The Better Bones Blog

by Dr. Susan Brown, PhD.

High perceived stress level increases fracture risk

Do you think you’re a stressed-out person? I certainly think I am — which is one reason I’m so interested in the results of a new Danish study looking at perceived stress and fracture risk.

Not only did the study find that high-stressed participants had a 68% increased risk of hip fracture and a 37% increased risk of any osteoporotic fracture. The research also suggests that it’s not just the stress itself, but our perception of that stress that’s important.

The study determined this with nearly 8,000 Danish adults age 55+ who were categorized according to their self-perceived level of stress. Note that the researchers didn’t try to measure the level or type of stress itself! Instead, they asked the individual participants to describe what their level of stress was — then watched to see who in the cohort experienced an osteoporotic fracture over the next five years.

The one-fourth of people who reported a “high” level of perceived stress had the significantly increased risk of fractures – again a 68% increased risk of hip fracture and a 37% increased risk of any osteoporotic fracture – compared to those who reported “low” perceived stress.

How to free yourself from worry and stress

I’m quick to identify myself with that high-risk cohort. My mother dubbed me her “worry wart” and that personality trait still challenges me today.

That’s why I took up meditation and have developed various methods to “dial down” my perception of stress. A favorite self-help approach is what I call the “BE FREE” method. Those of you who are also “worry warts” might give it a try.

  • BreathE: Throughout the day, I consciously try to stop what I’m doing and slow down my breathing. Just two or three slow, deep breaths offer a calming chance for the more rational part of my brain to kick in. This exercise is all the more important when I find myself in a stressful situation.
  • Feel: Once I’m quieted down, I focus my attention inward, telling myself to note the emotional response I am feeling—fear, anger, frustration, jealousy, or whatever. I just allow myself to feel that particular energy.
  • RElease: Next, I intentionally release the negative emotion, and the energy behind it dissipates. I can feel my heartbeat slow, and the anxiety-producing stress hormones begin to quiet down.
  • Envision: Still taking deep, conscious breaths, I asked myself, “How do I want to feel?” or “How do I want to be?” Then I envision that desired energy flowing through my body.

If you give it a try, let me know how my “BE FREE” method worked for you. Even more, perhaps you’d like to share some of your personal methods and tips for maintaining resilience amid the ups, downs and of modern life. I would love to hear about them!


Pedersen AB, Baggesen LM, Ehrenstein V, et al. Perceived stress and risk of any osteoporotic fracture. Osteoporosis International, 2016;27:2035–2043.


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.



judy better bones customer

Hidden celiac disease and osteoporosis: Learning from Judy

Judy had never even heard of celiac disease when she was told she had extremely severe osteoporosis in 2009. She was 57, underweight and suffered from excessive and life-limiting fatigue, but had no digestive symptoms to suggest a hidden problem was lurking to cause her bone loss.

Frightened by the diagnosis, Judy tried two bone drugs for a few months, but felt much worse on one and quickly stopped the other due to tiresome daily injections and scary side effect warnings. Judy decided that bone drugs weren’t for her; she began researching natural approaches, and that’s how she found the Better Bones program. She started my Better Bones Builder supplement, developed an alkaline diet and began walking.

Despite her good efforts, Judy’s fatigue persisted. Finally, during her annual physical in 2011, Judy discovered she had celiac disease — an autoimmune disorder in which exposure to gluten (a protein in wheat, rye and other grains) leads the immune system to damage the intestinal tract, causing malabsorption. Although she had no digestive problems or other symptoms, her blood work showed her to be extremely iron deficient. She wasn’t losing iron through an intestinal bleed, so a thoughtful physician decided to test her for celiac, which often leads to malabsorption of iron and other nutrients. The blood test for celiac was positive, as was a follow-up intestinal biopsy.

All excessive bone loss has a reason

Shortly after her physical, she began her gluten-free diet in combination with iron infusions for her anemia and the life-supporting nutrients in the Better Bones Builder. Within weeks, she began to feel and look better, regaining both energy and weight. Even more important: Over the next 8 years, Judy’s bone mass increased by a remarkable 20% — and this was between the ages of 57 and 65, when most women expect to lose bone.

In short, the key factor to restoring her bones was uncovering that she had celiac disease. Using that information as incentive, she initiated a gluten-free yet alkalizing diet and incorporated our targeted nutrient supplementation and lifestyle suggestions to gain back her health, vitality, and bone. She’s an inspiration and a reminder of something I tell all my clients:  all excessive bone loss has a reason, and at any point in life we can start regaining bone strength!

For more information see my DVD, Uncovering the Hidden Causes of Bone Loss.

A message from Judy

“I would like to thank Dr. Brown for all the research she has done on osteoporosis. Because I found her website my life has changed.

“I began using the Better Bones Builder in 2009 after I was diagnosed with severe osteoporosis. Along with taking the Better Bones Builder I tried to eat better, alkalize and walk at least 3 times a week and doing this I have had significant improvement in my bones.

“Every time I have had a DEXA scan since my first one in 2009 I have experienced improvement in bone density. My gains in bone density and in overall well being were especially dramatic after detection of and treatment for hidden celiac disease in the fall of 2011. In particular, between 2014 and 2016 there was a 13.7% improvement in my hip and a 6.4% gain in my spine.

“I think this is very impressive and I will continue to take the Better Bones Builder and do the other parts of the Better Bones program. Thanks to Dr. Brown, I feel that I am not forced to take bone drugs that harm the body.”

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