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Nothing comes from nothing—rethinking “primary osteoporosis”

When osteoporosis is diagnosed in men, a great effort is made to uncover the causes of the excessive bone loss. In fact, most male osteoporosis is considered to have a secondary cause, that is, to be caused by something, whether it's a disorder like celiac disease, the use of various medications, or habits such as smoking, etc. Most osteoporosis in women, however, is simply considered a normal development due to menopause or advancing age. However, outside of the Western world, women don’t necessarily develop osteoporosis as a matter of course — and that says it’s not normal.

We at the Center for Better Bones have come to challenge this distinction between what scientists call “primary” and “secondary” osteoporosis. Our work leads us to suggest that all osteoporosis is indeed caused by something, and in this sense, all osteoporosis is secondary to something else. For example, the American College of Rheumatology has estimated that 20% of all osteoporosis in the US is due to use of steroid medications. Other researchers have suggested that 20% of all hip fractures are related to smoking. The use of acid-blocking drugs has been shown to double fracture rates. Some studies suggest that almost 20% of those with osteoporosis have the disorder caused or worsened by an excessive loss of calcium in the urine. Vitamin D inadequacy could be causing half or more of all osteoporosis, and so forth.

The reasons why someone may develop osteoporosis are many and varied, including undiagnosed medical problems or unhealthy lifestyle issues, such as smoking, acidic diet, etc. But if you can pinpoint out why you're losing bone, there may be some way to halt your bone loss and perhaps even restore your bones to health. Lifestyle issues are easy to spot; undiagnosed medical issues take a bit more work.

I always tell my clients, "Take heart, and take action." If you are losing bone but don't know why (or if you've been told that your bone loss is "normal" or "expected" for someone of your age and gender), then it's time to find some answers. I encourage you to review my article on secondary osteoporosis so that you understand — and maybe recognize — some of the hidden sources of bone loss that might be affecting you.

 

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.

Comments

March 31. 2010 13:52

Dear Dr. Brown: I am a nutritional consultant who has been on your program for two months now with a new monthly set of Better Bones Basics coming soon. However, I would like some additional information if possible. I have had thoracic bone injury years ago and due to a hip replacement surgery procedure three years ago it has made this thoracic area more painful. Additionally since the hip replacement was NOT seated correctly in one of the three areas that too is painful. Additionally I have osteoporosis hence my going on your program. IS there anything else you could suggest that could make things a little less painful. I am wearing a thoracic back brace which does help a little but to say I am depressed is putting it mildly. ANYTHING you can suggest would be appreciated and I have discussed your product line with a few of my clients who are interested so I want to thank you for thinking of us " bone deficient sufferers"  Marilyn S. Hirsch, NC

marilyn hirsch

April 1. 2010 11:05

Dear Marilyn, Thanks for your note.  Certainly the full Better Bones Progam will aid your bones and when there is osteoporosis we also suggest you ask your doctor for a complete set of tests to detect any hidden causes of bone loss, The tests are listed here: http://www.betterbones.com/bonehealth/medicaltestingforosteoporosis.aspx.  As for the hip replacemennt bone injury, the best I could suggest is to use a good dose of the repair and anti-inflammatory nutrients, especially minerals, vitamin C and D and perhaps quercitin and curcurmin.  Best wishes, Susan

Susan Brown

April 12. 2010 11:05

Dr Brown
I have heard a lot about the astronauts who come back with osteoporosis and that they return to using a vibrating machine.  Does this really help osteoporosis and build bone.

Debbie

April 12. 2010 21:06

Hi Debbie,
For years I have read of positive results using whole body vibration (WBV).  Here at the Center for Better Bones we are putting together an overview of the existing clinical trials using WBV for bone health improvement. I will publish our analysis on this site as soon as it is ready. Also we have just purchased a WBV machine and will do doing some experiments here.  Yes, I think they really do help build muscle, balance and bone.  Susan

Susan Brown

April 13. 2010 11:54

I want to add strong support to Dr. Brown's advice to look for secondary causes of osteoporosis.  My bones were fine at 50; then took a sharp turn into slight osteoporosis, losing 8% of bone mass in a year.  I was sent to an alert endocrinologist, but unfortunately had a compression fracture of the top of my tibia before my appointment.   The doctor ran me through lots of tests, including the nuisance of a 24-hour urine.  We found hypercalciuria.   Medications stopped the bone loss for a time; with Fosamax I regained some.  The meds worked on the urine calcium loss for only a few years, but I've been able to stem it quite a bit with diet - very low salt, almost no animal products, lots of veggies and legumes.

Now, almost 10 years later and at 68, I've had ups and downs, and I'm an "expert" on doing the 24-hour urine collections.  My hips are almost unchanged on bone density tests, and my spine is better.   By choice I lead a highly active lifestyle, with lots of hiking and some backpacking.   I've had no more broken bones!  

Doris

April 13. 2010 14:15

Have you done any research or talked with Colin Campbell, the author of "The China Study?"  This research looked at diets of people in China (rural areas where people lived their entire lives and the diet didn't vary much) and compared them with the standard American diet. I'm sure osteoporosis is mentioned, I just don't remember particular statistics.

Doris--Perhaps your MD read The China Study!

Betty

Betty Wyckoff

April 13. 2010 20:28

Doris, Yes looking for the cause of bone weakening is essential. About 15% of all those with osteoporosis are loosing calcium in the urine and reducing salt, increasing potassium foods, using vitamin K and developing a strong alkaline diet helps conserve calcium, as do the thiazide diuretics given by physicians.  I will be writing more on urine calcium loss in the future, so stay tuned and try to do all the steps of our Better Bones Program. Best, Susan

Susan Brown

April 13. 2010 20:32

Betty,
As an anthropologist I have great respect for the cross-cultural work of Colon Campbell.  He found, as I also suggested, that the Chinese had much lower fracture rates on their low meat, traditional diets.  Thanks for reminding me of his important work. I have his China Study book  and after reviewing it again I will write a blog highlighting his findings regarding bone health in rural China as compared to the US. Best wishes, Susan

Susan Brown

April 14. 2010 18:12

I think Susan's work is absolutely brilliant.  Bone is living tissue that needs a wide variety of nutrients and exercise (just like muscles).

Health is largely an invisible process; you can't see high cholesterol.  Therefore, a tailored Comprehensive Blood Chemistry is essential to see what's going on in your body.

I don't own stock, but folks can buy the tests directly on the web.  One source is www.directlabs.com. Ideally you want the DLS Interpretive Report which translates all the numbers into plain English.

Certainly you want to add a 25(oh) D test.  Read Dr Brown's meta-analysis report on that.

James Larsen

April 15. 2010 12:30

I had childhood kidney disease, and no one realized I was losing massive amounts of calcium through my remaining kidney until after 3 pregnancies when I started losing height at an alarming rate--in my early 30s. I was 5'7" tall when I graduated from high school. At 52, I'm 5' 2 1/4" tall.  Doctors tried treating my osteoporosis through my 30s, my 40s, and into my early 50s--when I finally did start menopause--as post-menopausal osteoporosis.  Not until age 49 was I sent to an endocrinologist who actually discovered the *cause* of my osteoporosis--the calcium leak from my remaining kidney.  I'm severely allergic to shellfish, sulfa, and thiazide diuretics, so it has been a challenge coming up with a "cocktail" to slow the leak.  I have been attempting to adjust my diet to a more alkaline one, per Dr. Brown's advice, and my most recent 24-hour urine shows some improvement for the first time ever.  Since 2007, I have had 13 fractures, and am permanently disabled with rheumatoid arthritis on top of the fractures. My fervent hope is to avoid further fractures. I can't undo the damage already done, but perhaps we can prevent further damage. I urge anyone diagnosed with bone loss to seek second, third, and fourth opinions.  Thank you for your work.

Deb Stover

April 15. 2010 14:06

Hi James,
Thanks for your kind comments.  Everyday it becomes clearer that each of us needs to become their own best advocate.  After all, who is as interested in your bone health as you are. Looking for the underlying causes of bone loss is essential. In fact, at a recent international meeting of bone health professionals I was pleased to hear a keynote speaker encourage doctors to do the "medical osteoporosis work-up" I speak of   http://www.betterbones.com/bonehealth/medicaltestingforosteoporosis.aspx.  Thanks also for the self-help testing link.  Best wishes, Susan

Susan Brown

April 15. 2010 14:33

Dear Deb,
Thanks for sharing you situation with us. I wonder if you could share the "cocktail" that was developed for you to help reduce bone loss.  We see the Alkaline for Life Diet, use of vitamin D, reduction of caffeine and salt to help reduce urinary calcium loss, but often those who cannot use thiazide diuretics need additional help.  Of yea, and be sure that you have had all the Better Bones medical osteoporosis work-up tests I write about.  Thanks, Susan

Susan Brown

April 16. 2010 16:38

As you said, dietary changes, vitamin D, potassium citrate, and Amiloride instead of the Thiazide diuretic.  A nephrologist finally came up with the "recipe" when I couldn't tolerate the HCTZ.  I've had a lot of tests.  I'll double check with your work-up.  Thanks.  I need the new book, too.  Have the older release.

Deb Stover

April 18. 2010 10:23

Deb Stover, Thanks for the Thiazide alternative.  Great idea to go to a nephrologist, they are the ones who really understand kidney issues ( and pH issues also).   Do double check the full osteoporosis medical work-up. Best wishes, Susan

Susan Brown

April 25. 2010 22:28

I am 57 and since 9/09 to 1/10 I had 8 vertabrea compression fractures.  My problem is no parathyroid hormone being made by my body.  So now on Forteo - the replacement after three months now shows that I am at the minimum level of PTH.  PTH is rarely if ever checked - please add this to your investigation.  Thanks

Becky

April 30. 2010 22:12

If my Vit D level checks fine, is there any reason to get the PTH, & if my urine ph is always 7 in the morning, is there any reason to do the 24 hr. urine collection test?  Thanks, Irene

Irene

May 4. 2010 13:43

Irene,
If there is on-going, unexplained bone loss it is god to check the PTH even if the D level is fine.  Also worth checking the 24 hr urine calcium loss, even if pH is good.  Best wishes, Susan

Susan Brown

May 5. 2010 20:43

Hi Becky,
Interesting...very low parathyroid hormone is quite rare, glad yours was discovered.  Yes, I do include the test for intact parathyroid (PTH) in our  recommended osteoporosis medical work-up. http://www.betterbones.com/bonehealth/medicaltestingforosteoporosis.aspx   Generally you see high PTH, not low.  Best wishes, Susan

Susan Brown

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