More than eight million American women have osteoporosis, and another twenty-seven million are at risk due to low bone mass, according to 2014 data from the National Osteoporosis Foundation. The disease is responsible for more than 1.5 million fractures a year. Osteoporosis (the word means “porous bones”) is a serious problem in which the skeletal system weakens and fractures easily. It may be accompanied by pain, especially lower back pain, loss in height, and body deformity.
Eighty percent of those affected are women, with postmenopausal women being at greatest risk. Osteoporosis is attributed to the gradual loss of calcium. In women, this loss begins in the mid-thirties at a rate of 1 to 2 percent a year, and can increase during menopause to a rate of 4 to 5 percent a year.
In the past, osteoporosis was thought to be an inevitable part of the aging process, particularly in women. Now most of us know that it is treatable and, more important, preventable.
According to naturopathic physician Dr. Jane Guiltinan, the most likely candidates for osteoporosis share a number of characteristics:
Contrary to what we’ve been told, large quantities of calcium rich dairy products in the diet can actually contribute to the condition of osteoporosis. If you asked your physician or your dietician or your nutritionist what would help prevent or reverse osteoporosis, the answer would be dairy products. Not true. It’s just the opposite. Dairy products cause osteoporosis. Acid blood is a condition induced by the consumption of acidic foods. Extra quantities of protein from animals or stress with the accumulation of hazardous waste products within the body creates osteoporosis because the parathyroid glands are forced to balance the pH levels of the blood by releasing excess calcium from the bones. So the moment that you eat anything even though it makes you feel good and even though it’s a comfort food and even though you’re used to it, your bones are releasing calcium to balance out the high levels of acid to correct the pH.
A lot of women suffer from faulty calcium assimilation due to a deficiency of silica or phosphorous, while others may have a malfunctioning of the thyroid or parathyroid glands, which are responsible for calcium metabolism. The parathyroid glands control the level of calcium in the blood by secreting hormones that can be balanced, if you understand the right way of taking calcium in. During a calcium shortage, excess calcium, which is stored in the bones, joints, and soft tissues, is discharged in the bloodstream, and that reduces the bone loss. So you see it’s not just in what you do, but it’s also what you don’t do.
Registered nurse and acupuncturist Abigail Rist-Podrecca notes, “When I was in China, we noticed that no dairy was used. We expected to see a high incidence of osteoporosis, rickets, and other bone problems. In fact, we saw the lowest incidence. In the west, dairy is used a lot and osteoporosis is rampant. Something is not quite right here.” Three main factors responsible for the Chinese not getting osteoporosis, she learned, are diet, weight-bearing exercise, and acupuncture.
Dr. Sangeeta Pati, a board-certified physician who has practiced traditional and holistic medicine for two decades, explains that several hormones are responsible for bone health. As we age, hormone production declines, and this in turn can contribute to osteoporosis.
Progesterone is actually the first hormone in the body to decline. “The time to really look for this is the late thirties and early forties because that’s when we start losing most bone,” Dr. Pati says. Among the other hormones that may decline are testosterone, which promotes bone formation; estradiol, which prevents bone loss; DHEA, a precursor to testosterone; thyroid; and growth hormone.
In the past, osteoporosis was not diagnosed until the condition was so advanced that patients began to break their bones. Today, however, bone mineral density testing is being used to detect the disease and those at risk for developing it. New guidelines issued by the National Osteoporosis Foundation in 2014 recommend that every woman over the age of sixty-five have a bone density test. For post-menopausal women, the test is recommended if there are risk factors for fracture, such as excessive thinness, cigarette smoking, a previous fracture in adulthood, or a family history of fractures.
Bone density testing is noninvasive and takes only a few minutes to perform. It provides a measurement known as a T-score. T-scores can indicate normal bone density, low bone density, or osteoporosis.
Because progesterone starts to decline in the thirties and forties, Dr. Pati suggests that bone density testing be conducted much earlier than is currently recommended. “I find that the best way to know whether there is bone loss is to look at the urine bone markers,” she says. “There are a number of urine bone markers, but one of the common ones is Urine N Telopeptide. It’s called Urine NCX, and it’s literally a measure of how much bone you are leaking out in the urine. If that number is under thirty-five, you know that you have that process under real good control.”
Conventional treatment often involves the use of prescription medications. Synthetic estrogen was the traditional drug of choice for postmenopausal osteoporosis and its prevention, but controversy surrounds its safety and effectiveness. Among the other drugs that are used are biophosphonates, selective estrogen receptor modulators (SERMs), calcitonin, teriparatide, and tamoxifen.
Dr. Saralyn Mark, an endocrinologist and women’s health specialist, is often asked whether estrogen prevents osteoporosis. “It’s an important question,” she says. “I think with a lot of the results from the Women’s Health Initiative that came out over the last few years there has been a lot of concern about estrogen therapy and the risk for heart disease, stroke, and cancer. What we did see in the study was that estrogen did decrease the risk of hip fracture and overall bone fractures. Those women who select to go on estrogen for whatever reason need to talk to their doctors about checking their bone mass before they go on it and then for a period of time after they go off it because the effects of estrogen after you go off it don’t continue for years and years.”
The first step in osteoporosis prevention is noting whether or not you are at high risk for the condition, says Dr. Guiltinan. Obviously, certain risk factors cannot be changed, but many can be addressed, and will prevent the destructive effects of the disease.
A diet that is low in animal products and high in plant foods promotes bone growth and repair. Green, leafy vegetables contain vitamin K, beta-carotene, vitamin C, fiber, calcium, and magnesium, which enhance the bones. Other calcium-rich foods include broccoli, nuts, and seeds. Sesame seeds have high calcium content. The Chinese, who as mentioned earlier have low rates of osteoporosis, use sesame often in their foods, and cook with sesame seed oil.
Foods to avoid include sugar, caffeine, carbonated sodas, and alcohol, as these contribute to bone loss. Chicken, fish, eggs, and meat are also contraindicated. These are high in the amino acid methionine, which the body converts into homocysteine, a substance that causes both osteoporosis and atherosclerosis.
The official recommended dietary requirement for calcium for people at risk of osteoporosis is 1, 200 milligrams per day for women aged 51 and older. I recommend that women over twenty-five take approximately 1, 000 milligrams in supplement form and an additional 500 to 1, 000 milligrams from the diet. For those over forty, supplements of 1, 500 to 2, 000 milligrams are needed. Women on estrogen replacement therapy require about 2, 000 milligrams.
Vitamin D is also important. You can get this from food, supplements, and sunshine. “I often recommend to patients that if they have problems with their diet they can get a little bit of vitamin D from just going outside fifteen minutes a day,” says Dr. Mark. “I know that causes a lot of concern for people because we’ve done such a good job getting the message about sun protection to prevent skin cancer. But again, ten to fifteen minutes a day shouldn’t be much of a problem, and we know that it’s very helpful to allow your body to make its own vitamin D.” The official recommendation for vitamin D is 800 to 1, 000 IU per day, including supplements if necessary for people aged 50 and older.
In addition, the following nutrients are critical for keeping bones strong:
A balanced vitamin/mineral supplement will provide most of these nutrients. It is best to take zinc separately, however. Otherwise, it can have an adverse effect on vitamin and mineral absorption. Also recommended are black cumin seed oil (1tsp, 2x day), coconut oil (1tsp, 2x day), emulsified cod liver oil (1tsp), and Cytokine Supress with EGCG (300mg).
Research indicates that natural progesterone from wild yams is safer and more effective than estrogen in that it builds strong bones and has no harmful side effects. Dr. Jane Guiltinan notes, “Estrogen minimizes calcium loss from bones, but progesterone can actually put calcium back into bones.” Natural progesterone can be taken in pill form. It also comes in a cream form. Half a teaspoon should be rubbed into the skin over soft tissue and the spine, twice a day, for two weeks out of every month.
DHEA is important in the prevention of numerous chronic conditions asso-ciated with aging. As we get older, there is often a drop in DHEA. I recommend that you increase the DHEA to 25 to 50 milligrams a day unless you have breast or pancreatic cancer.
Dr. Pati explains that bioidentical hormones should be used. A hormone interacts “like a lock and a key with a receptor site on any organ that it’s going to affect,” she says. “A bioidentical hormone would be a hormone that is molecule per molecule identical to the human body. It could be made from soy or yam, or even synthetically, but the end product one is something that is molecule per molecule identical.”
This distinction is important and sometimes difficult to detect. For example, Dr. Pati says, “there are some over-the-counter creams that are yam derived, but we have to remember that these are literally wild yam progesterone, which means molecule to molecule they do not bind with receptors exactly the same way as human progesterone.” To remedy this, the product can be modified in a compounding pharmacy by essentially “cutting off all the extra molecules that don’t match the human body.”
To protect the bone, the progesterone level should be between 5 and 10 nanograms per deciliter, Dr. Pati says. “That’s the level that you’re looking for. I usually find that women who are progesterone deficient are also complaining of other things like anxiety and sleep issues, so I generally use the progesterone orally and it gets converted in the liver to 5 alpha pregnenolone.”
Some herbalists recommend horsetail, taken as a tea every day, to restore bone strength and density. They add that dandelion root tincture will promote absorption of calcium. The micronutrients important for bone flexibility and strength are found in the greatest abundance in seaweeds, dandelion, and nettles, and in organic vegetables and grains.
Dr. Howard Robins, former director of the Healing Center in New York City and coauthor of Ultimate Training and How to Keep Your Feet & Legs Healthy for a Lifetime, stresses the importance of weight-bearing aerobic and weight-lifting exercises for osteoporosis prevention.
Aerobic exercises use major muscle groups in a rhythmic, continuous manner.Weight-bearing aerobic exercises such as brisk walking, jogging, stair climbing, and dancing produce mechanical stress on the skeletal system, which drives calcium into the long bones. Non–weight-bearing aerobic exercises such as biking, rowing, and swimming are not as helpful in osteoporosis prevention, but they do promote flexibility, which is useful for people prone to arthritis.
People “need to perform aerobic exercises anywhere from three to five or six times a week,” says Dr. Robins. “You need a day off every third or fourth day so that the body can heal and reenergize.”
“Most women stay away from weight training because they are afraid of developing huge muscles like Arnold Schwarzenegger,” says Dr. Robins. “The good news is, that won’t happen. No matter how hard she trains, a woman will never get huge muscles unless she takes steroids to alter her body’s metabolism.”
Not only is weight training safe, it is important for preventing osteoporosis. As muscles are pulled directly against the bone, with gravity working against it, calcium is driven back into the bones. It also stimulates the manufacture of new bone. This adds up to a decrease in the effects of osteoporosis by 50 to 80 percent. People need to do weight training two to three times per week for fifteen to thirty minutes. All the different muscle groups should be worked on. Twentyfour hours should lapse between sessions to rest muscles. For women, an exercise program should be started long before the onset of menopause.
A complete routine is more than aerobic and weight-training exercises only. It incorporates warm-ups at the beginning and cool-downs at the end of a routine. Warm-ups are not to be confused with stretches. Rather, they are gentle exercises that produce heat by getting blood to flow into the muscles. To warm up leg muscles, for example, one could lie down on one’s back and move the legs like a bicycle, or walk gently in place. Moving the arms and joints gently in all their ranges of motion will warm up the upper body. Warming up the body helps prevent injuries.
After exercise, when the body is loosest, stretching is performed. Stretches are long, continuous pulls, not bounces. Bouncing only tightens the muscles and can lead to injury. Dr. Robins’s book Ultimate Training describes a holistic workout in detail. Aromatherapist Ann Berwick adds that essential oils enhance a warm-up and cool-down routine. “Before exercise, use warming and stimulating oils, such as black pepper, rosemary, ginger, and sage. Additionally, eucalyptus helps to deepen breathing. After exercise, you can apply a blend of lemon, rosemary, and juniper. These help to carry away waste products and ease any stiffness.”
Dr. Saralyn Mark also stresses the importance of exercise, and says that a lot can be done without even going to the gym. “What we need to understand is that what you do to your bones affects every part of your life. You can do just what you need to do in your daily life to maintain bones. For example, just walking up stairs or doing housework. People often complain about doing housework. Well try to look at it as if you’re doing something great for your body.”
Yoga prevents osteoporosis by building and fortifying bone mass, keeping muscles strong and flexible, improving posture, and helping balance and coordination. Physical therapist and yoga teacher Bonnie Millen explains why this is important: “With yoga, the old adage ‘Use it or lose it’ applies. Building and maintaining bone mass is most important for preventing osteoporosis. Remember, bone is alive. Yoga is unique in that it incorporates weight bearing on the upper extremities. This is important because many wrist, forearm, and upper arm fractures occur when people reach forward with outstretched arms as they are falling.
“Also important is building and maintaining muscle strength and flexibility. Let’s keep the muscles strong so that they can receive the stress before the fracture happens. Also if the body is strong and flexible, it can cushion falls when they occur.”
What about posture? “Good posture improves overall functioning and prevents osteoporotic fractures of the spine,” Millen says. “I teach yoga to a lot of older women who tell me they are afraid of getting a dowager’s hump. This is where the body slouches forward and there is a hump on the back. Just take a moment to get into that posture where your chest caves in and your shoulders slump forward, with your head looking down toward the floor. Try to raise one arm up as if you wanted to touch the ceiling, and see how high the arm comes up. Now let the arm down and come into a nice seated posture, as if someone were going to take your picture. Sitting very tall, raise your arm up and see how high it goes. You can see from that little exercise that the slouched posture really decreases your range of motion. That makes it difficult to function. This is why you want to keep a good posture.”
The dowager’s hump can create additional problems. Millen explains: “By placing great pressure on the spinal vertebrae, the dowager’s hump often leads to compression fractures of the spinal column. This is very painful, as you can well imagine, and you do not have to do anything special for it to happen. Just going up and down stairs or taking a step can cause breakage.”
Yoga also helps to improve balance and coordination. “When you are balanced and coordinated, there is less chance of your falling in the first place,” Millen says. “You are quicker to respond. And that can help prevent fractures.”
Millen points out that there are several styles of yoga, but that all systems have foundation poses that address the above needs. Here she outlines a few basic postures:
DOWNWARD-FACING DOG—This posture strengthens bone mass in the wrists and arms. In this pose, you stand and bring your hands to the floor so that the space beneath you is triangular. One part of the triangle is from your hands to your hips, and the other part is from your hips to your heels. The space on the floor between your hands and your feet is the third part. As you hold the position, you will feel that you are bearing weight on your arms.
WARRIOR POSES—These poses increase muscle strength and flexibility as well as balance. Here you are standing with your legs three to four feet apart, depending on your height. With your legs apart, you work at the hip to turn one leg out to the side. The other leg is turned slightly inward. That really works the hip muscles, which is important in helping to prevent the all-too-common osteoporotic hip fracture. The arms are either held out to the side or up over the head, depending upon which warrior posture it is.
COBRA—This is a back-bending pose that helps posture and gives flexibility and strength to the paraspinals, the muscles of the back of the spine. To begin, lie facedown on the floor. Using the back muscles, sequentially lift the head and chest away from the floor.
SIMPLE STRETCH FOR CHEST MUSCLES—This is another exercise for improving posture that is especially helpful for women who tend to slouch forward. Take a blanket and fold it to resemble a box of long-stemmed roses. Lie down on this bolster, making sure that your head and your entire spine are completely supported. Place your arms out to the side or up to form a V-shaped position with the palms facing up toward the ceiling. Just allow gravity to relax the shoul-ders down to the floor. Shoulders should not be on the blanket. Breathe deeply. That will expand the intercostals, the muscles between the ribs. This is important because the intercostals become constricted with slouching. That, in turn, decreases lung capacity and causes all the organs to become compressed. This is a wonderful pose where you don’t have to actually do anything. You just allow gravity to work for you and your breath to move through you.
Millen says that the best time to begin yoga is before osteoporosis sets in. “The time to begin a yoga practice, or any exercise, is not when you’ve gotten to menopause, and all of a sudden you realize, ‘Oh my gosh! I’m at risk for osteoporosis.’ You need to build bone mass throughout your whole life so that you have bone stored up. It’s like preparing for retirement. You build up bone mass through exercise, you eat right, you maintain a healthy lifestyle. Then, when you reach your menopausal years, you’ve got a good store of bone mass to help protect you.”
This technique, developed by Yamuna Zake, a bodyworker in New York City, uses a sixto ten-inch ball in a series of routines designed to elongate muscles and increase blood flow in all parts of the body. As you relax your body weight onto the ball, the ball applies pressure onto bone, stimulating even bone that has begun to ossify to “wake up.” “To me,” says Zake, “bone is like dried fruit. Just as a raisin plumps up after you put it in water, when bone is stimulated and becomes alive, it undergoes a subtle change, acquiring a supple quality.
“Studies have found that, by stimulating bone, weight-bearing exercise can prevent and possibly reverse osteoporosis. Weight bearing is nothing more than pressure exerted on bone. Body rolling is actually a mild form of weight-bearing exercise in which the pressure is never more than the person’s own body weight.”
As mentioned earlier in this chapter, in China, osteoporosis is the exception rather than the norm. When it is present, acupuncture is used. Acupuncturist Abigail Rist-Podrecca explains how this works: “The Chinese use an electrical stimulus along the spine. The electrical impulse actually helps the bone stem cells, which are the reproductive cells of the bone, to reproduce, thereby strengthening the bone mass. It was very exciting to see this because we have some Western studies proving that peripheral stimulation by electricity, espe-cially in the long bones in the leg, help this process also.” She adds that women low in calcium need to take this supplement so that the body has the raw materials for making bones denser. When weight-bearing exercises are added, the benefits are remarkable.
Homeopathy can be used as an adjunct to the nutritional and lifestyle factors discussed above. Among the remedies to consider are the following:
CALCAREA PHOSPHORICA—This may help where the bones are weak, soft, curved, and brittle. It can be given for a long period of time.
CORTICOID—Homeopathic corticoid is for painful posttraumatic osteoporosis, especially when it affects the hip. Consider this remedy for an elderly person who has fractured her hip because of osteoporosis.
PARATHYROID—For diffuse pain in the bones, especially the long bones. Walking is very painful. Often, there is pain in the ankles, hips, and knees.
Regarding the appropriate potencies for these substances, the late homeopathic physician Dr. Ken Korins said, “For acute conditions, meaning they come on suddenly, and they are very intense, use a 200c potency. That is a very dilute potency, but energetically speaking, it is very powerful. For more chronic conditions, where you will be giving the remedy for a longer period of time, you might want to start with 12c or 30c. In general, the remedies should be taken as three to four pellets placed under the tongue. Take them on an empty stomach. Wait fifteen to twenty minutes before or after eating. Avoid coffee and aromatic substances, such as mints, perfumes, and camphors, which can interfere with the remedies’ effectiveness. Also, it is a good idea not to touch remedies with your hands because any residues from perfumes or other substances can interfere with their energetic properties.”
An increasing body of evidence is showing the benefits of natural modalities to overall health and well-being. Following is a sample of recent peer-reviewed scientific studies relating to osteoporosis.
A 2011 study published in the British Medical Journal examined the effect of dried plum on bone loss in osteopenic postmenopausal women. When compared with a control group that received dried apple, the participants who received dried plum (100 grams/d) experienced significantly increased bone mineral density of the ulna and spine. In response to a 2010 analysis indicating that calcium supplements increased the risk of heart disease, Dr. Alan Gaby wrote in the Townsend Letter in January 2011 that although the results should be interpreted with caution, it would not be surprising if long-term monotherapy with calcium caused imbalances with other nutrients. This has occurred with other substances, including zinc, magnesium, and alpha-tocopherol, and the problem can be avoided by supplementing calcium with magnesium and silicon. Food sources of silicon include bananas, wheat bran, green beans, root vegetables, soybean meal, and beer.