Osteoporosis - Osteopenia

Osteoporosis - Osteopenia: Overview

"The silent crippler", as osteoporosis is often called, sneaks up on its victims and, without any pain, gradually causes bones to become more porous and fragile.  One day you grab your coat and your wrist snaps; or a friend hugs you and cracks your rib; or you step off a curb and break your hip...

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Osteopenia refers to decreased calcification or density of bone.  Having osteopenia places a person at risk for developing osteoporosis, the more serious condition.  Bone density is described in relationship to what it should be in young people; it is expressed as a "standard deviation" from the mean (average) bone density in a 35-year-old.  Within 1 standard deviation of the mean in either direction is considered normal.  A bone density within the range of 1 to 2.5 standard deviations below the mean is defined as osteopenia, and greater than 2.5 standard deviations below the mean is osteoporosis.

Put more simply, osteoporosis is defined as having a bone density of more than 25% below the average of young adults of the same sex and race; a bone density between 10 to 25% below average levels is termed osteopenia and reflects a milder degree of bone loss than osteoporosis.


Osteoporosis is the chronic loss of bone mass and strength which afflicts over 8 million Americans – one and a half million are subjected to life threatening fractures every year.  Of those who endure hip fractures, some 20% die from complications within a year; 60% become dependent upon constant help in their daily lives.

Treatment and Prevention

Bone mass does not increase beyond a "peak density" after age 35.  The loss of bone mass can be slowed and lost bone mass regained somewhat with the right treatments.  Building and maintaining bone early in life (up until the 40s) will delay or prevent the appearance of bone loss problems.

Diet, exercise and lifestyle are key factors in preventing osteoporosis from childhood.

Calcium. The NOS recommends daily intakes of calcium which are higher than the RDA.  Milk and dairy products are the best sources of calcium, and low-fat varieties generally contain as much or more.  Although diet is the best way to ensure adequate calcium intake, supplements may be needed by:

When advising on calcium supplements, pharmacists should take into account a person's dietary intake so as not to exceed 2gm daily.  They need to be aware how much elemental calcium a supplement contains, as with some preparations it may be necessary to take six to eight tablets a day to achieve the required amount.

Vitamin D. Vitamin D helps the body to absorb calcium and regulates bone resorption.  The best natural sources are sunlight and oily fish.  Production of vitamin D by the action of sunlight on the skin decreases with age, so elderly people who are unable to get out much may need calcium and vitamin D supplements.  Again, pharmacists need to assess a person's dietary intake before recommending supplements.  The therapeutic window recommended by the NOS is 400-800 IU per day, which should not be exceeded.

Magnesium. Recent research suggests that magnesium might also be important, as women with low dietary intakes have lower bone mineral densities.

Exercise. Exercise is also beneficial throughout life.  Studies have shown that weight-bearing exercise for about 30 minutes two or three times a week strengthens the bones and there is evidence that lack of exercise significantly increases the rate of bone loss.  If elderly people can only take moderate exercise, this is still useful in improving balance and co-ordination.

Joan Bassey, Queen's Medical Centre, Nottingham, UK, has reviewed various exercise programs and their effects on bone mineral density [Osteoporosis Review 1996; 4:1; pp.3-4)].  She recommends high-impact activity such as jogging or jumping, done in brief bouts to minimize the risk of over-use injury.

Brisk walking can strengthen the hip as well as the legs.  Swimming is a low-impact activity because of the cushioning effect of the water, so it does not increase bone density, although it helps to strengthen the muscles after a fracture.  People who have had a fracture should start with gentle exercise as soon as the fracture has healed, gradually building up to three sessions a week.

Lifestyle measures. Other lifestyle advice includes giving up smoking and limiting alcohol intake to the recommended safe amounts (28 units a week for men and 21 for women).  Something to consider in elderly people is whether medication is likely to cause drowsiness or dizziness which might make them more prone to falls.

Drug treatment. For individuals at high risk of osteoporosis, lifestyle measures are not enough and drug treatment is indicated.  Hormone Replacement Therapy (HRT) is still considered to be the best way to prevent osteoporosis in post-menopausal women.  Estrogen protects bone against the resorbing actions of the parathyroid hormone.  Studies have shown women who use HRT for at least five years, starting soon after the menopause, reduce the risk of fracture by about 60%.

But not all women need HRT.  A bone scan can estimate the degree of risk by comparing mineral density with the average measurements for people in the same age group.

The bisphosphonate etidronate has recently been licensed for the prevention of all common forms of osteoporosis in men and women, including corticosteroid-induced disease, so this is now another option for women unable to take HRT.

There is no consensus as to when preventive treatment should start in people taking corticosteroids, and consultants may wish to do a bone scan before deciding.  More than 7.5mg a day of prednisolone daily for more than six months is generally considered as 'high-dose, long-term' treatment.

To prevent further bone loss, women under 65 are likely to be prescribed HRT.  Women over 65 can still take it but may prefer alternatives because of problems such as bleeding, breast tenderness and weight gain.  Women with an intact uterus should receive estrogen plus progestogen to avoid the slightly increased risk of uterine cancer associated with long-term estrogen use.

Women who are at least one year post-menopause may prefer combined preparations which are taken continuously.  Tibolone, which is period-free, was recently licensed for prevention of post-menopausal osteoporosis.

Women for whom HRT might not be suitable include those with a history of thrombosis, high blood pressure, diabetes, migraine, a history of breast cancer or breast cancer in close family, and heavy smokers.

In risk-benefit terms, HRT is still considered to be the best treatment for post-menopausal osteoporosis.

Bisphosphonates. The bisphosphonates disodium etidronate and alendronate sodium reduce bone resorption by inhibiting the osteoclasts.  Trials have shown that bisphosphonates improve bone mass over two to three years.  A 50% decrease in spinal fractures is similar to that seen with HRT and calcitonin.  A study of cyclical etidronate showed up to 88% reduction in vertebral fractures in the second and third year of treatment of post-menopausal women.

Bisphosphonates can be used by women ten to 15 years after the menopause, although intervention is best during the initial rapid phase of bone loss.

Didronel PMO is taken as a 90-day cycle of etidronate for two weeks followed by a calcium supplement for 76 days, which aids mineralization of newly-formed bone.  Etidronate is given in cycles to prevent impairment of bone mineralization, although studies have shown it is well tolerated and effective for up to seven years.

Previously approved only for established vertebral osteoporosis, Didronel PMO is licensed for the treatment of osteoporosis at all sites, including the hip.  It is also the only treatment licensed specifically for corticosteroid-induced osteoporosis.

Etidronate must be taken two hours before or two hours after food, with water or fruit juice.  Milk, other calcium-containing products and iron supplements inhibit absorption.  It may cause nausea, as might the Cacit supplement, and diarrhea.

Alendronate is licensed for the treatment of post-menopausal osteoporosis, at all sites, in post-menopausal women.  It is taken continuously on a daily basis.  It has been associated with severe esophageal irritation and should be used with care in people prone to ulcers or heartburn.  The tablets should be swallowed whole with a glass of water 30 minutes before breakfast, with the patient standing or sitting upright for at least 30 minutes afterwards.

Calcium and vitamin D. Studies in the elderly have shown that calcium supplements can reduce the risk of a vertebral fracture by 20%, and that calcium and vitamin D supplements may reduce the risk of hip fracture by 30-40%.  Calcium supplementation around the menopause has some benefit on bone density, although not as much as estrogen replacement.

Calcium can irritate the gastro-intestinal mucosa and should be used with care in patients with ulceration.  It can accentuate the effects of digoxin and other cardiac glycosides.

Vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) increase bone mass and reduce fracture incidence.

Calcitriol is a hydroxylated vitamin D derivative which is licensed for post-menopausal osteoporosis.  It may cause hypercalcemia and hypercalciuria and should not be taken at the same time as other vitamin D supplements.

Calcitonin, released by the thyroid, briefly inhibits bone resorption by osteoclasts.  It is involved with parathyroid hormone in the maintenance of calcium balance.  Calcitonin increases bone mineral density, particularly in the spine, and there is evidence it reduces hip and vertebral fracture rates.  It also reduces the pain of spinal crush fractures.  It is given by injection, but an oral form is under clinical trial.  Prolonged use of pork calcitonin can lead to the production of neutralizing antibodies.

Salcatonin is a synthetic form of calcitonin, licensed for established post-menopausal osteoporosis.  Given by injection, it is regarded as most suitable for patients who cannot take HRT or bisphosphonates.  Clinical trials have shown an increase in bone density after two years, a 30% reduction in new fractures and 60% in crush fractures.  It is believed to inhibit the calcium pump that transports calcium out of bone cells into the extracellular space.  Patients should also take 600mg elemental calcium and 400 units of vitamin D daily.

Adverse reactions to calcitonins include nausea, vomiting, flushing and tingling hands.

Anabolic steroids. Nandrolone decanoate is restricted to very frail, elderly patients with severe osteoporosis or who have a very rapid rate of bone loss.  It stimulates new bone formation, inhibits resorption, enhances calcium absorption and relieves pain.  Disadvantages are androgenic effects such as hair growth, acne and voice lowering, as well as nausea, dizziness, rashes, headache, backache and nervousness.

Testosterone. In men, testosterone may be used to increase bone density in hypogonadal osteoporosis.  There is also evidence testosterone injection may be effective for some men with normal natural levels.

Treatment choice
In a review of drug treatments [Ann Rheum Diseases 1996;55:pp.700-714], Dr Sanjeev Patel, Department of Rheumatology, St George's Hospital, London, says that long-term estrogens are still the mainstay of treatment but the risks of breast cancer versus the cardiovascular and skeletal benefits have to be assessed in each individual.  When HRT is inappropriate or unacceptable, bisphosphonates should probably be considered next. [Since this article, etidronate has become the only option for corticosteroid-induced osteoporosis].

Calcium supplementation, or an increase in dietary intake if deficient, irrespective of what agent is used, is also of benefit, says Dr Patel.

Calcitriol is best considered as a third-line agent and reserved for specialist use, possibly in patients with renal impairment where vitamin D may not be effective or where there is intolerance to bisphosphonates, says Dr Patel.  Calcitonin could also be used as a third-line agent under specialist supervision.

Combination treatment, for example, with estrogens, bisphosphonates and calcium, may be 'an attractive option' in younger patients with higher bone turnover.

Signs, symptoms & indicators of Osteoporosis - Osteopenia:

Symptoms - Skeletal

(Significant) loss of height

Loss of height is an early sign of bone loss.

Having poor posture

Stooped posture is an early sign of bone loss.

Conditions that suggest Osteoporosis - Osteopenia:

Dental / Oral

Tooth Loss

Those with osteoporosis are 3 times more likely to experience tooth loss, according to the National Institutes of Health.  Osteoporosis can affect any bone in the body – including the jawbone.  The less white a dentist sees in a dental X-ray, the less bone there is in the jawbone and the lower the bone density elsewhere in the body.  Researchers at the University of California found that each 0.01mm per year decrease in a certain area of the jawbone increased hip fracture rate nearly threefold.

Lab Values - Scans



Rheumatoid Arthritis

According to researchers, women with rheumatoid arthritis have up to double the risk of developing osteoporosis and those who use steroid drugs to help control the arthritis are at an even higher risk of bone loss. [Arthritis and Rheumatism, March 2000]


Premature Hair Graying

Premature graying of hair is associated with other features of accelerated aging such as faster bone loss.  A study of 293 postmenopausal women has confirmed that early hair graying and greater bone loss tend to occur together.  The lower bone density was especially apparent in the hip region.

The authors found that when they adjusted bone mineral density for age and weight, there was a clear connection between the age of onset of hair graying and bone density.  "Age- and weight-adjusted bone mineral density (BMD) was significantly lower in those with the majority of their hair graying during their thirties compared with those in whom it occurred in their forties."  Premature hair graying before the age of 40 was associated with a lower BMD at most skeletal sites.  Also, women who started graying extremely early in life, already in their twenties, had lower bone density than those who started graying in their thirties. [J Clin Endo Metab 1997; 82: pp.3580-3]

In an earlier report, doctors in Maine showed that people with gray hair by age 40 are 4.4 times more likely to suffer from osteoporosis. [J Clin Endocrinol Metab 1994; 79: pp.854-7]

Risk factors for Osteoporosis - Osteopenia:


Cigarette Smoke Damage

The evidence is overwhelming: smoking boosts bone loss and is therefore a risk factor for osteoporosis and for bone fractures in general.


Gluten Sensitivity / Celiac Disease

A study concluded that reduced mineralization occurs even in asymptomatic celiac patients, and that early diagnosis and treatment can prevent bone demineralization. [Am J Gastroenterol 1994;89: pp.2130-4]


Excess Protein Consumption

High protein intakes may lead to loss of calcium, leading in turn to the development of osteoporosis.

Consequences of Poor Diet

Excess salt and sugar, found in junk foods, leach calcium from the bones into the urine.


Atrophic Gastritis

Stomach acid is required to enhance the absorption of minerals such as calcium.  Reduced calcium absorption encourages bone loss.

Ulcerative Colitis

Scientists believe osteoporosis may occur when the immune system triggers inflammation in other parts of the body.  These problems are usually mild and go away when the colitis is treated.

Environment / Toxicity

Fluoride Toxicity

Fluorides destroy collagen, which is the glue that adds strength to the bones.



Patients may have thinning of the bones without symptoms, but with risk of fractures.


Untreated hyperthyroidism accelerates bone resorption, reduces bone density, and over time increases the risk of osteoporosis.


People with hypothyroidism can develop osteoporosis if they are taking too much thyroid hormone.


Aerobic Exercise Need

A sedentary lifestyle increases the risk of suffering from osteoporosis later in life.  Exercise strengthens bones – inactivity encourages the body not to rebuild unused resources.

The Effects Of Overtraining

Cortisol – a hormone produced by the adrenal gland during periods of intense physical exercise – interferes with bone-building and reduces bone density by breaking down bone faster than it is made.


Low Male Testosterone Level

Some 30% of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men with testosterone deficiency have subnormal bone density that puts them at risk of fractures.

Lab Values

Elevated Homocysteine Levels

Elevated homocysteine levels disrupt collagen-forming processes in the body and raise the likelihood of developing osteoporosis.

Elevated Cortisol Levels

If a woman is not ovulating she may have lower estrogen and progesterone levels.  Low estrogen levels can increase the activity of osteoclasts (bone breakdown cells) while low progesterone has been shown to increase PMS symptoms and slow bone deposition.  Also, to provide the extra calcium needed when faced with intense stress situation, cortisol can directly stimulate bone breakdown cells.  Unchecked over a long period of time, high cortisol levels can cause you to lose bone faster than you can rebuild it.



Acidic diets (high in protein and refined food) will cause bone calcium leaching in order to maintain your blood pH balance.  Chronic leeching of calcium from the bones increases the likelihood of osteoporosis. [Am. J. Clin. Nutr. 2001: 73, pp.118-22, Lancet 1968:1, pp.958-9]

Anorexia / Starvation Tendency

The common medical complications of anorexia/starvation include osteoporosis.


Muscular Dystrophy

People with muscular dystrophy can develop osteoporosis due to lack of mobility and steroid treatments.


Manganese Requirement

Individuals with osteoporosis sometimes have low blood levels of manganese. [Raloff J. Reasons for boning up on manganese. Science Sep 1986, 199 (review)]

Calcium Requirement

When body stores of calcium are low, the body must draw calcium from the bones in order to avoid serious complications.

Vitamin B12 Requirement

Researchers at the University of California devised a study to determine if low levels of vitamin B-12 might be associated with bone loss in older women.  Results showed that women with the lowest levels of B-12 had a significantly higher risk of bone loss and fractures compared to women with the highest levels.  The researchers also noted that for some women, B-12 supplements may help slow the rate of bone loss.

Folic Acid Deficiency

Folate (folic acid) and the B-vitamins involved in homocysteine conversion (such as B12 and B6) may be beneficial in reducing the risk of osteoporosis because high levels of homocysteine are implicated in chronic diseases such as osteoporosis.

Supplements, Medications, Drugs

Much/some B-complex supplementation

By reducing homocysteine levels in the blood, the B vitamins reduce the risk of developing related conditions.  A Harvard University study found a strong connection between high homocysteine levels and risk of hip fracture in postmenopausal women.

Symptoms - Environment

Limited lifetime sun exposure

A lack of natural vitamin D (obtained through exposure to sunlight) increases the risk of getting osteoporosis later in life.

Symptoms - Food - Beverages

Caffeinated soft drink/high caffeinated soda consumption

Regular consumption of caffeinated carbonated beverages has been associated with increased risk of bone fracture both earlier and later in life, yet the contributions of the individual components of these beverages to calcium loss is unclear.

The per capita consumption of carbonated beverages has risen dramatically, making them the preferred beverage of women 20-40 years old, many of who already have an inadequate daily intake of calcium.

The effect of caffeinated and noncaffeinated beverages on urinary calcium excretion was measured in a group of 30 women with an average age of 31 years.  The subjects habitually drank from two to seven 12-ounce cans of carbonated beverages daily; 27 drank predominantly colas.

Though the caffeine in the drinks was primarily responsible for excess calcium excretion, previous studies of the effect of caffeine have shown a compensatory drop in calcium excretion over the 24-hour period following ingestion.  The fact that the small calcium loss from carbonated beverages was offset by reduced excretion later in the day, and the habituation of the subjects to frequent consumption, lead the authors to conclude that the main cause of calcium loss from carbonated beverages was their lack of nutrients needed for bone health. [Heaney, Rafferty; Am. J of Clin. Nutr., August 2001]

(High) coffee consumption

Drinking too much coffee increases risk of osteoporosis.  A study of 84,484 patients showed a correlation between bone fractures and heavy coffee consumption.

Low/moderate/high alcohol consumption

Alcohol interferes with the body's absorption of calcium.

Symptoms - Food - General

Long-term/short-term low-carb dieting or discontinued low-carb diet

The concern with bone health arises from the fact that muscle ("meat") protein has a high sulfur content.  When people eat too much of this protein, the sulfur forms acid within our bodies which must somehow be neutralized to maintain proper internal pH balance.  One way our body can buffer the sulfuric acid load caused by the meat is with calcium borrowed from our bones.  People on high meat diets can lose so much calcium in the urine that it can actually solidify into kidney stones. [Journal of Pediatrics 117 (1990): p.743]  Over time, high animal protein intakes may leach enough calcium from the bones to increase one's risk of osteoporosis.  People may be literally peeing their bones into the toilet.

In the Harvard Nurse's study, which followed over 85,000 nurses for a dozen years, found that those who ate more animal protein had a significantly increased risk of forearm fracture.  While plant-based (vegan) proteins did not show a deleterious effect, women eating just a serving of red meat a day seemed to have significantly increased fracture risk. [American Journal Epidemiology 143 (1996): p.472]  Other studies have linked meat consumption to hip fracture risk as well. [American Journal of Clinical Nutr. 73 (2001): p.118]

In 2002, researchers from the Universities of Chicago and Texas published a study that put people on the Atkins Diet and measured 1) how acidic their urine got and 2) just how much calcium they were urinating out.  They reported that the Atkins Diet resulted in a "striking increase in net acid excretion."  After just two weeks on the Atkins Diet, the subjects were already losing 258mg of calcium in their urine every day.  They concluded that the Atkins Diet "provides an exaggerated acid load, increasing risks for renal calculi [kidney stone] formation and bone loss." [American Journal of Kidney Diseases 40 (2002): p.265]  In addition, the Atkins Diet is actually deficient in calcium in the first place.

Symptoms - Food - Intake

(High) dairy product consumption

Excess consumption of dairy products is implicated in osteoporosis.  This is due to their high animal fat content, and the lack of CLA in modern dairy products.

Symptoms - Head - Mouth/Oral

A few/many loose teeth or one loose tooth

The brittle bone disease osteoporosis affects all the bones in your body – including your jaw bone – and can cause tooth loss.  Several studies show that people with loose or weak teeth are at increased risk for developing osteoporosis.
[J Bone Miner Res. 1993 (Dec); 8 (Suppl 2): pp.S443-S606]
[J Am Dent Assoc. 1993; 124: pp.49-56]
[J Bone Miner Res. 1994; 9 (Suppl 1): p.S211]
[Lancet Editorial 1995 (April 8); 345: pp.876]

Symptoms - Muscular

Being lean or underweight or being very skinny

In general, the thinner a woman is, the lower her bone density.  Two reasons for this are (1) fat fuels estrogen production, and having too little estrogen can make bones porous and brittle; (2) bones need to carry weight to remain strong.  Weight-bearing exercises are especially important for thin people.

Symptoms - Skeletal

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Osteoporosis - Osteopenia suggests the following may be present:



Nutritional Deficiency

Trace minerals are necessary for the transport and absorption of calcium.

Osteoporosis - Osteopenia can lead to:

Neck / Spine

Low Back Pain

Back pain is an early sign of bone loss.

Recommendations for Osteoporosis - Osteopenia:


Dairy Products Avoidance

Dairy product consumption is not an appropriate way to reduce bone loss, as it will ultimately accelerate bone loss.  However, this fact is ignored by marketing experts in the milk industry who make certain that women aged 35 and over are targeted consumers for milk and dairy products.  Harvard University's landmark Nurses' Health Study, which followed 78,000 women over a 12-year period, found that the women who consumed the most calcium from dairy foods broke more bones than those who rarely drank milk.

Summarizing this study, the Lunar Osteoporosis Update (November 1997) explained: "This increased risk of hip fracture was associated with dairy calcium.  If this were any agent other than milk, which has been so aggressively marketed by dairy interests, it undoubtedly would be considered a major risk factor."

A study published in the January, 2001 edition of the American Journal of Clinical Nutrition examined the diets of 1,035 women, particularly focusing on the protein intake from animal and vegetable products.  Deborah Sellmeyer, M.D., found that animal protein increases bone loss.  In her study, women with a high animal-to-vegetable protein ratio experienced an increased rate of femoral neck bone loss.  A high animal-to-vegetable protein ratio was also associated with an increased risk of hip fracture.  Dr. Sellmeyer states: "Sulfur-containing amino acids in protein-containing foods are metabolized to sulfuric acid.  Animal foods provide predominantly acid precursors.  Acidosis stimulates osteoclastic activity and inhibits osteoblast activity."

Milk has been called "liquid meat".  The average American eats five ounces of animal protein each day in the form of red meat and chicken, at the same time consuming nearly six times that amount (29.2 ounces) per day of milk and dairy products.  How ironic it is that the dairy industry continues to promote the cause of bone disease as the cure!

Many foods naturally contain an abundance of calcium.  One must wonder why Asians traditionally did not get bone-crippling osteoporosis... that is, until they adopted the "American Diet", a diet of milk and dairy products.

Plant-Based Nutrition

A study published in the January, 2001 edition of the American Journal of Clinical Nutrition examined the diets of 1,035 women, particularly focusing on the protein intake from animal and vegetable sources.  Deborah Sellmeyer, M.D., found that animal protein increases bone loss.  In her study, women with a high animal-to-vegetable protein ratio experienced an increased rate of femoral neck bone loss, and an increased risk of hip fracture.

Dr. Sellmeyer stated: "Sulfur-containing amino acids in protein-containing foods are metabolized to sulfuric acid.  Animal foods provide predominantly acid precursors.  Acidosis stimulates osteoclastic activity and inhibits osteoblast activity."

A 1994 report in the American Journal of Clinical Nutrition showed that when volunteers are switched from a typical American diet to a diet eliminating animal proteins, calcium losses were reduced to less than half of baseline values. [Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am Clin Nutr 1994;59: pp.1356-61]

Sugar Avoidance / Reduction

Avoiding factors that encourage bone loss can be as just as important as calcium intake.  Diets high in refined sugar, protein, salt, caffeine, and phosphorous contained in soft drinks, all promote calcium excretion in urine.

Reduced Protein Diet

After looking at 34 published studies in 16 countries, researchers at Yale University found that countries with the highest rates of osteoporosis including the United States, Sweden, and Finland are those in which people consume the most meat, milk, and other animal foods.  They also found that African Americans, who consume on average more than 1,000mg of calcium per day, are nine times more likely to experience hip fractures than are South African blacks, whose daily calcium intake is only 196mg.  On a nation-by-nation basis, people who consume the most calcium have the weakest bones and the highest rates of osteoporosis.  Only in those places where calcium and protein are eaten in relatively high quantities does a deficiency of bone calcium exist, due to an excess of animal protein.  The association between the intake of animal protein
and fracture rates appears to be as strong as the association between cigarette smoking and lung cancer.

Caffeine/Coffee Avoidance

A study of 84,484 patients showed a correlation between bone fractures and heavy coffee consumption.

Increased Fruit/Vegetable Consumption

Studies suggest that eating just one serving of dark leafy greens or broccoli each day can cut your risk of hip fracture in half.  A diet low in green leafy vegetables can be low in vitamin KVegetarians have on average greater bone mass than meat eaters.

Soy Isoflavones

Higher intake of dietary phytoestrogens (isoflavones) was associated with higher lumbar spine and hip bone mineral densities in a study of 357 postmenopausal southern Chinese women. [J Clin Endocrinol Metab 2001;86(11): pp.5217-5221]

A one-month of treatment with a soy isoflavone extract reduced the excretion of bone resorption markers, in a placebo-controlled study of 23 healthy perimenopausal women. [J Am Coll Nutr 2002;21(2): pp.97-102]

It should be noted, however, that this benefit has not been seen in other studies.  It seems that the best chance of receiving any benefit by this means is if you are a Japanese premenopausal woman.  The closer you are to menopause, the less likely to be benefited. [Am J Epidemiol 2002;155(8): pp.746-754]

Alcohol Avoidance

Alcohol is toxic to the cells that form bones and inhibits the absorption of calcium.

Salt Intake Reduction

Sodium (salt) tends to leach calcium out of the bones.


Conventional Drug Avoidance

Prescription drugs can increase bone loss.  These include cortisone, blood thinners, antacids containing aluminum, chemotherapy, lithium, and certain antibiotics.


Some diuretics are useful against osteoporosis: Thiazides lower urinary calcium excretion, resulting in a positive calcium balance and increased bone mineral density and a reduction in fracture rates due to osteoporosis.  For reasons not fully understood, thiazides also stimulate bone mineral formation, which helps to slow the course of osteoporosis.


Sunlight Exposure

Habits to curtail include heavy smoking, excess alcohol consumption, and limited sunshine exposure or vitamin D intake.


Aerobic Exercise

Physical activity may help reduce fracture risk by enhancing bone strength and improving bone quality.  Exercise strengthens bones.

Tobacco Avoidance

Studies have shown that women who smoke one pack of cigarettes per day have on average 5-10% less bone density at menopause than do nonsmokers.



Natural Progesterone

Estrogen and progesterone are known to provide benefit.  The natural forms are best to use for many reasons.  When appropriate, they should be used in combination.  Estrogens decrease bone resorption, but also decrease bone formation, with an overall effect of reducing loss without substantially increasing bone mass.  In contrast, natural progesterone stimulates new bone tissue growth.  A three year study of 63 post-menopausal women using progesterone cream for osteoporosis found an average of 7-8% bone mass density increase the first year, 4-5% the second year and 3-4% the third year.

Estrogen Replacement

Within 5 years of the initial onset of menopause, there is an accelerated rate of loss of bone, particularly from the spine.  During this period of time, estrogen replacement is somewhat effective in preventing bone breakdown, but progesterone is needed for creating new bone.  Most doctors agree that estrogen does reduce fractures (at several fracture sites) by halting the reduction in bone density.  More recent studies have shown that women who start using estrogen in their 70s still have a benefit in their 80s, and that maybe half of the dose of estrogen will do the same job.  Estrogens decrease bone resorption, but also decrease bone formation, with an overall effect of reducing loss without substantially increasing bone mass.

Laboratory Testing

Bone Density Scan

A bone density scan can indicate what your current bone mineral density is.  Repeated scans (a year or two apart) can tell if you are gaining, losing or just maintaining bone.

A new urine test utilizes the two most specific markers of bone resorption – the collagen crosslinks pyridinium/pyridinoline (PYD) and deoxypyridinium/deoxypyridinoline (DPYD or DPD) – to identify elevated levels of bone loss before excessive damage occurs.  This profile enables regular testing of women for resorption rates, allowing treatment intervention at its most effective – i.e. before bone loss has occurred.  It also allows easy and rapid monitoring of treatment effectiveness.  As valuable as bone scan results can be in the definitive diagnosis of osteoporosis, the evaluation cannot be performed often enough for patients who are losing bone at a rapid rate.

In premenopausal women, estrogen produced in the body maintains bone density.  Following the onset of menopause, bone loss increases each year and can result in a total loss of 25-30% of bone density in the first five to ten years after menopause.  Your doctor can help you decide when and if you need a bone density test.



As you age, the need for absorbable calcium, in conjunction with other essential minerals and vitamins, can be increased.  One study found that a supplement containing calcium, manganese, zinc and copper prevented bone loss in postmenopausal women, whereas calcium alone was ineffective.  Calcium supplements for osteoporosis should contain other minerals as well, or the form of calcium used should have been proven to be of benefit.

Intake of supplemental calcium (1000mg per day or more) and vitamin D was associated with reduced tooth loss (due to bone loss) over a five year period in a study of 145 healthy subjects aged 65 years and older who completed a 3-year trial of the effect of calcium and vitamin D supplementation on bone loss from the hip, as well as a 2-year follow-up study after discontinuation of the study supplements. [Am J Med 2001;111(6): pp.452-6]

There are products using compounds of calcium which have been proven to reverse osteoporosis.  One such is AdvaCAL®.


Trace minerals (zinc, copper, manganese, and boron) are required for strong bone formation.


You can reverse bone loss and regain bone mass with calcium, magnesium, vitamin D, and vitamin K.  Minimum doses should be in the following ranges: calcium (1200mg), magnesium (400-800mg) vitamin D (400 IU – consider supplementing in the winter months in females), and vitamin K (80mcg).  Calcium comes in many forms, so use those which are more absorbable such as hydroxyapatite, citrate, gluconate, and others.  Some special preparations have been shown to increase bone density without the use of any other nutrients.


Moderate potassium supplementation improves calcium balance in post-menopausal women. [Sebastian A, Harris ST, et al., Improved mineral balance and skeletal metabolism in post-menopausal women treated with potassium bicarbonate. N Engl J Med 330: pp.1776-81, 1994]


Preventive measures against Osteoporosis - Osteopenia:


Vitamin K

Not enough vitamin K in the system is a predisposing risk factor for osteoporosis.  New research has shown that this little known vitamin is the key to calcium balance in the body.

Folic Acid

Folate (folic acid) and the B-vitamins involved in homocysteine conversion (such as B12 and B6) may be beneficial in reducing the risk of osteoporosis because high levels of homocysteine are implicated in chronic diseases such as osteoporosis.

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Health problems rarely occur in isolation or for obvious reasons

Your body is a highly complex, interconnected system.  Instead of guessing at what might be wrong, let us help you discover what is really going on inside your body based on the many clues it is giving.

Our multiple symptom checker provides in-depth health analysis by The Analyst™ with full explanations, recommendations and (optionally) doctors available for case review and answering your specific questions.


Weak or unproven link: may be a sign or symptom of; may increase risk of
Weak or unproven link:
may be a sign or symptom of; may increase risk of
Strong or generally accepted link: is often a sign or symptom of; often suggests; often increases risk of; often leads to
Strong or generally accepted link:
is often a sign or symptom of; often suggests; often increases risk of; often leads to
Definite or direct link: strongly suggests
Definite or direct link:
strongly suggests
Weakly counter-indicative: may decrease risk of
Weakly counter-indicative:
may decrease risk of
Strong counter-indication: often contraindicates
Strong counter-indication:
often contraindicates
May be useful: may help with; may help prevent
May be useful:
may help with; may help prevent
Moderately useful: often helps with; often prevents
Moderately useful:
often helps with; often prevents
Very useful: is highly recommended for
Very useful:
is highly recommended for
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