herbs, supplements, vitamins
information, natural treatment
January 20 2016 by Ray Sahelian, M.D.
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.
Osteoporosis is a condition characterized by micro-architectural deterioration of bone tissue leading to decreased bone mass and bone fragility. The major cause 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 due gluten intolerance. There are reports that megadosing with vitamin A, such as 50,000 to 100,000 units a day could interfere with bone formation.
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.
treatment and prevention
There are potentially numerous nutrients and dietary components that can influence bone health, and these range from macronutrients to micronutrients as well as bioactive food ingredients. A correct diet to prevent osteoporosis should contain adequate amounts of calcium, vitamins D and K, protein, and fatty acids.
Below I discuss a natural remedy for this bone thinning condition. Discuss with your
doctor before you implement any of these natural remedy
Eat more fruits and vegetables - 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. To reduce your risk, have a diet that contains adequate protein and calcium.
Antioxidants (Basel). 2014. Dietary Polyphenols, Berries, and Age-Related Bone Loss: A Review Based on Human, Animal, and Cell Studies. Natural antioxidant supplementation has been researched to aid in reducing bone loss caused by oxidative stress. Naturally occurring polyphenols, such as anthocyanins rich in berries, are known to have anti-oxidative properties. Several studies have been reviewed to determine the impact polyphenol intake-particularly that of berries-has on bone health. Studies reveal a positive association of high berry intake and higher bone mass, implicating berries as possible inexpensive alternatives in reducing the risk of age related bone loss.
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. Reduce or avoid soft drinks due to their phosphorus content.
Weight bearing exercises are tremendously helpful as an osteoporosis treatment and osteoporosis prevention. Weight-bearing activities, such as running, jumping rope and lifting weights, put the bones under stress. This forces the bones to respond by becoming stronger. In contrast, low-impact exercise, like biking or swimming, works the heart and trims the waistline, but puts little strain on the bones.
Calcium supplements were thought to be important for osteoporosis prevention and treatment but new research is questioning this long assumed benefit. The mineral supplement 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. Until more research is published, take no more than 300 to 600 mg a day in divided dosages, and it may work better with vitamin D.
Vitamin D rich foods include milk, cheese, sardines, cooked greens. Expose yourself to sun a few minutes a day. Or, take a multivitamin mineral supplement. Supplementation with vitamin D (400-2,000 IU per day) together with calcium (200-600 mg per day) may reduce the risk of falls and fall-related fractures in the elderly. Vitamin D deficiency is quite common in cases of hip fractures. 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.
Magnesium is not
discussed as much, but this mineral could also be helpful.
Soy isoflavones such as genistein may be helpful. Soy foods contain several components (isoflavones and amino acids) that potentially affect bone, however most studies do not show that ingestion of soy protein or soy foods has a major influence. Consume organic soy when possible, and fermented.
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 a 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.
I have not come across research indicating whether CoQ10 has a role to play in osteoporosis.
Since there is a slew of evidence that Fosamax can cause
osteonecrosis, is there any natural therapies that a post menopausal woman could
use to treat osteoporosis?
There is still a great deal of debate in the medical profession regarding the best natural therapies to prevent bone loss in post menopausal women. At this time there is enough evidence to recommend calcium supplements at a dosage of 600 mg to 1200 mg and vitamin D 400 to 1000 units. There is ongoing research regarding vitamin K, isoflavones, magnesium and strontium pills. I would also suggest smoking cessation, avoidance of excessive alcohol intake, and, most important, to engage in weight bearing exercises.
Calcium is an essential cotherapy in osteoporosis treatment. The relative effectiveness of various calcium salts for this purpose is uncertain. Many older women with osteoporosis have phosphorus intakes of less than 70% of the Recommended Dietary Allowance. Our objective was to test the hypothesis that calcium phosphate would better support anabolic bone building than would calcium carbonate. Our results show tricalcium phosphate and calcium carbonate appear to be approximately equally effective in supporting bone building with a potent anabolic agent; phosphate salt may be preferable in patients with restricted phosphorus intakes. Phosphate and carbonate salts of calcium support robust bone building in osteoporosis. Robert P Heaney, Robert R Recker, Patrice Watson and Joan M Lappe. From the Osteoporosis Research Center Creighton University Omaha NE. American Journal of Clinical Nutrition, 2010
Is natural progesterone cream good for osteroporsis ? I have had a hysterectomy 5years ago and I don't take any hormones and I don't have any menopausal sympthoms hot flashes ect.
There are not enough long term studies to determine whether progesterone, orally or topically as cream, is of benefit in treating this bone thinning condition. Furthermore, long term safety of progesterone use should be kept in mind, and we need more studies to determine the effects of various dosages on different tissues of the body.
Standard Medical osteoporosis
treatment - medication
Osteoporosis often is undertreated in part because it is a clinically silent disease until it manifests in the form of a fracture. Sufficient recognition 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. There is controversy regarding the long term benefit and risks of certain drugs. Biphosphanate use may leas to osteonecrosis of the jaw bone and potentially other serious conditions.
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, and whether
to take occasional breaks from use.
Osteoporosis in men
Although it is often regarded as a disease of women, 30% of osteoporotic fractures occur in men. Risk factors for osteoporosis or fractures in men include advancing age, 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. Because of their greater peak bone mass, men usually present with hip, vertebral body, or distal wrist fractures a decade later than women.
Symptoms and signs
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 symptoms a person could have. Another symptom could be back pain, along with vertebral fractures and loss of height.
Discomfort and 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.
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.
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).
effects and risk, danger
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.
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.
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.
Effect of Rehmannia glutinosa extracts on bone metabolism.
Clin Chim Acta. 2003.
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.
Natural Osteoporosis Treatment questions, emails
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 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.
I 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.
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.
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.
I recently had a bone density scan and it revealed that I
am at high risk in my left hip and in my lower back. I am 61 yrs. old and have
been on Nexium for about 7-8 years because of a hiatal hernia. I’ve been
researching Nexium and only now realize that it is inhibiting my body from
completely absorbing the calcium intake from the food I am eating. I usually
only need the Nexium every other day but without it, my life would be absolutely
miserable and intolerable. Is there another product on the market that would
work as well as Nexium but not have the side effects regarding the absorbtion of
calcium. I have to stay away from herbal products because I am also taking
Verapamil (Calan) and warfarin (Coumadin) for A-Fib (flutter) which is working
100% resulting in my heart beating as one. I would appreciate hearing from you
since the doctor’s don’t seem to know what to prescribe for me in the way of
bone support medication. Also, I had a soft tissue cancer tumor (self-contained)
20 years ago and cannot take the hormones that seem to be present in those
I can't provide specific suggestions as to what supplements or medications you should take, but you could review the information on this page and the page on heartburn with your doctor.
Your newsletter 8/13/2015 mentions ‘Dangers of high calcium supplement use’. I agree that calcium is way over ‘prescribed’ by many physicians, especially relating to osteoporosis. I think calcium should not be ‘prescribed’ for osteoporosis. Magnesium should be. Magnesium, along with D3, K2 and maybe some strontium will help get calcium out of joints and soft tissue and put it back into the bones where it belongs. This, along with carnosine, as you also talked about in this current email, will I thing have significant beneficial effect on macular degeneration. This approach will help stop/reverse calcium deposits that clog arteries, and thus also be effective in treating macular degeneration. Most of us get generous amounts of calcium from our diets, but often negligible amounts of magnesium. This leads to such things and arterial blockage, kidney stones, arthritis, soft tissue problems such as mitral valve prolapse (reversible with magnesium, D3, K2 supplementation). I am not a doctor, I am a chemist and a researcher. I study extensively. And I try to help educate people regarding keeping/regaining their health without reliance on pharmaceutical drugs, most of which have side effects that often are more serious than the malady being treated.
Additional pages of interest
lemon balm herb