An Excerpt from Dr. Duane Townsend's book,
The Maverick of Medicine Speaks to Women:
A World-Reowned Gynecologist's Solution
for a Better World in Women's Health Care.
Women with osteoporosis develop brittle bones, which increases their risk of bone fracture, particularly in the hip, spine, and wrist. While genetic factors play into your risk, when estrogen production takes a dive, your bone loss inevitably accelerates. People tend to think of osteoporosis as a disease that only targets women. It is, however, not an exclusively female condition. In one series, an estimated 40% of individuals affected with osteoporosis were men. Osteoporosis-related fractures are estimated to account for $13.8 billion in hospital and nursing home costs each year, and those costs are going up. Keep in mind that more than 25% of Americans will be age 50 or older by 2011 so we are only beginning to see the tip of the osteoporosis iceberg.
If you are a woman approaching menopause, you need to know that nearly half of all menopausal women either have the disease or are beginning to show the signs of bone loss (osteopenia). While your race, age, and gender will impact your risk, the incidence of osteoporosis varies widely. Of even more significance is the fact that this disease is preventable.
When Does Bone Loss Start?
You don’t have to be menopausal to start losing bone density. In fact, by the time you get to menopause, you may have already lost considerable bone mass. Most young women fail to consume the amounts of calcium they need to maintain good bone density. That coupled with a diet heavy on animal protein, sugar and soft drinks can set the stage for the development of brittle bones. In addition, a young woman who does not ovulate can be at a higher risk for osteoporosis.
Risk Factors That Raise Your Risk of Osteoporosis
Young women who repeatedly miss their periods and are not pregnant may develop premature ovarian failure which means that their hormonal output will not be adequate. When the ovaries stop producing hormones prior to age 35 or 40, periods cease and increased bone loss can commence. According to the National Institutes of Health, roughly 1% of American women experience ovarian failure by age 40. I know what many of you are thinking — what woman would complain about missing her period? Let me stress here that skipping periods at a non-menopausal age is medically significant and should be addressed by your doctor. Your ovaries produce the hormones that keep your bones flexible. A simple blood test for FSH, (follicular stimulating hormone) that is typically elevated above 20 can test you for ovarian failure.
Breast Cancer and Osteoporosis: A Hormonal Quandary
Women who have breast cancer have less osteoporosis and those who have osteoporosis have less breast cancer. Why? Because a woman with higher circulating levels of estrogen puts vulnerable tissue in estrogen’s path, thereby risking cellular changes that can turn into tumors. When it comes to bone health, however, higher estrogen levels mean that more calcium will get into the bone matrix helping to preserve bone density. It’s a catch twenty-two. By using estrogen blockers and natural progesterone however, a woman can have cancer AND bone protection. It’s like having your cake and eating it too.
Birth Control Pills: Good or Bad For Your Bones?
Interestingly, some studies also tell us that women who are taking birth control pills have lower bone mineral density (BMD) than women who have never used oral contraceptives. Remember that the hormones in a birth control pill suppress ovulation with doses of estrogen. Data from the a 2001 issue of the Canadian Medical Association Journal reveals that bone mineral density was 2.3% to 3.7% lower in women who had used birth control pills than those who had not. In addition, the bone loss appeared to target the spine and the upper part of the thigh bone more than other areas. Keep in mind that some experts have been telling woman that using oral contraceptive may actually protect them against osteoporosis because estrogen levels are artificially elevated. As is the case with so many studies on the effects of synthetic hormones, conflicting data is common. My view is that you should know all of the facts before going on an oral contraceptive for a long period of time.
Salt and Caffeine
Hide your salt shaker. Short-term increases in dietary salt consumption resulted in increased urinary calcium loss, which could cause bone loss over time. Granted, a concrete link between salt intake and osteoporosis has not yet been established, but regardless, cutting down on salt is wise, especially if you have high blood pressure or tend to retain water. Another culprit called caffeine also increases urinary loss of calcium and has been linked to the increased risk of hip fractures and overall lower bone mass especially in women who did not consume adequate amounts of calcium. Too many women rely on caffeine-containing soft drinks to boost their energy levels. Caffeine may temporarily spike your energy curve, but it comes with a high price tag. You can become dependent on its effect and when it wears off, feel like an old dish rag. Eating right and exercising are the only way to get through the day. Interestingly, caffeine-containing tea seems to prevent bone loss which would suggest that its high phenol (antioxidant) content may exert a bone-protective effect.
Get rid of your big gulp. People who regularly consume soft drinks have an increased incidence of bone fractures. Phosphoric acid found in many soft drinks can significantly lower your blood calcium levels. In one trial, children consuming at least six glasses of soft drinks containing phosphoric acid had more than five times the risk of developing low blood levels of calcium compared with other children. Soft drinks often contain sodium as well, which may also negatively impact bone density. When the phosphoric acid found in most soda pop is absorbed, your blood can become more acidic. When this happens, certain built-in alarms go off and the body neutralizes the acid with alkaline materials like calcium and magnesium. Where does the calcium and magnesium come from? Bone.
Dairy Products — Good or Bad?
Countries that have the highest rates of osteoporosis are England, Australia, and the U.S. Is it just a coincidence that citizens of these countries eat the most dairy products and red meat? I know what you’re thinking — don’t milk and cheese, etc. provide much needed calcium for bone strength? Perhaps not. There are several theories suggesting that our pasteurized and artificially treated milk, cheese, etc., is not digested the way it should be, therefore its calcium content may not be adequately absorbed. Moreover, when you add meat to your plate, it may cause calcium to be leached from your bones and teeth. So having a burger with a big glass of milk is not good for your bones. There is substantial evidence that eating a diet heavy on protein is not bone-friendly. If you’re going to consume dairy products, choose non-fat milk, which has a lower protein and salt content while sporting higher calcium content. Cottage cheese on the other hand, is actually higher in protein and salt and lower in calcium. Many hard cheeses are also high in fat and salt and are not preferable sources of dietary calcium. Low fat yogurt offers another good source of dietary calcium if they contain “active” lactobacteria cultures.
Smoking and Drugs
Here’s another reason to quit smoking. Smoking leads to increased bone loss. There is plenty of evidence out there that smoking causes a significant increase in the risk of bone loss and osteoporosis. For instance, one study showed that women who smoked one pack of cigarettes a day experienced a loss of bone density equaling five to ten percent more than nonsmokers by the time they reach menopause. Smoking reduces the blood supply to bones and nicotine inhibits the production of bone-forming cells (osteoblasts) and also compromises the absorption of calcium. When your bone mineral content goes down, the fragility of your bones goes up. Smoking also appears to impair the actions of estrogen, which naturally protects bone mass. We also know that smoking increases your risk of a hip fracture as you get older. Older women who smoke have a 41 percent increase in the rate of hip fracture. Bone density scanning is recommended for all women after the age of 40 but is absolutely crucial if you smoke.
Drugs That Hurt Bones
There are several drugs that can cause secondary osteoporosis and if you are on any of them, talk to your doctor about preserving the health of your bones. If you can’t get off of any of these drugs, then, for heaven’s sake, take the necessary steps to protect your bones from this additional hazard. For example, taking a compound called ipriflavone may help to mitigate some of the bad effects of these drugs.
Cortisone, prednisone, and dexamethasone are commonly prescribed corticosteroid drugs and if used over a long period of time, pose a significant bone risk. The amount of bone loss that you will experience while on these drugs can vary. For instance, your bone loss may be greater if you take corticosteroids orally as opposed to injections, inhalers, or in topical creams, etc. The stronger your dosage and the longer you take a corticosteroid drug, the higher your chances are for developing osteoporosis.
Thyroid Hormone Drugs:
Most people who take this class of drug have an underactive thyroid. Because artificially manipulating this hormone can be difficult, an excess amount can decrease bone mass when used over time. If you’re on this drug, make sure to have your blood tested every six months to check on your thyroid hormone levels and be diligent about taking calcium/magnesium supplements and exercising regularly.
While some antacid tablets contain calcium and are advertised as being good for your bones, those that contain aluminum are not if you have kidney problems, or repeatedly take them in high doses. Check your antacid for aluminum and don’t rely on antacids as your only source of supplemental calcium. If you are on prescription antacid drugs, talk to your doctor about potential bone loss.
Other Medications That Can Cause Bone Loss
Barbiturates that are used to prevent seizures
Methotrexate (Rheumatrex, Immunex, Folex PFS)
Cyclosporine (Sandimmune, Neoral)
Luteinizing hormone-releasing hormone agonists (Lupron, Zoladex),
Heparin (Calciparine, Liquaemin)
Cholestyramine (Questran) and colestipol (Colestid)
The Weight Loss Link to Bones
Someone told one of my heavier patients that because she carried extra fat stores that product estrogen, her risk of osteoporosis was less. Technically, this is correct but while being overweight may seem like an advantage, the extra weight exerted on your bones and muscles may not be. Moreover, obese women are at higher risk for breast cancer, heart disease, etc. You do need to know, however that women who lose weight have greater bone loss than those who don’t. While this info may sound like a mixed bag, the important thing is to be careful if you lose weight by keeping your bone mass in optimal condition through nutritious eating, supplementation and exercise.
Drugs for Osteoporosis
Conventional treatment options for osteoporosis include prescription drugs that suppress the breakdown of bone (e.g., alendronate [Foamex®], calcitonin [Calcimir®, Miacalcin®], raloxifene [Evista®]), and those that provide hormone replacement therapy (e.g., estradiol [Estrace®, Estraderm®, Fempatch®], conjugated estrogens [Premarin®], and conjugated estrogens with medroxyprogesterone acetate [Premphase®, Prempro®, Provera®]) for postmenopausal women. Many of these drugs come with unpleasant side effects which should be discussed thoroughly with your doctor. Unless your situation is extreme, I like to turn to Mother Nature has provided some viable alternatives to protect your bones.
Does HRT to Prevent Osteoporosis?
Why don’t women that live in third world countries and eat very little dairy or meat get the kind of osteoporosis American women do? Of equal relevance, if estrogen replacement is the way to prevent bone loss after menopause, what are these women doing? It’s certain that they aren’t wearing Depo patches or popping Provera. Obviously, there are more factors at play here.
Like the heart connection, the data on HRT and bone loss conflicts. There is abundant research that shows that synthetic hormones do NOT prevent bone loss. In fact, one of these studies concluded that the risk of hip fractures for women over 75 is the same whether or not she took synthetic estrogen. On the other hand, there are scores of studies that advocate the bone-protective properties of HRT, but does it justify any potential risks?
At the risk of sounding redundant, I believe that the most important aspect of osteoporosis management is prevention of the disease. Remember that the higher your bone mass before menopause, the less your risk of osteoporosis. Good bone health depends on exercise and diet (surprise, surprise).
So, while the ability of estrogen to prevent osteoporosis is still engendering debate, we do know this — synthetic estrogen cannot increase bone mass. Granted, it may delay or slow bone loss but it can never replace bone.
Bone Density and Soy Isoflavones
Recently, researchers at the University of Illinois in Urbana found that soy isoflavones can help to strengthen the bones of the lumbar spine and help to prevent the dowager's hump often seen in postmenopausal women with osteoporosis. The bone density of one group of women who took 92 mg of soy isoflavones daily increased by 2.2 percent over a period of six months. It's important to realize that most women lose 2 to 3 percent of bone density in the initial two to three years following menopause, suggesting that the sooner isoflavone consumption is increased, the better.
Eating soy foods such as tofu, soy milk, roasted soy beans, and soy protein powders is a good way to get these much-needed isoflavones. In another double-blind trial, postmenopausal women who supplemented with 40 grams of soy protein powder (containing 90 mg of isoflavones) per day were protected against bone mineral loss in the spine, although lower amounts were not protective. While the use of soy in the prevention of osteoporosis looks hopeful, no long-term human studies have examined the effects of soy or soy-derived isoflavones on bone density or fracture risk.
Ipriflavone: Potentiated Isoflavone Compound for Bone Health
Ipriflavone is an isoflavone synthesized from daidzein (which is naturally found in soy). It appears to have a great deal of potential in the prevention and treatment of osteoporosis and other bone diseases. Studies to date have found that it enhances bone formation and mineral absorption, thereby increasing bone density. It works by boosting the effect of estrogen, although it has no estrogenic activity in and of itself. For this reason, if osteoporosis runs in your family and you want an HRT alternative, ipriflavone may be a good choice for you. Preliminary studies also reveal that taking this compound may help to protect your bones from steroid use, immobility, and if you have had your ovaries removed.
Ipriflavone has the distinct ability to increase the activity of bone-building cells called osteoblasts while inhibiting the action of osteoclasts, which actually break down bone material. One study conducted in 1998 found that ipriflavone was able to dramatically boost new bone formation and repair. A group of 56 post-menopausal women with low bone density all received 1,000 mg of calcium and random subjects were given an additional 600 mg of ipriflavone. The women who only took the calcium actually experienced increased bone loss after two years. By contrast, bone loss was totally halted in those who took the ipriflavone. The study concluded that, "Ipriflavone prevents the rapid bone loss following early menopause." The recommended dosage of ipriflavone is 600 mg daily.
Natural Progesterone Lays On Bone
I don’t believe that soy alone offers a strong enough defense against bone loss. Complementing soy with natural progesterone cream is wise. Preliminary evidence suggests that progesterone reduces the risk of osteoporosis. Dr. John Lee talks about his encounter with scores of women who suffered from osteoporosis. Many of them were continually losing bone density regardless of the fact that they were on estrogen therapy. At best, he believes that all supplemental estrogen therapy did was to slow their bone loss, not stop it and certainly not reverse it. He mentions that even when these women took calcium, vitamin D and C, and even quit smoking, their bone loss continued.
He relates that over a 3 year time interval, the typical woman who was not taking any hormonal therapy would lose four and a half percent of her bone mass. He emphasizes that adding estrogen therapy can help maintain bone mass for several years, but that it will gradually go down. Here’s the clincher — by adding natural progesterone treatments, he saw a 15 percent increase in bone mass over a period of three years with no negative side effects.
Tips On How To Prevent and Even Reverse Bone Loss
Eat More Vegetables
A recent study reported in the Journal of Clinical Nutrition conducted by the Department of Endocrinology at the University of California Medical School in San Francisco, emphasized the importance of maintaining a proper balance between the consumption of animal protein and vegetable protein. Menopausal women whose protein consumption was 3:1 (favoring animal protein over vegetable protein) had a much risk of osteoporosis and hip fractures. When that ratio dropped to 1:1 the risk dramatically dropped. Once again the devastating effects of the typical diet of most North American women is underscored.
All Protein is Not Created Equal
Why does the type of protein source you choose to eat make such a difference to your health? For one thing, animal protein leaves a type of “ash” when it is burned because it contains high levels of sulfur amino acid contents (methionine and cystine). As a result, acid levels increase and need to be neutralized. Innate chemical mechanisms turn to calcium and magnesium to do the job. Where do we store the most calcium and magnesium? You know!
On the other hand, a diet rich in vegetables helps to keep your blood more alkaline which can prevent mineral depletion from the bones. Moreover, many vegetables are rich in vitamin K which works to maintain calcium deep within your bones.
While you may find opposing arguments by other experts, I believe that obtaining your protein from soy, and other legumes (beans, raw nuts, etc.) is not only bone protective, but is much better for your entire body. As opposed to red meat and dairy products, when was the last time you saw red beans or almonds linked to heart disease or cancer? And I must add that my vegetarian patients have excellent bone mass and flexibility. In virtually every health category, they far surpass my meat and potato patients.
Take The Right Calcium Supplement
Close to three fourths of all women DON’T get enough daily calcium and over 50 percent don’t even get half the recommended amount. Unfortunately, you may not find out you’re calcium depleted until your teeth and bones start falling apart. Moreover, if you're calorie or cholesterol-conscious, or if you're allergic to milk, or are lactose intolerant, getting enough calcium from your diet will be virtually impossible.
Calcium supplements are a good way to ensure that you get enough calcium and they are relatively inexpensive. The confusion lies in what type to pick. Be aware that it isn’t the amount of calcium listed on that label that counts, but rather how much of it your body will absorb.
There are three commonly available forms of this mineral – calcium carbonate, calcium lactate, and calcium citrate. According to the latest research available, calcium citrate wins over its competitors. A study found in the November, 1999 issue of The Journal of Clinical Pharmacology reveals that the human body absorbs 2-1/2 times more calcium citrate than calcium carbonate. So while calcium carbonate supplements may contain more elemental calcium than calcium citrate, less of it actually finds its way to your bones. You may find that a calcium supplement contains a variety of calcium types. Make sure that calcium citrate is the major calcium player on that label. Avoid calcium supplements derived from bone meal, oyster shell or dolomite. These supplements may be contaminated with lead.
Maximizing the Action of a Calcium Supplement
1. Make sure that you add Vitamin D and magnesium to your calcium supplement to enhance its absorption. The calcium-magnesium ratio in the supplement you choose should be 2-1 (for example, 500 mg. calcium to 250 mg. magnesium).
2. If possible, spread your calcium doses throughout the day, limiting each dose to no more than 500 mg. This helps to increase absorption and decrease any possible side effects, which can include constipation and bloating.
3. Take your supplement with a large glass of water to ensure that it breaks down properly. The last thing you need is a bunch of undissolved calcium tablets residing in your colon. Chewable forms of calcium are also recommended. Don’t take calcium supplements with meals because fiber can tie up the calcium and prevent its absorption.
Note: Check with your doctor before taking any calcium supplement. If you have kidney disease, kidney stones or an overactive parathyroid gland, you should not take calcium supplements.
Minimum Calcium Requirements
Pre-menopausal women age 25-50: 1000 mg daily
Pregnant/nursing women: 1200 - 1500 mg daily
Post-menopausal women under 65 on estrogen replacement therapy(ERT): 1000 mg daily
Post-menopausal women not on ERT: 1500 mg daily
All women over 65: 1500
NOTE: Calcium intake up to about 2,000 mg/day appears to be safe in most individuals.
I don’t recommend crunching on Tums to get your calcium. Tums are nothing more than calcium carbonate, which is a source of calcium, but is not the most absorbable kind. I like calcium citrate and suggest taking 1,200 to 1,500 milligrams prior to retiring.
Preferred Calcium-Rich Foods
Non-fat milk, active culture low-fat yogurt, leafy green vegetables, canned sardines and salmon with edible bones, calcium-fortified orange juice and cereal, tofu, raw almonds.
Encourage your teenage daughters to take start taking calcium supplements since the best time to build strong bones is during the second decade of life. Research has found that 12 year old girls who took calcium supplements had better bone building than those who did not. The more bone mass you can build when you’re young, the less your risk of osteoporosis later.
Magnify Your Magnesium
If you have osteoporosis, you may also have trouble absorbing magnesium. Low blood and bone levels of this mineral can be low in women suffering from osteoporosis. Magnesium supplementation at 250 mg to 750 mg per day actually stopped bone loss or increased bone mass in 87% of people with osteoporosis in a two-year, controlled trial. You need to take a minimum of 350 mg of magnesium with your calcium daily.
Vitamin D for Density
Good old Vitamin D boosts calcium absorption. How much of you have in your blood is directly related to the strength of your bones. A deficiency of vitamin D is common in the elderly and accelerates of age-related loss of bone mass and an increased risk of fracture. Many studies show that vitamin D supplementation reduces bone loss in women who don’t get enough of it in their diets.
Choose Your Oils Wisely
Elderly women with osteoporosis who were given 4 grams of fish oil per day for four months had improved calcium absorption and even showed evidence of new bone formation. Combining fish oil with evening primrose oil (EPO) may be even better. In another controlled study, women who took 6 grams of a combination of EPO and fish oil plus 600 mg of calcium per day for three years experienced no spinal bone loss in the first 18 months and showed a dramatic 3.1% increase in spinal bone mineral density during the last 18 months.
Vitamin K is For Keeps
Women who have osteoporosis are also frequently low in vitamin K. One study found that post-menopausal women can actually decrease a loss of calcium in the urine by taking 1 mg of vitamin K per day. And those who already have the disease who took supplemental vitamin K showed an increase in bone density and overall decreased bone loss after six months.
Trace Minerals Too
Trace minerals like zinc and copper are also critical for proper bone mass and should be included in your multiple vitamin and mineral supplement in chelated forms. You should be getting 10 mg of zinc and 2 to 3 mg of copper daily.
Weight Bearing Exercise
Engaging in weight bearing exercises is an absolute must for sustained bone health. These exercises require your muscles to work and can include aerobic exercises like walking, water aerobics (also known as aqua aerobics) and step aerobics. Women who exercise at least three times a week consistently show a higher bone mineral content than those who don’t. Mild weight lifting can be helpful but you should avoid exercises that put an abnormal amount of stress on your bones and joints. Simply stated, regular exercise protects against bone loss and the more weight-bearing exercise you do, the better your bone mass will be.
An Excerpt from Dr. Duane Townsend's book,
The Maverick of Medicine Speaks to Women:
A World-Reowned Gynecologist's Solution
for a Better World in Women's Health Care.