most likely to get osteoporosis.
Remodeling is regulated by estrogen. As estrogen levels reduce during menopause, the remodeling becomes unbalanced with greater loss than replacement.
Other women at great risk include those who:
- have a family history of the disease,
- have not gotten enough calcium throughout their lives,
- had an early menopause,
- had surgery to remove their ovaries,
- had extended bed rest,
- used certain medicines for a long time, or
- have small body frames.
Additional risk factors include:
- no exercise at all, or intense physical training
- soft drink consumption
The risk of osteoporosis grows as you get older. Bone loss may begin slowly in some people when they are in their late thirties. At the time of menopause women may lose bone quickly for several years. Then the loss may continue but more slowly. As men age, they do not have the same kinds of striking hormone changes as women do in mid-life because they do not have a menopause. In men the loss of bone mass occurs more slowly. But, by age 65 or 70 men and women are losing bone at the same rate.
- People with celiac disease often have unusually low bone density. This condition improves markedly when they go on a no-gluten diet.
- Osteomalacia is a similar condition in which bone mass may or may not have deteriorated, but the mineral content of the bones is deficient. In osteoporosis, it is the bone mass that is weaker, while the mineral content may be alright.
- Patients with rheumatoid arthritis, Crohn's disease, and diabetes are at greater risk.
Conventional treatment includes drugs to suppress the breakdown of bone including alendronate [Fosomax®], calcitonin, and raloxifene. Since loss of estrogen or testosterone contributes to osteoporosis, doctors may recommend hormone replacement therapy. Doctors also usually recommend adequate dietary calcium supplementation if the diet is insufficient.
Complementary Care - More Information
Vegetarianism & Protein
Whether a vegetarian diet is helpful to lower the risk of osteoporosis is a matter of debate. One stance is that consumption of large amounts of animal protein (meat, poultry, and dairy) is associated with an increased risk of osteoporotic fractures. Early research suggested that vegetarians may have more bone strength (measured as bone mineral density, or BMD) than do non-vegetarians. However, more recent studies have found that the BMD of vegetarians is similar to that of non-vegetarians. And a recent study found that vegetarians have consistently lower BMD at the hip, the main site of osteoporotic fractures. Until more is known, broad dietary changes (e.g., a change to vegetarianism) cannot be recommended without qualification. Recommendations arising from the Framingham Study in 2010 are that elderly women should include at least 46 grams of either vegetable or animal protein in their diet, and elderly men should include at least 56 grams of animal or vegetable protein.
Key nutritional supplements
- Generally speaking, a number of low mineral levels are found in patients with both osteoporosis and osteoarthritis, including not only calcium and/or magnesium, but phosphorus, zinc, iron, boron, copper, fluoride, and vitamins A, C, E and K (and D where skin exposure to sunlight provides an inadequate supply).
- Calcium (800-1,000 mg per day of supplemental calcium is generally added to diets that commonly provide between 500-700 mg calcium per day): Many trials have investigated the effects of calcium on bone mass. Although calcium supplements alone are insufficient to prevent osteoporosis, they can help. Although some research is controversial, the protecting nature of calcium on bone mass is one of very few health claims permitted by the FDA. A review of the research shows that calcium supplementation plus hormone replacement therapy is much more effective than hormone replacement therapy without calcium.
- Vitamin D: Vitamin D plays an important role in the relationship between muscle and bone.41400-800 IU per day, depending upon dietary intake and exposure to sunlight. There has been a surge in diagnosis of vitamin D deficiency in the US.42 Furthermore, in patients with osteoporosis (and rhematoid arthritis) who are receiving denosumab therapy, adding both calcium and vitamin D to denosumab improves the bone density significantly.43
- Ipriflavone (200 mg three times daily:) Ipriflavone is a synthetic flavonoid (coming from the yellow color of plants) which is developed from daidzein a component of soy products. Ipriflavone helps calcium be absorbed into bone mass and slows the deterioration of bone structure. A number of clinical studies, have noted marked benefits in long-term treatment with ipriflavone for women with bone loss. This is especially true of women who have had ovaries surgically removed. Ipriflavone, especially when combined with calcium supplementation (1,000mg daily) improves bone density in cases of osteoporosis.
Other nutritional supplements that may be helpful
- Magnesium: 250-350 mg per day.
- Vitamin K: Vitamin K1, also known as phylloquinone or phytonadione, 100-1,000 mcg per day.
- Copper: 2-3 mg per day.
- Fish oil and evening primrose oil: 6 grams per day of a combination containing 60% linoleic acid, 8% gamma-linolenic acid (GLA), 4% eicosapentaenoic acid (EPA), and 3% docosahexaenoic acid (DHA), plus 600 mg per day of calcium supplement, daily for 18 to 36 months has shown a beneficial effect.
- Soy: 40 grams of soy protein powder per day (containing 90 mg of isoflavones per day).
Other herbs that may be helpful
- Black cohosh (Cimicifuga racemosa)*: Black cohosh has been shown to improve bone mineral density in animals but it has not yet been studied in humans.
- Horsetail (Equisetum arvense)*: Horsetail is a rich source of silicon, and preliminary research suggests that this trace mineral may help maintain bone mass.
Smoking leads to increased bone loss37 and it is well established that smoking contributes to or causes many other serious health conditions.
Exercise, especially weight-bearing exercise,38 is well known to help protect against osteoporosis. Not only working out, but simply walking, is good and the more weight-bearing exercise the greater your bone mass and the lower your risk of osteoporosis.
However, exercise so intense (such as long-distance running) that it leads to cessation of the menstrual cycle actually contributes to osteoporosis.
Excess weight loss
Researchers have found that the amount body mass effects protection against osteoporosis and that people who quickly loss large amounts of weight have more bone loss compared with those who do not lose weight.40 Therefore, people on weight loss regimes need to be very vigilant about getting adequate nutrition, avoiding known bone loss contributors and preventing bone fractures.
Note that excess weight contributes to many serious health problems - respiratory conditions, diabetes, cardiovascular problems, joint, muscle and tendon health, etc. So it is important to lose weight, but also important to do so carefully and monitor bone mass.
41. Tanaka, KI, et al, Active vitamin D possesses beneficial effects on the interaction between muscle and bone, Biochemical and Biophysical Research Communications,
42. Huang, KE, et al, Surge in US Outpatient Vitamin D Deficiency Diagnoses: National Ambulatory Medical Care Survey Analysis, Southern Medical Journal, April, 2014
43. Y. Nakamura, T. Suzuki, et al, Vitamin D and Calcium Are Required during Denosumab Treatment in Osteoporosis with Rheumatoid Arthritis, Nutrients, April, 2017.
45. Basics of Bone in Health and Disease, Bone Health and Osteoporosis, Office of the Surgeon General, 2004