More than one million skeletal fractures occur annually in the U.S. and 300,000 of these are hip fractures. The World Health Organization estimates that the number of hip fractures will continue to rise worldwide from 1.7 million in 1990 to 6.3 million by 2050. Further, what we once thought were the answers to treating and/or preventing osteoporosis have been debunked. Following are some of the more commonly known risk factors:
o Previous history of fracture after age 50
o Decrease in bone mass
o Small frame and thin
o Family history of osteoporosis
o Vitamin D deficiency
o Low calcium intake
o Inactive lifestyle
o Cigarette smoking
o Use of certain medications (cortisone, chemotherapy, prednisone, anticonvulsants)
o Low testosterone in men
o Overuse of alcohol and/or caffeine
There are other medical conditions that can result in osteoporosis which are not as commonly known such as parathyroid tumors and digestion and absorption problems. Although there are medications available for the treatment of osteoporosis, there is also a fear of the side effects of medications. These fears have been brought about by the recent discoveries of side effects of hormone replacement therapy, Vioxx and other drugs. The cause and treatment of osteoporosis should not be taken lightly and people at risk would be wise to consult with their physician. That said, in an overview of the treatments shown to be effective at treating and/or preventing osteoporosis, there are three that stand out.
1. Eating balanced meals including fats, carbohydrates (fruits and vegetables) and proteins along with calcium and vitamin D supplementation. Given the status of our food sources recently, I believe supplementation is necessary.
2. Exercise has been shown to halt and even reverse osteoporosis. The recommended exercise program should include strength, weight bearing and flexibility training.
3. Sunlight in safe doses has also been shown to benefit bone health from the synthesis of vitamin D in the skin.
Study Shatters Myths about Milk
An article in the March 2005 issue of Pediatrics questions some long-established myths about milk. The authors–PCRM senior nutrition scientist Amy Joy Lanou, Ph.D.; PCRM president Neal Barnard, M.D.; and Susan Berkow, Ph.D., C.N.S.–have reviewed over 50 studies related to the effect of dairy products and other calcium-containing foods on bone density in children, adolescents, and young adults.
They concluded that there is little scientific evidence to support the suggestion that milk builds strong bones or to justify the U.S. government’s artificially high recommendations for calcium intake. A vast majority of studies found that here is no relationship between dairy or dietary calcium intake and measures of bone health.
The authors found no proof that milk is a preferred source of calcium. While milk and other dairy products contain calcium, many factors affect the availability and retention of the calcium from these products, one of these factors being lactose intolerance. Calcium from dairy products is not as well absorbed as that in many dark-green leafy vegetables, but has an absorption fraction similar to that of calcium supplements, calcium-enriched beverages, calcium-set tofu, sweet potatoes, and beans.
Physical activity has been shown to have the greatest positive impact on adolescents’ bone health. Besides safe exposure to sunlight, avoidance of smoking and high salt and caffeine intakes, and eating lots of fruits and vegetables are all good strategies for supporting healthy bone development and maintenance.
PCRM held a conference in Washington, D.C., on March 7, 2005 to share the findings of its bone health paper. It was covered by hundreds of media outlets, including Associated Press, Reuters, the Washington Post, CBS News, and CNN.
In discussing calcium supplementation, a story comes to mind. Over twenty-five years ago my mentor was running down a grassy hill when all of a sudden she tripped and fell on her back. At the time she was 68-years old and had been practicing chiropractic for close to thirty years. She asked me to x-ray her spine and pelvis and fortunately there was no fracture. As I was viewing the x-rays, I was shocked to see that her bones were like someone at least thirty years younger, despite the fact that she was also a smoker. She was a strong believer in calcium supplementation and recommended taking 2,500 mg. of calcium daily. She would frequently tell her patients to “flood” their bodies with calcium because calcium absorption is poor. Whether the supplements were working or she just had strong bones, I will never know, but I will never forget that incident.
Protein Does A Body Good?
Studies have shown that protein along with calcium and vitamin D are important for bone health. In a study (published in the American Journal of Clinical Nutrition), two groups of men and women aged 65 and older were followed over three years. One group was given calcium and vitamin D supplements and the other half received a placebo pill. The study demonstrated that the men and women who took the supplements and had a diet rich in protein had higher bone density. The placebo group did not benefit from the protein rich diet and had an increase in fractures over the three-year period.
How much protein and what source of protein should an individual consume depends on the person’s biochemical individuality. Let me explain by first telling you the story about Dr. Kelly. Dr. Kelly had become ill with cancer and through his studies determined that he should be on a vegetarian diet. While on the vegetarian diet his health improved tremendously and he felt better than he had in a long time so he decided that his wife should be on this program too. To his surprise, she became very ill and her health began to decline. When Dr. Kelly went back to his studies, he concluded that genetic heritage also played a role in metabolism. To further explain this concept, there are two contrasting groups to consider. The protein intake of Eskimos is estimated at 25 percent of total calories and they consume 2,500 mg. of calcium daily. Yet, their osteoporosis is among the worst in the world. The Bartus group of South Africa consume a diet of 12 percent mostly plant protein, and only 200 to 350 mg per day of calcium, about half our women’s intake. Although the women bear six or more children and nurse for long periods of time, osteoporosis is a very rare disease there. When these women immigrate to the United States, they develop osteoporosis but not as much as Caucasian or Asian women. I agree that there is a genetic difference that is modified by diet, but we cannot ignore the sun factor. The African women were getting more vitamin D than the Eskimos.
The Sun and Vitamin D
In his book, The Healing Sun, Richard Hobday, MSc, PhD explains that traditionally, sunlight deprivation has been linked with weak or brittle bones. The book quotes the writings of a Greek historian Herodotus (480-425 BC) who noted that after the battle of Pelusium (525 BC) there was a remarkable finding in the remains of the Persian and Egyptian casualties. The skulls of the Persians who always protected their heads from the sun with a skull-cap were very thin and fragile. The skulls of the Egyptians were very tough and difficult to break. The Egyptians shaved their heads from childhood to harden the skull by the effects of the sun.
Dr. Hobday relates that there is a relationship between lack of sunshine and certain conditions, one of them being osteoporosis. He explains that there are more hip fractures during the winter than at other times of the year and that these fractures also become more common with increasing latitude. While there is evidence that there is benefit from calcium and vitamin D supplementation, the digestive systems of the elderly become less efficient at absorbing oral supplementation. Therefore, it would be useful to include the benefits that sun bathing would bring from the synthesis of vitamin D in the skin. Dr. Hobday’s book is very interesting and informative on the benefits of the sun and explains how to safely sunbathe.
The Oregon State University Study
Oregon State University conducted a five-year study and revealed that postmenopausal women who participate in a long-term fitness regimen that includes jumping and resistance exercises using weighted vests can prevent significant bone loss in the hip.
The average age of the women in the study was 66 years at the start and participated in an exercise program for five years. The program included three sessions a week consisting of resistance exercises wearing vests weighted with one to 10 pounds. While wearing these vests they performed squats, lunges, stepping up and down and getting in and out of a chair. Jumping with weighted vests about 50 times a day, three days a week was also part of the program. The women were to jump no more than 4-5 inches and land flat-footed to distribute the force. Caution was taken that there was sufficient knee, ankle and hip strength and stability before subjects participated in these exercises.
Significant improvement was noted in the women’s bone density after five years. Christine Snow, director of the Bone Research Laboratory at OSU and principal investigator in the study stated that “Exercise was as good or better than either estrogen or Fosamax for preventing bone loss.”
Strength Training At The Mayo Clinic
More than ten years ago, scientists at the Mayo Clinic in Rochester, Minnesota took a group of 50 women aged 58-75 and randomized them into two different groups. One was a control group and the other performed back strengthening exercises for two years. While the report did not give the frequency of the exercises performed, I have to assume that three times per week would be reasonable. After two years the strength trainers had stronger back muscles but there was no difference between groups in bone density. Then eight years later, the scientists followed up on the women and tested them again to see if any difference still remained. The women who had originally been strength training still had stronger back muscles and better bone density than the controls. It was further noted that the women in the control group had experienced almost three times as many vertebral fractures than the women who were originally in the strength training group. The controls had 14 crush fractures and the strength trainers had had only 6 crush fractures. This was a very significant difference between groups. Whether the women in the strength training group continued training over the eight year follow-up period is unknown.
Flexibility exercises are important to improve mobility of the joints and improve posture. Once your muscles have warmed up, stretches can be performed to improve the range of motion in the joints. Stretches that flex the spine should be avoided or performed with caution. If you have a lower back condition such as sciatica, flexion can cause a flare-up. There is also a greater risk of a spinal compression fracture when osteoporosis is present. I encourage you to “mindfully” continue to exercise on a regular basis to improve strength and mobility. Because it is very important to avoid falls and fractures, paying close attention to movement throughout the activities of daily living is critical. Pilates is an excellent way of improving not only strength, flexibility and balance but it is superior at increasing awareness of movement. Pilates training is now available in local gyms and schools. All levels of Pilates exercises can also be found on DVD.
While thinking about osteoporosis and movement, another story comes to mind about an elderly female patient who came to see me for treatment of back pain. In taking her history, I asked if she had had any fractured bones. She explained that a couple of years prior she was taking out the garbage and by tying the plastic bag in a knot and “snapping” her arms back to pull on the knot, she fractured some bones. This is a good example of why we need to be more aware of how we move once we get more “advanced” in age.
I am excited that we are seeing reductions in fractures with simple strength training protocols. I am hopeful that this information will reach the majority of people so that bone loss can be prevented and/or reversed.
It has not been that long ago that doctors believed that bone loss in post-menopausal women could not be reversed. We had been led to believe that our only hope was hormone replacement therapy. The good news is that with the three natural ways of treating bone loss as outlined above, we can take more responsibility for our bone health and look forward to a better quality of life and independent living.