BONE HEALTH - Michael T. Murray, N. D.

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BONE HEALTH - Michael T. Murray, N. D. JoAnn Guest May 27, 2005 15:17 PDT

 

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When most people think of bones, what comes to mind are the lifeless,

dead bones of skeletons. But, bone is actually a dynamic, living tissue.

Healthy bones are dependent on an intricate interplay of many

nutritional and hormonal factors. In the human body, there is a constant

process of breaking down and remaking of bones.

 

When the rate of bone breakdown exceeds that of bone manufacture it can

result in a condition known as " osteoporosis. " Literally, the word

osteoporosis means " porous bone. " Osteoporosis affects more than twenty

million people in the United States including one out of four

postmenopausal women.1

 

What exactly causes osteoporosis?

 

Normally there is a decline in bone mass after the age of forty in both

sexes (about two percent loss per year), but women are at a much greater

risk for osteoporosis because of lower bone density prior to age forty.

 

Osteoporosis involves both the mineral (inorganic) and nonmineral

(organic matrix, composed primarily of protein) components of bone. This

is the first clue that there is more to osteoporosis than a lack of

dietary calcium.

 

In fact, lack of dietary calcium in the adult results in a separate

condition known as osteomalacia, or " softening of the bone. "

 

The two conditions, osteomalacia and osteoporosis, are different in that

in osteomalacia there is only a deficiency of calcium in the bone.

 

In contrast, in osteoporosis there is a lack of both calcium and other

minerals, as well as a decrease in the nonmineral framework (organic

matrix) of the bone.

 

Little attention has been given to the important role that this organic

matrix plays in maintaining bone structure.

 

Table 1 - Major Risk Factors for Osteoporosis in Women

Family history of osteoporosis

Gastric or small-bowel resection

Heavy alcohol use

Hyperparathyroidism

Hyperthyroidism

Inactivity

Leanness

Long-term glucocorticosteroid therapy

Long-term use of anticonvulsants

Low calcium intake

Nulliparity (never having been pregnant)

Postmenopause

Premature menopause

Short stature and small bones

Smoking

White or Asian race

 

Where does the bone loss in osteoporosis occur?

 

Although the entire skeleton may be involved in postmenopausal

osteoporosis, bone loss is usually greatest in the spine, hips, and

ribs. Since these bones bear a great deal of weight, they are then

susceptible to pain, deformity, or fracture.

 

At least 1.5 million fractures occur each year as a direct result of

osteoporosis, including 250,000 hip fractures, the most catastrophic of

fractures.

 

Hip fracture leads to death (both directly and indirectly as a result

of long-term hospital stays) in twelve to twenty percent of cases and

precipitates long-term nursing home care for half of those who survive.

Nearly one-third of all women and one-sixth of all men will fracture

their hips in their lifetime.2

 

How do I determine my bone density?

 

There are several techniques to measure bone density. The one that I

recommend is known as dual energy X-ray absorptiometry (DEXA).3 In

addition to providing the most reliable measurement of bone density, the

DEXA test also exposes a person to considerably less radiation than

other X-ray procedures for measuring bone density.

 

In the DEXA exam, the measurements will usually be of both the hip and

the lumbar spine. I recommend that women of high risk (see table 1) get

a baseline bone-density measurement and then monitor the rate of bone

loss using a urine test known as OsteoCheck (available through

www.bodybalance.com).

 

In other words, the DEXA test can be used to measure bone density,

while the OsteoCheck can be used to measure the rate of bone loss.

 

The OsteoCheck measures the urine levels of a compound linked to bone

breakdown (deoxypyridinium). The OsteoCheck can be used to monitor the

rate of bone loss and the success (or failure) of therapy.

 

The OsteoCheck provides faster feedback than DEXA, which can take up to

two years to detect a therapeutic response. For more information on the

OsteoCheck test, see www.bodybalance.com.

 

What can be done to maintain bone health and prevent osteoporosis?

 

Recently there has been an incredible push for increasing dietary

calcium intake to prevent osteoporosis. While this appears to be sound

medical advice for many, osteoporosis represents much more than a lack

of dietary calcium.

 

It is a complex condition involving hormonal, lifestyle, and

nutritional factors. A comprehensive plan that addresses these factors

offers the greatest protection against developing osteoporosis. The

primary goals in the treatment and prevention of osteoporosis are to:

 

Preserve adequate mineral mass,

Prevent loss of the protein matrix and other structural components of

bone,

Assure optimal repair mechanisms to remodel damaged areas of bone.

Achieving these goals requires adoption of lifestyle, dietary, and

nutritional supplementation practices to build healthy bones.

 

What lifestyle factors are important for maintaining bone health?

 

Certain lifestyle factors are extremely important to bone health.

 

For example, coffee,alcohol, and smoking cause a " negative " calcium

balance

(more calcium being " lost " than taken in)

 

and are associated with an increased risk of developing osteoporosis,

while regular exercise reduces that risk.

 

In fact, exercise is the most critical factor for maintaining healthy

bones. Physical exercise, consisting of one hour of moderate activity

three times a week, has not only been shown to prevent bone loss, but

actually increase bone mass in postmenopausal women.

 

What are the key dietary factors to maintain bone health?

 

Many general dietary factors have been suggested as a cause of

osteoporosis:

 

low-calcium-high-phosphorus intake

high-protein diet,

high-acid-ash diet,

high salt intake,

and trace-mineral deficiencies, to name a few.

 

Considering that the average American consumes 150 grams of sucrose in

one day,

along with other refined simple sugars,

" carbonated beverages " loaded with " phosphates " ,

and large quantities of protein,

 

it is little wonder that there are so many people suffering from

osteoporosis in this country.

 

When lifestyle factors are also taken into consideration, it is

apparent why osteoporosis has become a major medical problem.

 

One of the best things you can do for your bone health is to stay away

from soft drinks.

 

Soft drinks have long been suspected of leading to " lower " calcium

levels and higher " phosphate " levels in the blood.

 

When phosphate levels are high and calcium levels are low, calcium is

pulled out of the bones.

 

The phosphate content of soft drinks like Coca-Cola and Pepsi is very

high, and they contain virtually no calcium.

 

The high phosphate level is required for " dissolving " the sugar and

contributing to the taste.

 

It appears that increased soft-drink consumption is a major factor that

contributes to osteoporosis.

 

The United States ranks first among countries in soft-drink consumption.

 

 

The per-capita consumption of soft drinks is in excess of 150 quarts per

year, or about 3 quarts per week.

 

What about milk?

 

Contrary to what the advertisements from the dairy industry tell us,

milk consumption may not lead to strong bones.

 

While numerous clinical studies have demonstrated that calcium

supplementation can retard bone loss, the data is inconclusive in

regards to a high dietary calcium intake from milk and prevention of

osteoporosis and bone fractures.

 

One of the first clues that milk consumption may not be that beneficial

for bone health is data showing that that countries with the highest

dairy intake have the highest rate of hip fractures per capita.

 

In analyzing data from the Nurses Health Study, a stud involving 77,761

women, researchers found no evidence that higher intakes of milk

actually reduced fracture incidence.

 

In fact, women who drank two or more glasses of milk per day had a

relative risk 45% for hip fracture compared to women consuming one glass

or less per week.

 

In other words, the more milk that was consumed the more likely a woman

would experience a hip fracture.

 

This data simply does not support the idea that

 

" every body needs milk. "

 

Is calcium supplementation important in preventing and treating

osteoporosis?

 

Yes, absolutely. But, preventing and reversing osteoporosis involves

much more than calcium. Bone is dependent on a constant supply of many

nutrients.

 

A deficiency of any of a number of nutrients such as boron, magnesium,

vitamin K, and others will adversely affect bone health.

 

To truly support bone health in my patients at high risk for

osteoporosis, along with a high potency multiple vitamin and mineral

formula,

I recommend additional bone building nutrients such as calcium (to bring

total daily supplement levels to 1,000 mg), boron, magnesium, and folic

acid.

In my patients with existing osteopororis, I recommend adding

ipriflavone (Ostivone) to the program.

 

Ipriflavone has shown excellent results in helping to prevent further

bone loss. And, along with the calcium and other important nutrients

ipriflavone can actually help rebuild bone.

 

When should a woman start taking calcium?

 

There is a strong correlation between pre-menopausal bone density and

the risk of osteoporosis. In other words, how dense the bones are prior

to menopause is a significant factor in determining whether or not a

woman develops osteoporosis.

 

That being the case, building strong bones should be a lifelong goal

beginning in childhood. However, the reality is that most women probably

are not that concerned about osteoporosis until a couple of years before

menopause (the perimenopause).

 

Fortunately, even taking calcium just prior to the onset of menopause

has been shown to produce considerable benefit in increasing bone

density. For example, in a two-year study 214 women near the age of

menopause (perimenopausal) received either 1,000 or 2,000 mg of calcium

or a placebo. While the control group actually lost 3.2% of their bone

density of their spine, the calcium-treated groups increased the density

by 1.6% (there was no difference between the two calcium groups). These

results highlight the importance of calcium supplementation prior

menopause in the battle against osteoporosis.

 

Can calcium supplementation increase bone density in postmenopausal

women with osteoporosis?

 

Not by itself.

 

In women who have passed through menopause, supplementation of calcium

has only been shown to be effective in reducing bone loss.

Although on its own, calcium supplementation does not completely halt

the process, it does slow the rate down by at least 30 to 50% and offers

significant protection against hip fractures.

 

While menopausal and postmenopausal women are often told that without

hormone replacement therapy they will most definitely get osteoporosis,

several studies provide strong evidence on the " inaccuracy " of this

commonly held view.

 

For women with confirmed osteoporosis, I recommend strongly that they

discuss treatment options with their physicians. I also recommend,

regardless of the treatment chosen, that proper monitoring with

OsteoCheck levels be performed to validate effectiveness of treatment.

Ipriflavone (Ostivone) is an exciting natural approach to maintaining

bone health. Several double-blind studies have shown that this

naturally-occurring flavonoid (plant pigment) can dramatically halt the

progression of bone loss when used in combination with 1,000 mg of

calcium.15-17 The typical dosage of ipriflavone is 200 mg three times

daily.

 

What is an Effective Dosage of Calcium?

 

The effectiveness of calcium supplementation at a particular dosage is

ultimately dependent upon the womanís diet and lifestyle. As repeatedly

stated throughout this article, bone health and osteoporosis

treatment/prevention involves much more than calcium. That being said,

an effective dosage for supplemental calcium is 600 to 1,200 mg per day

for most women. If there is significant bone loss, the dosage may need

to be in the 1,000 to 1,500 range.

 

What is the Best Form of Calcium?

 

The best form of calcium is certainly neither oyster shell, bone meal,

or calcium hydroxyapatite. Studies have indicated that these calcium

supplements may contain substantial amounts of lead or have a lower

absorption profile compared to other forms of calcium.18 I would

recommend staying away from these forms of calcium.

 

Calcium bound to citrate and other Krebs cycle intermediates such as

fumarate, malate, succinate, and aspartate appears to be the best

overall form of calcium although refined calcium carbonate is still an

excellent form for the majority of women.

 

The additional benefit with using minerals bound to " Krebs cycle "

intermediates is that over 95% of the Krebs cycle intermediates ingested

are used to produce cellular energy with the remainder being excreted in

the urine where they may act to prevent kidney stone " formation " .

 

The Krebs cycle intermediates fulfill every requirement for an optimum

calcium chelating agent:

 

(a) they are easily ionized, (b) they are almost completely degraded,

© they have it virtually no toxicity, and (d) they have been shown to

increase the absorption of not only calcium, but other minerals as well.

 

 

In short, refined calcium carbonate has the lowest lead content, but

calcium bound to Krebs cycle compounds appear to be better absorbed

especially in women with low gastric acid output than other forms of

calcium.

 

The problem with calcium supplements bound to the Krebs cycle compounds

is their bulk ñ it basically requires three to four times as many

capsules or tablets to provide the same level of calcium compared to

calcium carbonate sources. Providing a combination of calcium carbonate

and Krebs cycle calcium appears to be a reasonable solution.

 

What about calcium hydroxyapatite?

 

Although this form of calcium - basically a purified bone meal -

receives a lot of hype, there is little science to support manufacturers

claims that it is a superior form of calcium for bone health. Quite the

contrary.

 

What scientific studies show is that among calcium supplements tested

for absorption, this form tested at 20% absorption compared to 30% for

either calcium carbonate or calcium citrate in one study and was the

poorest absorbed form out of five commercially available forms in

another

 

Clearly these results do not support the marketing hype for calcium

hydroxyapatite.

 

References:

 

Dempster DW and Lindsay R: Pathogenesis of osteoporosis. Lancet

341:797-805, 1993.

Lindsay R: The burden of osteoporosis: Cost. Am J Med

98(Suppl.2A):9S-11S, 1995

Kanis J: Bone density measurements and osteoporosis. J Int Med

241:173-5, 1997

Chestnut CH, et al.: Hormone replacement therapy in postmenopausal

women: Urinary N-telopeptide of type I collagen monitors therapeutic

effect and predicts response of bone mineral density. Am J Med

102:29-37, 1997.

Aloia JF, Cohn SH, Vaswani A, et al.: Risk factors for postmenopausal

osteoporosis. Am J Med 78:95-100, 1985.

Jaglar SB, Kreiger N and Darlington G: Past and recent physical activity

and the risk of osteoporosis. Am J Epidemiol 138:107-118, 1993

Opriot JC, et al.: Physical activity as therapy for osteoporosis. Can

Med Assoc J 155:940-4, 1996

Eaton-Evans J: Osteoporosis and the role of diet. Br J Biomedical Sci

51:358-70, 1994

Saltman PD and Strause LG: The role of trace minerals in osteoporosis. J

Am Coll Nutr 4:384-9, 1993

Feskanich D, et al.: Milk, dietary calcium, and bone fractures in women:

A 12-year prospective study. Am J Public Health 87:992-7, 1997.

Elders PJM, et al.: Long-term effect of calcium supplementation on bone

loss in perimenopausal women. J Bone Min Res 9:963-70, 1994

Aloia JF, et al.: Calcium supplementation with and without hormone

replacement therapy to prevent postmenopausal bone loss. Annals Intern

Med 120:97-103, 1994.

Reid IR, et al.: Long-term effects of calcium supplementation on bone

loss and fractures in postmenopausal women: A randomized controlled

trial. Am J Med 98:331-5, 1995.

Devine A, et al.: A 4-year follow-up study of the effects of calcium

supplementation on bone density in elderly postmenopausal women.

Osteoporos Int 7:23-8, 1997.

Adami S, et al.: Ipriflavone prevents radial bone loss in postmenopausal

women with low bone mass over 2 years. Osteoporosis Int 7:119-25, 1997.

Agnusdei D, et al.: A double-blind, placebo-controlled trial of

ipriflavone for prevention of post-menopausal bone loss. Calcif Tissue

International 61:141-7, 1997.

Passeri M, et al.: Effects of 2-year therapy with ipriflavone in elderly

women with established osteoporosis. Ital J Miner Electrolyte Metab

9:137-44, 1995.

Bourgoin BP, et al.: Lead content in 70 brands of dietary calcium

supplements. Am J Public Health 83:1155-60, 1993.

Carr CJ and Shangraw RF: Nutritional and pharmaceutical aspects of

calcium supplementation. Am Pharm 27:49-57. 1987.

Deroisy R, et al.: Acute changes in serum calcium and parathyroid

hormone circulating levels induced by the oral intake of five currently

available salts in healthy male volunteers. Clin Rheumatol 16:249-53,

1997.

_________________

 

JoAnn Guest

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