Osteoporosis is a systemic disorder causing low bone mass; usually in older people, it causes bones to become brittle and weak, and falls can cause breaks. Research Review
Strong bones as you age? Here we explode some of the Bone Health myths that maybe causing problems rather than solving them.
Osteoporosis and Osteopenia
Osteopenia – is also described as “low bone mass” or “low bone density”. Some ‘experts’ regard it as the first step en route to Osteoporosis because it is a condition in which bone mineral density is low making the bones weaker and causing a higher risk of fractures.
Osteoporosis – People with osteopenia may go on to develop osteoporosis. The word means ‘porous bone’. According to Cleveland Clinic, “When a bone is weakened by osteoporosis, the ‘holes’ in the ‘sponge’ grow larger and more numerous, weakening the inside of the bone. Until about age 30, a person normally builds more bone than he or she loses. After age 35, bone breakdown overtakes bone buildup, which causes a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis.”
There is no doubt that older women, more so than men, are concerned about osteopenia and osteoporosis. But so are women of any age taking aromatase inhibitors for breast cancer or endometrial cancer. The oncologists’ solution is to provide large amounts of calcium and tiny amounts of vitamin D. As you will see, all drugs, from chemotherapy to omeprazole to atorvastatin and more can cause brittle bones, not because they lower calcium, but they lower essential magnesium, which in turn lowers vitamin D.
The constant cycle of bone building
Firstly, you need to understand the cycle of bone strengthening. We all develop brittle bones throughout our lives and at any age, but our osteoclasts break down these brittle bones and hand the raw materials to our osteoblasts, which use them to remake strong bones, every minute of the day.
One of the biggest problems in bone health as we age is that there are a number of ‘myths’ about what you need to do to make strong bones. Here we look at research to understand whether the claims are true.
The Myths and realities of good bone health
- Supplement with vitamin K?
Japanese doctors have been using supplements of vitamin K2 for a number of years now to treat osteoporosis. But it is not yet approved in this context within the EU. Researchers from Madrid produced a review in 2019 of the effects of deficiency in vitamin K and bone health (1). In it they state, “most studies find that low serum K1 concentrations, high levels of undercarboxylated osteocalcin (ucOC), and low dietary intake of both K1 and K2 are associated with a higher risk of fracture and lower BMD“. Research concludes that you may help prevent osteoporosis by taking vitamin K, but can you correct osteoporosis by increasing levels once you have it?
Vitamin K is a fat soluble vitamin. The prefix K came from the German word Koagulant. Typically, vitamin K1 has been used with new-born babies to aid blood clotting.
But its alter-ego, vitamin K2 (as MK4 or MK7), seemed to have a ‘more direct’ effect on bones according to Dr. Geeta Hampson, who led an 18 month clinical trial at the Osteoporosis Screening and Research unit at King’s College London.
In this she used K1, or K2 (as MK4), or a placebo, with 105 women (Av age 68.7). Vitamin D and Bisphosphonate were also included and all the women has post menopausal osteoporosis.
There was consensus that sometimes the osteoclasts seem to break the cells down faster than bone-building osteoblasts can repair them. Vitamin K2 seems to be critically involved, and previous research has shown Vitamin K2 is known to activate several proteins known to be important in the osteoblasts’ role in bone formation. However, results in this clinical trial were not exactly stunning. Slight improvements were however noted (2).
2. Sort out your gut?
It used to be argued simply that K2 was found in egg yolks and some milk products such as cheese and butter; while K1 was found predominantly in green leafy vegetables. Now it is clear that commensal bacteria in your gut actually make these vitamins for you, assuming you have a healthy gut, with the right bacteria present.
Our osteoclasts and osteoblasts are made from stem cells in our bone marrow and the health of our bone marrow has now been shown to be dependent upon the health of our gut Microbiome (3).
This one is true – it is becoming increasingly clear that you need a healthy microbiome for strong bones. Read how to Heal Your Gut
3. Sort out your diet – don’t drink more milk?
Typically, osteoporosis treatment is in the hands of GPs, who recommend you consume more cows’ dairy. This advice is seriously questionable.
Why? Dairy consumption, whether from milk, butter, yoghurt or cheese, is rather a problem – dairy actually lines the gut wall and reduces the absorption of magnesium.
And Magnesium is essential for strong bones and teeth. 60-70% of the body’s magnesium is in the bones and teeth.
Consuming dairy, stress, alcohol and taking drugs (statins, PPIs, chemotherapy, antidepressants – the list is endless) and a magnesium-poor diet can each and all lower magnesium levels. Is it any surprise that 40-50% of adults in the UK and USA are low in magnesium?
Magnesium is absolutely essential for bone health – foods include nuts, seeds, vegetables and whole grains. Females who think they could be low can supplement with 350 mg a day, for males it’s 450 mg. Use magnesium glycinate, taurate or citrate, but not magnesium oxide or chloride which are poorly absorbed. We have a review (4) of ‘Essential Magnesium’ on our sister site CANCERactive. You will get good levels of magnesium in a colourful Rainbow Diet.
Calcium is essential for strong bones – But the level required is not as much as you are often told. And, crucially, calcium needs ‘helpers’ to incorporate it into the bones. The American Bone Health website recommends consuming 1,500 mg of calcium a day. If you don’t want to consume about two thirds of a cup of milk, try two large helpings of greens. Eat far more leafy greens anyway!
And beware calcium supplements and pills – there are important links to heart problems. People who build calcium levels in their arteries (from dairy or supplements) have a six times greater risk of coronary artery disease according to research from LA Biomed.
Also, increasing calcium levels in the body can even lower magnesium and vitamin D levels. Oncologists are the most guilty because they hand out Adcal and Cali-chew, without understanding the essential role of ‘helper’ compounds in incorporating calcium into bones.
Phosphorus is also crucial – Yale Medical School produced a thorough review (5) of its importance in bone health and healthy aging in 2020. Two helpings of pulses such as lentils each week will be enough. Other phosphorus-rich foods include whole grains, oats, spelt, quinoa, pumpkin and sunflower seeds, chicken, sardines, scallops, tofu and edamame beans.
The list of other useful minerals includes the trace mineral Boron. Like magnesium and phosphorus, boron is essential for integrating calcium into the bones and teeth and this has been known since a 1994 clinical trial (6). Low boron is linked to inflammation, arthritis and weak bones. Boron helps incorporate magnesium into bones. Boron is found in all fruits, vegetables, grains, nuts and seeds.
3. Vitamin D3 –
Last, but not least, is vitamin D. This is not a vitamin but a hormone, and adequate vitamin D plasma levels are absolutely crucial to bone health. Vitamin D has had multiple research studies on its pivotal role in bone health, for example there’s a German review of research (7) from 2016.
Go in the sunshine every day for 2-3 hours or supplement with 2,500 IUs of vitamin D a day when you cannot.
American Bone Health (8) recommend that 2500 IUs is the daily supplement level for good bone health as you age. That would be about three hours on the beach with the sun on your body.
There are various studies on healthy blood levels of vitamin D, Deficiency is widely reported (US Government, Harvard Health) as being below 80-88 nmol/L. Adequate blood levels are thought to be around 125 nmol/L (50 ng/ml).
You have two forms of vitamin D in your body – an active version and an inactive version. Obviously you need the active version to be healthy. A gut bacteria-produced compound (butyrate) and adequate magnesium levels are essential in the production of active vitamin D (4).
4. Oestrogen vs Progesterone
Hot flushes and bone pains after menopause? Doctors may well recommended HRT, but the biggest International study ever undertaken showed HRT could triple the risk of breast cancer (9).
While many people think that post menopausal osteoporosis stems from lowered oestrogen, the science is inconsistent and really doesn’t support this theory either. Research results are very mixed. Some articles talk about the benefits of HRT, or how lowered oestrogen affects osteoclasts, while other articles reference osteoblasts. Most articles make statements with no references.
Indeed, there are 14 receptor sites for progesterone for every single oestrogen receptor site on your bones. Judy Evans runs progesterone link in the UK and is adamant that you can prevent brittle bones and osteoporosis as you age by using Natural Progesterone creams (10)
5. A poor thyroid causes osteoporosis?
Iodine deficiency is a huge problem in the Western world. 50 or more years ago our salt was iodized, our wheat was processed with iodine before being made into bread (now it’s processed with bromide that blocks iodine), and we used to eat more seafood and even sea kelp. On CANCERactive we have a review of iodine and how 88% of landlocked adults in the West are deficient. Iodine ‘normalises’ the metabolism of our cells and increases oxygenation in the body. Low iodine is even linked to anaemia. Low iodine levels mean low thyroid hormone levels.
The thyroid does impact our bones, because it is one of the main controllers of metabolism. If we become fatigued, lethargic, start to increase weight, then our doctor may prescribe synthetic Levothyroxine. In the majority of cases this would be a mistake. Hashimoto’s can lead to low thyroid levels, as can lymphatic thyroiditis. The former may be associated with thyroid nodules, the latter may be associated with Goitre. Both stem from gut issues. We’ve come full circle.
In other cases, the reason for low thyroid hormone is simply due to low iodine. And sometimes low selenium – this collects in the thyroid and low levels of selenium prevent the release of thyroid hormone. Unsurprisingly, low iodine and low selenium can be linked to osteoporosis and brittle bones. Urinary iodine levels are significantly lower in women with osteoporosis (11).
6. Take exercise?
Yes and no. Aerobic exercise will help a little, but load bearing exercise is definitely the best way to prevent osteoporosis. Try some light weight-bearing exercise, if you can. Harvard Health are right behind me here (12). It is important – but this could be a problem, especially if you already have brittle bones!
Six simple steps to maintaining strong bones –
- Heal your gut,
- Focus on vitamin D (and possibly K2 for prevention),
- Consume Magnesium, Phosphorus, Boron,
- Limit dairy, increase natural calcium intake from plants,
- Consume Sea fish or Iodine drops at least 4 times a week, and
- Partake in weight bearing exercise.
It’s not hard to stick to a simple, natural solution, when you separate the truth from the mythology..
Go to: A simple guide to bone health and beating osteoporosis
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References
- Vitamin K and Bone Health: A Review on the Effects of Vitamin K Deficiency and Supplementation and the Effect of Non-Vitamin K Antagonist Oral Anticoagulants on Different Bone Parameters; Celia Rodríguez-Olleros Rodríguez, Manuel Díaz Curiel; J Osteoporos. 2019; 2019: 2069176.
- The additive effect of vitamin K supplementation and bisphosphonate on fracture risk in post-menopausal osteoporosis: a randomised placebo controlled trial; Amelia E. Moore et al; Arch Osteoporos. 2023; 18(1): 83.
- The gut-bone axis: how bacterial metabolites bridge the distance; Mario M Zeiss et al; J Clin Invest. 2019;129(8):3018–3028
- Essential Magnesium – sources, enemies and interactions
- Importance of Dietary Phosphorus for Bone Metabolism and Healthy Aging; Juan Serna and Clemens Bergwitz, Nutrients. 2020 Oct; 12(10): 3001.
- Essentiality of boron for healthy bones and joints; R. E. Newnham; Environ Health Perspect. 1994 Nov;
- Crucial Role of Vitamin D in the Musculoskeletal System; Elke Wintermeyer et al; Nutrients. 2016 Jun; 8(6): 319.
- American Bone Health – https://americanbonehealth.org
- HRT increases breast cancer risk by a third – https://www.canceractive.com/article/hrt-raises%20breast%20cancer%20risk%20by%20a%20third
- Natural Progesterone and Judy Evans – https://www.canceractive.com/article/progesterone–the-natural-protector
- Body iodine status in women with postmenopausal osteoporosis; Tufan Arslanca et al; Menopause, 2018 Mar;25(3):320-323.
- Weight bearing exercise and slowing osteoporosis – https://www.health.harvard.edu/staying-healthy/slowing-bone-loss-with-weight-bearing-exercise
