What You Don't Know About Osteoporosis

What keeps aging bones strong?

For years, I thought I knew.

When I first began my career in Integrative Medicine, integrating conventional and alternative approaches to healing, I felt I had a pretty good handle on the good and bad of bone health.

Don't smoke. Watch your alcohol intake. Drink plenty of milk. Don't be a vegetarian. Eat meat. Watch your weight. Was the weight thing really a risk factor? Didn't know, but it seemed like a good idea. Exercise and whenever possible, don't fall down. And whatever you do, don't get old. Old means brittle bones. Not much you can do about brittle bones once you got them. And vitamins seemed like a good idea.

Well, it turns out there was a lot more I had to learn. And along the way, came up with a slew of things I didn't know about osteoporosis. So here are the pearls -- some little, some huge -- I have found which continue to help my patients and myself as we age.

This is the first of three articles on what helps keep bones healthy and strong -- and what does not. We will be covering both prevention of and treatment for osteoporosis for women as well as men.

Don't Smoke?

True. Smoking is a well-defined contributor to osteoporosis. But it is also true if you are a smoker it can only help if you quit. Bones are living tissue and will remodel over time -- given the right kind of love and supplements and diet.1

Diet and Calcium Intake

We are all aware of the importance of high calcium intake in our diet and the need to take calcium supplements to protect our bones -- generally recommended by physicians to be at least 1200 mg a day. We see this regularly on television advertisements, hear this on the radio, and view it on the Internet as well.

We're also told how important it is to drink milk or take dairy -- yogurts of various name brands, cheese from happy cows in California and make sure we got milk with our chocolate chip cookies. That way we can help build strong bones and stave off osteoporosis, perhaps even help reverse it.

So it's a rather serious blow to the dairy industry, not to mention the current mythology of Calcium, to see the following five major studies -- including studies on children and young adults -- which rather clearly and quite emphatically state: "SORRY, CHARLIE. NOT TRUE." In fact the Harvard study suggests there may be an increased risk of fractures if one is taking calcium supplements.2-6

Evaluating over 190 thousand men and women over a period of time of up to 18 years, these studies concluded, "Neither milk nor a high-calcium diet appears to reduce risk. These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures. And for men we also find, "In conclusion, these results do not support a relation between calcium intake and the incidence of forearm or hip fractures."

Some studies put qualifications on all this myth shattering. Oxford says dietary calcium matters in younger women, but not so very much in older women and not in men at all. The British Journal of Nutrition says there may be an increased risk of fractures only if dietary calcium levels are extremely low. 7, 8

What's to believe? Is nothing sacred?

Bottom Line: Calcium -- either dietary or supplement sources - by itself does not offer any clear or consistent benefit in preventing osteoporosis or reducing fracture risk in anyone.

That certainly ruined my day when I realized some years ago that all the milk I was drinking was of -- at best -- questionable benefit for my bones. And yours as well. So did this mean calcium was totally out?

Calcium and Vitamin D Intake

One of the studies which showed no benefit from calcium intake alone also showed that of the 72,337 women who took Vitamin D in adequate amounts there was a 37% lower risk of hip fractures. The National Institutes of Health and the National Cancer Institute in their September, 2007 conference on Vitamin D concluded "Combined calcium and vitamin D supplementation decreases the risk of bone fracture and increases bone mineral density but vitamin D alone does not." 9

This conclusion about the ineffectiveness of vitamin D alone, however, was based upon relatively low doses of the vitamin as we will see below.

Bottom Line: Besides military secrets, medical truths may be perhaps the most fleeting of all. But for now, it is a reasonable approach to be taking adequate amounts of Vitamin D with Calcium to protect against fractures. In my clinical practice I routinely recommend 1200 mg of highly absorbable calcium combined with Vitamin D and the other nutrients listed below. So calcium by itself? Not so helpful. But with its colleague, vitamin D, this is a good thing.

What is an adequate amount of Vitamin D to take?

In March, 2007, an international group of medical University based Vitamin D researchers -- including those from Harvard, Switzerland, London, Germany, Australia, Finland, New Zealand and Canada -- urgently appealed for higher doses of D to be recommended to the general population. They urged policy makers to increase the daily recommended levels to significantly higher amounts for all adults. Their reasoning was straightforward. Higher intake of vitamin D is not only safe but is essential to provide optimal health and protection against disease.10

What diseases does vitamin D protect against? Besides osteoporosis, vitamin D deficiency causes muscle weakness and increases the risk of cancer, hypertension, type 1 diabetes, heart disease, infection, multiple sclerosis rheumatoid arthritis and other auto-immune diseases.11

And vitamin D deficiency is not an occasional issue. It is in fact, a worldwide epidemic.12

Higher doses approach the optimal levels of this crucial nutrient. The currently recommended dose of 400-800 IU per day "is not based on current evidence and is viewed by many as being too restrictive...Human clinical trial data... support a significantly higher" intake, and "are sufficient to show that vitamin D is not toxic at intakes much higher than previously considered unsafe." Furthermore, "the absence of toxicity in trials conducted in healthy adults that used vitamin D dose greater than 10,000 IU" per day "supports the confident selection of this value" as the tolerable daily intake level.13

Some proponents suggest 1000 IU a day should be taken. Yet the reviews we have seen, in fact, suggest the margin of safety is actually more than 10 times higher than the currently recommended daily intake.10

Caveat for smokers: High intake of vitamin D may increase a smoker's risk of cancer in one study of Finnish smokers. Smokers should maintain lower normal blood levels until further data is available.14

Bottom Line: Regardless of intake, you should have your blood levels of vitamin D checked by a DEQAS certified lab.15

In my clinical practice, I routinely measure vitamin D levels on almost all patients and ask patients to take between 2000 and 10,000 IU per day to achieve optimal blood levels of 25(OH) vitamin D.

The health risks associated with suboptimal levels of D go far beyond that of osteoporosis. I encourage all of us to take enough D to maintain blood levels of 40ng/mL to 80ng/mL to support optimal health. (Of course with the calcium).

In Part 2 of "What you don't know about Osteoporosis" we'll take a look at Bioidentical Hormone Replacement Therapy and its controversies and answer the question if being overweight can actually reduce your risk of osteoporosis. See you then!

Joseph Sciabbarrasi, M.D., has practiced Integrative Medicine in West Los Angeles since 1993. In addition to his work with Osteoporosis, Bioidentical hormone replacement therapy, Cardiovascular and Chelation therapies, he also lectures, writes and celebrates his weekends with his wife, Kathleen and their 8 year old son, Kieran. Join him at his website: www.drjosephmd.com

References

1. Wong PK, et al. The Effects of Smoking on Bone Health Clin Sci (Lond). 2007 Sep;113(5):233-41.

2. Lanou AJ, et al. Calcium, Dairy Products, and Bone Health in Children and Young Adults: a Reevaluation of the Evidence Pediatrics. 2005 Mar;115(3):736-43

3. Feskanich D, et al. Milk, Dietary Calcium, and Bone Fractures in Women: a 12-year Prospective Study. Am J Public Health. 1997 Jun;87(6):992-7

4. Owusu W, et al. Calcium Intake and the Incidence of Forearm and Hip Fractures Among Men. J Nutr. 1997 Sep;127(9):1782-7

5. Feskanich D, et al. Calcium, Vitamin D, Milk Consumption, and Hip Fractures: a Prospective Study Among Postmenopausal Women. Am J Clin Nutr. 2003 Feb;77(2):504-11

6. Bischoff-Ferrari HA, et al. Calcium Intake and Hip Fracture Risk in Men and Women: a Meta Analysis of Prospective Cohort Studies and Randomized Controlled Trials Am J Clin Nutr. 2007 Dec;86(6):1780-90.

7. Key TJ, et al. Calcium, Diet, and Fracture Risk: a Prospective Study of 1898 Incident Fractures Among 34 696 British Women and Men Public Health Nutr. 2007 Nov;10(11):1314-20. Epub 2007 Mar 19.

8. Xu L, et al. Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies. . Br J Nutr. 2004 Apr;91(4):625-34.

9. Brannon PM, et al. Overview of the Conference "Vitamin D and Health in the 21st Century: An Update". Am J Clin Nutr. 2008 Aug;88(2):483S-490S.

10. Reinhold Vieth, et al. The urgent need to recommend an intake of vitamin D that is effective. American Journal of Clinical Nutrition. Vol. 85, No. 3, 649-650, March 2007.

11. Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005 Nov;135(11):2739S-48S.

12. Holick MF, et al. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.

13. Hathcock JN, et al. Risk Assessment For Vitamin D. Am J Clin Nutr. 2007 Jan;85(1):6-18.

14. Rachael Z. Stolzenberg-Solomon, et al. A Prospective Nested Case-Control Study of Vitamin D Status and Pancreatic Cancer Risk in Male Smokers. Cancer Research 66, 10213, October 15, 2006. Published Online First October 15, 2006; doi: 10.1158/0008-5472.CAN-06-1876.

15. D E Q A S Vitamin D External Quality Assessment Scheme.

 

Comments

[GunneraGirl]

this article recommends 'highly absorbable calcium'. what exactly does this mean?

and do my regular calcium / magnesium supplements meet this criterion?

[Idytme]

I read a very interesting paper about insulin and it seems like insulin (not sugar, but blood circulating insulin) decreases the absorption of calcium. The person who wrote the paper turned people onto a low carb diet and actually reversed osteoporosis. EFA's do play a role, and since they are inhibited by blood circulating insulin, it makes since that in another set of papers I read that ballet dancers were able to reverse their bone damage *just* by adding EFA's to their diet.
I love science, but it has turned into sort of a Darth Vader/ Jedi situation in journals as you cannot do a definitive paper unless you are comparing this to that. But our bodies are so much more complicated than that and respond to probably hundreds of inputs that cannot be easily dissected into A or B.
Vitamin D, no doubt has a major role, but lets not forget about the Inuit who live in the same conditions as Sweden (the highest rate of osteoporosis) and have a very low rate of it if they are eating a native diet. The two main differences between the two is a low carb diet,and a diet high in EFA;s.
We can't make "the body simple".

[GunneraGirl]

that's very interesting about the inuit v. the swedish.

efa's are the one supplement i will not do without. if i miss taking them, as when i run out and then don't get to the store for a few days, i definitely feel the difference. and in the winter time, they make the difference between waking up feeling optimistic and happy versus suffering from S.A.D. and waking up feeling sad.

[devadasi]

What are efa's?

[Birgitta Lauren - Huffpost Blogger]

Absolutely calcium wont work on its own!. And of course it works better with vitamin D. But just like ingredients in a cake recipe, ALL nutrients need to be present for any of them to do their job. Ever tried baking a cake with just flour? There are 31 necessary nutrients for proper bodily functions. and Calcium needs it's co-workers: vitamin D preferably from some sunshine, magnesium, vitamin C, and weight bearing exercise. Exercise improves absorption rate of calcium into bones. without exercise absorption is dismal.
For any study to say calcium is useless without adding all the other ingredients into the story is irresponsible of the scientists who came up with it. the Harvard scientists either do not understand proper biochemistry or the study is most likely paid for by a drug company that prefer to sell a drug and is designed to confuse/misinform the public.

[ddanimal]

I'm surprised there was no mention of vitamin K2-a necessary enzyme cofactor for bone mineralization.

From www.lef.org

Osteoporosis and Vitamin K2 Intervention—the Evidence
Since it was first discovered in 1929, vitamin K has been best been known for its crucial role in the blood-clotting process. Since that time, scientists have uncovered compelling evidence that vitamin K plays an equally important role in bone health.

The majority of vitamin K research to date has focused on vitamin K1, the dominant dietary form of vitamin K that occurs in green, leafy vegetables. Yet it appears that vitamin K2, which occurs in organ meats, egg yolks, and dairy products, is a more important inducer of bone mineralization in human osteoblasts (bone-building cells) than vitamin K1.4

People living in the Japanese regions where this dish is eaten have several-fold greater blood levels of vitamin K2 (MK-7), accompanied by less osteoporosis and bone fractures.­6

These findings are supported by clinical trials, in which vitamin K2 has been shown to successfully reduce the incidence of bone fractures. A two-year Japanese study found that vitamin K2 (MK-4) reduced the incidence of vertebral (spine) fractures by 52% in 120 patients with osteoporosis, compared with patients who did not receive this nutrient.7

[vincealy]

On e of the leaders in the field of vitamin d research Dr, Holick http://www.vitamindhealth.org/?p=40
Watch the videos.

[Dr. Patricia Fitzgerald - Huffpost Blogger]

Welcome to Huff Post, Dr. Joe! Great piece. Looking forward to Parts 2 & 3.

[RMankovitz]

Excellent article.

You can get a simple Vitamin D home bloodspot test (it is monitored by a licensed MD) that is then sent to a lab to determine your Vitamin D level. For more information, Google: vitamin d blood spot test .

If your level is low, D3 supplementation is readily available at just about any health food store. I prefer an emulsified version, since there is some anecdotal evidence that it has higher absorption from the gut. For more information, Google: emulsified vitamin d3 .

Roy Mankovitz, Director
http://www.MontecitoWellness.com

[GunneraGirl]

at what level can you overdose with D? i've been doing 5000-10000 per day for a while now, and i've been wondering ...

[RMankovitz]

Since it varies for each person, the protocol is to test about every three months and adjust the dose accordingly.

[RMankovitz]

Since it varies for each person, the protocol is to test every three months and adjust the dose accordingly. The goal is to stay in the 50-80 ng/ml range.

[Dokadow]

Vitamin D supplementation is by far the single most important factor in maintaining general health. Everyone is deficient in the fall-early spring despite what your doctor says. THE HEALTHY LEVEL OF ACTIVATED VITAMIN D3 IS AT LEAST 50 NG/ML !!!

Get a blood test at any one of numerous sites or call your doctor.

For years those familiar with the therapeutic effects of vitamin D supplementation were trying to tell anyone who would listen ‘more vitamin D, less calcium!’ Finally it seems to be sinking in.

We are depleted of this vital nutrient and eating foods containing vitamin D is not nearly enough to achieve a healthy level. Supplementation is a must with moderate sun exposure in months with enough high angle sun to do the trick. We use to get 90% of our vitamin D via sunbathing but this was incorrectly deemed hazardous. The truth: we need lots of sun!

It was announced Tuesday, Nov. 4 in Toronto Canada that breast cancer is a disease whose origin is almost wholly based in vitamin D deficiency. This is official and irrefutable. See the Grassroots Health Vitamin D'action web site for the announcement.

Is anyone listening out there? Breast cancer can be almost completely eradicated by maintaining healthy, natural levels of activated vitamin D. And who will take my bet that autism is the result of systematic and prolonged vitamin D deficiency in the pre-natal and neo natal states?

Get the facts at: The Vitamin D Council

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