OSTEOPOROSIS information by Ray Sahelian, M.D. Natural treatment of osteoporosis

Osteoporosis is a public health problem affecting 75 million persons in the United States, Europe and Japan, including one third of postmenopausal women and most of the elderly in the United States, Europe and Japan. Osteoporosis results in more than 1.3 million fractures annually in the United States.

Cause of Osteoporosis
Osteoporosis is a condition characterized by micro-architectural deterioration of bone tissue leading to decreased bone mass and bone fragility. The major cause for osteoporosis is poor bone mass acquisition during adolescence and accelerated bone loss in persons during the sixth decade (the perimenopausal period in women). Both processes are regulated by genetic and environmental factors. Reduced bone mass is the result of varying combinations of hormone deficiencies, inadequate nutrition, decreased physical activity, and the effects of medications used to treat various unrelated medical conditions. In rare cases, a cause of osteoporosis can be gluten intolerance.

Natural Osteoporosis Treatment and Osteoporosis Prevention
Below I discuss a natural remedy for osteoporosis. Discuss with your doctor before you implement any of these natural remedy for osteoporosis options:
Eat more fruits and vegetables - For osteoporosis, the evidence from a combination of observational, experimental, clinical, and intervention studies strongly points to a positive link between fruit and vegetable consumption and bone health.
Reduce alcohol intake
Reduce caffeine intake
Reduce or stop smoking
Reduce cola intake - Intake of cola is associated with low bone mineral density in women.
Weight bearing exercises are tremendously helpful as an osteoporosis treatment and osteoporosis prevention
Calcium supplements are important for osteoporosis prevention and treatment. Calcium can be taken at mealtime with dinner. However, calcium from food is a better option. Calcium from dietary sources is associated with a shift in estrogen metabolism toward the active 16alpha-hydroxyl metabolic pathway and with greater bone mineral density and thus may produce more favorable effects in bone health in postmenopausal women than will calcium from supplements.
Vitamin D-- foods rich in vitamin D include milk, cheese, sardines, cooked greens. Exposure to sun a few minutes a day. Or, take a multivitamin mineral supplement. Several randomized, prospective, placebo-controlled clinical trials have documented that a supplementation with vitamin D (400-1,000 IU per day) together with calcium (800-1,200 mg per day) may reduce the risk of falls and fall-related fractures in the elderly.
Magnesium is not discussed as much, but this mineral could also be helpful.
Soy isoflavones such as genistein may be helpful
Reduce or avoid soft drinks due to their phosphorus content.
Estrogen replacement -- use lowest amount of natural estrogens for the least period of time
Hip Protectors - Padded undergarments designed to cushion a fall have been promoted as being an inexpensive way to prevent hip fractures in the elderly. However, one study shows hip protectors designed to absorb and disperse energy are not effective for preventing hip fracture among nursing home residents. JAMA 2007;298:413-422,454-455.

Subscribe to a FREE Supplement Research Update newsletter at Physician Formulas. Twice a month you will receive an email on various supplements and natural medicine topics -- including osteoporosis -- and their practical interpretation by Ray Sahelian, M.D.  We will mention osteoporosis as more research becomes available.

Osteoporosis Diet
To reduce your risk for osteoporosis, have a diet that contains adequate protein and calcium. For a list of foods that have calcium, see the link above.

Standard Medical Osteoporosis treatment - Osteoporosis medication
Osteoporosis often is undertreated and underrecognized, in part because it is a clinically silent disease until it manifests in the form of fracture. Sufficient recognition of osteoporosis and its appropriate medical and nonmedical treatment are essential. Osteoporosis drug treatments -- besides calcium and vitamin D -- include the medication bisphosphonates, estrogen, selective estrogen receptor modulators, calcitonin, parathyroid hormone, balance and exercise training programs, and the minimally invasive spine procedures vertebroplasty and kyphoplasty comprise a comprehensive multidisciplinary approach in the treatment of osteoporosis. There is controversy regarding the long term benefit and risks of certain osteoporosis drugs. Biphosphanate use may leas to osteonecrosis of the jaw bone and potentially other serious conditions.

Osteoporosis in Men
Although osteoporosis is often regarded as a disease of women, 30% of osteoporotic fractures occur in men. Risk factors for osteoporosis or fractures in men include previous fragility fractures, maternal history of fragility fracture, hypogonadism, low body mass index, smoking, high alcohol consumption, low calcium intake, corticoid therapy, physical inactivity, and the presence of conditions such as hyperthyroidism, hyperparathyroidism, hypercalciuria or chronic inflammatory diseases.

Osteoporosis Exercise
Any type of movement helps strengthen bones. If your bones are weak, try swimming first. Walking is great for lower extremities, but the best osteoporosis exercise is weight lifting. if you are concerned about osteoporosis, you have to be physically active, preferably throughout life. Walk, dance, do pushups, do yoga or stretching for flexibility, reduce smoking, and, if possible join a gym where you lift weights using all muscle groups. If you can't join a gym, buy a few cheap barbells and lift weights at home, do gardening, or lift rocks in your backyard... anything to make your muscles work. When muscles contract, they pull tendons that are attached to the bones, and this tells the bones to deposit calcium and thus bones become stronger and less apt to fracture. Bone is a living tissue that responds to exercise by becoming stronger. Just as a muscle gets stronger and bigger with use, a bone becomes stronger and denser when it is called upon to bear weight. Taking lots of calcium without being physically active is not going to be as effective.

Osteoporosis and Vitamin D Supplements
Vitamin D deficiency is quite common in cases of hip fractures. A look-back study of 548 patients older than 60 years of age who were admitted at South Glasgow University Hospital in Scotland in the previous 4 years, showed that 97 percent of the patients had vitamin D levels below normal. Dr. Stephen Gallacher, lead researcher and consultant endocrinologist at the hospital said: ''Although the numbers were too small to justify extensive subgroup analyses the study appears to demonstrate that vitamin D inadequacy represents a significant correctable risk factor for fragility fracture and perhaps specifically for the hip."
    Dr. Sahelian comments: Most elderly patients do not get enough vitamin D through sun exposure, particularly in cold climates with long winters. Vitamin D can be supplemented by taking a multivitamin and mineral complex, or through cod liver oil. A dosage of 400 to 800 units should be adequate. Sitting by the window or taking walks outside could be helpful.

Osteoporosis Pain
Osteoporosis may cause painful fractures, which can take many months to heal. In many cases, the pain starts to go away as the fracture heals. Pain that continues after a few month is considered chronic pain. One cause of chronic pain is vertebral fractures. When a vertebra breaks, some people have no pain, while others have intense pain and muscle spasms that last long after the fracture has healed.

Osteoporosis Medication - Biphosphonate side effects
Bisphosphonates - Side effects for alendronate, ibandronate and risedronate include gastrointestinal problems, abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus. There have been a few reports of osteonecrosis of the jaw  and of visual disturbances.

Alendronate Sodium (brand name Fosamax®) - Alendronate is approved for both the prevention (5 mg per day or 35 mg once a week) and treatment (10 mg per day or 70 mg once a week or 70 mg once a week plus D) of postmenopausal osteoporosis.

Ibandronate Sodium (brand name Boniva®) - Ibandronate is approved for the prevention and treatment of postmenopausal osteoporosis. Taken as a once-a-month pill (150 mg), ibandronate should be taken on the same day each month.

Risedronate Sodium (brand name Actonel®) - Risedronate Sodium with 500 mg of Calcium Carbonate (brand name Actonel® or Actonel® with Calcium) - Risedronate is approved for the prevention and treatment of postmenopausal osteoporosis. Taken daily (5 mg dose) or weekly (35 mg dose or 35 mg dose with calcium). Risedronate also is approved for use by men and women to prevent and/or treat glucocorticoid-induced osteoporosis that results from long-term use of these medications (i.e., prednisone or cortisone).

Osteoporosis Medication - Calcitonin side effects
Calcitonin-salmon (Calcimar, Miacalcin) calcitonin-human (Cibacalcin) - Side effects of the calcitonin nasal spray may include runny nose or nasal discomfort, nausea and skin redness (flushing). Side effects of the calcitonin shot may include nausea and/or vomiting, diarrhea, inflammation at the site of the shot, skin redness (flushing), and increased urination or increased number of bowel movements.

Osteoporosis Medication - Raloxifene side effects
Raloxifene is used to help prevent and treat thinning of the bones (osteoporosis) in postmenopausal women. Raloxifene works like an estrogen to stop the bone loss that can develop in women after menopause, but it does not increase the bone density as much as daily 0.625 mg doses of conjugated estrogens. Raloxifene will not treat hot flashes of menopause and may cause hot flashes to occur. Also, raloxifene does not stimulate the breast or uterus as estrogen does. Raloxifene side effects include bloody or cloudy urine; chest pain; difficult, burning, or painful urination; fever; frequent urge to urinate; infection, including body aches or pain, congestion in throat, cough, dryness or soreness of throat, and loss of voice; runny nose ; leg cramping; skin rash ; swelling of hands, ankles, or feet; vaginal itching. Bloody cough may also occur.

Osteoporosis Research Update
Depo-Provera, an injectable contraceptive, will come with a special warning that links prolonged use of the drug with bone density loss possibly leading to osteoporosis.

Onions can spice up your meals -- and maybe strengthen your bones. Investigators from the University of Bern in Switzerland found that after eating a small fraction of an ounce of onion with their food, rats became significantly less likely to lose bone. These findings suggest that adding onion to food may help people fight off the bone-thinning disease osteoporosis.

Some people develop osteoporosis, the mineral loss disease that leads to brittle bones, because their bodies cannot tolerate wheat flour. Gluten intolerance, called celiac disease, can be treated, so the damage done by osteoporosis can be reversed in such patients, says the report published in the March 2005 issue of the Archives of Internal Medicine.  As many as three to four percent of patients who have osteoporosis have the bone disease as a consequence of having celiac disease, which makes them unable to absorb normal amounts of calcium and vitamin D.

Prevention and management of osteoporosis.
World Health Organ Tech Rep Ser. 2003;921:1-164,
Bone is hard tissue that is in a constant state of flux, being built up by bone-forming cells called osteoblasts while also being broken down or resorbed by cells known as osteoclasts. During childhood and adolescence, bone formation is dominant; bone length and girth increase with age, ending at early adulthood when peak bone mass is attained. Males generally exhibit a longer growth period, resulting in bones of greater size and overall strength. In males after the age of 20, bone resorbtion becomes predominant, and bone mineral content declines about 4% per decade. Females tend to maintain peak mineral content until menopause, after which time it declines about 15% per decade. Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist. Osteoporosis occurs primarily as a result of normal ageing, but can arise as a result of impaired development of peak bone mass (e.g. due to delayed puberty or undernutrition) or excessive bone loss during adulthood (e.g. due to estrogen deficiency in women, undernutrition, or corticosteroid use). Osteoporosis-induced fractures cause a great burden to society. Hip fractures are the most serious, as they nearly always result in hospitalization, are fatal about 20% of the time, and produce permanent disability about half the time. Fracture rates increase rapidly with age and the lifetime risk of fracture in 50 year-old women is about 40%, similar to that for coronary heart disease. In 1990, there were 1.7 million hip fractures alone worldwide; with changes in population demographics, this figure is expected to rise to 6 million by 2050. To help describe the nature and consequences of osteoporosis, as well as strategies for its prevention and management, a WHO Scientific Group meeting of international experts was held in Geneva, which resulted in this technical report. This monograph describes in detail normal bone development and the causes and risk factors for developing osteoporosis. The burden of osteoporosis is characterized in terms of mortality, morbidity, and economic costs. Methods for its prevention and treatment are discussed in detail for both pharmacological and non-pharmacological approaches. For each approach, the strength of the scientific evidence is presented. The report also provides cost-analysis information for potential interventions, and discusses important aspects of developing national policies to deal with osteoporosis.

Depo-Provera (depot medroxyprogesterone), a popular birth control injection, seems to promote bone loss or osteoporosis, and the effects increase over a 2-year period.

Effect of Rehmannia glutinosa Libosch extracts on bone metabolism.
Clin Chim Acta. 2003 Aug;334(1-2):185-95.
Rehmannia glutinosa Libosch extracts were investigated to determine if they play roles in osteoporosis and bone metabolism. CONCLUSIONS: Rehmannia stimulates the proliferation and activities of osteoblasts, while inhibiting the generation and resorptive activities of osteoclasts. It also shows preventive effects on osteoporotic bone loss induced by an ovariectomy. Although the active substances have not yet been identified, it is believed that rehmannia seems to contain active components that have a potential to enhance the bone metabolism in osteoporosis.

glucomannan
lemon balm
curcumin
fenugreek

Osteoporosis Treatment questions
Q. How much calcium is appropriate for osteoporosis treatment?
     A. A wide range of calcium dosages have been recommended for osteoporosis treatment, ranging from 1000 to 2000 mg a day.

Q. What's the first or most common osteoporosis symptom ?
     A. Without your realizing it, osteoporosis leaks calcium from your bones, leaving them so brittle and frail that a minor fall or strain could cause the osteoporosis symptom or sign of a hip or spine fracture. That nagging back pain or dowager's hump might be one of the first osteoporosis symptom a person could have. Another osteoporosis symptom could be back pain, along with vertebral fractures and loss of height.

Q. I have postmenopausal osteoporosis. Is hormone replacement with estrogen still recommended>
     A. Depending on the severity of your postmenopausal osteoporosis, estrogen may be used in low doses - in addition to calcium and vitamin D - as long as you don't have an estrogen sensitive tumor or have a family history of breast cancer. There is no overall agreement in the medical community on the estrogen dosage to be used, the form of estrogen, and whether to take occasional breaks from use.

Q. Is magnesium a natural osteoporosis remedy ?
     A. This is a good question. Calcium is, of course, but I don't know if magnesium supplementation is also considered a natural remedy for osteoporosis.

Q. Can calcium by itself by an osteoporosis cure ?
     A. I doubt it. To cure or remedy osteoporosis, several things have to be done in addition to calcium and vitamin D. The most important is exercise, preferably weight bearing exercise to stimulate calcium deposition in bone.

Q. I've heard that heavy exercise is a cause of osteoporosis.
     A. You're probably thinking about osteoarthritis where running marathons could increase the risk, perhaps, of knee and hip pain. Exercise is not a cause for osteoporosis, in fact, lack of exercise is a common cause of osteoporosis.

Q. What's the relation between vitamin A and osteoporosis ?
     A. There are reports that megadosing with vitamin A, such as 50,000 to 100,000 units a day could interfere with bone formation and be a cause of osteoporosis.

Q. How common is osteoporosis in a man and what is the cause?
     A.  Osteoporosis in men is now recognized as an increasingly important public health issue. One in eight men older than 50 years will have an osteoporotic fracture. Because of their greater peak bone mass, men usually present with hip, vertebral body, or distal wrist fractures a decade later than women. Major risk factors for osteoporosis in a man are glucocorticoid use for longer than six months, a history of nontraumatic fracture, hypogonadism, and advancing age.

Q. Is CoQ10 a natural osteoporosis remedy?
     A. I have not come across research indicating the role of CoQ10 in osteoporosis.

Q. I read your newsletters cover to cover with great interest and have learned a lot. Your perspective is very refreshing. However, I was disappointed in your commentary (April 2006) on taking calcium. I believe you were remiss in not mentioning the necessity of taking magnesium (50% of calcium) as well as vitamin D with calcium, or for mentioning the benefits of calcium citrate versus calcium carbonate. Just recently I found out we cannot absorb more than 500mg calcium at a time, so now I take 500mg morning and evening. It seems plausible that avoiding a daily overload could help us all avoid the risk of kidney.
     A. We appreciate your email and your input. Please reread the newsletter and you will see that vitamin D is mentioned. As to the different forms of calcium, no research is available long term to determine which form over several years leads to better bone strength. And you make a good point about spreading the dose of the calcium over the day to minimize kidney stone formation, although research is needed to find out which way leads to better bone deposition -- small amounts a few times a day or high amounts once or twice. Often we think we know answers to questions based on a short term lab study, but the body behaves quite differently over a long period of supplementation
Also, a link is provided for osteoporosis information which mentions magnesium and other potentially beneficial supplements for osteoporosis.

Q. In your newsletter of April 2006. presumably for the public, I am surprised that you did not mention the nutritional co-factors to calcium supplementation for the purpose of bone building, particularly magnesium, which is one of the most effective therapies for preventing calcium renal stones. also, you dont mention the poor absorption qualities of calcium carbonate, which was used in the studies. I am a medical doctor.
     A. When I write a newsletter, I don't mention everything possible due to limited space, but if you notice there is a link to osteoporosis at the end of the newsletter where magnesium is mentioned. If you know of long term human studies with other forms of calcium that led to a decrease in fractures, please point these out to us, we would appreciate it. If there was an increase in kidney stones with calcium carbonate, one would assume that the calcium was absorbed well. If other forms of calcium get absorbed better, hypothetically there is a risk for more kidney stones.

Q. Add me to the countless others who regularly peruse your website in a quest for better health. You certainly seem to be both knowledgeable and compassionate. I think I'm at a crucial stage of life (54) at menopause and being diagnosed with osteoporosis, arthritis and plantar fasciitis. I won't take the Actonel or steroids the doctors want to prescribe, and there are no allopathic doctors here for guidance on supplements or herbals. More importantly, after paying health insurance premiums, I can't justify trying some of the nutritionists and other modalities that are here but aren't covered by the insurance! So, almost obsessively, I explore site after site and have filled almost three notebooks with info and suggestions and spent lots of dollars on this or that supplement. The result is I am a nervous wreck and can only sleep about 1 out of 2 or 3 nights. The other nights my mind is tumbling with mostly depressed thoughts and I feel like I can't draw a cleansing breath. So I stopped taking everything except a cod liver pill, a probiotic cap, a plant enzymes cap and a black currant cap, all one a day and oat seed extract, one dropperful a day. I know I'm lactose intolerant (just started trying raw cheese) and I was taking OsteoPrime Plus by Enzymatic Therapy, but I do think I must be sensitive to the B vitamins. I read in your FAQs about too much or too many supplements causing nervousness and heart palpitations, and that is me. I try to eat as healthy as possible, but I know I need some supplementation or wouldn't have these conditions, but don't know what to take as a natural osteoporosis treatment. Especially calcium; I've read that people with sensitivities should take chelated or citrate form--is this right? You don't make recommendations, but I would appreciate any input you have as to what basic supplements to take for osteoporosis, calcium in particular and supporting vitamins like D and K. Also curious about strontium and calcitonin.
   A. It's difficult to give a specific regimen for osteoporosis treatment without doing a full examination, blood studies, and knowing the results of bone mineral density studies. The most important factor in keeping osteoporosis at bay is exercise in various forms. You may wish to review this page on natural osteoporosis treatment and discuss with your doctor the best options. There are no simple guidelines that apply to everyone. Also to keep in mind that more is not necessarily better.