losing calcium in your urine

Are you losing too much calcium in your urine?

What’s the biggest problem with calcium? It may come as a surprise that while most people don’t have a problem getting enough calcium, there is a major problem for many people when it comes to keeping calcium in their body so that it can help strengthen bone.

In fact, 20% or more of people with osteoporosis suffer from hypercalciuria — excessive loss of calcium in the urine. No matter what the cause, hypercalciuria always jeopardizes bone and is associated with lower bone density and increased fracture risk.

The link between hypercalciuria and osteoporosis is so strong that expert researchers suggest everyone with a diagnosis of osteoporosis be screened for it.

Do you have hypercalciuria?

Luckily, there’s a fairly simple laboratory test to determine if you’re losing calcium. You’re asked to collect your urine over 24 hours and submit it for chemical analysis to determine how much calcium it contains. Most labs consider any 24-hour calcium loss over 250–300 mg of calcium to be excessive.

  • If your 24-hour urine calcium comes back high, don’t panic: You may have gotten that result simply because you are taking too much calcium. When there’s an unusually high consumption of calcium from diet and supplements, the body simply moves unneeded calcium from the body into urine to get rid of it. Your doctor will likely recommend you retake the test, but this time avoiding all calcium supplements (and probably also dairy foods) for a week before again collecting your 24-hour urine sample.
  • If your re-test shows you’re genuinely losing calcium, again: don’t panic. Excessive calcium loss in the urine can be due to factors like high intake of salt, caffeine, soda, or sugar, low levels of nutrients like magnesium, vitamin D, and vitamin K, and even prolonged stress. These factors all promote an acidic pH (which promotes calcium loss), and they’re all things you can begin correcting on your own.

Dietary and lifestyle changes may not always solve the problem (though they may), as loss of calcium can also be related to medical issues such as hyperparathyroidism, kidney issues, hyper-absorption of calcium, vitamin D toxicity, autoimmune sarcoidosis or excessive bone breakdown related to “silent” diseases like diabetes or thyroid disorders. If your calcium excretion is consistently high, such possible causes should be explored by your physician.

What are your options if you have hypercalciuria?

If testing confirms you’re losing excessive calcium but your healthcare practitioner can’t identify and correct the cause of this problem, it’s pretty common practice to recommend a thiazide diuretic, which is known to help keep calcium in the body.

I favor the approach used by functional medicine and naturopathic practitioners, which is to first try to reduce urine calcium loss with a program of lifestyle and nutritional changes, perhaps combined with acupuncture to enhance kidney functioning, before using medications. But no matter what therapeutic approach you choose, it’s always important to retest and make sure that you have effectively reduced the loss of calcium in the urine.

Keep in mind that a high loss of calcium in the urine not only weakens bone, but also puts you at risk of developing kidney stones. Thus, if you are experiencing a high loss of calcium in the urine, be sure to drink plenty of water; this dilutes urine and reduces the risk of kidney stones. (This works both ways: if you have a history of kidney stone formation, be sure to get testing for excessive urinary calcium loss.)

Here at the Center for Better Bones, I suggest every person with an osteoporosis diagnosis be tested to rule out hypercalciuria. For more information see my DVD on uncovering the hidden causes of bone loss and my article about testing for bone loss.


Diet and lifestyle contribute to urine calcium loss

High salt intake

High alcohol and caffeine consumption

A diet high in sodas, refined carbohydrates and sugar

Excess protein intake

Low intake of vegetables, fruits, root crops, nuts and seeds

Acid-forming diet

Low dietary intake of potassium, magnesium, vitamin K

Prolonged stress and high cortisol



Asplin JR, Donahue S, Kinder J, Coe FL. Urine calcium excretion predicts bone loss in idiopathic hypercalciuria. Kidney Int 2006;70:1463–1467.

Girón-Prieto MS, Cano-García M, Poyatos-Andújar A, et al. The value of hypercalciuria in patients with osteopenia versus osteoporosis. Urolithiasis August 2016. DOI: 10.1007/s00240-016-0909-2

Giannini S, Nobile M, Dalle Carbonare L, et al. Hypercalciuria is common and important finding and postmenopausal women with osteoporosis. Eur J Endocrinol 2003;149:209–213.



What do your FRAX results mean?

Your FRAX fracture prediction: Take it with a grain of salt

If you’ve had a DEXA scan, you may have noticed a statement on the report that reads something like this: “This test suggests that you have a __% risk of fracturing a hip within the next 10 years.”  Depending on what that magic number is, you may be very concerned about your potential fracture risk, or you may be thinking, “Great! Nothing to worry about there!”  Either way, you may want to take the number with a grain of salt. Here’s why:

Concerns about the FRAX and calculations

  1. There are some pretty serious concerns about how the FRAX makes its calculation — serious enough that the World Health Organization (WHO) has disavowed the tool and its recommendations (Ford et al., 2016).
  2. No one, apart from the people who developed it, knows how the FRAX calculation works (not even WHO).
  3. Even though nutritional deficits like vitamin D deficiency are known to play a major role in bone health and fracture risk, the tool doesn’t include them anywhere — a really key omission. Instead, they use a list of 10 rather general risk factors that barely scratch the surface.
  4. If your 10-year risk of hip fracture is ≥3% or of any other major osteoporotic fractures is ≥20%, you will be recommended bone drugs. Ditto if you have bone density T score of –2.5 or more. Yet according to these standards, most women would be told to take bone drugs as they age (Donaldson et al., 2009) — and many experts agree that medicating the majority of women isn’t needed or beneficial.

FRAX calculation tool for Caucasian women in U.S.


So what does my result mean?

Here’s where the grain of salt comes in. On the one hand, you shouldn’t be alarmed by a prediction that shows you to be at relatively greater risk of fracture — and I say this in full understanding that one-third of all women in the U.S. likely will experience a meaningful osteoporotic fracture in their lifetime.  The older we get and the more health problems we have, the greater the risk of fracture, but an individual’s risk for such fractures can be greatly reduced with appropriate nutrition and lifestyle modifications.

On the other hand, you should consider it a wake-up call encouraging you make an assessment — a comprehensive one! — of what factors you have that you might address to reduce your risk of fracture. I have dedicated my life’s work to helping people make such assessments, and this website offers plenty of information for strengthening bone at any stage of your life.

Take heart and take action. Consider making it an adventure to reduce your fracture risk factors and rebuild skeletal and overall health.  For a more comprehensive fracture risk assessment take my Bone Health Profile.



Ford N., Norris S.L., Hill S.R. Clarifying WHO’s position on the FRAX® tool for fracture prediction. Bull World Health Organ 2016;94:862 | doi: http://dx.doi.org/10.2471/BLT.16.188532

Donaldson M.G. et al. Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res. 2009 Apr; 24(4): 675–680. Published online 2008 Dec 1. doi:  10.1359/JBMR.081203

Getting to know the FRAX assessment tool

What you need to know about the FRAX assessment tool

The fracture risk tool known as FRAX has come under fire from the World Health Organization (WHO) recently for several reasons. One key reason is that, although it’s often referred to as the “WHO FRAX tool” and was developed at a WHO “collaborating center” at Sheffield University, the FRAX fracture risk tool was not developed, evaluated, endorsed, or validated by WHO itself (Ford et al., 2016).

In fact, WHO’s health policy organization has no access to the algorithms, coefficients, or underlying data on which the FRAX tool was developed (nor does anyone else, for that matter!).

FRAX uses these risk factors

The only thing we know about how FRAX works are the risk factors they use in making the prediction:

  1. Age
  2. Sex
  3. Weight
  4. Height
  5. Personal history of fracture
  6. Family history of hip fracture
  7. Smoking
  8. Corticosteroid use
  9. Rheumatoid arthritis
  10. Secondary causes of osteoporosis
  11. Heavy alcohol use

What FRAX doesn’t do

All of these are factors that affect osteoporosis risk, but they’re far from a complete picture. Among the more glaring omissions: FRAX gathers no data on intake of bone-building nutrients like calcium, vitamin D, vitamin K, and magnesium — all widely known to be vital to bone health — and it does not ask women about their menopause status. Given the fact that menopause looms large in determining a woman’s bone density (which is part of the data they ask for), that’s a pretty serious oversight!

Even more telling is the fact that the FRAX risk assessments are used as a basis of a recommendation for bone drugs. Keeping in mind that the tool has not been evaluated or endorsed by the WHO, the world’s premier health policy-making body, you have to wonder what the basis of a recommendation might be that omits so many key risk factors.

It may become clearer once you know that the FRAX was developed by researchers with vested interests in drug therapies for osteoporosis — a bias that encourages overtreatment of women concerned about their bone health. In fact, well respected osteoporosis researchers determined that if the FRAX criteria, which are endorsed by the U.S. National Osteoporosis Foundation, were applied universally, almost 75% of U.S. Caucasian women 65 or over and a staggering 93% of those 75 or older would be candidates for osteoporosis drug treatment.

For these reasons, I tell my clients and readers, “consider the source” of the information coming from this tool. You may want to try my simple but reliable Bone Health Profile to assess the health of your bones and your potential risk of fracture.



Ford N., Norris S.L., Hill S.R. Clarifying WHO’s position on the FRAX® tool for fracture prediction. Bull World Health Organ 2016;94:862 | doi: http://dx.doi.org/10.2471/BLT.16.188532

Diagnostic tests for causes of osteoporosis

I can’t help but draw attention to the fact that generally when a man is shown to have osteoporosis by bone mineral density testing or because of a needless fracture, he is immediately given a series of tests looking for the causes of his bone weakening.

Women with osteoporosis, on the other hand, are immediately told to take bone drugs. Most often no tests are done and no attempt made to uncover the causes of osteoporosis.

As a result, many women take bone drugs to cover up the real problem. It’s never discovered that they might be suffering from hyperparathyroidism, excessive loss of calcium in the urine, Celiac Disease, hypercortisolemia or any other of the hidden causes of osteoporosis.

Get thoroughly tested for hidden causes

I believe that any woman experiencing excessive bone weakening should be thoroughly tested for hidden causes.  After all, if a doctor thinks the problem is serious enough to tell a woman to take bone drugs, then it is serious enough to warrant a full diagnostic workup looking for hidden causes of bone weakening.

Just today I saw yet another woman who was told to take bone drugs because of excessive bone loss without any testing looking for the causes.  After working with me she discovered she was losing bone due to an overactive parathyroid gland, which I’ll write about more in an upcoming blog.

What are common diagnostic tests?

Here are some common diagnostic tests that can be used to uncover the underlying causes of 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)
  • N-telopeptides crosslinks (NTx) urine marker of bone resorption test
  • N-telopeptides crosslinks (NTx) serum marker of bone resorption test
  • Dpd urine marker of bone resorption test (deoxypyridinium crosslinks test)
  • 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)
  • Celiac disease and gluten sensitivity test
  • Sex hormone test

You can read more about each diagnostic test in my article What’s the cause of your osteoporosis? Diagnostic tests and what they mean. If you suspect excessive bone weakening I suggest you read, print out and discuss this article with your medical practitioner.

You can also learn more with my video Uncovering the hidden causes of bone loss —medical tests you should know about.

ground rules for DEXA

Help for understanding bone density test results

Have you had your DEXA scan which measures your bone density ? If so, you may have found yourself confused by what the results really mean.

If not, you may still be stressed about the possibility, which is understandable given how many practitioners talk about low bone density as the inevitable first step toward osteoporosis.

Whatever your situation, I want to reassure you that knowledge is power when it comes to your bone density test results. Not only is there a lot to know about the numbers themselves, but there are several key “ground rules” that are important to better understand bone density test results in general. I encourage you to take these into account when looking at your own test results:

“Ground rules” for understanding more about DEXA scan results

  1. DEXA scan should be several pages long, have many charts and x-rays of the spine and hip. Obtain copies of your full bone density reports from your DEXA or DXA scans. You’ll want to look at all the results, not just the summary page.
  2. Small changes in bone mineral density are not significant.  Research has shown that at least a 5-6% change on a bone density test is needed to be sure that any change is not simply due to placement on the machine.
  3. Bone density tests do not truly measure bone density.  DXA calculates BMD using area, so it’s not an accurate measurement of true bone mineral density. Those with smaller body size and/or thin, small bones will not get a true measure of their bone density from the scan.
  4. Bone density changes are related to life stage.  The menopause transition generally is a time of accelerated bone loss.
  5. Not all bone density reports are going to look exactly the same.  They may look different, but the reports should all have the same elements.
  6. Using the same type of bone density testing machine is important for comparing results.  Even better is to have the test done in the same location and even with the same operator.

What are the different bone density screening tests?

For more information about the different bone density screening tests, limitations of BMD testing and steps you can take to limit variability in BMD tests, see my article Bone density test.

You can also learn more about how to read your results with my How to read your bone density test video available as a download or a DVD.

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.

Am I Losing Bone Right Now? The NTx Test


Every day women are worried because they’ve been told that a DEXA test shows their bone density is that of an 80-year-old, or that they “must” take bone drugs.

But what worries me is that most of these women have NOT been told whether or not their bone loss is ongoing or if it occurred in the past. Knowing if your bone loss is still taking place is critical when it comes to your risk of excessive bone loss, osteoporosis and fracture.

The NTx test measures current bone loss

I recommend anyone worried about bone loss get an NTx (N-telopeptide) test. Unlike bone density tests which only provide a static snapshot of your bones, an NTx test tells you if your bones are currently breaking down. It does this by measuring molecules from bone excreted in the urine.

Get a video download about the NTx

You can get a video download that features my explanation of the NTx test, how to get one and how to understand the results. This 9 ½-minute video download also includes a transcript for those who prefer the read the information. You can also help educate your physician about the use of the NTx test and why you would like her/him to order this test for you. Get the video now.


3 Simple Tests Help Predict Hip Fracture Risk

Wouldn’t it be remarkable to have one way to predict future hip fracture risk?

Now, thanks to curious Finnish researchers, we have not just one, but three simple tests that can give us better insight into who is likely to break their hip down the road. After some study they settled on three physical tests, failure of which they thought might indicate that one was headed for a hip fracture. According to their findings presented at the recent ASBMR meeting, the highly predictive tests were:



Researchers had 2,791 women with the average age of 59 complete the tests — and then patiently waited 15 years to see who broke their hips.

What Researchers Discovered

Fifteen years later, researchers compared the rate of hip fracture from those women passing all tests to those women who had failed one or more of the tests. Here’s what they discovered:

• Women at age 59 failing any one of these tests had four times the risk for hip fracture, plus any fracture and even death.

• The strongest single determinant for hip fracture risk was the inability to stand on one leg for 10 seconds. In the study, failing this test at age 59 was associated with over eight times increase in hip fracture risk over the next 15 years.

• The inability to squat, touch the floor and stand back up was linked to a 5.2 times increase in hip fracture.

• Those with lowest grip strength at age 59 (or the bottom ¼ of women tested) ended up with over a four-fold increase in hip fracture as compared to women who passed the balance and squatting tests and were in the top ¾ of those tested.

What Does This Mean for You?

I’m encouraged that this research focuses on activities which suggest general fitness —and they are ones we can all practice to help minimize hip fracture risk. I suggest all women consider the following:

1. Balance is of utmost importance, if you do not fall you will not fracture a hip. If you can’t stand on one leg for 10 seconds at any age, I recommend look into exercise to enhance balance. For balance, I favor mindful exercises like Tai Chi and Qi Gong.

2. Leg strength and flexibility are hip-protective. Develop a leg strengthening exercise program. And the next time you are sitting on the floor or squatting, practice getting without using your hands. Full body strength can be enhanced with my Exercising for Bone Health DVD or the Skeletal Fitness DVD.

3. Diminished grip strength is repeatedly associated with vertebral fracture risk, and now we see it linked to hip fracture as well. If those jars are getting hard to open, it’s time to exercise your arms and hands. I like using the isometric OsteoBall exerciser to enhance arm and wrist strength.

For more information about exercise and bone health, read my article here.



Rikkonen, T. (Sept. 12, 2014) Simple functional tests predict hip fracture and mortality in postmenopausal women: 15 year follow-up. ASBMR abstract FRO455, ASBMR Annual Meeting.

Bone density tests aren’t enough. Why a Fracture Risk Assessment is essential.

Susan Brown, PhD

Many women first start wondering about bone health right at the age when the doctor recommends a bone density scan. But from my experience, getting the results of a bone density scan can generate more questions than answers — especially if your doctor isn’t up to date in the latest thinking on bone health. Here’s what you should know about using a bone density test to predict your risk of fracture or excessive bone loss.

What is a bone density test?

You need more than a bone density test to measure the health of your skeleton.

DEXA (Dual-energy x-ray absorptiometry) or other common bone density scans such as single-photon absorptiometry (SPA); broadband ultrasound attenuation (ultrasound); and quantitative computed tomography (QCT) help determine if you have low bone density, one important risk factor for osteoporosis. These tests measure the bone mineral content in various locations of your body (such as the hip or wrist).

The best known bone-density test is the DEXA scan. It’s a precise test and today is considered the gold standard by many conventional doctors as they evaluate bone health.

A bone density test result is generally presented in numbers as grams per cubic centimeter, and also calculated as a “T score” and a “Z score.” Your T-score compares your bone density to what’s considered the ideal density of a young woman. The Z-score compares your density with that of other people your same age and sex. As you’ll see from the chart below, there is also a big void of other information that a bone density test cannot ever tell you.

What a bone density test does — and doesn’t — do

What a bone density test does…What a bone density test
Estimates the mineral content of bone at a specific time.Doesn’t tell you if you are currently losing bone or if you have had low bone density for many years. Significant changes are rarely measurable in less than two years. Also, bone density can fluctuate based on the season.
Measures all body types the same way.Doesn’t take body type into consideration, for example women who are thinner will always have a lower bone density than heavier women.
Measures specifically the amount of minerals in bones to determine bone loss.Doesn’t detect either bone quality or bone strength. Many of the people who are shown to have low bone density on these tests will never suffer an osteoporotic fracture.
Uses a “gold standard” that compares your results to those of a “normal young woman” (your T-score) or measures against the average bone mineral density for people your age and sex (your Z-score).Doesn’t compare your bone density to healthy, fracture-free people of your age.
Delivers results that can vary greatly depending on the machine used — and the technician running it!Doesn’t provide an accurate assessment from test to test. Placement of patient on the machine is important and a 5-6% change from test to test is necessary to be sure the change was not due to errors in placement on the machine.

As you can see, a bone density test is best used as one of many tools to evaluate your bone health!

What are the options that can determine your bone health?

A woman happy to learn her options to determine her bone health.

Consider other bone health tests to get a more rounded perspective of your bone health. At our clinic we like to monitor the results of a woman’s NTx test, which is a blood or urine test that indicates the rate of bone breakdown by measuring a specific molecule, or marker, released during bone resorption. We also measure a woman’s pH level, which can help determine whether her diet and lifestyle are placing an excessive burden on her bones’ reserves of alkalizing compounds.

Why fracture risk assessment is a better indicator of bone health than DEXA

We know that extreme bone loss is often connected to many variables. That’s why I always recommend that my clients take advantage of the new fracture assessments tools. These tools are designed to look at multiple risk factors, with and without bone density measurement. Eleven of these key risk factors identified by the landmark Women’s Health Initiative are:

  • Age
  • Self-reported health
  • Weight
  • Height
  • Race/ethnicity
  • Self-reported physical activity
  • History of fracture after age 54
  • Parental hip fracture
  • Current smoking
  • Current corticosteroid use
  • Treated diabetes

Based on the research showing that a fracture risk assessment is truly the best way to know who will experience an osteoporotic fracture, I’ve developed my own simple Better Bones Fracture Risk Assessment. By answering just a few questions, you can get a much clearer picture about your potential risk of fracture. Get started now.

Directions for a 2-Day Urine Sample Collection for the NTx Bone Resorption Test

Susan Brown, PhDThe day before the urine collection, do not take any extra vitamin C (beyond that in your multi-vitamin). On the morning of each urine collection, do not take any vitamins, food, or coffee before collecting your urine sample. The sample must be taken BEFORE 10 AM.

Day 1

    1. The first thing in the morning, urinate as usual, not saving the urine.
    2. Drink 1 or 2 cups of water. Do not eat or drink anything except water until after you collect the second urine sample. (Thyroid pill is okay.)
    3. Collect a sample of the second morning urine in a clean plastic or glass container. This collection must be taken BEFORE 10 AM.
    4. Refrigerate this sample.

Day 2

  1. Follow steps 1 to 3, collecting your second morning urine in a second container.
  2. In a third container, mix half of each day’s urine. This is the sample you will write your name on and take to the lab designated by your doctor. The leftover urine from each day can be discarded.

Important: Make sure to REFRIGERATE the urine samples in the containers until you take them to the lab. Also, put the samples in a paper bag to avoid sunlight exposure.

Try to do the first urine collection on a Sunday and the second on a Monday.