I was diagnosed with osteopenia a few weeks ago. Well, my mother fell last winter and broke her hip. She was incapacitated for several months because of this accident. She is only now starting to recover, and very slowly at that. What natural methods can I use to avoid osteoporosis?

Thank you for your question. Despite the fact that osteoporosis is a skeletal condition resulting in debilitating effects - it is possible to prevent it, slow its progress and even reverse it. First things first, here’s a definition.

The term osteopenia is used when there has been up to an 11% decrease in bone density. "Osteopenia is a weakness of the bone that is not quite normal but is not yet serious enough to warrant the term osteoporosis."¹ Beyond this 11% decrease in bone density, the condition is called osteoporosis. Therefore, osteoporosis is not a disease but  a state of bone degeneration characterized by a loss of bone density.

In many cases, women and men lose their autonomy because of debilitating bone fractures due to osteoporosis. From a financial standpoint, this weakening of the bone is very expensive. Indeed, according to Osteoporosis Canada, the annual cost of treating osteoporosis and resulting fractures is estimated at $ 1.9 billion.² About 10% of people aged 40 or older have been diagnosed with osteoporosis and 8% of them have suffered an osteoporotic fracture.³ 

Several factors contribute to this decrease in bone density. Note that the most important factors are:

• Age. As we age, we experience a natural loss of bone mass.
• Sex. Osteoporosis is four times more common in women than in men.
• Hormone Levels. Several hormones play a role in bone density and their decrease invariably affects bone mass. The most important of these are estrogen⁴, progesterone⁵ and androgens such as testosterone, DHEA etc.⁶
• Physical activity. Regular physical activity is necessary to maintain bone mass.⁷ As we age, we tend to reduce our level of physical activity - thus reducing our bone density.
• Vitamins and minerals. Despite the emphasis on calcium and vitamin D for bone health, other nutrients such as boron, manganese, magnesium and vitamin K also play important roles. Thus, poor diet also has a negative effect on bone mass.
• Dietary protein. As we age, we tend to reduce our intake of dietary protein.⁸ However, consuming adequate protein is necessary to maintain bone mass.⁹
• pH Levels. pH is a measure of acidity. Though neglected, the body's pH is important in maintaining bone mass.¹⁰
• Poor lifestyle choices.  Habits such as smoking¹¹ and alcohol consumption¹² have a negative impact on bone density.
• Certain drugs. Proton pump inhibitors, i.e. drugs used to treat heartburn and acid reflux, reduce the absorption of calcium and magnesium - thereby increasing the risk of osteoporosis.¹³ Corticosteroids and drugs used in the treatment of breast or prostate cancer also increase the risk of osteoporosis.¹⁴

Osteoporosis: Causes and Remedies

Let's look at these "osteoporotic" factors in more detail.

Age and Sex

All other factors being equal, age and sex play an important role in the development of osteoporosis. While these are fixed factors – well, age, at least - I would like to note some points about them.

Bone mass reaches its maximum threshold between the ages of 25 and 30.¹⁵ After that, there is a gradual decrease in bone density. This brings us to three important points. 

First, it is important that we increase bone mass as much as is possible before this age. Studies in Norway have shown that children and teens who are sedentary are at a disadvantage when they reach the age at which bone mass decreases because they have not developed sufficient bone mass. Children and adolescents should be encouraged to do daily physical activity. 

Second, if bone mass inevitably drops after age 30, we should make more of an effort to properly manage factors that affect bone metabolism from this age forward. 

The last point is pretty obvious: even if loss of bone density is inevitable, there's no good reason to accelerate the process. If there are already some flames, do not add fuel to the fire. Bone density loss may be inevitable, but the speed and severity with which it occurs varies greatly.

Hormones

When it comes to osteoporosis, we tend to focus on estrogen, despite that fact several other hormones are also involved. Androgens play an important role in bone metabolism.¹⁶ These "male" hormones are produced in both women and men. With age, the production of these hormones decreases in both sexes. Progesterone, on the other hand, is a hormone produced uniquely by women and one its functions is to ensure pregnancy. It also plays a role in bone metabolism.¹⁷

The inevitable decrease in estrogen levels in postmenopausal women is generally considered to be the most important hormonal factor in the development of osteoporosis. However, it is interesting to note that in many parts of the world postmenopausal women have fewer fractures than do North American or European women. Another interesting fact is that in countries where women are generally more physically active - and where you would think the risk of fractures would be higher - women experience fewer fractures.¹⁸ Statistics suggest that when a society improves its "standard of living", as per the standards of industrialized countries, the rate of fractures increases.¹⁹ 

So, why do we put so much emphasis on hormone replacement therapy when the real issue is osteoporosis? Dr. André even writes: "In the prevention of fracture risk, the risk / benefit of HRT (hormone replacement therapy), regardless of the intended product, is unfavorable based on currently available data."²⁰

The situation regarding androgens is different. Indeed, studies have shown that regular physical exercise increases androgens in men as well as among women.²¹ These effects are especially obvious with resistance exercises.²² We will return to this point later.

Resistance exercise

Few factors have as important an effect in ensuring healthy bones. Indeed, the body needs to maintain its bone mass (and muscle) in order to counter the effects of gravity. If there's no gravity, there's no need to maintain bone mass. That is why people who are bedridden³⁰ or are living in weightless conditions, such as astronauts, lose bone mass.³¹ 

This is where exercise plays an important role. Indeed, exercise, particularly resistance exercise, increases gravity "artificially". Having more gravitational "stress", the body strives to maintain bone as well as muscle mass.³²

Interestingly, a study published in the journal of the American College of Sports Medicine has shown that resistance exercise (weights and machines) had beneficial effects on bone mass regardless of whether or not hormone replacement therapy or calcium supplements were being used.³³ A summary of the findings appears in the table below.

A question that emerges from this study is how is it that individuals in GROUP 4 - who took calcium supplements - had lower bone mass? The answer is based on studies performed on astronauts. If you do not do enough physical activity, your body does not use calcium to maintain bone mass. Calcium is important, but the body does not use it if it doesn't think it needs to.

So, if you want to have a positive impact on your bone mass you need to provide it with the increased stress it gets with resistance exercises. No resistance, no mass!

Why not walk, run or swim?

Water offers much less gravitational stress. In fact, we can float in water. Swimming - as great as it is for building muscle and improving cardiovascular fitness - is not the best exercise for increasing bone mass. As for walking or running, they have little effect on bone mass.³⁴

Conclusion

If there is one thing to remember in this first part of the series, it is that exercise plays a vital role in the prevention of osteoporosis. You can have adequate hormone levels and a healthy diet, but if you do not exercise you will not maintain your bone mass. On the other hand, if I get adequate exercise to increase my bone mass but I do not give the body the materials it needs to build bone, bone mass will decline. 

The next part of the series deals with the essential nutritional factors needed to produce strong bones. And no, calcium won't be at the top of the list!

References

¹http://www.allodocteurs.fr/actualite-sante-osteopenie-et-osteoporose-quel-rapport-_8540.html

²http://www.osteoporosecanada.ca/losteoporose-et-vous/donnees-et-statistiques-sur-losteoporose/

³ Points saillants de l’Enquête sur la santé dans les collectivités canadiennes de 2009 — Réponse rapide sur l’ostéoporose, Agence de La Santé Publique du Canada (2010)

⁴ Riggs, Lawrence The mechanisms of estrogen regulation of bone resorption J Clin Invest. 2000 Nov 15; 106(10): 1203–1204

⁵ Vanadin Seifert-Klauss and Jerilynn C. Prior Progesterone and Bone: Actions Promoting Bone Health in Women J Osteoporosis. 2010; 2010: 845180.

⁶ Ebeling, Peter R Androgens and osteoporosis Current Opinion in Endocrinology, Diabetes & Obesity: June 2010 - Volume 17 - Issue 3 - p 284–292

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