Factors and Effects on Osteopenia and Osteoporosis by Lauren Loya MD

(TRANSCRIPT FROM VIDEO)

Earlier today, I got a message from a patient that she had received her bone density results from her primary care doctor, and she has osteopenia. Her physician recommended that she take a dose of Fosamax each week to help build her bone density. So she called my office asking “Is there anything else I can do before I take these medications to improve my bone density?”

Many women in the perimenopausal and post-menopausal stage (particularly the post-menopausal age group), develop osteopenia, which is a precursor to osteoporosis. Combatting Osteopenia is important because it increases the risk of fractures both in the spine and the hip, which can be the most devastating for women as they age. Even instances like falling and breaking your wrist or your ankle can occur when the bones are thinning.

I started thinking about all the factors that go into the strength and density of our bones—A less obvious body type came to mind — people who are very thin and have a low BMI are at risk for osteopenia because weight bearing causes the skeletal system to remodel. Women who are very thin and lacking muscle or at the very bottom of the BMI range are at higher risk for osteopenia and osteoporosis because their bones aren’t carrying around as much weight. In that case increasing weight a little bit, preferably within a normal BMI range, can be protective.

The next solution is weight bearing exercise. A very simple example of weight bearing exercise would be jogging or walking (an exercise like swimming isn’t going to help improve bone density because most of your body weight is carried by the water.) At a minimum, we need the effects of gravity on our body to put weight on the skeletal system.

Weight and resistance training is essential to remodeling our bone and adding density. When we lift weights or experience resistance training, some of our muscle fibers tear including some of the fibers that are attached to the bone. As our body rebuilds our muscles we achieve that bone remodeling as well. Physical activity is one of the core ways to improve the bone density.

Another reason menopause and andropause can cause the onset of osteoporosis and osteopenia, is because as our hormone production decreases, we’re losing the positive effects of hormones on the bones.

For example, estrogen blocks a cell called an osteoclast. ‘Osteo’ means bone and ‘clast’ means it breaks it up or consumes it. So Estrogen stops osteoclasts from eating up the bone material. As we go through menopause and we lose estrogen, the osteoclasts that break down the bone become more active.

In addition, progesterone, which is another female hormone we lose when we stop ovulating and cease periods, stimulates another kind of cell called an osteoblasts. Again, ‘osteo’ for bone, ‘blast’ for build. Progesterone stimulates the cells that help build bone. Testosterone, as well as some other androgen hormones like DHEA, also help to improve the strength of the bone. So the loss of some of those hormones with menopause and andropause are why we see the incidence rates of osteopenia rise after that time.

There are some other hormonal influences on bone loss, primarily in the realm of cortisol. Cortisol is an adrenal hormone that we release in response to stress. It’s our body’s natural form of things like prednisone that might be used to treat asthma, an infection, or pneumonia. High levels of cortisol or even the steroid medications that people get for joint injections or asthma can cause the bone to thin. They can be a contributor to osteoporosis and osteopenia. So getting cortisol levels under control, and getting off medications that might contribute to it are useful.

So once we’ve looked to the pillars of health to address the issue, it’s also important to make sure the bones have all of the substrates and minerals they need to improve their density- things like magnesium, calcium, and boron. We need to make sure that our diet is high in those things or that we’re supplementing them.

Two particularly important vitamins are vitamin D and vitamin K. Vitamin D and vitamin K are important not because they go directly into the bone, but vitamin D helps us absorb more calcium and Vitamin K2 ensures that once the calcium is absorbed, that calcium goes into the bone. It helps to target the calcium we intake and send it to the bone. We don’t want calcium going, say, to the kidneys where it can cause kidney stones, or to the heart vessels, where it can lead to plaque formation and heart disease.

So as we’re increasing calcium intake and vitamin D intake, it’s very important to add vitamin K to the diet to make sure it goes to the right place.

Dietary influences are very important. When I talk about diet and nutrition, it gets to be a little bit of a broken record because we need to target a lot of the foods. Foods can have an acidic quality or an alkaline quality, and when foods are acidic, it leaches the calcium out of the bones. And I’m going to give you one guess as to what the most acidic food is—– it’s sugar.

Just like all the other problems and imbalances that we talk about with sugar, sugar exacerbates this problem as well. Carbohydrates are all acidic foods,  we want to target the diet to be say 75% of what we call alkaline, which is the opposite of acidic.

Vegetables are alkaline foods. So, like any healthy diet, the majority of our diet should be vegetables and if you’re not a vegetarian, then a little bit of lean meats, chicken, fish and things like that sprinkled in with some whole grains or healthy, complex carbohydrates.

In summary, there are many ways that you can take control of your osteoporosis or osteopenia without having to end up taking a prescription medication.

Lauren Loya MD