RAY D. STRAND, M.D.

Specialist in Nutritional Medicine

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Osteoporosis
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Osteoporosis is an epidemic nutritional deficiency in the United States. More than 25 million Americans suffer with this disease at the cost to the economy of the U.S. of approximately14 billion dollars each year. At least 1.2 million fractures occur each year in the United States as a direct result of osteoporosis. Spontaneous compression fractures of the vertebrae of the back cause tremendous pain and suffering for those with osteoporosis.

It is easily forgotten that bone is active, living tissue, and is continually remodeling itself through osteoblastic (bone forming) and osteoclastic (bone resorbing) activity. It is constantly engaged in biochemical reactions, which are dependent on many different micronutrients and enzyme systems. Therefore, like any living tissue, bone has diverse nutritional needs. It is not just a collection of calcium crystals.

In order to reduce the risk of fractures of the spine, hip, and wrist, we must pay attention to several factors: 1) preserving adequate bone mass, 2) preventing the loss of the protein matrix, and 3) making sure the bone has all the proper nutrients to repair and replace damaged areas of bone.

The American diet, with its high intake of white breads, white flour, refined sugars, and fat, has been shown to be deficient in many of the essential nutrients needed for healthy bones. Inadequate intake of any of these nutrients will contribute to osteoporosis. All of these nutrients must be present at optimal levels if we are going to have any effect on decreasing the amount of osteoporosis in this country.

Calcium
No doubt calcium deficiency can lead to osteoporosis. However, studies have shown that skeletal calcium depletion was present in only 25 percent of postmenopausal women. Calcium supplements in these women were found to increase bone mass; however, the supplements had no effect on the other 75 percent who were not calcium deficient. Recent studies of calcium and vitamin D supplementation have shown a slowing down of osteoporosis but not prevention. These studies have also shown a reduction in fractures of the hip, spine, and wrist.

Calcium is an essential nutrient in the fight against osteoporosis. You will get some calcium from your diet-the average American consumes approximately 700 mg daily. But calcium should be taken in supplementation at a level of 800 to 1,500 mg daily. Children also need this level of supplementation. In fact, studies show that children given this level of calcium prior to puberty will increase their bone density by nearly 7 percent. As a result the increased bone density will be carried with them throughout their lifetime.

Magnesium
Magnesium has many important functions throughout the body, including maintaining the electrical conduction of the heart. Magnesium is also important in several biochemical reactions taking place within the bone. Alkaline phosphatase, which is an enzyme required in the process of forming new bone crystals, is activated by magnesium. Vitamin D needs magnesium to convert it to its most active form. If there is depletion in magnesium, this can lead to a syndrome of vitamin D resistance. Dietary surveys have shown 80 to 85 percent of American women consume a magnesium-deficient diet.

Vitamin K
Vitamin K is required to synthesize osteocalcin, a protein found in large amounts within the bone. It is therefore critical in bone formation, remodeling, and repair. In a series of studies with osteoporosis patients, it was found their vitamin K concentration was only 35 percent of the control subjects. Clinical evidence shows for patients who have osteoporosis, the need for vitamin K is much greater.

Vitamin D
Vitamin D is absolutely necessary if we are to have any chance of absorbing calcium from our diet. A recent study in the New England Journal of Medicine showed that 93% of the acutely ill medical patients entering Massachusetts General Hospital were deficient in vitamin D. Even though vitamin D is produced in the skin when it is exposed to sunlight, as patients age they spend less and less time out in the sun and vitamin D deficiencies become very common. Vitamin D taken orally must be converted to its biologically active form, vitamin D3. Impaired conversion of vitamin D to its active form may be more of a problem than deficient intake. This gives rationale to the supplementation of vitamin D by using the active form, vitamin D3. Studies show patients with osteoporosis treated with vitamin D3 increased calcium absorption and reduced bone loss.

Manganese
Manganese is necessary for the synthesis of connective tissue in cartilage and bone. Like magnesium, manganese is lost in the processing of whole grains into refined flour. A study of osteoporotic women showed that the manganese level was only 25 percent of the control group.

Folic Acid, Vitamin B6, and Vitamin B12
Homocysteine (see Cardiovascular Disease) is not only bad for your blood vessels, it is also bad for your bones. Individuals with severe elevations of homocysteine have been found to have significant osteoporosis. Elevated homocysteine levels in the blood causes significant inflammation of the arteries and has now been shown to be an independent risk factor for hardening of the arteries. Elevated homocysteine levels are the result of a nutritional deficiency of folic acid, vitamin B12, and vitamin B6.

An interesting point about homocysteine is the fact that premenopausal women have great efficiency in breaking down methionine and not having a buildup of homocysteine. This changes dramatically after menopause. Postmenopausal women have much higher levels of homocysteine. Could this in part explain both the increased risk of heart disease and osteoporosis in postmenopausal women? The fact remains these women need higher amounts of folic acid, vitamin B6, and vitamin B12.

Boron
Boron is an interesting nutrient in relation to bone metabolism. When boron is given in supplementation, the urinary excretion of calcium decreases by some 40 percent. This means that boron helps conserve our calcium.

Silicon
Silicon is important in its ability to strengthen the connective tissue matrix by cross-linking collagen strands which strengthens bone. Patients with osteoporosis, in whom a generation of new bone is desirable, need increased amounts of silicon.

Zinc
This mineral is essential for the normal functioning of vitamin D. Low serum zinc levels are found in the serum and bones of patients with osteoporosis.
It is clear osteoporosis is not simply a calcium and estrogen problem. When you supply all of the nutrients needed for bone metabolism, you give yourself a greater chance of avoiding osteoporosis. Estrogen therapy is a decision you and your physician must make.
Osteoporosis has been presented to the public as a disease merely dependent on estrogen and calcium. However, it is important to know estrogen slows down the loss of bone but does not prevent it. There is growing concern over the possible increased risk of breast cancer in women who are on estrogen replacement.

In 1997, the New England Journal of Medicine reported a review of the medical literature wherein they found women who'd been on estrogen replacement for more than 5 years had over a 40 percent increased risk in developing breast cancer when compared to those women who did not take estrogen replacement. This is a grave concern to me. Why are physicians prescribing routine estrogen replacement, when conclusive evidence shows a significant increased risk for breast cancer?

Physicians justify their treatments by saying the good of estrogen replacement outweighs the bad. Estrogen replacement has been touted to decrease the risk of heart disease, possibly Alzheimer's dementia, and the risk of osteoporosis, while at the same time decreasing the patient's symptoms of menopause. However, recent studies indicate otherwise. ERT actually increases the risk of having a heart attack and stroke as well as increasing one's risk of developing ovarian cancer. Please refer to my September/October 2002 Bionutrition Newsletter for details.

Osteoporosis can be treated more safely and effectively through natural means. It is critical for adults to eat a healthy diet and develop a modest exercise program. Weight resistance exercises need to be part of one's program as they are a necessary component in stimulating the body to make more bone. Walking may help the lower legs but does little for the back and hips; upper body weight resistance exercises such as lifting weights over your head are critical to anyone who is trying to protect herself or himself from this devastating disease.

The cellular nutrition I offer further provides all the optimal levels of nutrients needed to build and preserve strong bone.

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