Building Better Bone

Defining (and redefining) osteoporosis

Osteoporosis is a degenerative disease that refers to thin or substandard bone. According to Osteoporosis Australia, over 2.2 million Australians now have this disease. It is increasing dramatically, partly because we are getting older as a population, partly because of our lifestyles, and partly because bone health has been redefined.

New Zealander Gillian Sanson, in her 2001 book The Osteoporosis ‘Epidemic’: well women and the marketing of fear, pointed out that we all lose bone as we age, but that doesn’t necessarily mean we are going to have a dowager’s hump or break bones. A healthy lifestyle is our best insurance. In 1994, osteoporosis was redefined, and a new term ‘osteopenia’ was developed as a label for bone density that was a little less than normal. Since ‘normal’ is the assumed average peak bone mass of a young white woman aged 25-30, those of us who are well beyond that age can expect to be labeled as having low bone density. (Most of us would notice that this is not the only thing about our bodies that is not the same as when we were 25 or 30!) Sanson also argued that low bone density doesn’t necessarily mean you are more susceptible to fractures. Asian women tend to have low bone density, but low rates of bone fracture.

What causes brittle bones?

We often hear that it’s low calcium intake and low estrogen, but while calcium is important, it is one of a range of nutrients essential for strong bone. Others include magnesium, manganese, boron, zinc and silica. Moreover, women in countries with lower calcium intake than Australia’s have stronger bones than we do. Bantu women in Africa and Japanese women are good examples.

All women, no matter what country they live in, lose estrogen at menopause — yet not all women develop osteoporotic fractures. According to Canadian Dr Jerilynne Prior, a researcher and professor of endocrinology at the University of British Columbia, it is not a loss of estrogen, but a loss of progesterone that results in bone loss.

A range of factors appear to contribute to osteoporosis. Dr Susan Brown is a world expert in this area, and the drawing below comes from her 2000 book Better Bones, Better Body.

A diet high in refined and fast food, sugar, poor quality fats, refined salt and soft drinks, artificial sweeteners such as aspartame, caffeine or alcohol will increase the likelihood of osteoporosis. Smoking and extreme exercise where women stop menstruating are also risky.

Experts have differing views as to when we should start checking our bone density. Some say we need a baseline measurement when we are about 40, while others argue that most of us needn’t do it before age 65. The most important issue is to keep a balanced view of the results. Remember that bone mineral density is not the be-all-and-end-all. A diagnosis of low bone density does not mean your bones are brittle or that you are likely to fracture them. Yet many women in this situation are being prescribed drugs such as Fosamax, which have side-effects and may not build the quality of bone that you need.

What else can you do to maximize bone health?

Avoid the foods listed above that are detrimental to bone. Eat a balanced, nutrient-rich diet including a wide variety of fresh vegetables (onions are especially good for improving bone density) and some fruit, good protein sources, and healthy fats. Include omega-3 fats in your diet and limit your intake of processed omega-6 oils such as corn, sunflower, safflower and soy.
Choose food sources of nutrients in preference to supplements. Rather than taking calcium tablets, eat food that contains bone building minerals such as leafy greens and herbs (parsley, rocket, watercress, spinach, dill, dandelion greens and so on), nuts and seeds (pumpkin, sunflower, brazil, walnuts, pecans, almonds, hazelnuts) and sardines. Unprocessed salt (Celtic sea salt or Himalayan salt) is also a good source of trace minerals.
Dairy products are healthy if they are organic and unpasteurised, but most commercial dairy foods are highly processed. Broths made from fish, chicken or beef bones with a little vinegar to extract calcium from the bones are an old-fashioned but nutritious way to obtain calcium.
Avoid high-gluten grains (wheat, rye, barley, oats). Gluten may reduce bone density, but it also causes digestive problems for many of us, and limits our uptake of essential minerals.
A long-term American study that focused on postmenopausal women’s vitamin D levels concluded that adequate vitamin D is more important than calcium in reducing the risk of fractures. The main source of vitamin D is the sun, but deficiency is common, even in warm climates like ours, so we need to make a daily effort to get some sunshine (10-15 minutes with at least 40% of the skin exposed has been proposed, but it’s important not to get burnt). Vitamin D increases bone mineralization and calcium absorption in the small intestine. As well as boosting bone health, it helps reduce the incidence of heart disease, diabetes, Alzheimer’s, cancer, autoimmune diseases such as MS and rheumatoid arthritis, hearing loss, insomnia, depression, migraine, asthma, myopia and macular degeneration. Vitamin D also slows ageing and is important for weight control. Optimising vitamin D levels can clearly have a profound impact on your health.

You can check your vitamin D levels via a blood test called the 25-hydroxyvitamin D or 25 (OH)D. The ideal range is said to be 115-128 nmol/l, but that’s quite high; 100 nmol/l is a good mark to aim for. The median in Australia is 81nmol/l, and levels below 50-80 nmol/l are regarded as deficient. If you need to consider supplementation, work with a practitioner to fine tune your levels and avoid overdosing. You need to take vitamin D3 (cholecalciferol) NOT synthetic vitamin D2.

Food sources of vitamin D include egg yolk and oily fish. Although cod liver oil has long been regarded as a good source, some products contain high doses of vitamin A and a token amount of vitamin D. Some practitioners believe that too much vitamin A inhibits the function of vitamin D.
Don’t diet or use diuretics in order to be thin.
Limit caffeine and alcohol to no more than two drinks per day.
A range of drugs and over-the-counter products may cause bone damage, and these include epilepsy drugs, blood thinners, laxatives, Methotrexate (for treating cancer and autoimmune conditions such as rheumatoid arthritis), Tetracyclines (antibiotics), antacids, benzodiazepines such as Valium and Librium, and diuretics. Check the side-effects of any medications that you take, especially in the medium or long-term, and if you take any on this list, investigate your options.
Take a regular probiotic to help ensure that your digestive system is functioning well and you absorb nutrients effectively. Also read the article on Digestion: the key to good health.
Minimise stress. Stress impacts your digestion, which determines your nutrient absorption
As much as possible, keep your insulin levels and your hormones in balance (see the article on How to Have Healthy Hormones).

Building Better Bone

Defining (and redefining) osteoporosis

What causes brittle bones?

What else can you do to maximize bone health?

Further reading