Osteoporosis is a condition affecting the bones, characterized by a decrease in both bone mineral density (BMD) and bone strength. It is a global concern, impacting 10.2 million adults over the age of 50 in the US alone, with nearly 9 million people experiencing fractures related to osteoporosis worldwide. As the population continues to age, it's important to focus on lifestyle choices that promote bone health throughout life.
Bones are made up of living cells and their health is largely influenced by lifestyle factors. They come in various shapes and sizes and play a crucial role in supporting the body's structure and movement, as well as protecting organs. Bones contain a matrix of collagen, minerals (especially calcium), hormones, growth factors, and immune cells. Bone marrow, located in the center of bones, contains stem cells that are responsible for producing red blood cells (RBC), white blood cells (WBC), and platelets, all essential for overall health.
The skeletal system undergoes regular remodeling, which is important for bone health and regeneration. This process can vary in speed depending on different factors. The primary cells involved in building and breaking down bone are osteocytes, osteoclasts, and osteoblasts. Osteocytes help maintain bone tissue health. Osteoblasts are responsible for building new bone, while osteoclasts break down old bone to make room for new growth. When osteoclasts break down more bone than osteoblasts can build, it can lead to a reduction in bone mass, contributing to osteoporosis.
Bone density is not the only factor in bone health. Maintaining muscle strength to support bones and prevent injury is also crucial. As people age, loss of muscle strength can lead to reduced function, range of motion, and an increased risk of falls. Bones need to be strong and flexible to withstand pressure, similar to how trees need to be strong and flexible to withstand the forces of nature.
Understanding lifestyle choices that can impact bone health is important for maintaining bone health as you age.
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Osteoporosis Signs & Symptoms
Osteoporosis often progresses without noticeable symptoms. Many individuals are unaware of their bone health until they undergo routine screening or experience a fracture. However, some subtle changes may indicate osteoporosis, such as:
- Loss of > 1.5 inches in height and a rounded upper spine: This can occur due to the bones in the vertebrae collapsing from reduced density. X-rays may show small fragility fractures. In some cases, a fragility fracture without a BMD scan can suggest osteoporosis.
- Dental Health: Less dense jawbones may shrink, affecting how the gum attaches to the bone, potentially leading to receding gum lines. Other dental issues may also suggest poor bone health.
- Hand Grip Strength: Grip strength is a strong indicator of decline in older adults. A weak grip strength may correlate with low BMD.
- Weak, Brittle Finger Nails: Nails share similar properties to bones. While there are many reasons for weak nails, such as occupation or hobbies, poor nail quality may suggest suboptimal bone health.
- Muscle and Bone Pain: These can be associated with low Vitamin D, an important nutrient for bone health. Individuals with Vitamin D deficiency may experience pain symptoms.
- Night Cramps: These painful cramps may be related to low levels of calcium, magnesium, and vitamin K, all important for bone health.
- Fractures: In people over 50, sustaining a fracture often leads to a Bone Mineral Density (BMD) assessment. Some studies suggest that while there is a known association between lower BMD and increased fracture risk, osteoporosis is not the leading cause of fractures and can only predict them in 30% of cases.
Osteoporosis Possible Causes
Bone health reflects the overall health and balance of the body. While bone density naturally decreases with age, it's important to explore potential causes when this process is accelerated. These may include:
Age, Gender & Race
Women, especially those over 50, are more commonly affected due to hormonal changes during peri-menopause, menopause, and post-menopause. However, younger women and men can also experience low bone density. Men account for 29% of osteoporotic-related fractures and, when the hip is involved, have higher morbidity and mortality rates compared to women. Hormones play a role in bone health by supporting bone metabolism and osteoblast activity. Race can also influence bone health, with Native Americans having a higher incidence.
Sedentary Lifestyle
Lack of movement contributes to reduced bone density and muscle mass, leading to weakness, gait instability, and loss of balance.
As people age, this loss of muscle mass, known as sarcopenia, is associated with higher rates of falls and fragility fractures seen in osteoporosis.
Chronic Stress
Chronic stress can impact bone health in several ways. Stress triggers immune system activation, which may require minerals like calcium to be used in countering inflammation. If there aren't enough available minerals, the body may break down bone to access them.
Stress can also reduce stomach acid, impairing the body's ability to digest essential nutrients needed for healthy bones.
Additionally, sustained stress can lead to high levels of cortisol, a stress hormone. Elevated cortisol may signal the body to lose more calcium in urine rather than depositing it in bones.
Chronic stress can also affect hormone levels, including progesterone and estrogen, which play roles in bone health. Estrogen supports bone biology and may help reduce bone resorption, while progesterone works with estrogen to support bone mass.
Diet
A diet high in refined sugar can cause oxidative stress, which may lead to an immune response and increased cortisol levels, potentially resulting in more calcium loss from bones.
Medications
Proton Pump Inhibitors (PPIs) and other acid-suppressing medications are associated with an increased risk of osteoporosis, even in young adults. PPIs reduce stomach acid production, which can affect the breakdown of proteins and release of essential nutrients for bone health.
Other medications like steroids, diuretics, seizure medications, antidepressants, chemotherapeutic drugs, and anticoagulants can also impact bone metabolism.
Nutrient Deficiencies
Calcium is important for bone health, but several nutrients work together to maintain bone density. For example, Vitamin D supports calcium absorption and utilization, while Vitamin K is needed to make osteocalcin, which helps bind calcium in bones. Low levels of these nutrients can affect bone mineral density.
Food Sensitivities
Consuming foods that the body perceives as threats can cause inflammation in the gut, triggering immune system activation and potentially leading to bone breakdown. Inflammation can also affect nutrient digestion and absorption, impacting bone health.
Toxins
Exposure to toxins can contribute to chronic inflammation, which may affect bone density. Toxins can include heavy metals like lead or aluminum, chemicals in personal hygiene products, pesticides, plastics, alcohol, and smoking.
Genetics
Genetics may increase the likelihood of developing osteoporosis, similar to other conditions.
Functional Medicine Labs to Test for Osteoporosis
Scans
The traditional method of assessing BMD is through a Dual-energy X-ray Absorptiometry (DXA) scan, a low-dose x-ray. The USPTF recommends screening for osteoporosis starting at age 65 for women. There is insufficient data to support routine screening in men, but those with risk factors may be advised to have earlier screening.
A DEXA scan provides a T-score comparing bone health to that of a healthy 30-year-old. Normal bone density is indicated by a T-score greater than -1.
Osteopenia, an early sign of bone loss, presents a T-score between -1 and -2.5.
T-scores below -2.5 are consistent with osteoporosis. The DEXA scan also provides a Z-score, comparing findings with individuals of the same age, gender, and race.
FRAX
The Fracture Risk Assessment Tool (FRAX) is used to assess fracture risk. By considering age, gender, race, BMD scores, and medical history, this tool can help predict a person's 10-year fracture risk. Along with lifestyle changes, it can guide decisions on pharmacologic management.
Lab work can provide insights into bone health. These include:
Basic Laboratory Markers
Traditional lab work can offer insights into bone health. A Comprehensive Metabolic Panel, CBC w/ differential & platelets, and Vitamin D 25OH can provide information about nutrient levels, blood cell health, and the immune system.
Inflammation
Inflammation, a factor in osteoporosis, can be assessed by testing C-Reactive Protein (hs-CRP) and ferritin. Elevated CRP indicates inflammation. Ferritin, primarily used to evaluate anemia, can suggest chronic infection if elevated. These labs can help explore further causes of osteoporosis.
Hormones
Hormones Panel: Hormone health is important for optimal bone density as they influence osteoblast and osteoclast activity.
Testing sex hormones like estrogen, progesterone, cortisol, and DHEA can provide guidance.
The Parathyroid hormone (PTH) helps regulate calcium and is another useful marker.
Gut Inflammation
For concerns about inflammation or dysbiosis, a Comprehensive Stool Test can identify possible pathogens and inflammatory markers in the stool.
Food Sensitivity Testing
Identifying and eliminating food triggers can help reduce systemic inflammation, supporting bone health.
Toxins
Total-Tox Burden & Organic Acid
This comprehensive test provides information about metabolic processes, amino acid health, and toxic burden, all of which play roles in bone health. For individuals with complex symptoms, this information can help prioritize steps towards wellness.
Functional Medicine Approaches for Osteoporosis
Food as Support
Learning which foods nourish the body is essential for overall health. Whole, organic foods may help reduce gut inflammation and support a healthy microbiome.
Consider gluten and dairy-free options if there is a presence of autoimmunity. Beverage choices are also important. Drinking clean water should be prioritized. Limiting or avoiding alcohol is advisable. Some beverages, like soda, may promote calcium loss in urine.
Physical Activity
For bone health, weight-bearing exercises can support bone regrowth. These may include strength training, HIIT, jump roping, jogging, dancing, or hiking. Incorporating movements that increase flexibility is also beneficial. Stretching after workouts, during TV time, or through yoga classes can help ensure flexible muscles and joints. Strength and flexibility are important for long-term bone health and function.
Mindful Eating
How you eat matters. Eating in a calm, relaxed environment can affect digestion. Being in a relaxed state supports proper digestion and absorption. Chewing food 20-30 times before swallowing can help slow down, enjoy meals, and enhance digestion.
Stress Management
Reducing stress is important for overall health. Techniques to reduce stress include deep breathing exercises, meditation, journaling, faith or spirituality practices, singing, dancing, spending time with pets or loved ones, or enjoying nature. Finding a hobby that brings joy can also help. Reducing stress can shift the body from a fight-or-flight state to a rest-and-digest state, which may help reduce inflammation.
Minimizing Toxins
Choose foods without preservatives, chemicals, fillers, or pesticides. Replace synthetic fragrances with high-quality essential oils. Use the EWG database to find healthier alternatives for home and personal hygiene products. Opt for fish low in mercury, such as salmon, sardines, anchovies, and haddock.
Supplements
Depending on deficiencies identified in bloodwork, supplements may be considered. Osteoporosis is often associated with vitamin D, calcium, Vitamin K2, and magnesium deficiencies. Calcium is best obtained from foods due to potential risks associated with supplementation. In cases of Vitamin D deficiency, individuals over 40 may consider taking Vitamin K2 to help ensure calcium is directed to bones rather than blood vessels and organs.
Hormone Support
Hormone Support (HRT): Hormone levels can influence bone health. Estrogen or progesterone may help by supporting bone health. Depending on individual risk factors, hormone support may be a tool to consider for bone health.
Medications
There are several medications available for managing osteoporosis, including hormone support. Bisphosphonates are commonly used to help manage bone breakdown, although they may have side effects. Medications can play a role in managing osteoporosis, especially in the short term, while supporting the body in other ways to promote bone health.
Summary
Osteoporosis is a condition that affects many as they age. Since signs and symptoms can be subtle, it's important to take proactive steps to support bone health and prevent accelerated bone loss.
These lifestyle choices can start in one's teens, 20s, and 30s to help maintain strong, flexible bones later in life. Prioritizing healthy nutrition, stress management, and engaging in weight-bearing and stretching activities are important steps in supporting bone health.
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