In the first part of this article, I emphasized the limitations of hormone replacement therapy and the undeniable importance of resistance exercise in the prevention and treatment of osteoporosis. In the 2nd part, I would like to address the subject of nutrition and its impact on the prevention of osteoporosis. But before I address this, I would like to add two additional points with regard to the use of medicines.

Injurious Drugs

As I mentioned briefly in Part 1, some medications, such as corticosteroids and certain drugs used to treat breast or prostate cancer, can increase the risk of osteoporosis.  The use of these drugs, though sometimes necessary, should be considered when it comes to the prevention and treatment of osteoporosis. Remember, there are natural therapeutic approaches which often eliminate the need for corticosteroids.

Proton pump inhibitors - drugs used to treat acid reflux and heartburn - reduce the absorption of calcium thereby increasing the risk of osteoporosis. Proton pump inhibitors also reduce the absorption of magnesium - an essential component of bone metabolism. In addition, these drugs also impair the digestion of protein, also essential to bone health. 

Even though these drugs bring some relief, they do not address the root of the problem. When it comes to acid reflux, you must always look at food intolerance - especially to gluten and dairy products. 

Some natural products, including DGL licorice, help improve symptoms without the negative side effects of proton pump inhibitors.

Drugs Used to Treat Osteoporosis

Yes, but, you will say, there are drugs that are effective in treating osteopenia and osteoporosis. Indeed there are, but in order to evaluate the effects, I will use as an example the most popular category of these drugs - bisphosphonates. This category includes the most-prescribed medications for osteoporosis, namely Fosamax, Didrocal and Actonel, as well as various generic copies.

More and more studies are showing that these drugs do reduce the risk of osteoporosis - but only for a short time. On average, their effectiveness is about 3 years - after which they can even increase the risk of fractures in the long term. In one study, the use of bisphosphonates appears to have caused necrosis (death) in some bones.

Finally, some researchers have associated the use of bisphosphonates with an increased risk of cancer of the esophagus. Despite the fact that the evidence of this link is inconclusive, the question arises as to whether it is prudent to use a drug whose effectiveness is questionable when it increases the risk, however minimal, of cancer or bone fracture.

For a more complete analysis on the limits of bisphosphonates, refer to the one published in the Sept-Oct issue of Therapeutics Initiative. For a more in-depth analysis of the potential effects of these drugs, consult the Nov-Dec issue of the same journal.

Nutrition

Nutrition is, on a par with resistance exercise, the most important factor in maintaining or developing bone mass. When it comes to nutrition and bone health, we automatically and almost exclusively think of calcium and vitamin D. Alas, these two nutrients, though essential, are only the tip of the ‘bone iceberg’ if we can put it this way. Various other nutrients, including vitamins C and K, magnesium and the trace elements boron and zinc, also play crucial roles in bone formation. To this list, we cannot omit the vital importance of maintaining bone mass.

Vitamins and Minerals

We all know the importance of calcium and vitamin D in forming and maintaining bone mass. So, I'm not going to go into detail about them except to point out that doctors usually prescribe calcium carbonate, an inexpensive form of calcium. Because of the low absorption rate of this form of calcium, they generally prescribe high doses - between 500 and 1000 milligrams. However, other forms of calcium - such as calcium citrate or chelated calcium - are absorbed significantly better and therefore require a much lower dosage. 

Various Vitamins and Minerals

Virtually all vitamins and minerals play an essential role in maintaining or improving bone mass. I would like to focus here on the most important, vitamins C and K, magnesium and the trace elements boron and zinc.

Vitamin C

When it comes to vitamin C, we tend to emphasize its antioxidant and immunostimulant effects. Although it is true that vitamin C has important effects in increasing immunity and as an antioxidant, its effects on bone health are also well established. Vitamin C plays a role in healing bone fractures, promoting normal bone growth and maintaining bone density. In its vitamin C monograph, Health Canada notes that it "helps develop and maintain bones".

Food sources of vitamin C include fruit (especially if it is locally sourced and picked ripe) and some vegetables such as tomatoes and peppers.

Vitamin K

Vitamin K is, like vitamin D, a fat-soluble vitamin. It also plays a vital role in maintaining bone health. A few years ago, recognition of the importance of vitamin K resulted in an increase of the recommended daily levels of intake by 50%. 

This vitamin has shown excellent effects in helping to maintain a healthy bone density, thus reducing the number of fractures. Dietary sources of vitamin K include beef liver, green tea, broccoli, spinach, cabbage and kale. Vitamin K is present in all green vegetables.

Here’s an important note. The letter "K" in "Vitamin K" comes from the German word "koagulation" - "coagulation" in English. Vitamin K got this name because the first of its benefits to be recognized was that played a role in blood clotting. People taking anticoagulant medication, such as Coumadin, should avoid vitamin K supplements.

Magnesium

When it comes to magnesium, most people think of its effect on insomnia, its ability to reduce muscle cramps or its role as a "nutritional superstar" at the cardiovascular level. Now, magnesium is that - and much more. Indeed, magnesium is one of the most important nutrients to ensure bone health, perhaps even more important than calcium. 

A disorder in metabolizing vitamin D can occur when there is a magnesium deficiency. This same deficiency will also have an effect on bone metabolism. Taking magnesium supplements reduces bone loss. Moreover, it is recognized that a decrease in the level of bone magnesium makes the bone more fragile. 

Even the journal of the American Geriatric Society emphasizes that getting magnesium from foods and supplements is associated with better bone density. In one study, postmenopausal women followed a diet with a high magnesium content rather than high calcium. The result was a significant improvement in bone density. 

The most important sources of magnesium are green vegetables as magnesium is in the centre of chlorophyll - the green pigment in plants. Almonds and cocoa also contain high levels of this mineral. Peanuts and whole grains are an also good source.

Zinc

When it comes to zinc, we tend to think about immunity, prostate health, and wound healing, among other things. Like magnesium, zinc is involved in more than 300 enzyme systems in the body - making it necessary for a wide variety of biochemical functions. 

As far as we are concerned, zinc has been shown to have significant effects on bone health. It has an anabolic effect so it helps in the construction and repair of bone. An article published in the British Medical Journal emphasizes that epidemiological studies suggest that osteoporosis is caused by a deficiency of zinc and magnesium. The same author pointed out in the same medical journal that taking replacement hormones can cause a relative deficiency in zinc, magnesium and the B-complex vitamins - thereby explaining the increase in osteoporosis in countries where HRT (Hormone Replacement Therapy) is used. Another study found that levels of magnesium and zinc were lower in women with osteoporosis compared to those with normal bones or osteopenia.

Taking Supplements

A dietary supplement cannot - and should not - replace a healthy diet. On the other hand, a supplement can help alleviate the poor quality of our diet and, for many, help to offset occasional deviations. But when it comes to treating osteopenia - or more importantly, osteoporosis - dietary supplements that target bone health should be – along with resistance exercise - the first line of intervention. It should be obvious from the above that a dietary supplement meant to promote bone health needs to provide more than just calcium or vitamin D. 

Protein

When it comes to protein, we invariably think of muscle mass. Indeed, do bodybuilders not rave about  the hyper-protein diet? What we generally ignore is that the volume of bone is 50% protein and its mass is made up of about 33% protein. Consuming enough protein is, therefore, vital to maintaining bone mass - as vital as consuming a sufficient amount of calcium. Many researchers go so far as to suggest that we increase the recommended daily intake of protein to mitigate the decline in protein absorption that occurs as we age. 

What's more, protein consumption has a significant positive effect on the bone health of women - who are more at risk for osteopenia or osteoporosis. Finally, a significant number of studies have shown that increased protein intake does not lead to loss of calcium, as was previously thought. On the other hand, an increased intake of protein must be accompanied by a proportional increase in alkalizing foods.

pH

The body needs to maintain a balance between acidity and alkalinity. Indeed, our body must not be acidic - the pH of arterial blood must be between 7.3 and 7.45. Any deviation from this pH to an increase in acidity will cause the body to release valuable minerals, such as calcium and magnesium, to counter this acidification. 

Unfortunately, the vast majority of our protein foods are acidic. Is not that a contradiction with what was noted in the previous section? Not at all. In the end, as in most things in life, it is a matter of balance. Indeed, we need more protein than is generally recommended. On the other hand, if we need more protein, which is acidifying, then we need a lot more alkalizing foods. So, the solution is to have a high-protein diet, but one that also ensures a balanced pH or acid-base balance.

The list of foods that are alkalifying (which help the body to be less acidic) varies greatly depending on the type of soil where they are grown and the time they are picked. Generally, all vegetables as well as most fruits are alkalifying. Studies have confirmed that a high consumption of fruits and vegetables is associated with better bone density. 

Green leafy vegetables and green herbs are among the most alkaline. Almonds are alcalifying as well as cacao (not commercial chocolate) and millet. In addition, food sourced from plants is an excellent source of silica - a mineral known for its bone health effects. 

A simple way to guarantee an alkaline diet is to ensure that 50 to 60 percent of the food consumed at lunch and dinner are vegetables and by adding juices or concentrated "green" smoothies as needed. These green juices can be made at home or purchased in liquid or powder form. It goes without saying that the quality of commercial products varies considerably, so be careful when you shop.

It should also be noted here that certain acidifying foods – or habits - can contribute to the loss of bone mass. These include tobacco, alcohol and coffee. Soft drinks contain a large amount of phosphorus and phosphorus is known for its demineralization effects.

Finally, it is important to note that a significant number of plant foods contain isoflavones. These "plant estrogens" have demonstrated important effects in maintaining bone health. Among the foods which have the greatest concentration of isoflavones are all types of legumes, flax seeds and red clover.

Conclusion

Osteoporosis can have serious consequences - the harmful effects on well-being and quality of life are undeniable. The purpose of this article is to shed light on natural factors such as exercise and nutrition and how they affect the development of healthy bones as well as how they can be used to help prevent or treat osteopenia and osteoporosis.

Before opting for medication or hormone replacement therapy, is it not better to adopt these natural approaches - approaches that are known to reduce the risk of cancer and cardiovascular disease? To ask the question, I think, is to answer it.