What causes osteoporosis?

Causes of osteoporosis

It is often suggested that the major causes of osteoporosis are low calcium intake and lower estrogen levels at menopause. Tracking a cross-cultural perspective, however, we find that this is not always true. For example, people in many countries have lower calcium intakes than in the US, yet osteoporosis is less prevalent in these cultures. As an example, the Japanese calcium intake has only recently risen to 540 mg per day, much less than the US RDA for post-menopausal women of 1,200 mg per day. And yet the US hip fracture rate is twice that of Japan! In fact, research has shown that countries with the highest calcium intake have the highest hip fracture rates. Furthermore, I have identified at least 19 nutrients in addition to calcium that are essential to bone health.

The same holds true for estrogen. Women all over the world experience a lowering of estrogen at menopause, but not all women experience osteoporosis. Attributing the causes of osteoporosis to the natural decrease in estrogen at menopause is too simplistic. The fact is that Mayan Indian women, Bantu women of Africa, and Japanese women all have lower estrogen levels than women of various ethnic groups in the United States, but they all experience many fewer fractures than American women. Also, the few years before menopause are a time of very rapid bone loss for most women, yet a woman’s estrogen level at this time is generally higher than during her reproductive years.

There are ways to detect low bone density and ongoing bone loss. It is not easy, however, to predict who will actually suffer an osteoporotic fracture. Bone density tests attempt to measure bone mass in various areas of the body, and markers of bone resorption can tell if your body is likely breaking down excessive bone at any given time. These tests can detect low bone density and high bone breakdown before a fracture occurs, and thus help identify your chances of a future fracture. They cannot, however, predict who will fracture. For example, over half of all women who experience an osteoporotic fracture do not have an “osteoporotic” bone density. They have either moderately low bone density, known as osteopenia, or even normal bone density. Given this, everyone, even those with good bone density, would do well to maintain a strong bone-building program.

Build Better BonesOur bone-building products ǀ Consult with Dr. Brown, PhD
Camel burdens

Total load model of bone-depleting factors ©2009. Please click on the image for a printable version.

A more realistic picture of the causes of osteoporosis portrays a variety of bone-depleting factors, each building one upon the other. Each bone-depleting factor adds to the others until the total load is more than our bone can support, so to speak. The camel image shown here depicts many of the factors that contribute to poor health and osteoporotic fractures. The array of bone-depleting factors is more wide-ranging and more important than generally recognized.

At the Center for Better Bones, our first step in developing an individualized Better Bones Program is always the same. That is to comprehensively assess each individual case, making the greatest possible effort to uncover the causes of bone loss and bone weakening for that individual.

Once we understand the causes — the root of the problem — then we move on to develop a holistic nutrition and lifestyle program that will halt osteoporosis, and build and strengthen bone.The camel drawing shows that there are many complex factors contributing to osteoporosis — and even this overloaded camel doesn’t contain all of them!

It’s virtually impossible, in fact, for any single person to have all of these factors going on at once, although certainly many of them are interconnected. But it shows us that the causes of osteoporosis can vary greatly from person to person. So it makes sense that the best ways to prevent and treat osteoporosis will also vary from person to person. Every case must be carefully analyzed to develop the best individualized osteoporosis program. Yet for everyone, dietary improvements — specifically, changing to an Alkaline for Life® diet — nutrition supplement therapy, exercise, and lifestyle modifications are powerful bone-strengthening tools.

As you begin thinking about how to improve your own bone health, take a moment and look at our wobbly camel, struggling under multiple bone-depleting burdens. Which burdens can you modify? Where do you want to start gaining and regaining bone strength? Remember, it is never too late (nor too early) to build, and rebuild, bone!

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

Hot topics in bone health

Hot topics from the bone scientists

Dr_Brown_ASBMRI’ve just returned from listening to thousands of scientists and physicians discuss their research at The American Society of Bone and Mineral Research Annual Conference.  You can imagine how exciting it is to hear the newest findings, especially when it comes to the natural approach to building bone.

I’ve got plenty of interesting blog ideas, and here’s just the start of the news I’ll be blogging on in the coming weeks:

The latest important topics in bone health

•    Vitamin D absorption can vary greatly from person to person —  one dose does not fit all.
•    3 simple functional tests to assess your hip fracture risk
•    New understandings about body weight and fracture — is being heavy protective?
•    Silica: New research on its bone-building actions
•    Skeletal nutritional needs: Have we missed the mark?
•    What your breathing pattern reveals about you bone health
•    Just how important is gym class for preventing osteoporosis decades later?
•    Inflammation destroys bone, and not just in rheumatoid arthritis
•    An engineer’s view on the 3 ways bone break — my views on why
•    Does bone size make a difference?

What topics peak your interest most? Let me know and I’ll do my best to get you the details as soon as I can. Stay tuned and be well!



How to transform your digestion

Osteoporosis, digestion and fermented foods

Marinated cabbage (sauerkraut) in glass jar, selective focus

Poor digestion ranks right along with vitamin D deficiency as a key factor in the development of osteoporosis, osteopenia and needless fracture. Years ago I developed a simple 10 Steps to Stronger Digestion program that has helped countless individuals to enhance their digestion.

But I recently discovered that I overlooked an important ancient custom that can literally transform digestion — eating fermented foods.

Fermented foods bring our body’s ecology into balance, enhancing beneficial bacteria and controlling unwanted pathogenic bacteria. Fermented foods are tasty and making your own is economical, easy, and leaves you with a feeling of self-reliance. Most importantly, eating them on a daily basis can transform your digestion — it certainly has transformed mine. My top 3 favorite, easy ferment recipes are sauerkraut, pickled ginger, and kefir. I enjoy making and eating them!

Here’s how I make sauerkraut

1.    Wash the cabbage and take off the tough outer leaves (one of which will be used later).

2.    Shred the cabbage with a mandolin or knife.

3.    Put the shredded cabbage in a large glass bowl. Thoroughly mix the crushed cabbage with your hands or a wooden spoon. Add 1 ½ teaspoons sea salt for each ½ head of large cabbage. (You can salt to taste. The salt helps the fermentation process, and controls undesirable bacteria). Juice should exude from the cabbage as it is crushed.

4.    Firmly pack the crushed cabbage and its juices in a wide mouth quart size Ball canning jar. Press it down tightly with a spatula or wooden spoon. Make sure that all the air is out of the jar and the cabbage is packed in its juices.

5.    Add spring water as necessary to cover the cabbage. Then cut one of the outer cabbage leaves to fit inside the jar, providing a sort of seal.

6.    I use an air-lock jar cap which allows for release of the gases produced by fermentation without letting air into the jar. You want the process to be totally anaerobic, that is, without oxygen. You can make your ferment without an air-lock device, but using the lock solves the problem of messy overflow as the cabbage ferments. I put a shot glass on top of the leaf and screw on the air-lock cover, compressing the cabbage even further (others find this shot glass compression is not necessary to keep the cabbage covered with water).

7.    The length of the pickling session varies depending on temperature and amount of salt. I let it sit for four days and then taste. My last batch was great at five days.

8.    When you are satisfied with the taste, put a regular ball jar cover on the jar and refrigerate.

9.    Enjoy!


should you take a drug for osteoporosis?

Osteoporosis risks vs. benefits of osteoporosis drugs — spinning the numbers

When it comes to osteoporosis, most patients and their practitioners are primarily concerned with fractures. The thinking behind bisphosphonates was that if we could halt the bone breakdown process and make bones denser, we could prevent them from breaking. Most of the ads you see will tell you this is the case. But on taking a closer look, the numbers don’t seem so hot.

What’s disappointing to me is the way numbers from studies can be manipulated to exaggerate treatment benefits. Allow me to give you an example. When the manufacturers of Fosamax say that the drug can reduce fractures by up to 50% in high-risk women, what they are referring to are results of a 2004 study showing relative risk reduction among women who, as a group, are already highly likely to fracture before they are even selected for the study. Most people don’t have time to analyze study results in detail, but these reveal that out of thousands of high-risk postmenopausal women (those with osteoporotic bone density and a history of previous fracture), about twice as many (2.2%) of the placebo group will fracture as those taking the drug (1.1%). Because 1.1% indeed is half of 2.2%, the drug’s manufacturer can advertise that the drug reduces hip fractures by 50% — which is the relative risk reduction (that is, a comparison of the number of people who fractured in both groups). But let’s not forget that both groups contained many more people who did not fracture at all, and if you include them in your comparison, you get what’s called the absolute risk reduction — a paltry 1.1% (2.2 minus 1.1) — in those taking Fosamax compared to those not taking anything.

A 2008 review of more than 40 years’ worth of data on more than 12,000 women using alendronate — that’s a lot of data — shows that overall, there was a mere 1-2% absolute risk reduction with its use. Co-opting this science, direct-to-consumer marketing continues to play up the 45-50% relative risk reduction figures. Yes, relative risk reduction can be a useful tool for researchers, and of value to a healthcare provider when determining absolute risk reduction. But any good biostatistician will tell you that it does not seem to be as useful a measure for patients or families when choosing a method of treatment!

Another detail we don’t hear from the drug companies is that fracture-reduction benefit of these drugs is largely for secondary prevention — that is, when bone density is already osteoporotic and/or there has been an existing fracture. There is much less benefit in primary prevention, where bone density is not osteoporotic and there have been no previous fractures. In women with osteopenia, some research even suggests increased rates of certain types of fracture with prolonged use! In fact, these drugs are not recommended at all for primary prevention, yet women who are not at elevated risk for fracture are among the largest target audience of direct-to-consumer advertising for bone drugs.

Possible adverse side effects associated with osteoporosis medications (bisphosphonates)

  • Ulcers of the esophagus
  • Upper GI irritation
  • Irregular heartbeat
  • Fractures of the femur
  • Low calcium in the blood
  • Skin rash
  • Joint, bone, and muscle pain
  • Jaw bone decay (osteonecrosis) (rare)
  • Increased parathyroid hormone (PTH)

If patients knew the reality of these numbers and the dangerous side effects that come with taking bisphosphonates (see chart at left), I’m sure they would reconsider the merits of taking a prescription for low bone density for the rest of their days. This information is hard to find, and many practitioners don’t have the time to analyze the statistics of each and every study that comes across their desk.

I would advise patients to ask their providers what the absolute risk reduction is for a drug before taking it. Or you can also ask about the number needed to treat (NNT). This figure gives you a sense of how many people would have to take the medication for one person to receive a benefit, and the lower the NNT, the better the chance that the drug will benefit you. For example, the above information tells us that Fosamax reduces fracture risk by about 1% (absolute risk reduction), so 100 people would have to be treated for one to benefit from fracture risk — the NNT is 100, in this case. In essence, the NNT is telling us that for every single person who is benefitting from these drugs, 99 more are getting no benefit at all!

The business behind bone density drugs

Unfortunately, the ads we see on television for various osteoporosis drugs don’t mention how small the benefits really are, or how serious the side effects can be. As the Baby Boomers begin to grow older, pharmaceutical companies have a market larger than ever before for bisphosphonates, and they aren’t stopping at much to capitalize on it. In fact, this large aging population is part of the reason it looks like osteoporosis has become an epidemic in this country. In reality, US hip fracture rates have gone down since the late 1960’s in women and since the early 1990’s in men, despite an aging population. Because of the large number of aging Baby Boomers, the actual number of fractures can seem overwhelming, even though the rate is decreasing.

It’s true that such a large group of people getting older, possibly fracturing, and taking up hospital beds will represent a burden to society. This is partially why drug companies want to find a solution, but the other part — as I’m sure you can imagine — has to do with profits. In 2006, at least $2 billion was spent on Fosamax alone. Drug companies are pushing hard for direct consumer advertising to encourage women to get bone density tests, in the hopes they’ll then be treated for low bone density.

In an article on leveraging the potential osteoporosis market, a contributing editor to Medical Marketing and Media writes, “In the United States, 95–100% of women who are screened and diagnosed with osteoporosis receive treatment.” He goes on to advise drug companies to “drive diagnosis rates” by sponsoring traveling DEXA scans in shopping malls, clubs for the elderly, and community events.

The DEXA scan was developed in the early 1980’s as a way to quantify bone density, but unfortunately it doesn’t reveal much about the actual strength of bone. Patients are given a T-score that compares their bone to that of a healthy 20- to 30-year-old, then told they have osteopenia or osteoporosis! The Z-score, which compares your bone density to that of other men or women in your age group, is more helpful for tracking your bone density over time, but still not great at predicting risk. The reality is there are many factors that go into predicting fracture risk, and bone density is just part of the whole picture. It clearly works in the interest of pharmaceutical companies to compare your T-score to a young person’s, but you should know that while a machine may categorize you as osteopenic or even osteoporotic, you may never fracture a bone in your life. And the odds are with you — most people don’t fracture their bones, even if they are at high risk.

The Surgeon General’s advice — work with nature

In one sense, I agree with pharmaceutical companies: prevention is best. But I don’t agree with their approach to prevention. Pharmaceutical medications, in my opinion, don’t work with your body. They work by suppressing or fooling it into doing something it wouldn’t do naturally. I know that in certain circumstances, bisphosphonates can be helpful, but for the most part they should remain a last resort.

In 2004, the Surgeon General studied osteoporosis in the United States and wrote a report over 330 pages long on the best ways to promote bone health and prevent osteoporosis and fracture. His advice, in essence, is to work with nature.

He provides an osteoporosis pyramid for prevention and treatment that starts with nutrition, physical activity, and fall prevention at the base. The second tier involves assessing and treating the underlying causes of compromised bone health. The very tip of the pyramid, and the last resort, is pharmacotherapy. The bottom line is that your bones are meant to last a lifetime. In most cases they don’t need drugs to keep them strong or prevent fracture. There are many, many natural ways to support your bones with proper bone nutrition and, many times, simple lifestyle changes to prevent osteopenia, osteoporosis, and needless fracture.

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

Rethinking “primary” osteoporosis: Isn’t all osteoporosis really just “secondary” osteoporosis?

The medical literature defines osteoporosis as either primary or secondary. Primary osteoporosis is held to be a bone disorder of relatively unknown origin that occurs with aging and accelerates at menopause. Authorities state that there is no direct or singular cause for primary osteoporosis.

Secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. This type of osteoporosis is “secondary to,” or caused by, something else. For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis.

Is there really such a thing as “primary osteoporosis”?

In many years of researching bone health, however, we at the Center for Better Bones have come to challenge this distinction between 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 osteoporosis. 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.

In other words, the more we scratch the surface, the more we see that many of our current dietary and lifestyle behaviors directly limit bone health and encourage osteoporosis. Even the classic primary osteoporosis that is vaguely attributed to “aging” is now known to be caused by many concrete factors that affect older people, such as reduced kidney function, vitamin D deficiency, chronic low-grade metabolic acidosis, increased use of mood-altering drugs and other pharmacological agents, reduced nutrient intake, loss of muscle mass, and a reduction in physical activity.

It is also interesting to note that when osteoporosis is discovered in men, a great effort is generally made to uncover the causes of this osteoporosis. In fact, most male osteoporosis is considered to have a secondary cause. When women are found to have osteoporosis, however, there are fewer attempts to discover the causes of this bone weakening and more a tendency to explain that this is just “primary osteoporosis,” something that happens to women as they go through menopause into their senior years — as if it were normal to the female gender. But in other cultures, women don’t develop osteoporosis as a matter of course — and that says it’s not normal.

We at the Center for Better Bones, however, suggest that if you look carefully enough you will find secondary causes for almost all the osteoporosis among women just as in men. If we can’t find the cause, it is because our tools are not yet precise enough to catch the problem, not because there is no cause.

Below I list the disorders and conditions associated with the development of osteoporosis. These are recognized causes of “secondary osteoporosis.” Over time, I suspect you will see this list grow as we come to understand that all osteoporosis has a cause and is indeed secondary to something else.

Known secondary causes of osteoporosis

Table 1. Nutritional Factors

NutritionAnti-nutrientsModern eating patterns
Chronic low-grade metabolic acidosisHigh caffeine intakeHigh fat intake
Imbalance among the 20 key bone nutrientsHigh salt intakeHigh sugar intake
Inadequate intake of 20 key bone nutrientsExcess alcohol consumptionProcessed and synthetic foods
Undereating or food restrictionColas and other sugar-sweetened drinksEating on the run
Excessive protein intakeSkipping and incomplete meals
Excess vitamin A
Parenteral nutrition

Table 2. Lifestyle Factors

Physical Activity/ExerciseOther
Inadequate physical activitySmoking
Poor muscle developmentSignificant weight loss
Sub-optimal strengthUse of recreational drugs
Immobilization (prolonged bedrest)Use of medications (see Table 3 below)
Weightlessness (as occurs in space flight)Birth control methods such as tubal ligation
Other surgeries such as hysterectomy, bariatric, gastrointestinal, etc.
Emotions such as worry, unhappiness, fear
Response to stress (increased levels of cortisol, epinephrine norepinephrine)

Table 3. Medical Conditions

Endocrine or Metabolic CausesConnective Tissue/Genetic DisordersDigestive Disorders / DysfunctionRheumatological & Autoimmune DiseasesNeurological Diseases
AcromegalyCystic fibrosisCeliac diseaseAnkylosing spondylitisEpilepsy
Adrenal disorders,
Adrenal insufficiency
Cushing’s syndrome
Ehlers-Danlos syndromeChronic hepatic diseaseLupusParkinson’s disease
Diabetes mellitus
(Types I and II)
Glycogen storage diseasesGastrectomyMultiple sclerosisPolio, history of
Gaucher’s diseaseHemophiliaGastric bypass (Bariatric surgery) or other GI surgeryRheumatoid arthritisSpinal cord injury
HemochromatosisHomocystinuriaInflammatory bowel diseaseBone, Bone Marrow, and Blood DiseasesPsychiatric Disorders
HyperparathyroidismHypophosphatasiaMalabsorption syndrome (celiac disease and IBD, such as Crohn’s disease or ulcerative colitis)Leukemia and lymphomasDepression
Hyperthyroidism (Graves Disease)Idiopathic hypercalciuriaMalnutritionMastocytosisAnorexia nervosa and bulimia
(sex hormone deficiency), including:
Androgen insensitivityAthletic amenorrheaEstrogen deficiencyHyperprolactinemia Klinefelter’s syndromePremature menopauseTurner’s syndrome
Marfan syndromePancreatic diseaseMultiple myelomaOther health factors
HypopituitarismMenkes steely hair syndromePrimary biliary cirrhosisPlasma cell dyscrasiasAlcoholism
HyperpituitarismMuscular dystrophyRenal DiseasesPost-transplant bone diseaseAmyloidosis
ThyrotoxicosisOsteogenesis imperfectaChronic kidney diseaseSickle cell diseaseCongestive heart failure
Pulmonary DiseasesPanhypopituitarismEnd stage renal diseaseIdiopathic scoliosis
Chronic obstructive pulmonary disease (COPD)PseudogliomaRenal tubular acidosisParental history of hip fracture
EmphysemaPorphyriaPremature ovarian failure
Riley-Day syndromePrior fracture as an adult


*(Not all drugs in each category affect bone health, so be sure to ask your physician to consider one that is less harmful to bone.)

Aluminum-containing antacids: interfere with the intestinal absorption of calcium.
Anticoagulants (heparin): used to prevent blood clotting. Vitamin K is one of several vitamins that play a role in bone metabolism. Since some oral anticoagulants interfere with vitamin K, their long-term use may increase the risk of osteoporosis, particularly of the spine and ribs.
Anticonvulsants: interfere with vitamin D metabolism, thereby lowering the availability of calcium for bone mineralization. The two widely used anti-epileptic drugs phenytoin (Dilantin®) and carbamazepine (Tegretol®) are recognized to have direct effects on bone cells.
Anti-depressants: daily use of SSRIs (selective serotonin reuptake inhibitors), a popular anti-depressant, may lead to increased risk for fragility fracture in older adults. Daily use of SSRIs is associated with a reduction in bone density in the hip and spine and with an increased risk of falling. Examples of drugs in this class include Prozac®, Paxil® and Zoloft®.
Anti-neoplastics (cancer treatments): used to treat a variety of cancers, immune disorders and resistant arthritic conditions. Cancer treatment-induced bone loss (CTIBL) is most common in breast (including aromatase inhibitors) or prostate cancer patients undergoing therapies resulting in low levels of sex hormones.
Antipsychotic drugs
Antiretroviral drugs
Aromatase inhibitors
Conception control agents: reports suggest that women who use Depo-Provera® (Depo-medroxyprogesterone) may lose significant bone mineral density, possibly because of the low estrogen that it induces.
Cyclosporine A and tacrolimus
Cytotoxic drugs
Glucocorticoids (≥ 5 mg/d of prednisone or equivalent for ≥ 3 mo)
Gonadotropin-releasing hormone (GnRH) analogues: used in the long-term treatment of endometriosis and uterine fibroids. GnRH therapy decreases production of the hormone estrogen to the levels women have after menopause. GnRH analogues are used in the treatment of breast cancer in women to suppress estrogen levels, and in prostate cancer in men to suppress testosterone levels.
Heartburn and ulcer medication: proton pump inhibitors that reduce stomach acid production have been associated with an increased fracture risk, perhaps because calcium absorption from food is less efficient in the absence of stomach acid.
Immunosuppressives: used in organ transplants and for the treatment of some diseases of the immune system.
Loop diuretics
Methotrexate (Rheumatrex)
Thiazolidinediones (diabetes medication): a study found a higher risk of fractures among women who take the drug rosiglitazone (Avandia®), possibly because the drug increases the activity of the cells that absorb bone in the bone remodeling process. Also, clinical trials have shown that female patients treated with pioglitazone (ACTOS®) for type 2 diabetes mellitus were at an increased risk of fracture, particularly of the forearm, hand and wrist, and foot, ankle, fibula and tibia. No increased risk of fracture was identified in men.
Thyroid hormone therapy: sufficient levels of thyroid hormones are necessary for normal bone development; excessive amounts, however, can cause bone loss over time.

Halting bone loss and reducing osteoporosis risk

Osteoporosis is quickly becoming a household word, and authorities now suggest that nearly 45 million Americans are facing a major bone health threat. According to the National Osteoporosis Foundation, an estimated 10 million people in the US today have osteoporosis, and an estimated 34 million are at risk of osteoporosis due to low bone density. Further, while we think of osteoporosis as a “woman’s disease,” more than one-quarter of the 45 million of those at risk are men.

Osteoporosis, by its most scientific definition, is a disorder characterized by low bone mass and structural deterioration of bone tissue associated with bone fragility and an increased vulnerability to low-trauma fractures. Thus, in the scientific sense, osteoporosis is diagnosed only upon occurrence of a low trauma fracture. The hip, spine, wrist, and forearm are common sites of such osteoporotic fractures. Because there are few symptoms associated with bone loss, many are unaware that they are indeed losing bone mass and at risk of osteoporosis.

There are ways to detect low bone density and ongoing bone loss. It is not easy, however, to predict who will actually suffer an osteoporotic fracture. Bone density tests attempt to measure bone mass in various areas of the body, and markers of bone resorption turnover can tell if you are likely breaking down excessive bone at any given time. These tests can detect low bone density and high bone breakdown before a fracture occurs, and thus help identify your chances of a future fracture. They cannot, however, predict who will fracture. For example, over half of all women who experience an osteoporotic fracture do not have an “osteoporotic” bone density. They have either just moderately low bone density, known as osteopenia, or even normal bone density. Given this, everyone, even those with good bone density, would do well to maintain a strong bone-building program.

While there is no way to totally reverse osteoporosis, there are many ways to prevent, halt, and significantly reverse low bone density and low bone strength. Because the average woman has acquired 98% of her skeletal mass by age 20, building strong bones during childhood and the teenage years is the first line of defense. Yet in adulthood, and even in old age, we can regain bone mass and strength. And as we age, it is particularity important to consider prevention, causes, treatment, and possible risk factors of osteoporosis.

Passionate about bone

Hsusangrandmaow does one develop a love affair with bone?

In my case, it began when my alert and active grandmother, who had both osteoporosis and rickets, died at the age of 102 after experiencing a hip fracture. I often wondered just how long she might have lived had she not fractured her hip. Then, at age 36, I was told that I had receding gums. I recognized that this was an early sign of osteoporosis, and I was motivated to learn everything I could about building bone strength. Finally, as an anthropologist I knew of populations in many parts of the world that did not experience osteoporosis as they aged. With this awareness, I became determined to uncover why nearly half of US Caucasian women age 50 and over would suffer one or another needless osteoporotic fracture their remaining lifetime.

These personal experiences ignited my interest in bone health and propelled me to undertake a comprehensive “rethinking” of osteoporosis, sorting fact from fiction. To this end, I founded the Better Bones Foundation (formerly the Osteoporosis Education Project, or OEP) — a nonprofit, public interest group dedicated to exploring the full human potential for building, maintaining, and regaining bone health.

At Better Bones, we have been rethinking the true nature, causes, and best prevention and treatment of osteoporosis for more than two decades. We now know that osteoporosis is a rather complicated disorder, but often presented as a simple problem of calcium or estrogen deficiency. As an anthropologist, I have been able to rethink osteoporosis from a cross-cultural perspective, developing critical new insights into this potentially crippling bone disorder.

In rethinking osteoporosis, we have found the nature of osteoporosis to be different than that commonly held. For example, hip fracture rates vary 30-fold around the world, with some cultures being almost immune to osteoporotic fractures. Cultures with the highest calcium intake have the highest osteoporosis rates. Further, in many countries, such as Germany and China, people have lower bone density than we do, yet they fracture much less than we do in the US.

Rethinking the causes of osteoporosis

Adequate levels of many minerals like calcium, magnesium, manganese, zinc, and boron are important to bone. Vitamins are also essential. Vitamin D, well known for its role in calcium absorption, is taking on new importance as we learn more about its vast physiological functions, while simultaneously finding that a growing number of us are actually vitamin D-deficient. Vitamin K, especially in the form of vitamin K2 (MK-7), is another key bone-building nutrient you will be hearing more about. We are coming to realize that vitamin K is not only the “glue” that binds calcium to bone, but also the key factor in preventing calcium from hardening the arteries. Vitamin A, on the other hand, should probably be limited to less than 5000 IU daily, as high doses of vitamin A (but not beta-carotene) might hamper bone health.

We’ve also learned how many other dietary and lifestyle factors can affect our bones. For example:

  • Excessive intake of coffee, sugar, fat, alcohol, and protein also damage bone. Yet many who take one or two alcoholic drinks a day actually have better bones than nondrinkers, and low protein intake is just as bad for bone as excessively high protein intake.
  • Exercise builds muscle and strength builds bone, while disuse causes atrophy of both.
  • Rapid weight loss as well as obesity causes bone loss, so dieters need special nutrient supplement programs.
  • Strong medications like corticosteroids have been long known to damage bone. Now research shows that other common medications, including some antidepressants and acid blockers, also damage bone and increase one’s risk of fracture.
  • Dear to my heart, the most hidden cause of osteoporosis, namely chronic low-grade metabolic acidosis, is finally becoming recognized as a major “bad guy” for bone health.

Rethinking the best prevention and treatment of osteoporosis

Recognizing the complexity of osteoporosis, we at the Better Bones Foundation have developed a comprehensive program for bone health maximization. Each of the steps is life-supporting in itself, making this program one that builds better bones and better bodies.

Better Bones, Better Body® is a great motto for all of us. It is never too early or too late to build and rebuild bone naturally! Furthermore, everything we do for bone can be, and should be, good for the rest of our body as well!


125 secondary causes (and more) for osteoporosis

The Better Bones Revolution Manifesto states in truth #4: “There is always a cause for excessive bone loss and bone fragility.”

How about 125 different causes?

That’s the number of secondary causes of osteoporosis — in addition to low vitamin D — researchers found in a recent study of patients who had already experienced low-trauma or fragility fractures.

Here’s a summary of the findings from the study, which focused on secondary causes:

• Study participants were 399 patients who had sustained fractures suspected to be due to osteoporosis.

• 54% of the patients were vitamin D insufficient or deficient.

• Nearly 33% had a secondary cause of osteoporosis other than lower than optimal levels of vitamin D.

• The 98 patients with acceptable vitamin D levels suffered from a combined total of 125 different secondary causes with the most common including medication use, smoking, excessive alcohol use, premature ovarian failure, kidney impairment, gastrointestinal conditions and endocrine conditions.

Of course, we know that there are many more secondary causes such as nutritional factors (including a high-acid diet) and lifestyle factors (lack of exercise or too much worry). You can see more details in my article Rethinking “primary” osteoporosis.

What this tells us about treatment for osteoporosis

Rather than simply reminding us that there’s always a cause for excessive bone loss and bone fragility, researchers also used their study as an opportunity to declare how investigating the cause of secondary osteoporosis can “inform and influence specific treatment regimen.”

I couldn’t agree more! Over and over, my work has shown that all osteoporosis is caused by something — it doesn’t just happen. And it’s my job to help each of you as individuals consider what could be putting you at risk, and how you can take steps to deal with these risks. You can find more in The Better Bones Revolution Manifesto, including truth #5: “Treating the root cause of sub-optimal bone health offers the greatest opportunity for creating life-long healthy bones.”



Bogoch, E., et al. 2012. Secondary Causes of Osteoporosis in Fracture Patients. J Orthop Trauma, 26 (9) e145-e152.


What a difference 20 years makes…

As an anthropologist, I have the opportunity to study how different cultures react to change. I enjoy seeing how an idea that at first seems impossible or “radical” eventually becomes accepted by the mainstream.

For example, in January of 1992, AT&T released the first video-telephone, costing a mere $1,499. How many of us realized then that 20 years later it would be common to be video chatting on our cell phones… even on a daily basis?

Thinking back to my work 20 years ago, I was one of the few advocating that there was more to osteoporotic fractures than low bone density and also, that women had natural options to strengthen their bones. Now, let me be clear, I wasn’t saying these things because I was a genius — I was saying them because they were supported by impressive research. But then, as timing would have it, the natural approach became overshadowed with the approval of Fosamax in 1995.

That’s why I was delighted recently to see that leaders in the field are now expanding their perspective regarding what is the best approach for bone health.

In a January 18, 2012 article in The New York Times titled “Patients With Normal Bone Density Can Delay Retests, Study Suggests,” medical reporter Gina Kolata writes that the study, which was published in The New England Journal of Medicine, “is part of a broad rethinking of how to diagnose and treat” bone loss.

Kolata then points out how the medical community itself isn’t convinced bone drugs are your best option for bone health. To be exact, Kolata writes “…medical experts no longer recommend the medicines (bisphosphonates) to prevent osteoporosis itself. They no longer want women to take them indefinitely, and no longer consider bone density measurements the sole defining factor in deciding if a woman needs to be treated.”

I am also impressed by Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University interviewed by the Times, who noted that osteopenia is a risk factor, not a disease. I am hoping to talk with Dr. Siri about her work in an upcoming blog post.

I find it encouraging that attitudes seem to be shifting away from such a narrow view of bone health. Let’s hope that the “radical” thoughts about bone drugs and bone health advance as quickly as phone technology!



The New York Times, Kolata, G. Patients With Normal Bone Density Can Delay Retests, Study Suggests, http://www.nytimes.com/2012/01/19/health/bone-density-tests-for-osteoporosis-can-wait-study-says.html?_r=1,(Accessed 01.31.12)

Gourlay, Mararet L, M.D., M.P.H2012. Bone-Density Testing Interval and Transition to Osteoporosis in Older Women. N Engl J Med 2012; 366:225-233 http://www.nejm.org/doi/full/10.1056/NEJMoa1107142 (Accessed 01.31.12)

Welcome to the Year of the Dragon: Thoughts on TCM and bone health

2012_Chinese dragonJanuary 23 marks the beginning of the Chinese New Year, the Year of the Dragon, and it’s a great time to consider what we can learn about optimizing bone health from the 5,000-year-old medical science of Traditional Chinese Medicine (TCM). With all the technological innovation of modern medicine, we tend to forget that ancient cultures developed sophisticated and complex medical systems that are still highly effective today.
According to TCM, what’s known as the kidney meridian energy system controls bone. So within TCM, one builds kidney health to maintain and improve bone health. Foods and herbs, exercises, emotions, environmental factors and even colors are thought to influence the kidney organ and meridian system via their vibrational nature, or essence.
Now as we recover from our own holiday eating extravaganzas, let’s see which foods TCM suggests as the most beneficial for bone:

1.    First of all, TCM recommends choosing hot and cooked foods, which are easy to digest and more nourishing. Cold and raw foods take more energy to digest and can weaken digestion, creating gas and bloating.

2.    Seafood, especially sea animals that create shells (shrimp, scallops, oysters, lobsters, and clams) are held to specifically benefit bone.

3.    Soups made with bones and bone marrow are regarded as terrific bone builders.

4.    The essences of walnuts and pine nuts favor the kidneys and thus the bones.

5.    Amongst the oils, sesame oil and walnut oil are considered to be skeletal strengtheners.

6.    The color black vibrates in harmony with kidney functioning — and black beans and black sesame seeds are traditional foods for bone building.

7.    As for spices, cinnamon is traditionally held to warm and enhance digestion while promoting bone health.
Oh, about the Year of the Dragon — the Chinese Dragon is a symbol of power and wisdom, heralding a time of action, achievement, and good fortune. I’m looking forward to a great year and send you wishes for the same!

Worried about osteoporosis? Read Gillian Sanson’s book

Imagine how New Zealander Gillian Sanson felt when her 16-year-old daughter was diagnosed with osteoporosis—and then it was uncovered that 6 of 9 close family members of all ages also had osteoporosis as diagnosed by bone density testing.

Initially devastated, this journalist and women’s health educator took the proverbial bull by the horns and immersed herself into a comprehensive rethinking of osteoporosis.

Sanson bookI find her book, The Myth of Osteoporosis, a must-read for any healthy person who has spent more than one minute worrying about their bones.

Analyzing the scientific research, Gillian uncovers and debunks various major myths about osteoporosis — and she does this with real science. Her analysis is exquisite and her documentation flawless. The myths she busts include:

• The myth that all postmenopausal women are at risk for osteoporosis

• The myth that bone mineral density testing is accurate, reliable, and meaningful

• The myth that age-related bone loss is the cause of deadly fractures in the elderly

• The myth that high calcium intake alone prevents osteoporosis

• The myth that bone drugs are highly effective and safe

“Knowledge has organizing power” so the ancients said. This, the new second edition of Gillian Sanson’s The Myth of Osteoporosis, is a work of knowledge and empowerment.

Take heart and take action — read the book. Dial down your worry index and ratchet up your knowledge base! The Myth of Osteoporosis is available on our website and all proceeds from its sale are donated to our non-profit research arm, The Better Bones Foundation.