Thirty-four million Americans are currently living with osteopenia; however, the incidence is expected to increase as our population ages. By 2030, over 20% of the United States population is expected to be over age 65. (33)
Early identification and management of osteopenia are important as they may help support bone health and reduce the risk of fractures. They provide an opportunity for lifestyle modifications that support bone health, such as dietary changes, exercise, and stress management. Early detection also enables timely consideration of various interventions if necessary. Overall, addressing osteopenia early contributes to long-term bone health, better quality of life, and the maintenance of mobility and independence. This article will discuss a functional medicine approach to managing osteopenia.
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What Is Osteopenia?
Osteopenia is characterized by low bone mineral density (BMD), which means the bones have lost some of their calcium and other minerals, making them weaker and more prone to fractures. It is a precursor to osteoporosis, a more severe condition where bone density is significantly reduced. Although osteopenia may not cause noticeable symptoms, it is important to address this condition to support bone health and prevent further progression.
What Causes Osteopenia?
An imbalance between bone remodeling and resorption processes in the body primarily causes osteopenia. Bone remodeling is a continuous process involving removing old bone tissue (resorption) and forming new bone tissue (deposition). This process helps maintain the strength and integrity of the skeletal system. (24)
In osteopenia, there is an increased rate of bone resorption compared to bone deposition. Several factors can contribute to this imbalance:
Aging
Bone density naturally decreases with age. Even in healthy people, bones begin to break down faster than they build up after age 35, causing bone density decreases by less than 1% annually (22).
Hormonal Imbalances
Hormonal changes can also accelerate bone loss. Estrogen plays a vital role in maintaining bone density by supporting the function of osteoclasts (cells responsible for breaking down old bone tissue) and promoting the activity of osteoblasts (cells responsible for building new bone tissue). Therefore, in states of low estrogen, such as in menopausal women, the rate of bone breakdown can surpass that of bone formation, leading to bone loss.
Similarly, progesterone and testosterone play a role in maintaining bone health in men and women by supporting bone formation and inhibiting bone resorption. Low progesterone and testosterone levels, which can also occur with aging, can increase the risk of osteopenia.
Other endocrine conditions characterized by excess thyroid hormone (hyperthyroidism) or parathyroid hormone (hyperparathyroidism) can increase bone resorption and calcium release from bones, leading to weaker bones. (22).
Nutrient Deficiencies
Inadequate intake of bone-specific nutrients can contribute to osteopenia.
Calcium is a crucial mineral for building and maintaining strong bones. Hydroxyapatite is a mineral form of calcium phosphate that is the primary component of the inorganic matrix of bones and teeth. It provides the structural framework of bones. Good sources of calcium include dairy products, leafy green vegetables (such as broccoli and kale), fortified plant-based milks, and calcium supplements if needed.
Vitamin D plays a critical role in calcium absorption and utilization. It helps regulate calcium levels in the blood and supports bone mineralization. The primary source of vitamin D is sunlight exposure, but it can also be obtained from fatty fish (e.g., salmon, mackerel), fortified dairy products, egg yolks, and supplements.
Phosphorus works in conjunction with calcium to form hydroxyapatite. Good sources of phosphorus include dairy products, meat, fish, nuts, and legumes.
Magnesium helps to activate vitamin D, influences the concentration of parathyroid hormone (PTH), and is a regulator of osteoblast and osteoclast cellular activity.
Vitamin K is necessary for the synthesis of proteins involved in bone mineralization. It helps direct and bind calcium to the bone matrix. Green leafy vegetables (e.g., spinach, kale), broccoli, and fermented foods are rich in vitamin K.
Adequate protein intake is essential for bone health as protein makes up a large portion of bone mass and volume, creating the structural framework for mineralization. Collagen is the body's most prevalent type of protein, comprising 25-35% of total protein mass. Vitamin C, copper, and manganese are essential micronutrient cofactors for the endogenous production of collagen.
Stress
Chronic stress has adverse effects on bone density. When the body experiences stress, activation of the HPA axis results in the release of cortisol. Elevated cortisol over an extended period can lead to increased bone resorption, impaired bone formation, nutrient imbalances, and reduced estrogen and testosterone levels (35). This is why chronic use of corticosteroid medications, such as prednisone, is also associated with an increased risk of osteopenia (22).
Lifestyle Factors
Lack of physical activity, especially weight-bearing exercise, and prolonged periods of inactivity can lead to reduced bone density (35).
Smoking has been linked to decreased bone density and an increased risk of fractures. Smoking interferes with bone remodeling and reduces estrogen levels in both men and women, contributing to bone loss. (1)
Chronic and excessive alcohol intake can have detrimental effects on bone health. It interferes with the absorption and utilization of calcium, decreases bone formation, and increases the risk of fractures. (17)
Insufficient body weight, such as in cases of underweight individuals or those with eating disorders, can lead to decreased bone density.
Certain medications, such as long-term use of glucocorticoids (steroids) or proton pump inhibitors (PPIs), can contribute to bone loss and osteopenia (35).
Osteopenia Symptoms
Osteopenia is often called a "silent" condition because it typically doesn't cause noticeable symptoms in its early stages. People with osteopenia may not experience pain or physical manifestations until the condition progresses, leading to more severe bone loss or fractures. (22)
How Is Osteopenia Diagnosed?
Osteopenia is diagnosed using a dual-energy X-ray absorptiometry (DEXA) scan, which measures bone mineral density. The results of this scan are compared to the bone density of a healthy young adult of the same sex, and a T-score is assigned. A T-score between -1 and -2.5 standard deviations below the average indicates osteopenia, while a T-score below -2.5 signifies osteoporosis. (33)
Functional Medicine Labs That Can Help Individualize Treatment for Osteopenia
Functional medicine labs are beneficial tools to assess underlying factors for low bone density so that functional medicine providers can create personalized and effective plans for supporting bone health.
Nutritional Assessment
A comprehensive nutritional assessment, such as Genova Diagnostic's NutrEval, analyzes biomarkers related to nutrient status, inflammation, and metabolism. The results of this test can be used to identify nutrient deficiencies and risks associated with low bone density, evaluate the patient's overall dietary patterns, and help personalize dietary recommendations to ensure nutritional needs are met.
Comprehensive Hormonal Panel
Doctors may order a thyroid panel, PTH, and sex hormones to assess endocrine imbalances that may contribute to dysfunctional bone remodeling and reduced bone mass.
Comprehensive Gut Assessment
Gut health is important for proper absorption of nutrients and supporting healthy hormonal levels required for maintaining bone health. Especially in patients with multiple nutrient deficiencies or symptoms of hormone imbalances, thoroughly evaluating the gut for signs of inflammation, dysbiosis, and malabsorption with a comprehensive stool analysis and serum celiac disease panel may be beneficial in addressing the underlying cause of the condition.
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Functional Medicine Approach for Osteopenia
A functional medicine approach to managing osteopenia focuses on addressing underlying factors contributing to increased bone resorption. The core options for individuals with osteopenia involve education on maintaining healthy bone mass levels through lifestyle modifications, optimizing nutrition with targeted dietary supplementation, and addressing root causes (e.g., chronic stress, digestive dysfunction, hormonal imbalances) based on lab findings.
Diet and Nutrition Considerations for Osteopenia
A nutrient-dense, anti-inflammatory diet, such as the Mediterranean diet, may support bone health by providing essential nutrients required for improving bone density and mineral content, reducing the risk of fractures, decreasing bone resorption, and reducing systemic levels of inflammation in the body. Additionally, this type of diet will support the endocrine and digestive systems of the body. A diet rich in fish, fruit, vegetables, legumes, low-fat dairy, nuts and seeds, and whole grains will provide sufficient protein and bone-essential micronutrients. (36)
Studies also show that incorporating prunes into the diet may help reduce bone resorption and inflammation, offering potential benefits for bone health.
Exercise Recommendations for Osteopenia
A combination of weight-bearing, resistance training, and balance training exercise is suggested for encouraging bone health and supporting balance. Weight-bearing exercises include walking, stair climbing, and jogging. Resistance training involves using weight machines, free weights, and resistance bands. Yoga and tai chi are forms of exercise that can improve strength and balance. (9)
Supplements Considerations for Osteopenia
The following discusses various supplements that may be considered for supporting bone health in individuals with osteopenia, including their potential benefits. This article will not discuss supplements specific to gut health or hormone balance, but these may be considered for individuals whose lab results indicate it is necessary.
Osteo-K Minis
In addition to providing 400 mg of calcium and 2000 IU of vitamin D daily, Osteo-K Minis also deliver 45 mg of MK4, a type of vitamin K2. Studies have shown that combined calcium and vitamin D supplementation may support bone health in postmenopausal women. Additional studies suggest that MK4 may support bone health in individuals with low bone density.
Dose: 2 capsules twice daily with food
Duration: Consult with a healthcare provider for personalized recommendations.
Collagen
Individuals not meeting daily protein requirements through diet alone may consider adding collagen peptides into their routine. Research suggests that collagen may support bone health. (8, 14). Other research suggests that taking collagen peptides to meet protein requirements is generally considered safe.
Dose: Consult with a healthcare provider for personalized recommendations.
Melatonin
Melatonin, a hormone produced by the pineal gland, is known for its role in sleep regulation but may also support bone health. It has antioxidant and anti-inflammatory effects, which may help reduce oxidative stress and inflammation. Melatonin may influence bone metabolism by affecting osteoblast and osteoclast activity. It also aids calcium balance, which is important for bone mineralization. Recent studies have shown that melatonin may have a positive effect on bone health in postmenopausal women. (18)
Dose: Consult with a healthcare provider for personalized recommendations.
When to Retest Labs
A DEXA scan may be considered every 1-2 years to monitor bone density. Functional medicine labs monitoring nutrient status, hormones, and gut health may be reordered every 3-12 months, as indicated by clinical necessity and doctor/patient preference.
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Summary
In this article, we explore a functional medicine approach for managing osteopenia, a condition characterized by decreased bone density. Functional medicine takes a comprehensive and personalized approach to address the underlying factors contributing to osteopenia, including nutrient deficiencies, hormonal imbalances, gut health, stress, and lifestyle factors. By targeting these root causes through dietary and lifestyle modifications, stress management, and natural supplements, a functional medicine approach aims to support bone health and prevent further bone loss.
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