A year ago, I told you the story of Mary, a 27-year-old client of mine who had broken her leg in a low-impact fall and came seeking answers for why her bones were weak. In the 18 months that have passed since her accident, Mary has learned a lot about the underlying health issues that led to her fracture. I think her story has some remarkable lessons to offer.

First, let’s recall that Mary’s vitamin D was low — 24 ng/mL. After our consult, Mary went ahead with a vitamin D supplementation protocol of 50,000 IU per week for 8 weeks to raise her vitamin D levels to the 32 ng/mL minimum needed for bone health. However, she couldn’t get retested as planned because shortly after she started, she was involved in a car accident that injured her back. Her physician told her that he wanted to wait until she was off the anti-inflammatory medications before retesting her, so she simply had to assume that the restorative dose she’d taken had done its job. She did take a maintenance dose of 4000 IU per day in the interim, knowing that Maine winters tend to deplete vitamin D stores. When she was finally able to get re-tested, surprisingly, Mary’s vitamin D level had only increased by 4 ng/mL, from 24 to 28.

Why had her vitamin D level stayed low? It’s somewhat unusual that “front-loading” vitamin D won’t appreciably raise a person’s blood levels, so I realized that Mary’s problem might be more convoluted than we first thought. My first thought was that she might have an absorption problem — and since she said she had reported no obvious GI symptoms, I thought perhaps she had a “silent” disorder such as celiac disease, or perhaps hidden food allergies (and later testing showed that she indeed has multiple food allergies). But the story got even stranger when she recounted to me what she’d learned because of the car accident.

The car accident had taken place not long after our second consult. Mary was rear-ended, hard, by another car while her car was stopped. While checking her for spinal injuries, her primary care physician had ordered an MRI. This MRI uncovered a surprising fact: Mary has an abnormal thyroid. A normal thyroid gland is shaped like a butterfly, but Mary’s thyroid has only one “wing.” From this, you’d expect that Mary might have hypothyroidism, but as I mentioned in the earlier blog, her doctor had told her that her thyroid tested “normal.” Upon retesting almost a year after the car accident, though, Mary’s free T3 and T4 levels were high, not low — and excess thyroid hormones can be bone-damaging.

But there was still more. Mary asked to have a free cortisol blood test performed — one of the tests I generally recommend for a medical osteoporosis work-up, and particularly appropriate given her high stress levels. (Cortisol, for those who don’t know, is a stress hormone produced in the adrenal glands, and consistently high cortisol can be bone-depleting.) After almost a year of telling Mary it was a waste of time and money, in the end her doctor reluctantly ordered the test — and bet her $5 that it would show nothing of consequence. To his great surprise, it showed that Mary’s cortisol levels were at the high end of normal in the morning, and were significantly elevated above normal levels in the evening. The high cortisol levels help explain Mary’s recent bouts of insomnia, and are consistent with the high-stress life she leads. And it’s possible that they contribute to the weakness in her bones that led her to fracture.

These test results are building a picture of Mary’s bone health in which significant endocrine dysfunction, and possibly autoimmune disease, play a role. Let’s look at the pieces of the puzzle:

• Irregular menstrual cycles / possible sex hormone imbalance

• Vitamin D malabsorption / possible GI tract issue or autoimmune disorder

• Hyperthyroidism / possible thyroid hormone dysfunction • Hypercortisolism / possible adrenal gland dysfunction

Now, it’s worth noting that even though Mary has all of these issues going on, she feels like a normal, healthy young woman. She has energy, she feels pretty good, and if it weren’t for her broken leg and her car accident, she wouldn’t have discovered these problems until much, much later in life. If there’s a silver lining to both incidents, it’s that she has uncovered these issues sooner rather than later — while she’s still young enough to address them and build strong, healthy bone before her menopause transition.

Mary is continuing to explore the source of her endocrine problems, but for me, her experience underscores some of the points I like to make about bone health:

• A low-trauma fracture is osteoporosis “proof of the pudding” and should inspire a search for causes of bone weakening,

• it’s never too early OR too late to pay attention to your bones,

• bones do not stand alone — they are intimately connected with all our bodies’ other systems, and

• if you strive to have better bones, you will have a better body — whether you’re young or old.

In the last few years, I have been reporting about the decreased rates of osteoporotic fracture in the US, Canada, and other highly industrialized countries. I have also noted that these reductions are not due to the use of osteoporosis drugs. New data from Denmark confirms the same positive trend in this Scandinavian country.

Between 1997 and 2006 the hip fracture incidence rate in Denmark declined by 20% in men and 22% in women. During this same time period, use of osteoporosis drugs increased only 1.8% in women and 0.2% in men aged 60+. As the investigators report, the number of prevented hip fractures that could be attributed to drug therapy was only 1.3% in men and 3.7% in women.

So what’s behind Denmark’s drop in hip fractures? Well, researchers are still scratching their heads, but my vote would be increased awareness about — and use of — vitamin D. As I noted in a 2009 medical journal publication, there is good data to suggest that fracture rates worldwide could be reduced by 50% if everyone were to achieve a minimum 32 ng/mL vitamin D blood level.

I’m going to keep an eye out for even more research.

References:
Abrahamsen, B and Vestergaard, P. 2010. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006. Osteoporosis International, 21:373-80.

Brown, Susan E. 2008. Vitamin D and fracture reduction: An evaluation of the existing research. Alternative Medicine Review, 13(1).

I think it’s time we all put a little more muscle into our fracture prevention efforts.  Exercise, specifically strengthening tendons and muscles, can enhance bone and reduce risk of recurrent fractures.

This is most important for those of you who have already experienced a fracture and are therefore much more likely to experience another — especially if you had a fracture with only minimum trauma, like falling from a standing position.

Below, I share some exercises to strengthen the wrist and the spine — as well as a balance enhancement exercise that will help reduce hip fractures. 

To strengthen the wrist

Wrist fractures are the second most common of all osteoporotic fractures with some 400,000 occurring each year in the U.S. Wrist breaks most often happen if you fall forward and land on your hand.

Get started: Use hand weights, or even soup cans. With the weight in hand, flex the wrist up, then down, and then in a circle for full range of motion. Do 20 repetitions of each movement, gradually using heavier weights.

To strengthen the spine
Vertebral body fractures are the most common of all low trauma fractures in both women and men. Several studies have shown that back strengthening exercises reduce the risk of a first or recurrent spinal fracture. Any movement that strengthens your back extensor muscles (those muscles which go up and down the sides of the spine) will enhance spinal bone density and significantly reduce fracture risk.

Get started: Practice the back extensor chest lift daily, as shown below, to reduce the incidence of new spinal fracture. Start with one rep a day and work up to 20 reps a day for five days a week. For extra strength, you can add a weighted backpack as illustrated below or wear a weighted vest. 

To reduce hip fractures

Nearly all hip fractures occur as a result of a fall, so balance enhancement ranks right along with leg strengthening for hip fracture prevention. The exercise below strengthens the lower body, improves balance, and is said also to enhance digestion.

Get started:  "A simple kicking the heel forward exercise builds both balance and leg strength. Stand firmly on both feet placing your hands on your hips, then lift up one leg by bending the knee, then push that foot out in front of you with foot flexed, thrusting the heel out. Hold on to a chair or table if you are unsteady. Begin with 10 reps on each leg and work up to 20.

If you have already fractured, it is wise to take a serious look at every step of our Better Bones Program.