Over 10 million people in the U.S. have osteoporosis. Additionally, 30 – 50% of women and 13 – 30% of men will sustain a facture attributable to osteoporosis in their life. No wonder most of us are worried about this disease. The good news, however, is that osteoporosis does not have to be a given.
Our bones are more amazing and complicated than most of us realize. They provide the structure for our body and contain many minerals necessary for life. Additionally, within the bone marrow, our body makes red and white blood cells, so the bones are an integral part of our immune system and our body’s health as a whole.
- Keith McCormick, an expert in bone health, explained that, because the bone serves these various roles, bone loss is not a localized problem but is probably a symptom of illness. “Osteoporosis is not just the weakening of the bones; it is a weakening of the body’s entire physiology,” McCormick said.
Your Amazing Bones
Our bones are continually being made over; old bones are replaced with new bones in a process called remodeling. Three types of cells are involved in this remodeling:
Osteoclasts – are bone resorbing cells (not re-absorbing). Osteoclasts break down old bone and then they ingest the resulting fragments.
Osteoblasts – are bone forming cells. They deposit new collagen that will become strong bone filled with minerals.
Osteocytes – are the supervisor cells that oversee the process. These live within the bone.
For remodeling to work well, there needs to be a careful balance between amount of bone broken down and absorbed by the osteoclasts, and the amount of bone formed by the osteoblasts. When the osteoclasts are resorbing more bone than the osteoblasts are creating it’s called uncoupling.
This uncoupling leads to bone loss. And if the uncoupling becomes chronic, the result is osteoporosis.
Do I Have Osteoporosis?
There are some common tests for determining if someone has this disease and one is called a DXA examination. This provides your doctor with two results:
T score – which compares your bone mineral density to a healthy young woman.
Z scale – compares you to people of your same age and sex.
Your doctor will compare your scores to those of a person with healthy bone mass and will determine the deviation away from that healthy mass, either plus or minus. A deviation of -2.5 means you are osteoporotic but does not mean you will fracture.
The problem with looking at a person’s bone mass density, however, is that it shows the bone quantity but not bone strength. As result, it’s helpful to also use some indirect tests to try to find out how much bone turnover is happening.
McCormick said that when osteoclasts become too aggressive in their work of breaking down bone, they are like carpenter ants boring hundreds of destructive tunnels in wood. And just as the ants leave sawdust in their wake, osteoclasts leave small pieces of collagen that are released into the body’s circulation and end up in the urine. Doctors can look for these resorption markers to determine if the process is out of balance.
Other signs of an uncoupled bone building process can include: brittle fingernails, flattening of nails with raised ridges, dry and brittle hair, skin problems, cracks at the edges of the mouth, decreased taste or smell, periodontal disease, bloating or prolonged fullness after eating, and weight loss.
Causes of Osteoporosis
Functional Medicine seeks to find the root causes of disease and treat those causes, rather than medicate the symptoms. So what are the root causes of osteoporosis? Is it just a normal part of aging or are there some sources that are within our control?
There are some risk factors for osteoporosis, such as: eating disorders, depression, family history of osteoporosis and a sedentary lifestyle. Additionally, osteoporosis can be caused by diseases like: autoimmune disease, cancer, Crohn’s disease, cystic fibrosis, diabetes, MS and Parkinson’s disease.
It’s helpful, though, to know that we can address some roots of osteoporosis such as nutrition, gut health and inflammation.
Some might question how nutrition, gut health and inflammation could be related to osteoporosis. Functional Medicine Practitioners believe these topics have everything to do with each other and with the health of the body as a whole.
(To read a more detailed explanation of how inflammation is related to bone health, see the separate article on inflammation.)
In brief, the health of your bone depends on the health of your body and if your body is not getting the proper nutrition, everything is going to thrown out of whack. When our gastrointestinal tract is not healthy, one resulting problem is that our body can’t efficiently absorb nutrients. A body that is not getting the nutrients it needs becomes desperate for fuel and begins to take parts of digested food before these vitamins and minerals can be used to form muscles, nerves, connective tissues and bones.
When a body becomes increasingly desperate for energy, as with a chronic disease, it will even begin to mine its own skeleton in order to get the minerals it needs to sustain life.
Chronic inflammation feeds into this problem because it often causes chronic disease. This constant inflammation causes the immune system to be always turned on, which leads to an unbalanced system. Because the bone marrow is the place where all your immune system cells are created, an unbalanced system is going to wreak havoc within your bones.
What Can I Do?
Osteoporosis is a serious and widespread issue but there are steps you can take to increase the health of your bones.
First of all, medication can help pull a person out of crisis but it shouldn’t be the only solution. Unfortunately, many medications used to treat this disease stop osteoclasts from resorbing the bone. This seems to make the bone healthier but the medicine also stops osteoblasts from rebuilding. As a result, while the bone is getting denser, it is not getting stronger and, in the long term, the bone will actually become weaker. Dr. Anderson said it’s like glass which is very hard but will shatter if dropped. A bone that is constantly being rebuilt by a healthy partnership between osteoclasts and osteoblasts will be more like bamboo, able to bend but not break.
Exercise! This is one of the most important things we can do to improve bone health because it provides the double benefit of strengthening bones and also working muscles and balance, which helps prevent falls. Try to fit in weight bearing exercise such as walking, jogging, tai chi, yardwork or stairclimbing, as well as strength or resistance training.
Diet It comes as no surprise that the same recommendations for overall health hold true for bone health. Stop smoking, limit alcohol, sugar and salt. Avoid soda pop. And fill your plate with vegetables, fruits and lean protein.
Stress Try stress management techniques to manage stress, which can contribute to inflammation. Work to avoid other toxins as well, including household and yard chemicals and pesticides, all of which contribute to inflammation.
Supplements With the help of your medical practitioner, determine which supplements would be helpful. Vitamin D is critical for bone health. Calcium can also be helpful, although Dr. Anderson said calcium carbonate is not the most beneficial. Additionally, calcium gluconate, lactate or phosphate are not recommended Whole bone calcium is preferred.
The good news is that skeletal health can be improved through diet and exercise. The better news is, that because the body is an interrelated system, by working to create healthier bones, you’ll increase the well-being of your entire body and end up feeling healthier, stronger and more confident in your body’s ability to meet the tasks of daily life.
(Information for this article came from R. Keith McCormick’s wonderful book, The Whole Body Approach to Osteoporosis. The book is available to borrow from the Thriven library.