By Dr Sandra Cabot

The bone thinning disease of osteoporosis is becoming more common. We can take effective steps to increase and maintain bone strength. You can increase your bone density to safe levels with the right tools.

Osteoporosis is a silent disease in that it is often not diagnosed until there has been a bone fracture and it is then harder to repair the bone damage. It is obviously better to prevent osteoporosis, and this is why it is important to check your bone density with a DEXA test at middle age especially if you have risk factors.

What causes Osteoporosis?

Osteoporosis is NOT just a calcium deficiency. Many factors affect our risk of developing osteoporosis such as:

• Advancing age
• Lack of exercise
• Low levels of vitamin D and vitamin K in your body.
• High levels of parathyroid hormone, which are commonly caused by longstanding unrecognized vitamin D deficiency. The parathyroid hormone levels usually normalize once the vitamin D is supplemented.
• A diet lacking in minerals such as calcium, magnesium, boron, strontium, manganese, zinc, copper and silicon.
• Low intake of vitamin C which weakens the collagen that gives bone its flexibility.
• Low levels of the sex hormones estrogen and testosterone, especially in women with a premature menopause.
• Medications such as long-term corticosteroids, antacid medications (which prevent adequate production of hydrochloric acid in the stomach), excess thyroid medication, and some anticoagulant drugs
• Excess consumption of alcohol and/or cigarette smoking
• Thin build with fine bone structure
• Eating disorders such as anorexia
• Undiagnosed gluten intolerance
• Pancreatic insufficiency with resultant lack of digestive enzymes causing poor absorption of nutrients.

Osteoporosis is not a simple case of not getting enough calcium in the diet and is more related to our modern-day lifestyles. It is also the epidemic of vitamin D deficiency, and if you are low in vitamin D you cannot absorb calcium from your food. You can take a lot of calcium, but if you are vitamin D and/or vitamin K deficient then the calcium is useless!

Factors that cause bone loss

• A mineral deficient diet. Calcium is not the only mineral needed for a strong skeleton. Magnesium, manganese, zinc, silica, boron and copper are essential also. Dairy products such as milk, yogurt and cheese are a source of calcium, but some people are allergic to dairy. Foods high in calcium and other minerals include tinned fish (including the bones), broccoli and bok choy. Refined foods are sadly lacking in all minerals – these include foods made of white flour and white rice. Gluten can reduce the absorption of minerals in many people, especially if they eat large amounts of gluten.
• Lack of physical activity. Sedentary jobs and hobbies promote bone loss as well as muscle loss. Weight bearing exercise helps to strengthen bones, and all exercise helps to maintain balance and flexibility; reducing the tendency of falls that cause fractures.
• A high sugar diet with sodas and diet drinks being especially bad. The high level of sugar and phosphorus in soft drinks is particularly detrimental to bones.

What can you do to prevent osteoporosis?

Vitamin D

Vitamin D3 is made in large amounts from cholesterol in the skin when the skin is exposed to the sun. Vitamin D is actually a steroid hormone and not a vitamin.

In addition to skin manufacture from sunlight, vitamin D can be found in some animal foods. It is also available in supplement form, with the current recommendation being that you take between 400 and 1000 I.U. of vitamin D 3 daily. Many people, especially those who avoid the sun or those living in cold countries, need much more than this. Regardless of how you get it, make sure that you have an adequate amount of vitamin D in your body or your parathyroid hormone will go up and leach precious calcium out of your bones; this can cause kidney stones. It is vitally important to ask your doctor to check your blood level of vitamin D. The correct blood test to measure your vitamin D level is called 25(OH) D, also called 25-hydroxy-vitamin D 3.

Vitamin D can be measured in two different units of measurement and in the USA the units used are ng/mL In Australia and Canada the units of measurement are nmol/L.
The normal ranges of vitamin D for blood tests reported by different laboratories and countries vary significantly and you will be surprised by the large range between lower normal and upper normal – see table below;

Lower Limit Vitamin D    Upper Limit Vitamin D
75 nmol/L                            200 nmol/L
30 ng/mL                            100 ng/mL

You don’t want to be average here; you want to have levels of vitamin D that optimise strong bones. The optimal levels of vitamin D are higher than the average levels. You only want to supplement with natural vitamin D3, which is human vitamin D. The synthetic and inferior vitamin D2 does not work as well as D3.

The synthetic vitamin D used to fortify foods is vitamin D2 (known as ergocalciferol) – it is used to fortify many foods and drinks. In nature, vitamin D2 sources are found in mushrooms, various algae (such as spirulina, chlorella, and blue-green algae) and dark green leafy vegetables, but not in adequate amounts to satisfy human needs.

The other form of vitamin D is D3 (cholecalciferol), which is the kind your body produces as the result of sun exposure, and is also found in some non-vegan foods including egg yolks, butter, and oily fish like mackerel, salmon, sardines, and herring.

I recommend you take enough supplements of vitamin D3 and/or get enough sunshine to keep your serum vitamin D levels around 150 to 200 nmol/L or 70 to 80ng/mL. Excess vitamin D intake can cause elevated blood calcium levels; so, don’t overdose on it – it’s not a case of the more the better. Get your blood level checked every 6 months to find the dose of vitamin D3 that keeps you in the optimal levels.

Vitamin K

Vitamin K is extremely important for those with low bone density as it works in concert with vitamin D to remineralise the bones. Vitamin D is required to absorb calcium from the intestines and to put calcium into the bones. However, the calcium needs to be integrated and spread throughout the bones in the correct places and this is what vitamin K can do. Vitamin K improves the architecture and strength of the whole bone.

What should you eat to beat osteoporosis?