Osteoporosis – the “silent thief”
Osteoporosis - The Facts
It affects approximately ¼ of Canadians at some point in their lives (80% of whom are in their 50’s or beyond).
It costs the Canadian healthcare system between 3-4 Billion dollars per year (in acute care, outpatient care, prescription drug, long term care and other indirect costs).
It results in pain, disfigurement, reduced/loss of mobility and independence, as well as decreased self-esteem.
Obviously Osteoporosis is a disease that deserves attention and understanding.
What is Osteoporosis?
Osteoporosis, the name describes it perfectly: Greek for “porous bones” (osteo: bone, poros: pore).
It is a condition where bones lose their density and become porous, eventually resulting in decreased bone mass and thinner, weaker bones. This disease, as it is commonly referred to, typically effects the entire skeleton, but may also effect only one limb, which may occur in cases of disuse.
The thinning and loss of strength of the bones causes them to become more fragile, which increases the risk of fracture (broken bones).
Fractures due to osteoporosis most commonly occur in the wrist, hip, ribs and vertebrae (bones of the spine), but may occur in any bones of the body.
There are 3 different forms of osteoporosis:
Primary Type 1 Osteoporosis: Affects women after menopause.
This is due to the decline in Estrogen, which results in a loss of its protective effects (namely maintenance of bone density).
Primary Type 2 Osteoporosis: Affects individuals of both sexes after the age of 75, women twice as frequently as men (2:1).
Secondary Osteoporosis: Affects individuals of any age and sex in equal proportions.
This form results from chronic medical conditions/diseases (an example is hyperparathyroidism, where excess parathyroid hormone causes calcium excretion), and extended use of certain medications (for example glucocorticoids – a class of steroid hormone drugs often used to treat inflammatory, autoimmune, allergic and septic conditions).
There are three main ways that osteoporosis can develop, and either one or a combination of two may be related to the development of weak bone in an individual:
If, during youth, there is inadequate bone mass achieved (meaning the skeleton does not gain sufficient mass and strength)
If, during the remodeling process, there is excessive resorption (more bone broken down than built)
If, during remodeling, there is inadequate formation (less bone built than is being broken down)
What are the Signs and Symptoms of Osteoporosis? Why is it called “the Silent Thief”?
The term “Silent Thief” comes from the fact that even though bone is being lost, there are no obvious symptoms. It’s typically not until an apparently healthy individual suffers a fracture (most commonly of the wrist, hip, rib or vertebrae/spine) that a diagnosis is made.
The main method of testing for osteoporosis is by Duel-Energy X-Ray Absorptiometry, known as DEXA
DEXA measures bone mineral density (BMD) using 2 X-Ray beams with different energy levels.
Osteoporosis is diagnosed when bone mass falls below 25% (or 2.5 standard deviations) of normal (as tested by a DEXA scan – an X-Ray which measures BMD: bone mineral density). Less than 25% bone loss is called osteopenia.
Who gets Osteoporosis? How common is it?
In the past few decades in North America, the incidence of Osteoporosis has been rising. In fact osteoporotic fractures are more common than that of heart attacks, strokes and breast cancer combined! It’s estimated that at least 1:3 women and 1:5 men will suffer from a fracture related to osteoporosis during their lifetime.
The fact that Osteoporosis is much more common in more affluent areas of the world (namely North America) is unquestionably due, at least in part, to the extreme deviation that most individual’s diets and lifestyles have strayed from their ancestors.
Diets lacking in nutrients, not to mention the fact that many individuals suffer from poor digestive function (which further results in mal-absorption of what they are ingesting) mean less nutrients available for healthy strong bone development and maintenance.
Sedentary lifestyles mean that bones and joints are not being used: and with bones, as the saying goes, you either “Use it or Lose it”.
At what age do bones form in the first place, and then when does Osteoporosis usually happen?
There are 3 phases in the process of skeletal development, and they break down into bone building, maintenance and loss.
Assuming a healthy diet, exercise and other factors, peak bone mass is achieved during the late teen to young adult years (16-20 years of age in women, 20-25 in men). Prior to this age, bones are being built and strengthened, due to more bone being formed than is being reabsorbed. In these years, formation exceeds loss.
Through an individuals 20s and 30s, bone mass typically remains stable, with bone being broken down and formed at an approximately equal rate. In fact at any one time, approximately 10% of your bones are being “remodeled”.
Bone Loss (Resorption)
After one passes their 30s-40s, bone formation starts to slow down while resorption continues at the same or a faster rate, which means loss exceeds gain.
What are the risk factors for developing Osteoporosis?
There are 2 groups of risk factors for the development of Osteoporosis, these include non-modifiable (ones you can’t change) and modifiable (ones you have the ability to influence)
Non-Modifiable: Risk factors you cannot change
Age: Advancing age is a primary risk factor for both women and men
Gender: Women are 3x more likely to develop osteoporosis due to the significant drop in the hormone estrogen following menopause. Estrogen is a protective factor, helping to maintain strong bones. In men, the hormone testosterone does decline following andropause, but its effects on bone are much less pronounced.
Ancestry: Individuals of European or Asian ancestry are at a higher risk than those from many other cultures.
Family History: Having parents and/or grandparents who’ve suffered from osteoporosis may increase your chances from 25-80%.
Small Stature: Those with a smaller physical stature typically have smaller bones in the first place, meaning less to lose as they age.
Modifiable: You can control these ones - here are some general recommendations:
Alcohol Intake: Minimize alcohol - Chronic high alcohol intake (more than 2-3 units/day) increases fracture risk.
Smoking History: Don’t smoke! Tobacco smoking prevents osteoblast (cells that build bone) activity meaning bone isn’t well built or re-formed.
Whole foods (fruits, vegetables, whole grains, nuts and seeds) promote an alkaline state in the body, and this helps calcium stay in bone. Processed foods are typically more acidic, and this causes calcium to be excreted at a higher rate.
Increase consumption of Calcium and Vitamin D containing foods: Leafy greens, nuts & seeds, broccoli, legumes and beans, as well as some seafoods (ie: herring and salmon) help prevent against bone loss and maintain bone density.
A word of caution about Protein: Do get enough, but not too much. Protein is necessary for healthy bone, but too much acidifies the body, causing calcium to be excreted.
Steer clear of carbonated beverages: The high phosphorus content of soda binds and increases the excretion of calcium from the body.
Cut the sweets: Not only does excess sugar cause calcium to leach from bone, eating a diet high in sugary foods means there’s less room for nutritious ones.
Caffeine: Keep it at a cup a day. More than this similarly acidifies the body and promotes bone loss.
Is there a way to prevent and/or manage Osteoporosis?
For the most part, Osteoporosis is preventable. As with most things, prevention starts in youth and continues throughout life.
Some key recommendations for any age include:
Promote physical activity for your children and stay that way yourself! Regular vigorous physical activity encourages bone deposition. In youth, this means that thicker, stronger bone is being formed during these critical years. In later years, the more bone is moved and used, the more active the bone building cells (osteoblasts) are, meaning bone building doesn’t slow down as much as it otherwise might.
Weight bearing exercises (like walking, dancing, jogging) and muscle-strengthening exercises like weight-lifting help to increase bone mineral density, thus decreasing the risk of fractures.
Flexibility exercises like yoga, pilates, dance and simple stretching improve balance to help prevent falls!
Adopt and uphold a Healthy Diet: Ensuring that all of the essential vitamins and minerals are present when the cells need them (formative years and beyond!) is essential to promoting healthy bone development and maintenance.
If you are at increased risk, your Naturopathic or Medical Doctor might recommend additional supplementation. As bone is composed of over two dozen different nutrient components, it is important to ensure that your supplement contains an adequate proportion and balance of the vitamins, minerals and microminerals. Calcium, Magnesium and Vitamin D are vital, while nutrients like boron, zinc, manganese, vitamin K, etc are also necessary for bones to form properly. Additionally, you need to ensure you are digesting and absorbing them well. Ensure your supplement is of good quality and consider a liquid or powdered form.
Between diet and supplementation, try to aim for a daily Calcium intake of 1200mg (for women) and 1000mg (for men), the majority coming from whole foods. These numbers vary for pregnant and lactating women, children and teens, as well as those with certain medical conditions, so speak with your practitioner if you have any questions.
If you or someone you care about is at risk of or has already been diagnosed with osteopenia (pre-osteoporosis) or osteoporosis, I encourage you to visit your Naturopath. Naturopathic Physicians have the knowledge and tools to help guide you through an appropriate diet, exercise and supplement plan to help prevent debility, improve your quality of life and keep you healthy, mobile and independent well into old age!
Dr Katarine Holewa, ND
Note: Image courtesy of The Guardian (www.guardian.co.uk) and cbc.ca