10 myths about osteoporosis

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.

Are You really losing bone?

Who needs a medical work-up to find the causes of their osteoporosis?

Here at the Center for Better Bones, we often say that it is difficult to solve a problem you do not fully understand.Osteoporosis does not happen “just because” — there are always underlying causes of osteoporosis. Some of these causes are lifestyle-related, but others can be undetected health problems of which the bone loss is just a symptom.

If you have a bone health problem — or if you or your doctor simply suspect you might have a serious bone concern — an osteoporosis medical work-up of tests is in order to look for the causes of your bone loss.

Step #1: Find out what is happening — are you really losing bone?

When there is any type of bone health concern, an attempt should be made first to understand exactly what is happening with the bones.

Questions we might ask here include:

  • What is your bone density compared to young folks of your same sex?
  • What is your bone density compared to folks of the same sex and same age?
  • Are you underweight with small bones, and thus more likely to have a low bone density reading?
  • Is your bone loss ongoing?
  • If you’re female, is your bone loss related to the transitions of perimenopause and early postmenopause?
  • Do you have multiple osteoporosis risk factors?
  • Have you experienced any fractures?
  • Overall, is there a real problem?

Step #2: Find out why it is happening — what’s the cause of your bone loss?

After these questions have been answered and it has been determined that there is a real concern, then the next step is to undertake medical testing to uncover the underlying causes of any real problems. A good osteoporosis medical work-up can include a variety of tests such as the ones listed below. Background information for these tests and their interpretation is provided in my two articles, The diagnostic tests to find what causes osteoporosis and Understanding your test results.

Tests included in the medical work-up for osteoporosis

  • Vitamin D 25(OH)D blood test
  • Ionized calcium test
  • Intact parathyroid hormone blood test (iPTH)
  • 24-hour urine calcium excretion test
  • Thyroid hormone function test (TSH)
  • Markers of bone resorption tests (NTx, Dpd, CTX)
  • Vertebral deformity assessment
  • Free cortisol test (blood or saliva)
  • DHEA test (blood or saliva)
  • C-reactive protein test (high sensitivity if possible).
  • Homocysteine test (plasma or serum)
  • Sex hormone testing

The final step in this process should be clear: once you know that you’re losing bone and have found out why you’re losing bone, you can stop the bone loss by addressing the underlying health problem that’s costing you bone! In some cases, it may be something as simple as improving your vitamin D status, either by spending more time in the sun or using vitamin D supplements, or both if needed. Other health concerns might need more complicated solutions, requiring further discussion with your healthcare provider to help you understand what your test results mean.

3 special bones that help your bones

3 bones to thrive in life

9488_10152807153898865_1206375352389284246_nTo thrive in life you need 3 bones: a wishbone, a backbone and a funny bone.

Oh, how I wish I had been the one to come up with the quote above.  Instead, the credit for this wise — and clever — thinking needs to go to the famous country music singer Reba McEntire.

I wonder if Ms. McEntire realizes how paying attention to your wishbone, backbone and funny bone can also help build and strengthen the 206 other bones that are in your body?

How 3 special bones benefit your bones

Wishbone. I believe that we put our attention on grows stronger in our life.  And putting attention to something often begins as a simple wish.

For all of the things that I wish for, I make a clear list, carry it wherever I go, and take time to give attention to those things.  At the same time, I intentionally release worries and concerns that could be harmful to my goals.

Backbone. You have a wise inner guide when it comes to your health — have the confidence to listen to it!   Remember, you always have the right to question the information you’re being given about your health and to make the ultimate decisions about what to do.  If a recommendation “doesn’t feel quite right” but you can’t put your finger on why not, use your backbone to pay attention to your inner voice.

got-your-backFunny bone. Every action we take to strengthen our bones should also increase our overall health and enjoyment of life.  What’s more enjoyable than laughter, joy and celebration — all which benefit our bones?  Many studies show that laughter helps to decrease stress, improve immune function and even reduce our response to pain.

If you want to get started with your funny bone, to the right is one of my favorite cartoon drawings.

Here’s to the health of all of your bones!

is forteo worth it?

Forteo — is this bone drug too good to be true?

Forteo™ (teriparatide) is a new and different drug on the scene as a treatment for osteoporosis. Other bone drugs, like Fosamax, Actonel, Boniva, or even estrogen work to halt bone breakdown. Forteo, on the other hand, works to increase new bone formation. Short-term studies, in fact, report a common 9% increase in lumbar spine bone density and a 2–3% increase in hip density accompanied by significant reductions in fracture incidence. Sound too good to be true? Sure does. So let’s take a second look and try to understand this new drug from what the manufacturer, Eli Lilly, tells us in their 2008 Forteo Product Monograph.

What exactly is Forteo?

Forteo is a man-made (well, E. coli-made) recombinant parathyroid hormone that has an amino acid sequence identical to part of the human parathyroid hormone (PTH). Forteo was approved by the US FDA in 2001 as an osteoporosis drug.

How does Forteo work?

In the body, natural parathyroid hormone serves to regulate bone metabolism in many ways. Chronic elevation of PTH, as in hyperparathyroidism, results in increased bone breakdown, a loss of calcium, and osteoporosis. On the other hand, daily injections of the PTH drug Forteo have the paradoxical effect of increasing bone mass and reducing osteoporosis. As scientists report, it seems to be that the pattern of exposure to parathyroid hormone determines its effect on the skeleton.

Through activation of various bone metabolic pathways, the PTH drug (Forteo) increases the number of active osteoblasts (bone-building cells), decreases the naturally programmed death of osteoblast cells, and recruits bone-lining cells as osteoblasts. This drug appears to act largely upon the bone-building osteoblast cells stimulating them to overactivity. Safety studies on this drug in rats, in fact, have shown findings of excessive new bone formation and bone cancer. Interestingly enough, the cancer this drug was found to cause in rat studies (osteosarcoma — I’ll say a little more about this shortly) is a cancer often associated with high osteoblast activity and rapid bone growth.

By how much does Forteo reduce fractures?

  • Reduction of spinal fracturesAmong 1637 postmenopausal women with severe osteoporosis and one or more vertebral fractures at baseline, the drug produced a 9.3% absolute fracture risk reduction over 19 months.
  • Reduction of hip, pelvis, wrist, rib, humerus, and other fracturesOver 19 months in these same high risk women, Forteo reduced nonvertebral fractures by an absolute 2.9% reduction in fractures.

So, overall, the short-term studies on Forteo reported above show this drug to reduce fracture risk substantially more than the bisphosphonate drugs like Fosamax. In addition, Forteo in these studies increased bone density more than the bisphosphonates.

Just how much does Forteo increase bone density?

In this same 19-month study of high risk osteoporotic women, Forteo increased bone density by an average 9.7% in the spine and 2.6% in total hip, while the wrist lost bone density and total body mineral content remained the same.

Why are there just short-term studies on Forteo, and is it safe?

As the manufacturer reports, the longest studies on the safety and efficacy of Forteo were of only a two-year duration. Why are there only short-term studies on this new drug? There are only short-term studies because in the animal safety studies, Forteo was shown to cause a high incidence of osteosarcoma (a rare malignant, often fatal, bone tumor), as well as osteoblastoma (abnormal mass of tissue in bone) and osteoma(small benign bone lesions). As with all drug safety tests, the drug doses tested were from 3-, 20-, and at times, 60-fold higher than those used in human medications. Notably, bone tumors were observed at all Forteo doses, with the incidence reaching 40–50% in the higher-dose groups.

Given this major safety concern, human trials with this drug were terminated early and guidelines were set to limit the duration of its use in humans. In fact, as the manufacturer specifically states, “The safety and efficacy of Forteo have not been evaluated beyond two years (median 19 months in women and 10 months in men). Consequently, the maximum lifetime exposure to Forteo for an individual patient is 18 months.” Also, given the cancer-causing effect of the drug, the FDA required a “black box” label warning, clearly stating the increased cancer risk shown in rat studies.

Expensive, experimental, possibly cancer-causing, and inconvenient

As near as I can calculate, since its development, studies on this drug have included only 1943 patients. According to the manufacturer, a study of one year is considered “long term,” while the maximum length of any study was only two years. Thus, not only is Forteo relatively new, but it is also experimental and, I would say, inadequately tested. In addition, it is very expensive — the drug costs upwards of $600–$700 per month! Further, it is inconvenient to use as it must be given as a daily self-administered injection. Most importantly, since this drug has shown to cause cancer in rat safety studies, its use by humans is limited to two years or less. While there may be significant bone density gains while using Forteo, the research is clear that these gains are lost once the drug is stopped. To maintain bone density gains, antiresorptive drugs such as Fosamax must be used after stopping Forteo.

Is there a better way?

This is the question I constantly ask myself — is there a better way to increase bone strength and reduce needless osteoporotic fractures? Is there a way that does not run the risk of causing cancer, or lead to excessive new bone formation — a way that is not only safe, but also good for the entire body? Yes, in most cases there is another way, and that way is through a comprehensive, life-supporting bone-building program that enlivens natural human healing and the body’s regenerative capacity.

To learn more on the topic of osteoporosis and bone loss, read our additional articles here:

My perspective on osteoporosis

I’ve noticed that when I approach things from a little different angle I gain new insights. So, in celebration of May as “National Osteoporosis Awareness and Prevention Month,” let’s look at osteoporosis from a little different perspective than what many conventional practitioners tell us:

Did you know . . .?


Up to 80% of all those who experience an “osteoporotic” fracture do not have “osteoporosis” as defined by bone density (that is, a T-score of -2.5 or greater.)

Instead, they may have “osteopenia” or even normal bone density. These fractures are not related to mineral density issues, but to sub-optimal health and inadequate repair of the bone protein collagen matrix.

What this means for you:  Get enough of all the 20 key bone nutrients daily as well as adequate protein to enhance healthy bone protein matrix.

You can reduce your real risk of fracture even without gains in bone density.

For example, supplementation with vitamin K2 strengthens bone and reduces fracture risk without substantially increasing bone density. Strength training also significantly reduces fracture risk yet only causes minor changes in bone mineral density.

What this means for you: Go beyond seeing bone density as the most important factor in bone health. Consider your total body muscle strength, balance, wellness, and zest for life. Keeping bone density loss to a minimum is important, but big gains are not essential for useful fracture reduction.

Bone size matters

Small and thin women have special bone health concerns. For example, small bones break more easily than larger ones; thin women lose more during the menopause transition; and often as a group they experience  tendencies toward weak digestion, poor sleep, low energy, excess worry and anxiety, and low bone formation.

What this means for you: If you’re thin, much less thin and worried, keep building and maintaining bone strength as top priorities. Take care not to lose weight, since when you lose weight you also lose bone.

During the transition into menopause the average woman loses 10% of her bone mass

And many thin women and selected others lose up to 20%. Interestingly enough, much of this loss occurs in the first year before the last period.

What this means for you: Begin a bone building program well before you see signs of the menopausal transition. Bone loss actually begins in the early 30s. Even in youth we need to build stronger bones with appropriate diet, exercise, and nutritional supplementation.

Remember, it is never too late (nor too early) to build, and rebuild, bone.  And what better time to start than National Osteoporosis Awareness and Prevention Month!

What’s the risk of osteoporosis for men?


While I focus this blog on women and their greater risk for bone loss, it’s important to remember that men suffer from poor bone health and osteoporosis too.

In fact, some risk factors may affect men even more than women. For example, a new study highlights than men who smoke were more likely than women who smoke to have osteoporosis and fractures of their vertebrae.

How does bone loss affect men?

  • Bone density decline: Just as women do, men lose bone density as they get older. The rate increases after the age of 50, due to lower vitamin D, calcium absorption and sex hormone levels.  A low level of testosterone is associated with the development of osteoporosis.
  • Hip fractures: About 30% of hip fractures occur in men. However, mortality in men after a hip fracture is considerably higher than in women.
  • Cost of osteoporosis: Approximately 20% of the total cost of osteoporosis in the United States is attributed to fractures in men.
  • Secondary causes: Two-thirds of men with osteoporotic fractures have one or more secondary causes of metabolic bone disease, including steroid use and low testosterone.

What men can do for bone health

As more attention is paid to osteoporosis and fracture risks of men, we inevitably will see a push to drug therapy.  But the natural approach for bone health is highly effective for men too:

•    Determining if there’s a secondary cause for bone health, including low testosterone
•    Getting enough of the 20 key bone-building nutrients, with my Better Bones supplements
•    Eating an alkalizing diet and
•    Strengthening bones and muscles through exercise
•    Reducing stress and practicing meditation
•    Eliminating any tobacco use and excessive alcohol intake
•    Avoiding pesticides and plastic food contamination as they can be estrogenic and reduce testosterone

Now that you know the risks men face to their bone health, you can help family members, friends and partners take steps to better bones and a better body.  One good place to start is the Bone Health profile that is designed for both men and women.  Take it or share it now!



Joshua D. Jaramillo, Carla Wilson, Douglas J. Stinson, David A Lynch, Russell P Bowler, Sharon Lutz, Jessica M Bon, Ben Arnold, Merry-Lynn N McDonald, George R. Washko, Emily S Wan, Dawn L DeMeo, Marilyn G Foreman, Xavier Soler, Sarah E Lindsay, Nancy E. Lane, Harry K. Genant, Edwin K Silverman, John E. Hokanson, Barry J Make, James D Crapo, Elizabeth A Regan. Reduced Bone Density and Vertebral Fractures in Smokers: Men and COPD Patients at Increased Risk. Annals of the American Thoracic Society, 2015; 150226144213008 DOI: 10.1513/AnnalsATS.201412-591OC

NOF: http://nof.org/files/nof/public/content/file/252/upload/85.pdf


can stress lead to osteoporosis?

Stress-induced osteoporosis: A new concept

stres“Can stress cause osteoporosis?”  I’ve been asked this question by thoughtful women at least a   thousand times. Until now, my response of “yes” was based on ancient Eastern medical sciences which directly link emotions and bone health.

For some 5,000 years ancient Eastern medicine has said that skeleton health, as all health, flows from a state of internal mind-body-spirit-emotional balance. Strong emotions and one’s response to them hold sway over specific organs and internal energy circuits. For example, while anger upsets the liver, the emotion of fear, anxiety and worry drain and dry the bones.

Modern Science catches up with Ancient Science

Now with the concept of “stress-induced osteoporosis,” modern Western science is catching up with ancient Eastern science.  Here’s how.

One important way Western medicine is showing a healthy respect for the power of emotions is by recognizing that depression and anxiety are linked to weaker bones. The emphasis is the detailed study of the biochemical mechanisms involved, and I recently saw the first medical article identifying “stress-induced osteoporosis.” The research focused on the production and activity of stress hormones such as cortisol, epinephrine and norepinephrine.

As most things in modern medicine tend to do, the article attempts to unravel the nuts and bolts mechanisms by which stress alters physiology.  I suspect they are most likely looking for knowledge which would allow for the development for a drug to interfere with the mechanics stress-induced damage.  While contemporary medicine is not exactly aimed at getting to the roots of anyone’s stress response, it at least now recognizes the emotion-bone link.

However, from my clinical practice it is clear to me that Traditional Chinese Medicine, Ayurveda of India and ancient biblical texts had it right.  Health lies in balance, and chronic negative emotions are powerful forces that can disrupt internal balance.  As for bone…fear, anxiety and worry take their toll. Previously I detailed a simple procedure to begin modulating the fear response.  Read more here.

I’ll be writing more on this soon.



Baldock, P. A., et al. 2014. Neuropeptide y attenuates stress-induced bone loss through suppression of noradrenaline circuits. Journal of Bone and Mineral Research 29(10):2238–2249. DOI: 10.1002/jbmr.2205.

Furlan, P. M., et al. 2005. The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density. Biological Psychiatry 57(8):911–917. DOI:  10.1016/j.biopsych.2004.12.033.

Top bone blogs for 2014

When I look back, 2014 was an exciting year for bone blogs!  I think my personal favorite was my blog about new information about strong women and strong bones.

In case you missed it — or any other top 2014 blogs — here are the blogs women found most helpful this year on their path to Better Bones.

Nourish the root to receive the fruit
Strong women, strong bones
25 positive intentions
Probiotics and bone health
How to overcome your fear
My own vitamin D miracle
Why I value meditation
Protein: good or bad for bone?

What blog was your favorite or what did you enjoy learning more about bone health this year? I look forward to reading your responses below to continue our conversations in 2015!

Happy New Year!

woman reading drug information

5 reasons why bone drugs should be your last resort

Rethinking osteoporosis

susanI know how scary a diagnosis of osteoporosis or osteopenia can be — especially when you’re told your only option is to take a bone drug – possibly for the rest of your life. I work with women every day who are facing this fear and frustration.

Most women aren’t aware they have other choices — because their doctors don’t know what those options are, and the big drug companies certainly aren’t going to tell them!

The first thing you should consider before filling that prescription is that you have a right to know all of your options — as well as the whole story about that drug you’re being asked to take. As someone who has studied the effectiveness of a natural approach to bone health for more than 20 years, here are five crucial reasons whybone drugs should be your last resort for osteoporosis, osteopenia or fear of bone loss.

1. You’ll put your bones at long-term risk.

Bone drugs have troubling side effects that can significantly affect your bone health, especially when used over time. One troubling side effect is seen with bisphosphonate drugs. While they may halt bone breakdown in the short term, after about a year, these bone drugs also halt bone building — leading to brittle bones that may bemore susceptible to fracture, not less. How’s that for irony?

2. You’ll also face risks to your whole body.

Serious consequences like stomach irritation, heighten risk of esophageal cancer, blood clots, leg cramps, vision changes, nausea, vomiting, constipation… for a complete look at thedangerous side effects of using bone drugs long-term, I’ve developed this chart. These side effects are critically important to consider, especially if you’re being asked by your doctor to take bone drugs for may be likely normal bone loss or even as prevention.

3. Bone drugs produce few lasting results.

Popular bisphosphonate bone drugs “work” by temporarily creating bone mass from drug molecules, but they don’t offer lasting results. Based on my experience, I’ve learned that just because bones may look denser on a bone scan it doesn’t necessarily mean they are measurably stronger. What’s more, the recommended limit for taking bone drugs safely is just five years, at which time any “benefits” of bisphosphonates disappear.


4. The U.S. Surgeon General recommends natural approaches first.

When it comes to treating patients with osteoporosis and osteopenia, guidelines from the Surgeon General of the United States state that improvements to dietary and exercise habits are the first steps your physician should recommend, followed by investigation of potential underlying causes of bone loss. The report goes to say the final step — the last resort — is to use bone drugs – and only in cases of osteoporosis. I couldn’t agree more!

5. Your doctor may not truly understand what’s best for you.

Unfortunately, I don’t see many conventional physicians following the Surgeon General’s guidelines. They try to “fix” the problem immediately, and as a result, too many women are automatically prescribed bone drugs rather than being offered natural and effective options. You have a right, and even the obligation, to decide what is best for you and your body!

Common causes of bone loss – how to address them naturally

I’ve found that for many women, the underlying cause of their bone loss can be effectively addressed by working with Nature and the body’s own healing capabilities. Here are a few of the most common causes for you to consider:

Cause of osteoporosis and bone loss

How the natural approach works

Inadequate nutrients can cause your body to steal the minerals you need from your bones’ reserves.Even a perfect diet may not provide your bones with enough nutrients, so considersupplementation for optimal bone health.For example, getting adequate vitamin D can reduce fractures as much as – or even more than – drug therapies.
An acid-forming diet causes your body to release buffering mineral compounds from your bones that should instead be safeguarded for your future bone health.An alkaline-forming diet with fresh vegetables, nuts, fruits and adequate protein helps keep buffering minerals in your bones where they belong.
Chronic stress increases your production of the stress hormone cortisol, which is extremely damaging to your bones.Minimize your stressors — both physical and emotional — through self-care activities such as exercise, meditation or relaxation, to support your health and to feel calmer.
Lack of weight-bearing exercise leads to muscle and bone loss.Exercise halts bone loss because bones strengthen in response to the strain put upon them. Doing something as simple as walking 20 minutes per day can reduce your fracture risk.

What’s causing your bone loss?

There’s a lot of fear and anxiety around an osteoporosis or osteopenia diagnosis. To help you understand more about your true risk for bone loss and how a natural approach can help without the risks and side effects of drugs, take our exclusiveFracture Risk Assessment. Remember, you have a right to explore all your options, and to do what is right for you.