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Osteoporosis – Natural Solutions
April 2005
Articles
A Summary of the Prevailing Research • By Alan R. Gaby, M.D.
Osteoporosis affects as many as 30% of post-menopausal women and about 5% of older men in the United States. More than 1.2 million fractures (primarily of the hip, spine or wrist) occur each year as a direct result of osteoporosis. As recently as the late 19th century, osteoporosis was considered a rare disease. Since that time, the prevalence has increased progressively, even after adjusting for the age of the population.
Since our genes have not changed much during the past century, environmental factors are likely responsible for this epidemic of thin bones. I have outlined many of these factors in my book Preventing and Reversing Osteoporosis (Prima Publishing, 1994), and suggested various non-drug strategies for preventing and treating the disease. Following is a summary of that information, updated according to research published since the book was written.
Environmental pollution
Several heavy metals that contaminate the environment (e.g., aluminum, lead, cadmium, and tin) have been shown in animal studies and in some human research to promote osteoporosis. Of particular concern is aluminum, which has become widely distributed in our environment. Sources of aluminum include beverages stored in aluminum cans, some municipal water supplies (aluminum is added to prevent the accumulation of particulate matter), processed cheeses and other processed foods, food additives (including preservatives, coloring agents, and leavening agents), aluminum cookware, aluminum products used to store or wrap food, underarm deodorants, and antacids. While it is not possible to avoid aluminum completely in our modern environment, exposure to this metal can be greatly reduced by making some basic lifestyle modifications.
The main source of tin exposure is food packaged in tin cans. While some tin leaches into foods and beverages before the can is opened, an even greater amount can leach if the food or beverage is allowed to sit in the container after the can is opened. Tin exposure can be reduced by decreasing the use of tin cans, by not allowing tins cans to be stored at high temperatures, and by transferring the contents of the can to another container after it is opened.
An important environmental source of lead is tap water which, in many cities, still flows through lead-soldered pipes. The accumulation of lead is greatest in water that has been allowed to sit in the pipes for long periods of time; consequently, letting the water run for a minute or two before using it will reduce the amount of heavy metals consumed. Of course, a clean source of bottled water is preferable to tap water, because the latter contains chlorine and other potentially toxic substances.
Diet and lifestyle factors
It is well known that weight-bearing exercise can strengthen bones and reduce the risk of developing osteoporosis. Even some non-weight-bearing exercises (such as swimming) can improve bone health, although not as much as walking, jogging, jumping, and weight-lifting. Cigarette smoking also appears to promote osteoporosis, and should be avoided.
Dietary factors that may cause thinning of bones include excessive consumption of refined sugar, caffeine, alcohol, and animal proteins. Consuming moderate amounts of alcohol or animal protein does not appear to promote bone loss, and inadequate protein intake has a deleterious effect on bone. Circumstantial evidence suggests that repeatedly eating foods to which one is allergic increases the risk of osteoporosis. Celiac disease, an extreme example of food intolerance, is a known cause of osteoporosis, and people with unexplained bone loss should be screened for celiac disease, even if they do not have the typical gastrointestinal symptoms.
Calcium
Adequate intake of calcium is important for maintaining healthy bones. For most healthy younger people, the type of supplemental calcium used does not appear to be particularly important, as all of the commercially available calcium salts are absorbed to about the same extent (excluding improperly formulated tablets that do not dissolve in the gastrointestinal tract). People with hypochlorhydria (low stomach acid), on the other hand, may not be able to absorb calcium carbonate, although their absorption of calcium citrate is usually good.
For older people, there is evidence that at least a portion of supplemental calcium should be provided in the form of calcium phosphate (tricalcium phosphate). Although phosphorus is a key nutrient for bones, it is left out of most bone-building supplements, because the typical American diet contains abundant or even excessive amounts of this mineral, and ingesting too much phosphorus can interfere with calcium utilization. For many older people, however, dietary intake of phosphorus may be marginal. Supplementing with calcium can further compromise the phosphorus status of older people, because calcium inhibits the absorption of phosphorus. It has been pointed out that one of the most effective trials of calcium supplementation in elderly patients used tricalcium phosphate as the calcium source.
The importance of other nutrients
While calcium has received most of the attention among doctors, there is good evidence that many other micronutrients are involved in promoting bone health. These include magnesium, manganese, zinc, copper, boron, strontium, silicon, vitamin D, vitamin C, folic acid, vitamin B6, and vitamin K. Many of these nutrients are in short supply in the typical processed Western diet. While none of these nutrients has been studied as extensively as calcium, the available evidence suggests that some of them (particularly vitamin K, vitamin D, copper, and magnesium) are at least as important as calcium. Consequently, consuming whole foods that are high in micronutrients, and taking a broad-spectrum nutritional supplement, will often be more effective than taking calcium by itself.
Recent studies have shown that vitamin D deficiency is far more prevalent than previously believed. In addition, it appears that some people need to supplement with 800-1,000 IU of vitamin D per day, rather than the more commonly recommended 400 IU per day, in order to prevent or treat vitamin D deficiency. Some investigators have argued that we are overdoing our sun-phobia, and that modest amounts of sunlight exposure can greatly enhance our vitamin D status, without increasing the risk of skin cancers. Holick recommends daily exposure of the hands, face, and arms, or arms and legs, to sunlight for a period equal to 25% of the time it would take to cause a light pinkness of the skin (i.e., one-quarter of the minimum erythema dose). That level of exposure would be sufficient to satisfy the body’s vitamin D requirement, and to synthesize enough of the vitamin to store in the skin for use at times when sunlight exposure is inadequate. In addition to helping maintain strong bones, vitamin D supplementation reduces the number of falls in older people, thereby further decreasing the risk of fractures.
Strontium therapy
Strontium is a normal component of human bone, where it replaces a small proportion of the calcium in hydroxyapatite crystals. Supplementing with large doses of strontium (about 200 to 300 times as much as that in a typical diet) has recently been shown to increase bone mineral density in postmenopausal women and to reduce the incidence of fractures by more than 40% over a 3-year period. While no serious adverse effects were seen in this study, additional research is needed to determine whether it is safe to use high-dose strontium for longer than three years. In animal studies, administration of large doses of strontium has caused bone-mineralization defects. While these abnormalities may have been due entirely or in part to the use of calcium-deficient experimental diets, it is also possible that chronic use of high-dose strontium would lead to an excessive ratio of strontium to calcium in bone crystals, even if the diet contains ample amounts of calcium.
Doctors using high-dose strontium should also be aware that its use causes artifactual results when bone density is measured by dual-energy X-ray absorptiometry (DEXA). Strontium attenuates X-rays more than calcium does, so the DEXA reading must be corrected according to the estimated bone strontium content. For example, in one study, strontium supplementation increased mean lumbar spine bone mineral density by 5.53% according to the measured value, but by only 1.41% after adjustment for bone strontium content. Short of performing a bone biopsy, there is no way to know exactly how much strontium has accumulated in any particular patient. Consequently, monitoring of strontium treatment will be somewhat imprecise.
Strontium supplementation may also be useful for preventing osteoporosis, but high doses are probably neither necessary nor desirable for that purpose. When considering lifetime supplementation of a trace mineral for disease prevention, it makes sense to think in terms of an amount that is present in a typical diet, which is about 1 to 3 mg/day for strontium. Foods high in strontium include fish, whole grains, kale, parsley, lettuce, Brazil nuts, and molasses; some multivitamin-mineral preparations also contain small amounts of strontium.
Hormonal therapies
Horse-urine-derived estrogen as a treatment for humans has finally been relegated to the place in history that it deserves. At the same time, doctors are beginning to take a more serious look at the concept of using bio-identical hormones that has been advocated for many years by proponents of natural medicine. This includes bio-identical estrogens (e.g. a combination of estrone, estradiol, and estriol, as originally suggested by Jonathan Wright, M.D.), natural progesterone (as opposed to unnatural medroxyprogesterone acetate), DHEA, and testosterone. Each of these hormones has been shown to have a beneficial effect on bone mineral density, although the research on natural progesterone has produced conflicting results. The appropriate doses and combinations of these hormones are highly variable, and should be determined by a practitioner experienced in their use.
Some women do not appear to need hormone therapy at all; indeed, I have seen bone mineral density increase in some postmenopausal women who did nothing more than take a moderate-dose comprehensive micronutrient supplement.
Other therapies
Eating soy foods or supplementing with soy isoflavones such as genistein have been shown in some studies to be beneficial. Ipriflavone, a semisynthetic flavonoid that is structurally similar to the soy isoflavone daidzein, has also been shown to preserve bone in postmenopausal women. The usual dose is 200 mg 3 times a day. Ipriflavone does not appear to work for people with advanced osteoporosis, and it has caused lymphocytosis (of uncertain clinical significance) in approximately 13% of people who have taken it. In addition, Ipriflavone inhibits cytochrome P450 and, therefore, could interact with various medications. For example, treatment with Ipriflavone has been shown to increase blood levels of the asthma drug theophylline.
Conclusion
I have found that a comprehensive natural-medicine program is frequently successful at halting, or even reversing, bone loss. This approach does not work well for everyone, however, and some patients need to take Fosamax or other prescription medications in order to achieve adequate results. Nevertheless, because of its safety and low cost, the natural approach to preventing and treating bone loss should be at or near the top of the list of interventions for people who have, or are at risk of developing, osteoporosis.
Alan R. Gaby, M.D., is past-president of the American Holistic Medical Association, author of Preventing and Reversing Osteoporosis (Prima Publishing; available at Amazon.com), and developer of Osteoprime (Enzymatic Therapy, Inc.), a nutritional supplement designed to promote bone health. Health food stores can order the supplement from the manufacturer, Enzymatic Therapy, Inc, or individuals can order it online. (Type in Osteoprime to any search engine to find the relevant websites.)
This article was reprinted from Townsend Letter for Doctors & Patients – The Examiner of Medical Alternatives, April 2005 issue. (Dr. Alan Gaby is a Contributing Medical Editor). Subscriptions for Canadians: US$74/year. For more information email: info@townsendletter.com, or call 360-385-6021. Website: www.townsendletter.com
References
• Heaney, RP, Nordin BEC, Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis. Journal of American College of Nutrition 2002;21:239-244
• Chepuy MC, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. New England Journal of Medicine 1992; 327:1637-1642
• Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. American Journal of Clinical Nutrition 2004; 79; 362-371
• Pfeifer M, et al. Effects on short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. Journal of Bone Mineral Res 2000; 15: 1113-1118
• Meunier PJ, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. New England Journal of Medicine 2004; 350; 459-68
• Meunier PJ, et al. Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis - a 2 year randomized placebo controlled trial. Journal of Clinical Endocrinology Metab 2002; 87:2060-6
• Reginster JY, et al. Prevention of early postmenopausal bone loss by strontium ranelate: the randomized, two year, double masked, dose-ranging, placebo controlled Prevos trial. Osteoporosis Int 2002;13:925-31
• Monostory K, et al. Ipriflavone as an inhibitor of human cytochrome P450 enzymes. British Journal of Pharmacology 1998;123:605-610
Osteoporosis affects as many as 30% of post-menopausal women and about 5% of older men in the United States. More than 1.2 million fractures (primarily of the hip, spine or wrist) occur each year as a direct result of osteoporosis. As recently as the late 19th century, osteoporosis was considered a rare disease. Since that time, the prevalence has increased progressively, even after adjusting for the age of the population.
Since our genes have not changed much during the past century, environmental factors are likely responsible for this epidemic of thin bones. I have outlined many of these factors in my book Preventing and Reversing Osteoporosis (Prima Publishing, 1994), and suggested various non-drug strategies for preventing and treating the disease. Following is a summary of that information, updated according to research published since the book was written.
Environmental pollution
Several heavy metals that contaminate the environment (e.g., aluminum, lead, cadmium, and tin) have been shown in animal studies and in some human research to promote osteoporosis. Of particular concern is aluminum, which has become widely distributed in our environment. Sources of aluminum include beverages stored in aluminum cans, some municipal water supplies (aluminum is added to prevent the accumulation of particulate matter), processed cheeses and other processed foods, food additives (including preservatives, coloring agents, and leavening agents), aluminum cookware, aluminum products used to store or wrap food, underarm deodorants, and antacids. While it is not possible to avoid aluminum completely in our modern environment, exposure to this metal can be greatly reduced by making some basic lifestyle modifications.
The main source of tin exposure is food packaged in tin cans. While some tin leaches into foods and beverages before the can is opened, an even greater amount can leach if the food or beverage is allowed to sit in the container after the can is opened. Tin exposure can be reduced by decreasing the use of tin cans, by not allowing tins cans to be stored at high temperatures, and by transferring the contents of the can to another container after it is opened.
An important environmental source of lead is tap water which, in many cities, still flows through lead-soldered pipes. The accumulation of lead is greatest in water that has been allowed to sit in the pipes for long periods of time; consequently, letting the water run for a minute or two before using it will reduce the amount of heavy metals consumed. Of course, a clean source of bottled water is preferable to tap water, because the latter contains chlorine and other potentially toxic substances.
Diet and lifestyle factors
It is well known that weight-bearing exercise can strengthen bones and reduce the risk of developing osteoporosis. Even some non-weight-bearing exercises (such as swimming) can improve bone health, although not as much as walking, jogging, jumping, and weight-lifting. Cigarette smoking also appears to promote osteoporosis, and should be avoided.
Dietary factors that may cause thinning of bones include excessive consumption of refined sugar, caffeine, alcohol, and animal proteins. Consuming moderate amounts of alcohol or animal protein does not appear to promote bone loss, and inadequate protein intake has a deleterious effect on bone. Circumstantial evidence suggests that repeatedly eating foods to which one is allergic increases the risk of osteoporosis. Celiac disease, an extreme example of food intolerance, is a known cause of osteoporosis, and people with unexplained bone loss should be screened for celiac disease, even if they do not have the typical gastrointestinal symptoms.
Calcium
Adequate intake of calcium is important for maintaining healthy bones. For most healthy younger people, the type of supplemental calcium used does not appear to be particularly important, as all of the commercially available calcium salts are absorbed to about the same extent (excluding improperly formulated tablets that do not dissolve in the gastrointestinal tract). People with hypochlorhydria (low stomach acid), on the other hand, may not be able to absorb calcium carbonate, although their absorption of calcium citrate is usually good.
For older people, there is evidence that at least a portion of supplemental calcium should be provided in the form of calcium phosphate (tricalcium phosphate). Although phosphorus is a key nutrient for bones, it is left out of most bone-building supplements, because the typical American diet contains abundant or even excessive amounts of this mineral, and ingesting too much phosphorus can interfere with calcium utilization. For many older people, however, dietary intake of phosphorus may be marginal. Supplementing with calcium can further compromise the phosphorus status of older people, because calcium inhibits the absorption of phosphorus. It has been pointed out that one of the most effective trials of calcium supplementation in elderly patients used tricalcium phosphate as the calcium source.
The importance of other nutrients
While calcium has received most of the attention among doctors, there is good evidence that many other micronutrients are involved in promoting bone health. These include magnesium, manganese, zinc, copper, boron, strontium, silicon, vitamin D, vitamin C, folic acid, vitamin B6, and vitamin K. Many of these nutrients are in short supply in the typical processed Western diet. While none of these nutrients has been studied as extensively as calcium, the available evidence suggests that some of them (particularly vitamin K, vitamin D, copper, and magnesium) are at least as important as calcium. Consequently, consuming whole foods that are high in micronutrients, and taking a broad-spectrum nutritional supplement, will often be more effective than taking calcium by itself.
Recent studies have shown that vitamin D deficiency is far more prevalent than previously believed. In addition, it appears that some people need to supplement with 800-1,000 IU of vitamin D per day, rather than the more commonly recommended 400 IU per day, in order to prevent or treat vitamin D deficiency. Some investigators have argued that we are overdoing our sun-phobia, and that modest amounts of sunlight exposure can greatly enhance our vitamin D status, without increasing the risk of skin cancers. Holick recommends daily exposure of the hands, face, and arms, or arms and legs, to sunlight for a period equal to 25% of the time it would take to cause a light pinkness of the skin (i.e., one-quarter of the minimum erythema dose). That level of exposure would be sufficient to satisfy the body’s vitamin D requirement, and to synthesize enough of the vitamin to store in the skin for use at times when sunlight exposure is inadequate. In addition to helping maintain strong bones, vitamin D supplementation reduces the number of falls in older people, thereby further decreasing the risk of fractures.
Strontium therapy
Strontium is a normal component of human bone, where it replaces a small proportion of the calcium in hydroxyapatite crystals. Supplementing with large doses of strontium (about 200 to 300 times as much as that in a typical diet) has recently been shown to increase bone mineral density in postmenopausal women and to reduce the incidence of fractures by more than 40% over a 3-year period. While no serious adverse effects were seen in this study, additional research is needed to determine whether it is safe to use high-dose strontium for longer than three years. In animal studies, administration of large doses of strontium has caused bone-mineralization defects. While these abnormalities may have been due entirely or in part to the use of calcium-deficient experimental diets, it is also possible that chronic use of high-dose strontium would lead to an excessive ratio of strontium to calcium in bone crystals, even if the diet contains ample amounts of calcium.
Doctors using high-dose strontium should also be aware that its use causes artifactual results when bone density is measured by dual-energy X-ray absorptiometry (DEXA). Strontium attenuates X-rays more than calcium does, so the DEXA reading must be corrected according to the estimated bone strontium content. For example, in one study, strontium supplementation increased mean lumbar spine bone mineral density by 5.53% according to the measured value, but by only 1.41% after adjustment for bone strontium content. Short of performing a bone biopsy, there is no way to know exactly how much strontium has accumulated in any particular patient. Consequently, monitoring of strontium treatment will be somewhat imprecise.
Strontium supplementation may also be useful for preventing osteoporosis, but high doses are probably neither necessary nor desirable for that purpose. When considering lifetime supplementation of a trace mineral for disease prevention, it makes sense to think in terms of an amount that is present in a typical diet, which is about 1 to 3 mg/day for strontium. Foods high in strontium include fish, whole grains, kale, parsley, lettuce, Brazil nuts, and molasses; some multivitamin-mineral preparations also contain small amounts of strontium.
Hormonal therapies
Horse-urine-derived estrogen as a treatment for humans has finally been relegated to the place in history that it deserves. At the same time, doctors are beginning to take a more serious look at the concept of using bio-identical hormones that has been advocated for many years by proponents of natural medicine. This includes bio-identical estrogens (e.g. a combination of estrone, estradiol, and estriol, as originally suggested by Jonathan Wright, M.D.), natural progesterone (as opposed to unnatural medroxyprogesterone acetate), DHEA, and testosterone. Each of these hormones has been shown to have a beneficial effect on bone mineral density, although the research on natural progesterone has produced conflicting results. The appropriate doses and combinations of these hormones are highly variable, and should be determined by a practitioner experienced in their use.
Some women do not appear to need hormone therapy at all; indeed, I have seen bone mineral density increase in some postmenopausal women who did nothing more than take a moderate-dose comprehensive micronutrient supplement.
Other therapies
Eating soy foods or supplementing with soy isoflavones such as genistein have been shown in some studies to be beneficial. Ipriflavone, a semisynthetic flavonoid that is structurally similar to the soy isoflavone daidzein, has also been shown to preserve bone in postmenopausal women. The usual dose is 200 mg 3 times a day. Ipriflavone does not appear to work for people with advanced osteoporosis, and it has caused lymphocytosis (of uncertain clinical significance) in approximately 13% of people who have taken it. In addition, Ipriflavone inhibits cytochrome P450 and, therefore, could interact with various medications. For example, treatment with Ipriflavone has been shown to increase blood levels of the asthma drug theophylline.
Conclusion
I have found that a comprehensive natural-medicine program is frequently successful at halting, or even reversing, bone loss. This approach does not work well for everyone, however, and some patients need to take Fosamax or other prescription medications in order to achieve adequate results. Nevertheless, because of its safety and low cost, the natural approach to preventing and treating bone loss should be at or near the top of the list of interventions for people who have, or are at risk of developing, osteoporosis.
Alan R. Gaby, M.D., is past-president of the American Holistic Medical Association, author of Preventing and Reversing Osteoporosis (Prima Publishing; available at Amazon.com), and developer of Osteoprime (Enzymatic Therapy, Inc.), a nutritional supplement designed to promote bone health. Health food stores can order the supplement from the manufacturer, Enzymatic Therapy, Inc, or individuals can order it online. (Type in Osteoprime to any search engine to find the relevant websites.)
This article was reprinted from Townsend Letter for Doctors & Patients – The Examiner of Medical Alternatives, April 2005 issue. (Dr. Alan Gaby is a Contributing Medical Editor). Subscriptions for Canadians: US$74/year. For more information email: info@townsendletter.com, or call 360-385-6021. Website: www.townsendletter.com
References
• Heaney, RP, Nordin BEC, Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis. Journal of American College of Nutrition 2002;21:239-244
• Chepuy MC, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. New England Journal of Medicine 1992; 327:1637-1642
• Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. American Journal of Clinical Nutrition 2004; 79; 362-371
• Pfeifer M, et al. Effects on short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. Journal of Bone Mineral Res 2000; 15: 1113-1118
• Meunier PJ, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. New England Journal of Medicine 2004; 350; 459-68
• Meunier PJ, et al. Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis - a 2 year randomized placebo controlled trial. Journal of Clinical Endocrinology Metab 2002; 87:2060-6
• Reginster JY, et al. Prevention of early postmenopausal bone loss by strontium ranelate: the randomized, two year, double masked, dose-ranging, placebo controlled Prevos trial. Osteoporosis Int 2002;13:925-31
• Monostory K, et al. Ipriflavone as an inhibitor of human cytochrome P450 enzymes. British Journal of Pharmacology 1998;123:605-610