Bone health

It’s more than just thin bone — the top 10 myths about osteoporosis

by Dr. Susan E. Brown, PhD

We’ve heard a lot in the media lately about the rise in osteoporosis and how this disorder is affecting more women than ever before. There are ads on TV and in magazines, warning us that we might be losing bone and recommending that we ask our doctors about this drug or that one to stop the process. If you’re like many of the women I talk with, you’re probably wondering, Are my bones really breaking down? And is medication the only way to stop it from happening?

The answers floating around out there are confusing and sometimes untrue, making an already overwhelming situation seem that much worse. It’s true that osteoporosis is affecting many people. An estimated ten million people in the United States have osteoporosis, and another 34 million are at high risk for the condition due to low bone density. But osteoporosis is often portrayed as a problem that simply “arrives” in your body without clear causes, and this is not the case. There are many known factors that can lead to osteoporosis, but the great news is that osteoporosis can be treated, and even significantly reversed, with a natural approach.

Women have maintained healthy bone for centuries without prescription medication. There are lots of changes you can make to naturally improve your current bone health and prevent future bone loss without using expensive medications for the rest of your life. If you’ve been confused about osteoporosis, don’t be discouraged. Let’s take the first step in preventing, halting, and reversing osteoporosis by clearing up the facts.

Myth 1: Osteoporosis is a result of normal aging.

Cross-cultural studies show us that throughout the world, most individuals do lose bone mass as they age. But simply losing bone does not equal osteoporosis. The remaining bone of a healthy aging woman is strong and capable of constant self-repair. This bone, though lower in mass, should be able to withstand the stresses and strains of daily activity.

In osteoporosis, bone loss goes beyond that of normal aging. It is a condition in which bone becomes excessively fragile due to a loss of both mineral and protein matrix. If we look at the research and the brilliance of the human body, it becomes clear that osteoporosis happens when the body attempts to compensate for factors interfering with its normal biochemical balance. Some of these factors include poor nutrition, lack of sunlight exposure and low vitamin D levels, high caffeine intake, lack of exercise, inflammation, an acid-forming diet, the use of various prescription medications, and chronic stress.

Removing even one of the above factors can make a difference. If cared for, the body is perfectly capable of building and maintaining lifelong healthy bones.

Myth 2: Osteoporosis is only a disorder of the elderly.

It may come as a surprise, but more and more young women and men are being diagnosed with osteoporosis. Hormonal imbalance and poor nutrition are two serious factors that may be leading to this.

The lack of adequate nutrients can have a major impact on bone health regardless of where it comes from — whether it’s related to an individual making poor food choices, limiting food intake to lose weight, or simply suffering from a physical condition that affects the body’s ability to absorb nutrients, when someone has insufficient nutrients for long periods of time, the bones suffer. Researchers have found that anorexic individuals, training ballet dancers, and other high-intensity athletes who under-consume nutrients while trying to remain slim can seriously compromise their bone health. Individuals with celiac disease and other digestive disorders, or people who have low body weight for any reason, can be at higher risk for osteoporosis.

Poor bone health is also related to many kinds of hormonal imbalances — diabetes, menstrual irregularities, ovary and/or uterus removal, and long-term steroid therapy can all lead to poor bone health. The two problems are interrelated, as poor nutrition affects hormonal balance — and neither one is restricted to the elderly.

In fact, we’re seeing increasing fractures among the young. Forearm fractures — the most common in children — have increased by 32% in males and by 56% in females over the last three decades. Interestingly enough, obesity seems to be associated with the increased risk of forearm fracture.

With the efforts toward prevention and treatment of osteoporosis in the chronically ill — including children — as well as those with hormonal imbalances and nutritional issues, we can see that osteoporosis involves the whole body and affects many more than just the elderly.

Myth 3: Women are physiologically predisposed to osteoporosis.

In the US and other Westernized countries, more women have osteoporosis than men, which is probably why osteoporosis is held to be largely a disorder of women. But men are not immune to it. Between one-quarter and one-third of all hip fractures occur in men. And it is estimated that 30% of all men over 50 will have an osteoporosis-related fracture during their lifetimes.

I believe the difference in osteoporosis incidence between men and women is partially influenced by our roles in society. As women, we are inundated with messages like, “You can never be too thin,” and “You’re not feminine if you build muscle mass.” Unfortunately, these messages draw many women to unhealthy diets and unnatural weight loss. It’s extremely difficult to consume the nutrients required for bone maintenance, much less those needed for bone growth, on a diet that restricts certain food groups. And during periods of inadequate nutrient intake, bone is robbed of the precious minerals that make up its matrix. Low muscle mass also puts women at a higher risk for osteoporosis. Strong muscles are a good indicator of strong bones, but it takes strenuous activity to build strong muscles, and to this day many more men engage in strenuous activity than do women.

As I mentioned before, osteoporosis is a natural human response to imbalances in the body. Though it happens more in women, it certainly isn’t something that only women get. And because we know more and more about the causes of osteoporosis, there are ways to prevent, and even to reverse the process by restoring balance to the body.

Myth 4: Osteoporosis is caused by low estrogen.

Estrogen does play a role in bone health by increasing calcium absorption in the gut and by preserving calcium in bone, but it is by no means the only factor that prevents osteoporosis. The idea that a natural lowering of estrogen at menopause causes osteoporosis suggests that nature made a mistake in her design of female physiology, and that women should have been provided with lifelong high estrogen levels.

From an anthropological perspective it’s clear that a woman’s estrogen production is gauged by her body’s needs. So the normal universal decrease in estrogen production after a woman’s reproductive years is most likely beneficial to her survival. After all, greater total lifetime exposure to estrogen is a major risk factor for cancers of the breast, endometrium (the lining of the uterus), and possibly others. Less estrogen is produced in menopause because less is needed. In healthy women, there are certainly other ways to keep bone strong without the use of supplemental hormones.

Myth 5: Osteoporosis is caused by low calcium intake.

Increasing calcium is certainly one way to strengthen bone — but we have to look at it in context. It’s been the opinion of Western researchers for decades that low calcium intake leads to osteoporosis. Because bone is composed largely of calcium, it might appear logical to link calcium intake directly with bone health. But in reality calcium depends on other nutrients to do its work, and so just increasing calcium without other bone-building nutrients may cause more harm than good.

What’s interesting is a glance at the cross-cultural data, which shows us that most areas of the world have lower calcium intake than we do, yet have lower rates of osteoporosis. In fact, it has been documented that the countries with the highest calcium intake have the highest hip fracture incidence. So more calcium doesn’t automatically equal stronger bone.

All researchers agree that adequate calcium is absolutely essential for development and maintenance of bone health. The question so often asked is, how much calcium is adequate? The data I’ve looked at indicate that there is no one standard ideal calcium intake, but that it varies based on a number of other coexisting factors. These factors include digestive health; intake of other bone-building nutrients; consumption of potentially calcium-depleting substances like excess protein, salt, fat, and sugar; the use of some drugs, alcohol and tobacco; the level of physical activity; exposure to sunlight; environmental toxins and stress; ovary and uterus removal; and many other factors that limit absorption and endocrine gland functioning.

Myth 6: Osteoporosis is common all over the world.

Looking around the world, we see that osteoporosis occurs in some areas much more than in others — just as the incidence of cancer, heart disease, and diabetes varies from one culture to another. This clarifies that the development of weak bones is not a natural artifact of aging. While the United States has one of the highest osteoporosis rates in the world, there are other areas where this disorder is relatively rare, even among the older segments of the population.

For example, the inhabitants of Singapore, Hong Kong, and certain sectors of former Yugoslavia, as well as the Bantu of South Africa have traditionally held extremely low rates of osteoporotic fracture. In Japan, vertebral compression fractures among women between ages 50 and 65 were so rare that many physicians doubt their existence, and the incidence of hip fractures among the elderly Japanese historically has been much less than half that of Western countries. Africans and native peoples living traditional lifestyles have been classified as “almost immune” to osteoporosis. Interestingly enough, as these less technologically advanced countries become more Westernized, their rates of osteoporotic fracture are steadily increasing.

As you can see, osteoporosis is more about a collection of contributing factors rather than one deficiency or another. Here’s another example:

Myth 7: Osteoporosis is caused by faulty bone metabolism.

As I mentioned above, osteoporosis is really our magical body’s intelligent response to long-term imbalances and stressors. I like to call bone “the great giver of life” because it serves as a nutrient reservoir. When the blood is low on minerals, nutrients are drawn out of the bone to compensate. Without adequate blood levels of calcium, phosphorus, magnesium or sodium, the body cannot survive. When the body’s other alkali reserves run low, compounds are drawn from bone to buffer body acids and maintain our all-important pH balance.

The immediate effect of drawing minerals and buffering compounds out of bone is for the most part a positive one — indeed, a matter of survival. Blood mineral levels return to normal and pH balance is maintained, allowing the body to continue functioning. If the mineral compounds are not redeposited to the skeleton, however, osteoporosis results as a long-term negative effect of repeated, short-term, positive coping processes.

Osteoporosis is really the end product “disorder” of our body’s lifelong attempt to maintain a crucial internal “order.” If we look at it this way, osteoporosis can be seen as a positive, life-supporting, coping mechanism that allows the body to maintain the necessary degree of internal balance under less than ideal, perhaps even life-threatening, circumstances.

Myth 8: Osteoporotic fractures occur because of low bone density.

For decades it has been assumed that thin bone was the sole cause of osteoporotic fractures. The assumption was that once bone reached a certain level of thinness, it became subject to fracture more easily. But this is not the full story. Bone does not fracture due to thinness alone; that is, low bone mineral density by itself does not cause bone fractures. We know this by these two simple documented facts: many people with thin, osteoporotic bones never fracture; while at the same time, more than half of all fractures occur in people who do not have an “osteoporotic” bone density.

What then distinguishes the thin osteoporotic bones that do fracture from those that do not? The answer to this question concerns two characteristics of bone other than mineral density: bone architecture and the self-repair capability of bone. When analyzed from a structural-architectural point of view, we find that nature in all her wisdom has provided each of us with plenty of surplus bone. We have such a large bone mass safety reserve, in fact, that even with an osteoporotic bone density, most of us have enough bone mass to withstand the stresses and strains of daily activity without ever sustaining a debilitating fracture.

Bones that fracture are weak because they lack the ability to repair themselves properly from the microfractures that regularly occur due to normal stress and strain. So bone that fractures isn’t only thin, but also of poor quality with diminished self-repair capability. Self-repair can be inhibited by many factors, including lack of nutrients and exercise, an acid-forming diet, systemic inflammation, various medications, an overload of chemicals and pollutants, and the like.

Myth 9: Once bone loss occurs, it is impossible to rebuild bone.

Bone is dynamic, living tissue that constantly repairs itself. Similar to the cells of our skin, bits of old, worn-out bone are replaced by fresh new bone regularly. Tiny microfractures occur daily and are healed through a several-week process of bone repair. When full fractures occur, our bones spontaneously heal and generate new bone. Equally, we have a capacity to rebuild lost bone mass.

This regenerative capacity of bone is clearly seen in those severely malnourished (as in anorexia), and in cases of prolonged illness or lengthy immobilization. While all of these conditions cause a great loss of bone mass, this bone can be rebuilt with the normalization of proper nutrition plus regular physical activity. This regenerative capacity of bone is especially potent in both females and males before midlife, when hormonal levels are still high. Nonetheless, substantial rebuilding of lost bone has been documented at all life stages. Even nursing home residents (with an average age of 81), were shown to build bone mass doing light exercises and taking calcium and vitamin D daily.

Unfortunately, the common misconception that lost bone is gone forever has led many to turn to bisphosphonate drugs such as Fosamax, which fall into the class of osteoporosis medications known as antiresorptive drugs. These medications dramatically reduce bone loss (resorption) by bringing premature death to osteoclasts, the cells that break down and recycle old, worn-out segments of bone. Bone breakdown and bone build-up, however, are tightly coupled, so that just as bone breakdown is dramatically reduced by Fosamax, so too is new bone formation. In fact, studies show that the bone-forming surface of bone is suppressed by 60–90% with the usual dose of bisphosphonates. As Dr. Susan Ott, a bone specialist at the University of Washington, notes, “Many people believe that these drugs are ‘bone builders,’ but the evidence shows they are actually bone hardeners.”

The reason for the confusion is that in bone density tests, Fosamax often appears to increase bone density. As Dr. Ott explains, “This is because the bone is no longer remodeling, and so there is not much new bone. The older bone is denser than the newer bone; there is less water and more mineral in the bone, and the radiographic techniques thus measure the higher density.” While this looks like new bone tissue, it isn’t. Antiresorptive drugs like Fosamax and Actonel, as their very name implies, simply halt bone breakdown — they do not actually build new bone. (Read our article on drug therapy for osteoporosis to learn more.)

Myth 10: Osteoporosis is an isolated condition.

Osteoporosis does not stand alone. It is not an isolated disease process that happens to fully healthy people. Excessive bone thinning and the development of weak bones occurs with due cause. And the due cause of osteoporosis is often associated with other health problems. Lifelong patterns of poor eating, little exercise, smoking, irregular periods, surgeries, and medication use, plus toxic exposure, and excessive stress take their toll on the whole body, not just the bones.

A 1994 study done on 10,000 older American women found an increased risk of hip fracture among those who rated their own health as fair to poor and indeed were less fit than others of their age. Interestingly, the following risk factors were found to raise a woman’s risk regardless of her bone density:

• Being unable to rise from a chair without using one’s arms
• Being on one’s feet for less than four hours a day
• Not walking for exercise as opposed to walking for exercise
• Having poor depth perception and/or poor contrast sensitivity.
• Having a resting heartbeat of 80 or greater beats per minute

Studies increasingly document that individuals with osteoporosis and fragility fractures often experience other health problems. For example, the coexistence of osteoporosis and cardiovascular disease has been frequently noted, as has the association between declining kidney function and osteoporosis. The more closely we look and the more variables we study, the more interesting becomes the osteoporosis story.

Your body already knows how to build strong bone

Bone loss is not a “mistake” made by your body. It happens as a natural protective measure when your body is out of balance over several years. There are many ways to bring your body back into balance so that your bones don’t have to be called on so relentlessly. You can start simply by giving your body the nutrients it needs in the form of a high-quality nutritional supplement and by learning more about our Better Bones Alkaline for Life nutrition plan.

The bottom line is that our bodies require micronutrients and minerals to carry out their daily functions. Our bones are built on these minerals. They’re also maintained by the vitamin D we make from sunshine and by the stimulation of regular movement. If you stop and listen to the wisdom of your body, you’ll see that many of the factors that promote strong bones come instinctually. Just as a plant knows to take water into its roots or open its leaves for the sun, you too have Nature’s prescription for bone health written in your genes. Forget the myths and listen to your body.

Related to this article:

References & further reading on myths about osteoporosis

 

Last Modified Date: 05/25/2011
Principal Author: Dr. Susan E. Brown, PhD