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Dr. Susan E. Brown

Bone testing — assessing bone breakdown and bone loss

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Bone is composed of a living protein framework upon which mineral crystals are placed. As bone breaks down, bits of this living protein framework appear in the urine or the blood. Tests of bone breakdown, called bone resorption tests, measure the amount of one specific bone protein in the urine or in the blood, and thus gauge the current rate of bone breakdown. Markers of bone breakdown (known as markers of bone resorption) are simple tests that can help determine if you are currently losing bone or not. Such bone breakdown testing can also indicate if your bone-building program is effective at reducing and normalizing the bone breakdown process. 

As bone is broken down, certain bone protein by-products are excreted in the urine or blood. Measurement of the amount of these bone breakdown by-products can determine the rate of bone breakdown. A high rate of bone breakdown is strongly suggestive of current, ongoing bone loss and a greater risk for osteoporotic fracture. A low rate of bone resorption is generally thought to suggest that one’s rate of bone loss is that of the ideal young adult. Most ongoing bone loss is associated with high bone turnover. There is, however, also a situation of “low turnover osteoporosis.” Here, bone testing shows that bone breakdown is low similar to that of healthy young adults, but the rate of new bone formation is even lower. 

Two common markers of bone breakdown 

The two most widely used bone resorption markers are the N-Telopeptides test (known as NTx) and the C-terminal cross-linked telopeptide test (known as CTx).  

Urine NTx test for bone breakdown: This simple urine test looks at the number of cross-linked N-telopeptides of bone type I collagen (NTx) in the urine.  

The standard laboratory range for the urine NTx test is very wide. The ideal for post-menopausal women would be an NTx urine level in the high 30s or low 40s. The healthy average for pre-menopausal women, for instance, is around 36 bone collagen equivalent units/mmol creatinine (nM BCE/mM creatinine). The average for men is 27 nM BCE/mM creatinine. 

Serum NTx bone breakdown marker: This is a simple blood test that measures the amount of cross-linked N-telopeptides of bone type I collagen (NTx) in the blood. The amount of NTx in the blood is used also to assess the degree of current bone breakdown. The blood draw for this test is to be done first thing in the morning in a fasting state.  

For serum NTx, the pre-menopausal mean is 12.6 nM BCE and the male mean is 14.8 nM BCE.  The post-menopausal range is very wide and not very useful. The goal for post-menopausal women is to reduce the NTx to as close to the pre-menopausal level as possible without taking bone drugs. 

Serum CTx bone breakdown test: CTx is a blood test used to monitor the rate of bone breakdown and the effectiveness of anti-resorptive natural or drug bone therapies. It tests for the C-terminal telopeptide of type I collagen, which is a peptide fragment derived from the carboxy terminal end of the bone protein matrix.  

Similar to the urine NTx and the serum NTx, the range for serum CTx is very wide. For instance, Labcorp uses the range of 34 to 635 pg/mL for pre-menopausal women. Unfortunately, the pre-menopausal mean is not documented like with the NTx test, so it is hard to know what the post-menopausal goal should be. Summarizing the research I suggest that 400 or 450 is probably a good level for post-menopausal women not using bone drugs. But we don’t know for sure.

If a woman is on bone drugs that suppress bone breakdown, this marker reflects the degree to which the drug is reducing bone breakdown. If the CTx goes down to the range of 150 to 200 pg/mL, there is a reported risk of osteonecrosis of the jaw.  

With any of these tests, values above the ideal range could indicate that bone loss is occurring. In our studies, we like to see more than a 30% reduction in these markers, or normalization to young adult levels.  

All these bone breakdown tests should be done first thing in the morning before eating anything (in a fasting state). For at least twelve hours before these tests do not take multivitamins or dietary supplements containing biotin or vitamin B7, which are commonly found in hair, skin, and nail supplements, and multivitamins. 

Your physician can order either of these tests or you can order them online and self-pay. 

Other tests of interest 

In addition to the NTx and CTx tests, three other tests look at calcium levels to determine whether calcium is being lost from the bone:  

  • the 24-hour urine calcium excretion test,  
  • the serum blood calcium test, and  
  • the ionized blood calcium level test.  

The 24-hour urine calcium excretion test looks at how much calcium is being excreted in the urine—usually, among other things, this is a sign that the body is too acid. For this test, you collect all your urine over a 24-hour period for laboratory analysis to measure the amount of calcium in the urine. For more information on calcium loss in the urine, see my article Are you losing too much calcium in your urine? 

The serum blood calcium test and the ionized blood calcium level test require a blood draw to determine the level of calcium in the blood. Of the two, the ionized calcium level test is more precise. Although blood calcium stays within a fairly tightly controlled range in the blood, small variations in blood calcium levels can provide useful information for your physician. 

See the full list of diagnostic tests for osteoporosis.  

It’s never too late 

It is never too early nor too late to begin building and rebuilding bone, and these tests can, at times, help assure that you are on the right path or uncover a hidden cause for ongoing bone loss. Remember, that bone resorption tests exhibit wide within-subject day-to-day variation. Even with proper collection, shipping, and processing, there is a substantial day-to-day variation in these bone breakdown markers. No single test result should be taken as a “bad sign” or an indication that all is not well; instead, the various tests should be used in concert to get an accurate picture of current bone health. 

what causes osteoporosis
Dr. Susan E. Brown

Rethinking the causes of osteoporosis

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It’s often suggested that the major causes of osteoporosis in women are low calcium intake and lower estrogen levels at menopause. A cross-cultural perspective, however, shows that this is not always true. 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!

Anthropologists also have long noted that many native African populations exhibit very low fracture rates while consuming 300 mg of calcium a day. This low calcium intake was recently verified in anthropological study on Gambian women.  In fact, overall research has shown that countries with the highest calcium intakes have the highest hip fracture rates.

The same holds true for estrogen. A decrease in estrogen at menopause is universal in women worldwide, but osteoporosis is not. Mayan women in Central America, 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 is a time of rapid bone loss for most women, yet a woman’s estrogen level at this time can be higher than during her reproductive years. So attributing osteoporosis to the natural decrease in estrogen at menopause is too simplistic.

But if neither calcium nor estrogen causes osteoporosis, what does?

How We Lose Bone

In adulthood, bone mass and strength are maintained through the balance of bone breakdown and bone buildup forces. Both building up new bone and breaking down old bone are essential, as bone needs to repair itself and “remodel” itself on a daily basis. Excessive bone weakening and osteoporosis occur when, over time, the forces of bone breakdown are much greater than the forces of bone buildup.

It’s all a question of balance…

Healthy Bone

balanced bone breakdown and bone formation

Osteoporosis

ongoing bone loss from excessive bone breakdown

 

What Are the Real Causes of Osteoporosis and Bone Loss? The New Science

Many of our common lifestyles and cultural patterns actually add to our total load of bone breakdown forces. Unwittingly, we’ve taken on ways of being, eating, doing and acting that weaken bone. As my mentor, Dr. Russell Jaffe, summarizes: “Osteoporosis is a hidden tax of high-tech living.”

The Total Load Model of Bone-Depleting Factors

total load of bone depleting factors

Take a look and asses which bone depleting factors you face.

The 5 Categories of Bone-Weakening Factors

The forces contributing to or directly causing osteoporosis are divided into five categories:

  • Dietary causes and nutrient inadequacies
  • Lifestyle factors
  • Medicines that cause osteoporosis
  • Medical procedures the cause osteoporosis
  • Diseases that cause osteoporosis

Dietary causes and nutrient inadequacies: 

  • Low intake of the 20+ key bone nutrient
  • Widespread nutrient inadequacies
  • Low antioxidant intake combined with high antioxidant need
  • Chronic low-grade metabolic acidosis from our low mineral diet
  • Low vitamin D blood levels/deficient sunlight exposure
  • Low protein intake among seniors

Lifestyle factors that cause osteoporosis:

  • Sedentary lifestyle/Lack of exercise
  • Stress: Emotional/mental stress, hormonal/nervous system imbalances
  • Eating disorders, excessive weight loss, weight cycling
  • Smoking
  • Excessive alcohol use

Medicines that cause osteoporosis:

  • Prednisone and other steroid medications (glucocorticoids), including steroid inhalers
  • Proton pump inhibitor antacids
  • SSRI antidepressants
  • Antiseizure medications
  • Excessive thyroid hormone doses
  • Heparin
  • Lithium
  • Medroxyprogesterone
  • Thiazide diuretics
  • Aromatase inhibitors
  • Cytotoxic drugs
  • Gonadotropin-releasing hormone
  • Immunosuppressants
  • Warfarin
  • Canagliflozin
  • Methotrexate
  • Vitamin A (retinoid) medications
  • Thiazolidinediones
  • Immunosuppressant agents

Diseases that cause osteoporosis:

  • Digestive disorders such as Crohn’s and celiac disease
  • Autoimmune disorders like multiple sclerosis, ulcerative colitis, rheumatoid arthritis, Graves’ disease, type 1 diabetes
  • Ovarian dysfunction (irregular periods or early menopause)
  • Parkinson’s disease, spinal cord injuries, stroke, or other movement disorders
  • Breast cancer
  • Prostate cancer
  • Leukemia and lymphoma
  • Sickle cell disease
  • Thalassemia
  • Depression
  • Eating disorders
  • Diabetes
  • Low testosterone
  • Low estrogen
  • HIV/AIDS
  • Female athlete triad
  • Liver disease
  • Polio
  • Organ transplants
  • Scoliosis
  • Inflammatory bowel disease
  • Medical procedures that cause osteoporosis:
  • Gastric bypass
  • Cancer treatments with estrogen antagonists
  • Weight loss surgery
  • HyperParathyroidism

How to reduce your total load of total bone-weakening factors

An excellent first step is to assess your individual load of bone-depleting factors. Take a moment and look at our wobbly camel, struggling under multiple bone-depleting burdens.
Where do you want to start in your journey of building bone strength? Which burdens can you modify?  There are some things you cannot change, but there are others that you can—so start there. A simple start might to be make a new exercise commitment, to set the goal of eating 3 to 4 cups of vegetables a day, or to begin meditating and reducing emotional stress.  All of the bone-building—and bone-depleting—factors are interrelated, and even small changes over time add up and can make a big difference!

And it’s not unusual to find that changing one factor in a small way can also improve one of those other factors that you can’t change directly — for instance, changing your diet or reducing your stress burden may not only help your bones, but also improve digestive or autoimmune disorders, giving you a doubly beneficial effect.

Here at the Center for Better Bones we offer our comprehensive time-tested natural Better Bones, Better Body Program. Join us for a deeper dive into building Better Bones and a Better Body at any age!

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

Dr. Susan E. Brown

Am I Losing Bone Right Now? The NTx Test

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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.

 

Dr. Susan E. Brown

What’s the risk of osteoporosis for men?

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

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

How does bone loss affect men?

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

What men can do for bone health

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

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

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

 

References:

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

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

 

Dr. Susan E. Brown

Stop bone loss and osteoporosis in menopause: 6 steps to get started right now

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Menopause is a time of many changes for women. But there’s no reason for one of them to be bone loss, osteoporosis, or increased fracture risk.

You have so many options to preserve your bone density — or even increase it — in the time around menopause.

Since most women experience accelerated bone loss in the first few years before and the first few years after their last period, these years are the most important ones for preventing excessive bone loss.

Let’s take a look at 6 ways you can take action.

  • Get the 20 key nutrients needed for strong bones.
  • Include in your meals a variety of vegetables and fruit, whole grains, seed and nuts, and lean protein.
  • Avoid excess animal protein, refined grains, sugar, and preservatives.
  • Support your body’s acid-alkaline balance to keep much-needed minerals in your bones. See my list of alkalizing foods and acid-forming foods.
  • Pay close attention to vitamin D levels:
    • Minimum intake of 2,000 IU vitamin D3 daily.
    • Test your 25(OH)D vitamin D level.
    • Natural sunlight is a good source of vitamin D.
  • Add more vitamin K:
    • Try sauerkraut, aged cheese, natto and kimchee.
    • Supplement with the form of vitamin K2 known as MK-7.

 

Step 2: Exercise to increase your muscle mass — and bone.

When you build muscle mass, you build bone — no matter what your age. As most of us have reached our peak muscle and bone mass at age 30, exercise is an ideal opportunity for building bone density and strength during the years leading up to and right after menopause.

Tips to build (or preserve) muscle mass:

 

Dr. Susan E. Brown

Bone loss in menopause — how to reduce your risk

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Menopause and osteoporosis go hand in hand in the minds of many women — and unfortunately, many conventional healthcare practitioners too. But while menopause is a something we all go through, you should know that excessive bone loss isn’t.

Why you lose bone in menopause

menopause

Hormonal changes during menopause disrupt your body’s natural bone building process. Experts used to believe declining estrogen was the single “culprit” when it came to menopausal bone loss. After all, estrogen helps preserve calcium in the body and prevent bone breakdown. Recent thinking, however, recognizes that more is at play than just estrogen alone. As noted researcher Dr. Jerilynn Prior and many other experts now understand, the low progesterone levels common in perimenopause may also affect bone-building cells, disrupting the natural process of bone breakdown and repair. Interfering with this process can have a chilling effect on the health of your bones over time.

On average, a woman loses 10% of her bone mass during the menopause transition — an entirely normal part of the bone breakdown and build up process. After we reach our peak bone mass at age 30, we naturally experience more breaking down than building up. While most women have enough bone mass to handle this loss just fine, added risk factors like poor diet, family history and lifestyle can lead to excessive bone loss of up to 20%.

menopause

Recently, we’ve more accurately pinpointed the timing of menopausal bone loss. After looking at a 10-year timeframe around menopause, researchers found most bone loss occurred during one year before and two years after a woman’s last period. These three years are an important window of time for bone protection that you need to take advantage of.

You can reduce extra risk factors for bone loss in menopause

You can do a lot to preserve your bone density — and even increase it — in the years leading up to menopause and following it just by taking control of your risk factors. Since you don’t know exactly when your last period will take place, it’s best to get started now.

Your nutrient needs change in menopause. When estrogen levels decline, vitamin K function in bones also declines, including its role in the proper formation of bone protein which provides the framework for our bones. Most of us don’t get enough vitamin K, especially the most bone-supporting form, vitamin K2 as MK-7. Vitamin K2 MK-7 is found in aged cheeses and fermented foods, including the Japanese dish natto (fermented soy beans). Dark leafy vegetables such as kale, collards or spinach contain vitamin K1. For many, it’s so hard to get enough vitamin K through diet that supplementation is required.

menopause

Unfortunately, most of us are also chronically deficient in vitamin D, which your body needs to absorb calcium and limits bone breakdown. I recommend every woman have her vitamin D level tested at least yearly — it’s not very costly. Sun exposure boosts vitamin D production in the skin, but you may need supplements to reach the optimal blood levels of 50–60 ng/mL. The vitamin best D3 form is cholecalciferol.

Lose weight without losing bone.Weight gain — especially around the middle — can be a big problem for women in menopause. But certain weight loss efforts can harm bone. While we’re still analyzing the connection, I think that calorie restriction prevents women from getting enough nutrients in general. Weight loss trends such as eating diets high in animal protein and/or fat can also lead to a loss of calcium in the urine. If you’re going to lose weight, do so slowly (1-2 pounds a week) and include some form of weight-bearing exercise in the mix to foster bone strength.

Reduce physical and emotional stress. Our bodies are under enormous physical and emotional stress during hormonal transitions such as puberty and menopause. Stress causes us to release higher levels of the fight-or-flight hormone cortisol, which can lead to increased programmed cell death in bone-building cells. Over the years, excessive cortisol can weaken our bones. Because our bodies are particularly stressed during the menopausal transition, it’s critical to make time for stress reduction in our busy lives.

Manage hormonal fluctuations. Extreme hormonal fluctuations are not only bone-damaging, but they can also cause difficult menopause symptoms such as hot flashes, irritability and low energy. Many of the steps above will also help reduce extreme hormonal fluctuations. And, we’ve found that herbal remedies, including ashwagandha, red clover and wild yam are effective in restoring hormonal balance and reducing symptoms.

Remember that no matter what stage of life you are in, it is possible to improve your bone health naturally. The most effective approach is to give your body the support it needs to take care of itself and continue to build bone — just as Nature intended.

Dr. Susan E. Brown

Halting bone loss and reducing osteoporosis risk

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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!

 

Dr. Susan E. Brown

Do your medications cause bone loss?

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iStock_000007770475SmallHow bone-friendly is your medicine cabinet? Maybe you’ve added vitamin D with the goal of reducing bone loss. Or you might have even stopped taking a bisphosphonate. Congratulations!

You may not be aware how popular medicines can cause excessive bone loss — and even osteoporosis. One incredible example is that approximately 20% of osteoporosis in the U.S. is the result of corticosteroid use. That’s 4 million people who want relief from inflammatory conditions, allergies, arthritis or other conditions and end up with severe bone loss.

Of course, medication use may be necessary to treat a serious illness. If this is the case, it’s still important to discuss the risks with your healthcare practitioner as well as options for reducing the harm to your bones. Here’s a list of 4 of the many common medications that cause bone loss to help you get started with that conversation:

4 common medications that cause bone loss

  • Anti-inflammatory (corticosteroids): Cortisone and prednisone increase the urinary loss of calcium, impair bone buildup and increase bone breakdown. Fortunately, research suggests that the use of supplemental nutrients can limit bone loss due to corticosteroids.
  • Anti-seizure medications/anti-convulsants: These medications interfere with vitamin D metabolism and reduce the amount of calcium available for bone mineralization. Phenytoin (Dilantin®) and carbamazepine (Tegretol®) are two common examples.
  • Antacids/Anti-heartburn medications: Many popular antacids contain aluminum hydroxide — which is toxic to bone! Even small doses of aluminum in popular antacids can cause a loss of calcium from the body. Proton pump inhibitors used for heartburn and ulcer medication have been associated with an increased fracture risk, perhaps because calcium absorption from food is less efficient in the absence of stomach acid.
  • Anti-depressants: Daily use of anti-depressants known as SSRIs (selective serotonin reuptake inhibitors) may lead to increased risk for fragility fracture in older adults. SSRIs are also associated with a reduction in bone density in the hip and spine and with an increased risk of falling. Drugs in this class include Prozac®, Paxil® and Zoloft®.

I recommend having the conversation about your medication and its effect on your bones frequently with your practitioner, especially after being on a medication for a great deal of time or knowing that entering menopause or other bone loss risk factors may be increasing. For a more complete list of medications that can be harmful to bone, as well as medical conditions that may also cause bone loss, see my articleRethinking “primary” osteoporosis: Isn’t all osteoporosis really just “secondary” osteoporosis?

 

References:

Hodgson, S.F., “Corticosteroid-induced osteoporosis,” Endocrinolo-Metab-Clin-North-Am 19.1 (199): 95-111.

Skolnick, A. “Public Health Experts Take Aim at a Moving Target: Foodborne Infections,” Journal of the American Medical Association 277.2 (January 1997): 98-100

Cutler, W., Hysterectomy: Before & After, (New York: Harper & Row, 1988).

Adler, A., et.al., “Aluminum absorption and intestinal vitamin D-dependent Ca binding protein,” Kidney Int 37 (1990).

 

Dr. Susan E. Brown

The Tao of bone: is fear weakening our bones?

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Tao of boneI recently had the privilege of attending a retreat given by a foremost Taoist master, Dr. Nan Lu, director of the Traditional Chinese Medicine World Foundation in New York City. Always intrigued by how ancient cultures look at bone health, I jumped right in asking questions.

According to the 5,000-year-old Traditional Chinese Medicine perspective, the physical body is energized and informed by “rivers” of energy and information known as meridians. The meridians are named for the organs of the body. For example, there is a lung meridian, a heart meridian, a kidney meridian, and so on. These meridians refer to a particular field of energy and information that flows through the entire body, not just the named organ. A healthy, balanced flow of energy through the meridians is the key to good health.

Here are some highlights from my conversation with Dr. Lu

  • Meridian energy flow is disrupted most notably by emotional and mental distress.
  • Bone health is controlled by the energy and information of the kidney meridian.
  • Most of all, the emotion of fear disrupts the kidney meridian energy, and thus fear damages bone.

Dr. Lu’s answer to my question about what most affects bone was immediate and clear: fear. He explained that our culture is rather fear-based, and because of this we have a special challenge in building and maintaining bone health.

Later I’ll be writing more about traditional Chinese medical perspectives, but for now, and just for the fun of it, you might reflect on your “fear index.”  Do you have faith in your body’s ability to heal?  Do you believe things will turn out okay?  Do you believe things happen for a reason?

It seems the ancient Chinese agree with the Ancient Indian Vedic scholars in that“Nothing holds more power over the body than thoughts held in the mind.”

 

 

Better Bones Blog
Dr. Susan E. Brown

Bone and muscle: Lose them together, build them together

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These days, it seems like the media is full of folks talking about aging bone loss in women. What they seem to often forget, however, is that just as we lose bone mass over time, so we also lose muscle mass — and most often, the two are linked.

Let’s look at the spine as an example. The average woman loses about 47% of her spinal bone mass during her lifetime, while most men lose 30% of their spinal bone density as they age. As for muscle loss, studies estimate that between the ages of 21 and 89, a woman loses 50% of her back muscle strength and a man loses 64%. This is the normal, average loss of bone and muscle in long-lived Americans. Excessive bone loss and the condition of weak bones is called “osteoporosis” and excessive muscle loss and weakened muscles is called “sarcopenia.” The longer you live, the more likely excessive bone and/or muscle loss will become a factor that limits your vitality.

Longer life means a greater chance of losing excessive amounts of your youthful bone and muscle mass, unless you take deliberate steps to head in another direction. An action plan for building the health, strength, and fitness of the entire body is the antidote to age-related losses. If you care for your bones in a natural, holistic fashion, as with my Better Bones Health Package you are actively involved in an anti-aging program.

In our program, everything you do for bone is good for the entire body. Every nutrient you take, every step you make towards developing an Alkaline For Life® eating plan, every physical exercise you do is a move towards preserving bone, muscle, and vitality.

 

References:

Riggs, B.L., Melton, L.J. III. 1986. Involutional osteoporosis. N. Engl. J. Med., 314:1676–1686.

Riggs, B.L., Wahner, H.W., Melton, L.J. III, et al. 1986. Rates of bone loss in the appendicular and axial skeletons of women: Evidence of substantial vertebral bone loss before menopause. J. Clin. Invest., 77:1487-1491.

Scheffler, N.M., Sheitel, P.L., and Lipton, M.N. 1992. Use of cryo/cuff for the control of postoperative pain and edema. J. Foot Surg., 31:141-148.

Sinaki, M. 2003. Critical appraisal of physical rehabilitation measures after osteoporotic vertebral fracture. Osteo. Int., 14:773-779.

 

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Dr. Susan E. Brown

Is My Bone Loss Normal or Excessive? (+Video)

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Q. Is my bone loss normal or excessive?

Dr. Brown suggests that if you are an older woman and concerned about your bone loss you should ask yourself a few questions. For example, how old are you and when was your last menstrual cycle? Are you near menopause or beyond menopause? The 2 years before and the 5 years after menopause is a time of rapid bone loss. If you are 5 years or so beyond menopause and still have high bone loss, we suggest that you ask your primary care doctor about a workup for osteoporosis. If your bone density is declining and the rate of loss is currently high, medical workups are very important.

Listen to Dr. Brown discuss more on this topic in her blog, Bone Testing — Assessing Bone Breakdown and Bone Loss.

Dr. Susan E. Brown

Do drugs like Advil® cause bone loss? (+Video)

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Q. Do drugs like Advil® cause bone loss?

Although Dr. Brown believes that NSAIDS can be harmful and should only be used as little as possible, she does not believe drugs like Advil® are a major cause of bone loss. At the Center for Better Bones we believe that getting a comprehensive examination and looking further into the possible causes of your bone loss are the best ways to start.

Listen to Dr. Brown discuss the important nutrients that should be in your diet. And then find out more by reading The Tests You Need to Know for Bone Health on our Better Bones blog.