Is it osteoporosis — or something else?

Here is the scenario. A woman seeks my services, concerned and even fearful after having been told she has osteoporosis and should take a bone drug. We sit down and after a careful review of her case, I am led to ask, “What’s the real problem here? Is osteoporosis really the major issue?” Quite often, the answer is “no,” and then I ask, “Should we start by addressing bone, or is it more effective to start on another level?”

Here’s an example that reveals why:

Barbara’s story

Barbara came to consult with me about her doctor’s recommendation that she should begin bone drugs. Barbara, a nurse, had suffered from an autoimmune disease for years that caused debilitating digestive issues. Between the ages of 47 and 50, she experienced an autoimmune flare that left her only able to eat a small amount of food at each meal. She became extremely debilitated and lost 25% of her body weight — and 14.9% of her spinal bone density — before she had identified dietary and lifestyle modifications that could quiet the autoimmune activity.

Her doctor’s insistence that she use bone drugs was based on this rapid decrease in spinal bone density. But Barbara was now 53, her digestive issues were better, and her most recent DEXA showed only an insignificant loss in the spine — she’d even gained a bit in the hip.

Was osteoporosis really the problem to address first?

We realized that Barbara’s spinal bone density loss coincided with her serious, prolonged problem with esophageal spasms stemming from her autoimmune disorder and its related allergic responses. Rather than concentrate on her bones, it made more sense to address her autoimmune disorder, which was the likely root cause of her bone loss.

Changing our focus was also important because while Barbara’s bone density had stabilized and her digestion was better, she was still experiencing occasional esophageal spasms, palpitations, chest pain, and fatigue. Any flare of these symptoms could lead to another bout of rapid weight and bone loss.

To help alleviate these concerns, I suggested Barbara undertake a partial elimination diet, alkalize her pH, use a few immune-enhancing and bone-building nutritional supplements, exercise, and meditate daily. Within one month, Barbara reported she was feeling healthier and stronger than she had felt in the past six years.  Our plan now is to undertake a comprehensive Better Bones, Better Body program for building both Barbara’s immunity and her bone strength.  “Nourish the root to receive the fruit” is an ancient aphorism I keep in my back pocket — in this case to Barbara’s benefit.

Barbara is happy to share this short video interview that she had with me. We both hope it will encourage each of you to look for the root causes of any excessive bone loss.

Diabetes and osteoporosis

woman-thinking-about-blood-sugar-levelsWith World Diabetes Day on November 14, this is an ideal time to take a look at what osteoporosis and diabetes have in common. It’s a lot more than you may realize!

High blood sugar and high insulin levels damage bone

Scientists are untangling a multitude of ways in which high blood sugar and high insulin levels damage bone, including:

  • Suppressing bone turnover. Insulin has been known to contribute to the bone remodeling process for a number of years (Rosen & Motyl, 2010). But when insulin is present in excessive amounts (as in type 2 diabetes), bone resorption and circulating levels of osteocalcin both decrease — within hours of an insulin surge, according to a recent study (Ivaska et al., 2015).
  • Increasing inflammation. Hyperglycemia has been found to increase oxidative stress, which in turn promotes inflammation throughout the body (Fiorentino et al., 2015).
  • Weaknesses in collagen that occur when blood sugar is chronically high. This means that bone in someone with diabetes (regardless of type) is more fragile than would be expected for a given bone density, putting them at greater fracture risk. One recent symposium of international scientists even called for recognition of “diabetic osteodystrophy” given how well-known the connection between diabetes and poor bone health has become (Epstein et al., 2016).

Diabetes dramatically increases fracture risk

Even though folks with diabetes often have higher bone densities then their non-diabetic peers, they fracture much more. A recent systemic review of 16 studies confirms that those with type 2 diabetes have nearly 3 times the risk of hip fracture as age-matched non-diabetics. Persons with type 1 diabetes fare even worse, having more than a 6-fold increased risk of hip fracture as they age.

3 steps to manage blood sugar and support bone health

Given these connections, it might not be surprising that many steps you can take to manage blood sugar are the same things we recommend to support bone health:

  1. Get regular exercise. Just as exercise stimulates osteoblasts to build bone, it also makes cells more receptive to insulin — particularly in skeletal muscle. Studies have shown that even short-duration exertion can improve blood glucose levels (Colberg et al., 2013). So every time you walk, hop, or do yoga for bone health, you’re also maintaining your insulin sensitivity and reducing blood sugar.
  2. Try the Alkaline for Life diet. People with diabetes are urged to eat a diet rich in vegetables, legumes, whole grains, nuts and seeds, and lean meats with very limited processed sugars — sound familiar? My Alkaline for Life diet and diabetes-friendly diets such as DASH or the Mediterranean diet (Ley et al., 2014) advocate these foods for good reason, as they reduce inflammation and support stable blood sugar levels, making them good for bones as well as diabetes.
  3. Test your vitamin D. We know that vitamin D is essential for bone health. No surprise, correlations between both types of diabetes and low vitamin D have also been found (Song et al., 2013; Raab et al., 2014), so have your vitamin D level tested and make sure you have a 50 to 60 ng/dL level all year round.

And should you be among the nearly 10% of our population that already has diabetes, or if you have been told you are “pre-diabetic,” now is the time to get serious about both controlling your blood sugar and implementing my comprehensive Better Bones Program.

So in honor of World Diabetes Day, I urge everyone to remember that taking care of your blood sugar is taking care of your bones — and vice versa!


Colberg, SR, Hernandez, MJ, and Shahzad, F. Blood Glucose Responses to Type, Intensity, Duration, and Timing of Exercise. Diabetes Care 2013 Oct; 36(10): e177-e177.

Epstein S., Defeudis, G., Manfrini, S., Napoli, N., and Pozzilli, P on behalf of the Scientific Committee of the First International Symposium on Diabetes and Bone. (2016). Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporosis International 27: 1931–1951.

Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013;19(32):5695-703.

Ivaska, K.K., Heliövaara, M.K., Ebeling, P., et al. The effects of acute hyperinsulinemia on bone metabolism. Endocr Connect 2015; 4(3): 155-162.

Janghorbani,M., et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166 (5):495–505.

Ley, S.H., Hamdy O., Mohan V., Hu F.B. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet 2014; 383(9933):1999–2007.

Raab, J., Giannopoulou, E.Z., Schneider, S. et al. Prevalence of vitamin D deficiency in pre-type 1 diabetes and its association with disease progression. Diabetologia (2014) 57: 902. doi:10.1007/s00125-014-3181-4

Rosen, C.J., Motyl, K.J. No bones about it: Insulin modulates skeletal remodeling. Cell 2010;142:198–200.

Song, Y., Wang, L., Pittas, A.G., Del Gobbo, L.C., Zhang, C., Manson, J.E., Hu, F.B. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013 May; 36(5): 1422-1428.


6 ways standard osteoporosis treatment is dead wrong: Part 2


I’ve written recently about two of my top six concerns about the standard approach to bone health.  And now, here are two more that emphasize how women are often being misled about how to best protect their bones:

3. Contemporary osteoporosis management treats bone as if it were separate and isolated from the rest of the body.

It’s tempting to look at the body the way we look at cars — as a collection of independent parts, each with a specific job. But that’s not what the body is! It’s a set of dynamic, interconnected systems that are constantly changing in response to what goes on around us and inside us.

While most people lose some bone as they age, bones don’t just “wear out” over time, the way a car’s parts do. If bones are weak or rapidly become thin, it’s nearly always because of a larger systemic problem in the body. The most effective approach in this situation is a big-picture perspective that looks at bone health as an indicator of overall health — it’s been shown that older adults who experience a hip fracture have lower baseline health-related quality of life than those who don’t.

But the standard approach is to focus on the mechanics of bone breakdown and interfere with them. Most bone drugs work by targeting the cells that break bone down and stopping them from doing their job. Doing this doesn’t actually solve the problem — it just masks the effects.

Enduring bone health requires rebuilding strength and vitality. That’s why it makes sense to look at the complete body system — circulation, bone, acid-base balance — to find the places where something isn’t working right to cause bone loss, rather than focus in on halting bone loss itself, which is most often an effect of a larger problem.

4. High-dose calcium is still considered the first-line treatment, yet it does not prevent fracture, and may be harmful.

Speaking of “larger problems,” let’s take a look at what happens when you try to address fracture risk with calcium supplements. There is tremendous controversy about calcium and bones, but now it’s becoming clear that high-dose calcium supplementation is not the solution.

Multiple studies show that calcium does not decrease fracture risk except in those with a very low calcium intake — and some studies suggest that taking high-dose calcium supplements can lead to an increase in arterial calcification, stroke, kidney stones.  In my own research, it’s quite clear that while adequate calcium is needed for healthy bones, using high doses is counterproductive.

It seems wise to obtain the total 1,200 milligrams of calcium daily from diet and supplements as recommended by the National Institute of Health. At the same time, we recommend you also learn about the other key bone nutrients and make sure you obtain adequate doses of all these essential bone builders.

Stay tuned for next week’s blog for my final two reasons the standard approach to bone health doesn’t make sense. And as you’ll see, are far less effective and far more risky than commonly thought!

See Part 1 here.



Randall, AG et al., Deterioration in quality of life following hip fracture; a prospective study osteoporosis international 2000, 11(5);460-6.

Bischoff-Ferrari HA, et al., Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007

Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015;351:h4580. doi: 10.1136/bmj.h4580.
Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Ther Adv Drug Saf. 2013 Oct;4(5):199-210. doi: 10.1177/2042098613499790

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 3

iStock_000010779625XSmallIn my previous two blogs, I’ve given you 4 important reasons why I don’t believe standard osteoporosis treatment is effective. In this final blog of the series, I want to emphasize that there is no magic bullet for optimal bone health – despite what you may have heard about calcium or bone drugs.  Here’s why:

5.    The calcium-centered focus has distracted us from the fact that at least 20 nutrients are essential for bone health.

I’ve pointed out that calcium doesn’t reduce fracture risk and excessive calcium intake holds increased risk of cardiac problems. But if calcium isn’t the “magic bullet” for bones, what is? Well for one thing, adequate vitamin D levels are essential, and  a lot of doctors are finally realizing how important vitamin D is for bone health.

Yet too little attention is still paid to other essential bone nutrients — especially vitamin K, which makes a major contribution to bone health and supports many other systems as well, but also zinc, magnesium copper, boron, folate, manganese and vitamin C.

6.    Bone drugs are far less effective and far more risky than commonly thought.

Here’s where it really becomes frustrating. Our health system pushes high-dose calcium (which doesn’t work) as the solution to low bone density (which is not necessarily the problem). Then when there’s no improvement in bone density from overloading the body with calcium, the typical next step is to prescribe a bone drug.

I’ve always maintained that such medications should be used only as a last resort, for very severe cases where drastic measures are needed — for instance, a person experiencing low-impact fractures or excessive, uncontrollable bone loss. This is not the situation for most people who have relatively low bone density .

With that in mind, it shouldn’t be surprising that the results of bone drug therapy are often  very disappointing. Even worse, the evidence suggests no benefit from bisphosphonate bone drugs on real-world hip fracture incidence. Nor do these drugs benefit people 80 years old and older — which is, of course, the group most likely to fracture a hip!

What it all boils down to is this: If we’re to really help people to live long, healthy lives free from the fear of bone fractures, we don’t need more bone drugs.  Instead, we need to change our approach by:

  • Carefully assessing each individual case to identify whether excessive bone loss or weakness exists;
  • Detecting and correcting both obvious and hidden causes of excessive bone weakening;
  • Broad-spectrum, whole-body support with nutrition, exercise, neuroendocrine and hormonal balance, stress reduction, and resilience enhancement.

Such an approach would limit bone drugs to the few specific situations where obvious bone weakness cannot be offset by natural means and requires heavy-duty intervention.

Missed the previous blogs?  Read more.

Part 1

Part 2

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 1

Wrong in right , full frame

It’s no secret that I’m not a fan of the way bone drugs like Prolia® and Fosamax® are used these days. But people sometimes misinterpret my thinking as being “anti-drug” — yet it’s not just the drugs I object to. It’s how medicine in general approaches bone health and fracture risk.

I have at least 6 major objections to the standard approach, but for the sake of brevity, we’ll look at them two at a time over the next three weeks.

1.    Treatment is based on bone mineral density — but bone mineral density does not predict fracture.

Having a low-side bone density isn’t actually a health problem. It doesn’t hurt or limit mobility — it doesn’t even necessarily mean the bones aren’t strong! It’s only when you fracture a bone that you have a health problem — and more, you cannot predict fracture by bone density alone. In fact, the majority of people whose bones are so fragile they experience a low-trauma fracture do not have an “osteoporotic” bone density.

That’s why treating low bone density bones as a “disorder” that “needs to be addressed” with heavy-duty medications makes no sense. Weak bones, on the other hand, need intervention. And, as far as weak bones go, there’s almost always an underlying problem causing the depletion of bone strength — whether it be nutritional, hormonal, bone-damaging medications, or some other hidden health condition or lifestyle factor. Properly detected and corrected these underlying causes can greatly reduce the risk of fracture. This is why a real fracture risk assessment and an assessment of underlying causes are so critical to developing a comprehensive bone-building program.

2.    The standard medical approach to osteoporosis is fear-based — and fear actually damages bone.

Given that a low-side bone density does not necessarily indicate weak bones, why do you suppose doctors are so adamant that people with a low-side bone density need treatment? They’re afraid their patient will have a serious fracture.

But fear of fractures is itself bone damaging and can be a self-fulfilling prophecy — literally, as studies have linked higher levels of stress and the stress hormone cortisol with osteoporosis and increased fracture risk. A recent Danish study, for example, showed that just the perception of stress — seeing yourself as stressed — increases risk of osteoporotic fracture by 68%. It is bad enough that we have so many reasons to fall into stress and worry, we really do not need our health professional piling on more stress with unfounded fears of fracture. Again, what’s needed is a fracture risk assessment leading to a comprehensive bone building program — one that includes stress reduction and hope.

It’s interesting to note that Traditional Chinese Medicine holds that bone health is determined by the “kidney energy” and that fear is the emotion that disrupts the kidney energetic system. (And even Western medicine links osteoporosis with renal disease because the kidneys play such a central role in vitamin D metabolism, mineral reabsorption, and acid-base balance. (As I have discussed before, when kidneys can’t adequately buffer metabolic acids, calcium from bones is called upon to rescue essential pH homeostasis.) The ancient Chinese wisdom tradition suggests that the kidneys control bone and fear damages the kidneys — and I have found this to be true. All in all, we need less fear and more hope and bone-building solutions.

This isn’t all of course. Look for my post next week giving two more problems with the standard approach to bone health!



Adeva, M. M., and G. Souto. 2011. Diet-induced metabolic acidosis. Clinical Nutrition 30(4):416–421.

Azuma, K., Y. Adachi, H. Hayashi, and K. Y. Kubo. 2015. Chronic psychological stress as a risk factor of osteoporosis. Journal of UOEH 37(4):245–253.

Häussler, B., H. Gothe, D. Göl, G. Glaeske, L. Pientka, and D. Felsenberg. 2007. Epidemiology, treatment and costs of osteoporosis in Germany: The BoneEVA Study. Osteoporosis International 18(1):77–84.

Lu, Nan. 2010. Traditional Chinese medicine: A woman’s guide to a hormone-free menopause. TCMWF Publishing, New York.

Seeman, E., J. P. Devogelaer, R. Lorenc, T. Spector, K. Brixen, A. Balogh, G. Stucki, and J. Y. Reginster. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Journal of Bone and Mineral Research 23(3):433–438.

Stone, K. L., D. G. Seeley, L. Y. Lui, J. A. Cauley, K. Ensrud, W. S. Browner, M. C. Nevitt, S. R. Cummings, and Osteoporosis Fractures Research Group. 2003. BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures. Journal of Bone and Mineral Research 18(11):1947–1954.

Fosamax® is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

Prolia® is a registered trademark of Amgen Inc.

Men and osteoporosis risk

man-with-a-fractureDid you know that 25% of men over the age of 50 will experience an osteoporotic fracture?

Or that nearly 30% of all hip fractures occur in men? What’s more, their long-term outcome for hip fracture as a whole is worse than that of women.

Because osteoporosis is often described as a woman’s concern, many men may not realize they’re at risk for harmful bone loss too. As part of National Osteoporosis Awareness & Prevention Month, it’s time to share the news with your male family and friends so that they can take action too.

Risk factors for osteoporosis and fragility fractures in men

The vast majority of factors that weaken bone in women are also risk factors for men:

  • Inadequate vitamin D
  • Low nutrient intake
  • Being underweight
  • Physical inactivity and low muscle mass
  • Deficiency of sex hormones which results in accelerated bone loss in men just as in women. For men this is mostly an issue of testosterone, but men also have some estrogen and this “female” hormone helps protect their skeleton.
  • The use of various bone-depleting medications including steroids (glucocorticoids), anti-depressants, proton pump inhibitors and anticonvulsants. Steroid medications directly cause osteoporosis when used over time, even in 5 mg doses
  • Various medical conditions such as hyperparathyroidism or thyroid disease, rheumatoid arthritis, multiple myeloma, etc.
  • Lifestyle factors particularly smoking and excessive alcohol intake. Consumption of 10 or more alcoholic drinks per week is associated with a moderately increased risk of fracture.
  • Having a previous fracture. Older men with a prevalent vertebral fracture have three times increased risk of sustaining new fractures compared to men without vertebral fracture. (Karlsson et al. 2016)
  • A family history of hip fractures. A Swedish study found that men who had grandfathers who had suffered a hip fracture had both lower bone density and smaller bones than those who did not have a male relative who had fractured. (Rudäng et al. 2010)

A natural approach to bone health works best for men too

Very few studies have tested the common bone drugs in men. A 2015 reports an overall lack of evidence concerning the effectiveness of bisphosphonates for reducing hip and other non-vertebral fractures in osteoporotic men.

I suggest for men and women that bone drugs be used as a “last resort” only when all hidden medical causes of bone loss have been explored and all known lifestyle and nutrient interventions have been tried and proven unsuccessful. You can read more about my natural approach to bone-building here.



Karlsson, M. K., M. Kherad, R. Hasserius, J. A. Nilsson, I. Redlund-Johnell, C. Ohlsson, M. Lorentzon, D. Mellström, and B. E. Rosengren. 2016. Characteristics of prevalent vertebral fractures predict new fractures in elderly men. Journal of Bone & Joint Surgery Am. 98(5):379–385.

Rudäng, R., C. Ohlsson, A. Odén, H. Johansson, D. Mellström, and M. Lorentzon. 2010. Hip fracture prevalence in grandfathers is associated with reduced cortical cross-sectional bone area in their young adult grandsons. Journal of Clinical Endocrinology and Metabolism 95(3):1105–1114.

Willson, T., S. D. Nelson, J. Newbold, R. E. Nelson, and J. LaFleur. 2015. The clinical epidemiology of male osteoporosis: A review of the recent literature. Clinical Epidemiology 7:65–76.


1 minute with Dr. Brown: Is losing height normal?

Got a minute? Every week I receive dozens of questions from women like you with concerns about their bone health. In my new series, “1 Minute with Dr. Brown,” I will try to answer your most pressing questions. If you have a question, send it in to us at

Question: I shrunk an inch at age 50. Is this normal?

1 minute with Dr. Brown: Will I get osteoporosis too?

Got a minute? Every week I receive dozens of questions from women like you with concerns about their bone health. In my new series, “1 Minute with Dr. Brown,” I will try to answer your most pressing questions. If you have a question, send it in to us at

Question: My mother had osteoporosis. Will I get osteoporosis too?

Top 10 myths about osteoporosis

Are you frightened by what you hear about bone loss and osteoporosis? You certainly don’t need to be! That’s because much of what we’re told about bone health is actually a myth. In reality, there’s a lot you can do to build bone strength, prevent osteoporosis and reduce fracture risk. Let’s set the record straight:

Myth 1: Lack of calcium causes osteoporosis.


Yes, calcium is important, but it’s a myth that simply taking a high amount of calcium will guarantee bone health. To protect your bones, you need enough of 19 additional essential bone nutrients, not just calcium. In fact, you need some of those nutrients just to get any benefits of calcium.

For example, without enough vitamin D, your body only absorbs about 10-15% of the calcium from your diet, but when you take enough, the absorption rate jumps to 30-40%. Other critical nutrients for bone health are vitamin K, magnesium and strontium.

Myth 2: Osteoporosis is normal… as your bones age they should get weak.

Bone loss — even osteoporosis — can affect you in your 20’s, 30’s and 40’s.

One of the most dangerous bone health myths is that osteoporosis is inevitable as we age. While there are some fixed risk factors — such as our age and gender — you can control many of the risk factors that lead to excessive bone loss, osteoporosis and fracture. The truth is, you can have strong bones at any age.

Myth 3: A diagnosis of osteoporosis means you’ll suffer a fracture.

Research shows that over half of the people with thin “osteoporotic bone” never experience a fracture. What’s more, many people who have normal bone density do experience fractures. To identify your personal fracture risk, take a fracture risk assessment rather than relying only on a bone density test (DEXA).

Myth 4: Osteopenia leads to osteoporosis.

An osteopenia diagnosis means you have a state of relatively low bone mass, compared to the standard. For many women this may be only in one area — not necessarily throughout your body. And it doesn’t automatically mean that you’re currently losing bone. Your bones are alive. It’s never too late to build bone because it’s living tissue that constantly repairs itself. One study finds that even nursing home residents, average age of 81, build bone mass from doing light exercises and taking calcium and vitamin D daily.

Myth 5: Lack of estrogen causes osteoporosis — it’s a woman’s problem.

We hear all the time that osteoporosis is a “women’s disease” and men don’t really need to worry about it. This may stem from the long-standing belief that low estrogen levels cause bone loss. But in many countries, women maintain healthy bones for life — even though they experience the same lower estrogen levels with menopause the rest of us do. So while estrogen may play a role in osteoporosis, it’s certainly not the major cause. And unfortunately, men get osteoporosis too!


Myth 6: You don’t need to worry about osteoporosis until menopause.

Bone loss — even osteoporosis — can be secretly affecting you in your 20s, 30s and 40s. We normally achieve peak bone mass in our 20s and then begin to lose it, some of us more quickly than others. The earliest type of bone loss takes place for women who are thin, have celiac disease, suffer from irregular menstrual cycles or poor nutrition, or use steroid drugs.

Myth 7: There’s nothing you can do once you have osteoporosis other than take a drug.

The U.S. Surgeon General recommends much more than drugs! In fact, in 2004 the Surgeon General provided a pyramid outlining the best ways to promote bone health and prevent osteoporosis and fracture. The first steps in the pyramid are the natural approach to bone health combining nutrition, physical activity and fall prevention. Next comes assessing and treating the underlying causes of compromised bone health. Finally, as the final resort, is the use of bone drugs.

Myth 8: Osteoporosis is common all over the world.

Osteoporotic fracture rates vary greatly around the world, with the U.S. having one of the highest fracture rates. It’s clear that certain lifestyle factors play major roles in bone loss, including:

  • High levels of stress and anxiety
  • Lack of exercise
  • High caffeine intake
  • Use of certain prescription drugs
  • Poor nutrition

Myth 9: Osteoporosis isn’t linked to other health issues.

More and more, research appears to indicate that there’s a link between the existence of osteoporosis and other diseases. When you build your bones, you’re likely building a healthier, stronger body and improving metabolic fitness, muscle strength, blood pressure regulation and cardiovascular health — all at the same time.

Myth 10: There aren’t any signs or symptoms of bone loss.

While many women don’t realize they have a bone issue until they fracture, there are early signs and symptoms of bone loss. These include receding gums; decreased grip strength; weak and brittle fingernails; cramps, muscle aches and bone pain; height loss and low overall fitness. Another good way to know if you are losing bone is to test your pH level to see if your body is acidic, which can deplete your bone mass systematically until you begin eating a more alkalizing diet.

By knowing these facts about bone loss, osteoporosis and fracture, you can take the steps to have better bones now and for life. A good next step is to take my Fracture Risk Assessment to find out your true risk. Why don’t you take it right now?

What’s the cause of your osteoporosis? Diagnostic tests and what they mean

One of the basic principles of the Better Bones Program® is that all osteoporosis, all excessive bone loss, or all real increased risk of low-trauma fracture has a cause. To better understand any undetected causes of bone loss, it is important to obtain a medical work-up — that is, further tests that can help find the causes of osteoporosis.

In addition to the standard DEXA bone density test, we suggest that our clients discuss the following tests with their doctor to see which ones are appropriate. Below are examples of tests that could be helpful and the basics of what the test results mean so that you can better discuss your personal situation with your doctor.

Tests to help reveal what causes osteoporosis

Vitamin D 25(OH)D blood test

This test determines your blood level of vitamin D. The results tell you the amount of vitamin D supplementation needed to reach a therapeutic blood level of vitamin D, which is important for adequate calcium absorption and basic bone support.

What your results tell you: The reported “normal” range is very wide, often from 30 to 100 ng/mL. We now know that anything less than 32 ng/mL is likely to seriously limit calcium absorption and lead to bone loss. At the Center for Better Bones, we strive for a 50-70 ng/mL blood level of 25(OH)D.

Ionized calcium test

This is a simple blood test to measure the level of free calcium — that is, the metabolically active portion of calcium not bound to proteins in the blood. This test isn’t meant to assess the appropriateness of your calcium intake as much as it is meant as an indirect test of parathyroid functioning (see below). It can also indirectly tell us some things about vitamin D status.

What your results tell you: The body controls free calcium in the blood very tightly, with a normal laboratory range between 4.8 and 5.2 mg/dL (between 1.2 and 1.3 mmol/L) as reported by the Merck Index. When thinking of bone health, we look for high ionized calcium as a possible indirect indicator of excessive parathyroid hormone activity. A low ionized calcium level might be related to low albumin and low protein status.

Intact parathyroid hormone blood test (iPTH)

High parathyroid hormone levels are associated with excessive bone loss, as an overactive parathyroid gland draws calcium from bone. The medical reasons for this overactivity need to be addressed to halt the excessive bone loss. Also, a normal parathyroid reading in the face of vitamin D deficiency can indicate magnesium inadequacy

What your results tell you: At the Center for Better Bones, we look for an intact parathyroid hormone level within the normal range established by the particular testing laboratory. Two common causes of an excessively high parathyroid hormone level are vitamin D deficiency (which is easily corrected with proper vitamin D3 supplementation and monitoring); and an overactive parathyroid, which is most often due to benign tumors on the parathyroid glands. Correction of this situation often requires surgery to remove the overactive glands.

Excessively high parathyroid hormone levels cause the body to release too much calcium from the bone contributing to bone loss, and more importantly, high blood calcium. A high parathyroid condition is best treated by an endocrinologist.

24-hour urine calcium excretion test

This test looks at how much calcium is being excreted in the urine. For this test, you collect all your urine over 24 hours in a large container for laboratory analysis to measure the amount of calcium in the total volume of urine. Excessive urinary calcium excretion is a common cause of bone loss and osteoporosis.

What your results tell you: The normal laboratory range for a person eating an average diet is around 100 to 250 mg of calcium lost in the urine each day. I consider a calcium loss of more than 250 mg to be a concern. In such cases, the first step is to stop all calcium supplements for 4 to 5 days and then retest the 24-hour urine calcium. If the urine calcium loss is still high, then steps should be taken to reduce this loss of calcium in the urine, as it can cause bone loss. Nutritional, lifestyle, and medical approaches can help.

Thyroid hormone function test (TSH)

TSH is a hormone produced in the pituitary gland that signals the thyroid to produce more of its hormones. If TSH is high, it usually means that the thyroid isn’t producing enough T3 and T4, so checking your TSH level is a simple way of screening for an underactive thyroid. Thyroid hormone levels that are too high or too low can contribute to osteoporosis, as can a dose of thyroid medication that is too high. To screen for overactive thyroid, or to make sure your dose of thyroid medications isn’t too high if you’re already being treated for hypothyroidism, you’ll need tests for free T3 and free T4.

What your results tell you: The common laboratory range for all adults is 0.35 to 5.50 and a more ideal level is 0.35 to 2.0.

Markers of bone resorption tests

Bone resorption (or breakdown) tests measure the amount of one specific bone protein in the urine or blood. As one loses bone this bone protein fragment shows up in the urine and blood in increased amounts. At the Center for Better Bones, we generally use the N-telopeptides crosslinks (NTx) urine test, but there are several others available. One commonly used test is the urine Dpd test (deoxypyridinium crosslinks test). There is also an NTx serum test and the CTX serum test..

As there can be a great deal of day-to-day variation in urine bone breakdown markers, we’ve developed a two-day collection procedure for bone resorption testing for greater accuracy. These instructions can be used for either the urine NTx or the Dpd test.

N-telopeptides crosslinks (NTx) urine marker of bone resorption test

What your results tell you: The test result “normal” range often listed on the test report is very broad. For example, test reports from our local lab list the premenopausal normal range for women as 17-94 nM BCE/mM creatinine and the postmenopausal range as 26-124 nM BCE/mM creatinine. The male range is 3-51. These ranges are far too wide to be useful.

Ideally, a woman would like to have an NTx level near that of the average premenopausal woman, which in the urine is around 35, but levels often soar into the 60s to 80s or higher in and around menopause. For adult men, the mean NTx is 27, which is a more ideal value than the higher numbers. Also, these markers can get very high in rare diseases such as Paget’s Disease and bone cancer. These situations are unusual and understood by a knowledgeable physician familiar with bone resorption testing.

We use the NTx urine test from Osteomark to judge the success of our bone building program. We look to bring the urine NTx level down to the 40’s, which in most cases indicates that bone breakdown has normalized. There are some cases, however, where bone breakdown is very low, but bone build-up is even lower. This condition, known as “low turnover osteoporosis,” is detected when a person has a low NTx, but is still losing significant bone (5-6%) as seen on bone density testing.

N-telopeptides crosslinks (NTx) serum marker of bone resorption test results

What your results tell you: The NTx bone-breakdown marker can also be measured in the blood. The female range listed by the manufacturer is 6.2-19.0 nM BCE/L, with a mean of 12.6. The male range is often listed as 5.4-24.2 nM BCE/L, with a mean of 14.8. Again, this range is too wide to be useful for us at the Center for Better Bones. We look for a result of 12 or somewhat lower in women, and 14 or somewhat lower in men.

Dpd urine marker of bone resorption test (deoxypyridinium crosslinks test)

What your results tell you: This bone resorption test also lists a broad range of normal values — for women, 3.0 to 7.4 nM/mM and for men 2.3 to 5.4 nM/mM. Clinically, adult women should strive for a Dpd test score in the 4’s, and in men an ideal level would likely be somewhat lower.

Vertebral deformity assessment

This is another x-ray test for bone that images each vertebral body of the spine and looks to see if there are deformities or fractures. The Vertebral Deformity Assessment can be done on newer bone density testing machines, with special software that takes a “lateral” view of the spine.

What your results tell you: The radiologist will give a full report of what he or she sees for each vertebral body, reporting any abnormalities, deformities, or fractures.

Free cortisol test (blood or saliva)

Cortisol is a corticosteroid hormone produced by the adrenal cortex, which is part of the adrenal glands. It is usually referred to as the “stress hormone” as it is involved in response to anxiety and stress. Abnormally high cortisol levels are damaging to bone and as such represent a major risk factor for osteoporosis and low-trauma fractures. This test can be done with blood or saliva.

What your results tell you: Cortisol is the “get up and go” hormone that should rise in the early morning and decline during the day. Thus, test results vary by what time of day the test was taken. Testing labs will give their normal range readings and the timing of the test should be taken into account when interpreting test results.

DHEA test (blood or saliva)

Dehydroepiandrosterone (DHEA) is a hormone produced by both the adrenal glands and the ovaries. DHEA helps to neutralize the effects of cortisol. DHEA helps to protect and increase bone density. Stress reduction activities like yoga and meditation can help maintain youthful DHEA level as we age. Low levels of DHEA are a risk factor for osteoporosis. This test also can be done with blood or saliva.

What your results tell you: In saliva testing, the results are often correlated with the results of the cortisol testing. It is also often measured as DHEA-S, that is, DHEA in its sulfated form. Again, each lab will offer its normal range depending on the test used.

C-reactive protein test (high sensitivity if possible)

C-reactive protein is a plasma protein that is held to be a marker of general inflammation within the body. It is a known risk factor for heart disease because heart disease is largely an inflammatory disorder. Osteoporosis is also inflammatory in nature and this test is helpful in detecting unwanted inflammation, which may contribute to bone health problems.

What your results tell you: Generally, in the C-reactive protein (or CRP) test, the lower the score the less inflammation and thus the better reading. I look for a high sensitivity CRP level less than 1.0mg/dL.

Homocysteine test (plasma or serum)

Homocysteine is a non-dietary amino acid, a product of the metabolism of a dietary amino acid, methionine. In the absence of adequate B vitamins, homocysteine can accumulate in the body. High levels of this substance damage collagen and represent powerful risk factors for both cardiovascular disease and for osteoporotic fractures.

What your results tell you: Normal levels of homocysteine in the blood range from 5 to 15 mM/L. At the Center for Better Bones we like to see a homocysteine level of 8 or below.

Celiac disease and gluten sensitivity test

Celiac disease, or even just sensitivity to gluten, can lead to inflammation of the gut. This inflammation is related to a complex inflammatory cascade which can increase bone loss. Also, those with celiac disease suffer from weak indigestion and malabsorption of many nutrients including vitamins A, K, and D. These deficiencies in turn damage bone. If there is any suggestion of gluten sensitivity or celiac disease, appropriate testing should be considered

What your results tell you: There are varied tests used to help determine if one is suffering from the autoimmune disease known as celiac disease, or if there exists the intolerance of gluten sensitivity. Talk with your healthcare practitioner about what might be right for you.

Sex hormone test results

Post-Menopausal Females: Progesterone, Estrogen
Female sex hormones drop naturally at menopause among all women, so I don’t generally suggest testing of these hormones. Those interested in this type of hormone testing, or those taking hormone replacement medications, should be tested for hormone levels by their physician.

Pre-Menopausal Females (reproductive years hormone testing): Progesterone, Estrogen
For women from their teens to menopause, proper levels of sex hormones are very important to bone health. Low levels of either estrogen or progesterone can limit development of optimum peak bone mass. Irregular, or frequently missed, periods should be studied by a knowledgeable physician.

According to noted progesterone researcher, endocrinologist Dr. Jerilynn Prior, some 25% of young women in the US and Canada fail to develop optimum peak bone mass due to undetected ovulatory disturbances which result in low progesterone levels. Testing of estrogen and progesterone can be helpful in pre-menopausal women with a bone health concern.

Both blood and saliva testing are available for pre-menopause sex hormone testing. Each testing laboratory will have its range of normal sex hormone test results.

Sex Hormone Testing in Males: Testosterone and, at times, Estrogen
A common cause of osteoporosis in men is low testosterone; thus a medical work-up for osteoporosis in men almost always includes a test for testosterone. Interestingly enough, estrogen also plays a role in male bone health and at times the physicians will test for estrogen in men with osteoporosis.

Both blood and saliva testing are available for sex hormone tests in men. Each testing laboratory will have its range of normal sex hormone test results.

Everyone deserves the full story on their health

It seems like healthcare has become a knee-jerk reaction of “see a symptom, take a pill,” but we believe that everyone deserves better than that. Your bone loss is a symptom of something that’s just not right in your body — and rather than treating the symptom with medications (and living with the side effects involved, some of which are plain frightening!), I encourage everyone to dig deeper and find out the source of the problem.