Osteoporosis is clearly a major problem in our modern world. For example, a woman’s chance of having an osteoporosis-related fracture today is 10 times greater than being diagnosed with breast cancer and 5 times more likely than having a heart attack. If you plan on living to at least 85, your chance of having a hip fracture is about 30 percent. So if you are a woman and not already thinking about protecting your bones, you need to start now!
The problem today is that in the last 30 years, we have been led to believe that drugs are the answer for all of our ailments. The reality is our diet and lifestyle determine our overall health, not drugs. Specifically regarding osteoporosis, the bisphosphonates commonly prescribed for osteoporosis are not as effective as we have been led to believe and, as more and more research data has come out about the long-term risks of these medications, we are finding out that they are more dangerous than we had previously thought.
Side effects of Bisphosphonates
- Abdominal pain
- Atrial fibrillation
- Bone pain
- Esophageal cancer
- Irregular heart beat
- Muscle cramping
- Muscle pain
- Reflux esophagitis
- Stomach ulcer
- Stomach upset
- Swollen ankles and feet
- Osteonecrosis of jaw or dead jaw syndrome
Since exercise and proper nutrition are more effective than drugs, it only makes sense for people to consider medication if they have very severe osteoporosis or have suffered from an osteoporosis-related fracture.
Osteopenia—when T-score is between -1 and -2.5.
Osteopenia is when bone mineral density is lower than normal, but not severe enough to be labeled osteoporosis. This is not a disease but merely a measurement of bone strength, set one standard deviation below that of an average 30 year old. It does not mean that person has a medical problem. Medications are even more inappropriate when a person is given a diagnosis of osteopenia, yet this is the event that triggers the majority of prescriptions for these medications. If you have osteopenia and your loss in bone density is not so severe, bisphosphonate medications like Fosamax may actually be harmful, as these medications may increase the risk of suffering a fracture.
John Abramson, M.D., of the clinical faculty of Harvard Medical School, dissected the raw data in the osteoporosis trials and reported on the outcome in patients with osteopenia, not reported in the published article. He discussed these findings in his book, Overdosed America, that the risk of hip fracture in the trials mentioned above was actually worse for women with osteopenia that were treated with bisphosphonates.1 The risk of hip fracture increased 84 percent and the risk of wrist fracture increased 50 percent. These medications (and others) are just not as effective as people think. Medical studies paid for by the drug companies and then written by people on the pharmaceutical company payroll are not impartial science.
Bone has a dense outer coating, called cortical bone, and an inner sponge-like filling, called trabecular bone. Once the bone loses its trabecular bridges, drugs cannot build them back. The build-up of bone from a drug is primarily thickening of cortical bone. That may look better on a DEXA scan but it really has little effect on the bones ability to resist fracture. Furthermore, DEXA scans have never been extensively studied to see if they are highly predictive of hip fractures. A person’s fitness level and agility are far more important in determining such risk. Most importantly, only exercise can strengthen and protect the entire structural matrix of bone; both cortical and trabecular bone. Our bodies are meant to be used and to be used in a vigorous fashion. When you exercise vigorously you not only protect your skeleton, but you will decrease your risk of developing heart disease, stroke, diabetes and dementia.
Preventing osteoporosis-related fractures
Nine out of ten hip fractures result from falls and an individual’s risk of falls is better indicated by strength and balance skills rather than bone density score.2 We know that the size and strength of muscles and bone decrease with age. We know that certain factors can accelerate or slow this decline. The strength and density of bone over time is directly proportional to the muscle strength that moves that bone. Just as muscles build with regular exercise, the bone strengthens and increases its density too, right along with muscle. Bones, like muscles, respond to stress by becoming bigger and stronger, and, like muscles, bones weaken and literally shrink if not used.
It is essential to exercise, and, in particular, to exercise the back and legs. In fact, muscle strength is an accurate way to predict bone strength and strengthening muscles has been shown to be the most effective way to strengthen bone and protect against osteoporosis-related fractures.3 Compared to exercise, medications are relatively ineffective.
Primary cause of hip fractures
- Poor nutrition
- Sedentary lifestyle
- Muscle weakness
- Side effects of prescription drugs
- Declining vision
- Cigarette smoking
- Vitamin D deficiency
The Best Food for Bones: Fruits and Vegetables
Millions of women have been falsely led to believe that there is a correlation between osteoporosis and the inadequate intake of dairy foods. Bone health is much more than just calcium. Vegetables, beans, fruits, and nuts are rich sources of calcium, potassium, vitamin K, magnesium, and vegetable protein, as well as the phytochemicals and micronutrients that are gaining recognition to be important for bone strength. Calcium is an important component, but like protein, we don’t need as much of it as most people think. The current U.S. daily calcium recommendation of 1200 to 1500 milligrams for postmenopausal women is an attempt to offset the ill-effects of the Standard American Diet which creates excessive calcium loss in the urine because most people consume so much sodium, caffeine and animal protein.
Contrary to popular belief, you do not need dairy products to get sufficient calcium. Every natural food contains calcium. When you eat a healthy diet, rich in natural foods such as vegetables, beans, nuts, and seeds, it is impossible not to obtain sufficient calcium. In fact, the addition of more natural plant foods to the diet has been shown to have a powerful effect on increasing bone density and bone health. Fruits and vegetables strengthen bones. Researchers found that those who eat the most fruits and vegetables have denser bones.4 These researchers concluded that fruits and vegetables are not only rich in potassium, magnesium, calcium and other nutrients essential for bone health, but, because they are alkaline, not acid-producing, they do not induce urinary calcium loss. Green vegetables, in particular have a powerful effect on reducing hip fractures, for they are not only rich in calcium, but other nutrients as well, such a vitamin K, which is crucial for bone health.5
So most unprocessed, natural foods contain calcium and green vegetables have particularly high levels. In fact, one four-ounce serving of steamed collards or kale has about the same amount of calcium as one cup of milk. Take a look at some natural foods and their approximated calcium levels.
|Bok-choy, 2 cups
|Broccoli, 2 cups
|Collard greens, 2 cups
|Calcium-fortified orange juice (8 oz)
|Garbanzo beans, 1 cup
|Kale, 2 cups
|Milk, 1 cup
|Romaine Lettuce, 4 cups
|Sesame seeds ¼ cup
|Soybeans, 1 cup
|Spinach, 2 cups
|Sweet potato, 2 cups
|Tahini (sesame seed paste) 2 tbsp
|Tofu, 1 cup
|Tahini (sesame seed paste) 2 tbsp
Green vegetables also have calcium absorption rates of over 50 percent, compared with about 32 percent for milk.6 And, since animal protein induces calcium excretion in the urine, compared to dairy, the calcium retention from vegetables is higher. All green vegetables are high in calcium.
The American, “chicken and pasta” diet-style is significantly low in calcium, so adding dairy as a calcium source to this mineral-poor diet makes superficial sense—it certainly is better than no calcium in the diet. However, it is much more than just calcium that is missing. The only reason cow’s milk is considered such an important source of calcium is because the American diet is centered on animal foods, refined grains, and sugar, all of which are void of calcium.
Of course, when our calories come mostly from oil, sugar, flour, and animal meat, instead of unrefined plant foods such as these, it can appear that, without dairy, the diet would be too low in calcium. But, medical studies confirm that drinking cow’s milk does not lead to stronger bones and just relying on milk without sufficient vegetable intake can actually worsen bone health. When more vegetables are consumed, you get extra calcium and a cornucopia of phytochemicals that are not found in dairy. Studies demonstrated that individuals who drank one glass or less of milk per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week.7 It was also noted that high total calcium intake and milk consumption did not protect against osteoporotic fractures.
Other Highly Critical Issues
Vitamin D Deficiency
Vitamin D is the sunshine vitamin, but since most people work indoors, most Americans have sub-optimal levels of this important vitamin. Recent research studies have corroborated the fact that most Americans are vitamin D deficient. This deficiency occurred even among a majority of study subjects who were already taking a multivitamin with the standard 400 IUs of vitamin D. More and more health authorities are recommending that an additional 800 to 1200 IUs of vitamin D be taken over and above the 400 typically present in a multiple vitamin. The way to know for sure if you are taking the right amount of vitamin D, or if the mixture of your sun exposure and vitamin D intake is adequate is to test your blood for vitamin D, 25 hydroxy. Most women take an excessive amount of calcium, recommended by authorities and their doctor, but insufficient amounts of vitamin D.
Vitamin A Supplements
In high doses, vitamin A (retinol) is associated with birth defects, and recent research suggests the dose that causes risk is much lower than previously thought. If vitamin A is toxic to a person who is pregnant and potentially harmful to the developing baby, it can’t be good for us the rest of the time. Research has shown it is linked to calcium loss in the urine and osteoporosis. For example, an important study found that subjects with a vitamin A intake in the range of 1.5 mg had double the hip fracture rate of those with an intake in the range of .5 mg.8 For every 1 mg increase in vitamin A consumption, hip fracture rates increased by 68 percent. Most multivitamins contain about 5000 IUs of vitamin A, which is equal to 1.5 mg. This means if you conform to the current recommendations, which have become outdated, and get your vitamin A from supplements, you could be weakening your bones. Instead, the body can naturally self-fabricate vitamin A by consuming beta-carotene and other carotenoids in real food. Vegetables contain beta carotene and other carotenoids (not vitamin A), which do not lead to excessive vitamin A formation or cause calcium loss. Vitamin A supplements have also been documented to shorten lifespan.9 Do not take vitamins that contain vitamin A.
How much calcium is needed?
Government advisory panels reviewed many calcium balance studies, which examine the point at which the amount of calcium consumed equals the amount of calcium excreted—suggest that a reasonable or adequate intake of calcium is about 550 mg/day. To ensure that 95 percent of the population gets this much calcium, the National Academy of Science recommends:10
- 1,000 mg/day for those age 19-50
- 1,200 mg/day for those age 50 or over
- 1,000 mg/day for pregnant or lactating adult women
The advice that most people get regarding how much calcium to consume assumes that the person taking the supplement consumes no calcium in their diet and the supplements typically supply 1000 mg or more of calcium daily. Taking supplements of 1000 mg or more of calcium is likely excessive. It important that the majority of your calcium intake comes from healthy, micronutrient-rich food, not supplements.
In an analysis of trials involving calcium and bone density it is generally recognized that calcium supplements alone do not prevent osteoporosis. Similarly, high-dose calcium supplements do not prevent or reduce the severity of osteoporosis more than low-dose supplements. A long-term, 18-year analysis showed that 600 mg of calcium was as effective as 1200 mg in preventing osteoporosis as long as adequate Vitamin D was present. Low serum Vitamin D levels correlated best with fracture risk.11 Plus, the research shows we do not need as much calcium when our dietary habits do not promote excessive calcium loss in the urine.
Despite the debate surrounding milk and osteoporosis and how much calcium is ideal, one thing is clear: adequate calcium is important for reducing the risk of osteoporosis. And when women supplement their diet with extra calcium, hip fractures do decrease. A combination supplement containing 800 IU of Vitamin D along with calcium has been shown to reduce both bone loss and hip fractures.
Calcium should not be taken in excessive doses and I recommend that, if supplemented, calcium should be in the 400–600 mg range, not the 1000–2000 mg range. In conclusion, a modest increase in calcium via supplementation is appropriate for most people, but real food should supply a good percentage of your calcium intake to achieve the right balance of supportive nutrients to maximize bone health. Advice that might encourage total calcium intake (food plus supplementation) to approach or exceed 2,000 mg/day seems more likely to produce adverse effects and should be avoided.
- Eat a high nutrient diet. My dietary solution is deliciously described in my book Eat For Health. It is mandatory reading for anyone wanting to reduce their risk of disease or treat a medical condition with diet.
- Do the right type of Osteoporosis fighting exercises. Swimming and biking will not do it. The best bone building exercises designed to strengthen muscles and bone and to improve balance, reducing the risk of falls are demonstrated in my DVD—Osteoporosis Protection For Life
- Take the right supplements. My multivitamin/mineral supplements contain no Vitamin A and no isolated beta carotene both which have been linked to increased health risk and increased mortality (death) in recent medical studies.12 They also contain an expensive and effective form of Vitamin K (K2), more effective at promoting bone strength than K1. My Osteo Biotect is my Vitamin D/Calcium/Magnesium supplement with a lower dose of calcium compared to most other Vit D/Calcium/ Magnesium products. The combination of one of my multivitamins with either 1000 or 2000 IU of D and the Osteo Biotect allows women to customize their vitamin D and calcium doses, not too much and not too little to protect their bones, without the risks of overdosing on from the overzealous use of supplemental ingredients, which has a downside.
Osteopososis Protection For Life
In Osteoporosis Protection for Life, I have put together a comprehensive approach, combining dietary advice, supplements and special exercises, that offers a significant improvement over drug-treatment for osteopenia and osteoporosis. I want to give people the information they need to put an effective plan into action, so I created a DVD to deliver my advice and to demonstrate the best exercises to effectively build your strengthen and bone mass. It takes only a few minutes a day or fifteen minutes twice a week to run through the exercises.
A Weighted vests also aid in the fight against osteoporosis
For years, I have advised women to wear and exercise with a weighted vest. Weighted vests can be worn for hours each day and are the most effective prescription a doctor can order to prevent and treat osteoporosis13 The problem in the past has been finding the best vests that are designed for women and have the weights in the right position, high on the torso and balanced to keep the spine erect. The weight should be felt primarily over the shoulders to stimulate bone growth in the spine.
It is advisable to start with merely 6–8 pounds in the vest and gradually increase the weight to ten percent of your body weight. Wear the vest for a few hours each day if possible, not only during exercise, but during your everyday activities around the house, especially shopping, cooking and cleaning. Wearing a weight vest has other benefits as well, such as burning more calories, increasing core strength and improving balance. It should not be used if a person has significant bone disease or structural back problems.
1. Abramson J. Overdosed America. Harper 2004; 215.
2. Ueki S, Kasai T, Takato J et al. Production of a fall prevention exercise program considering suggestions from community-dwelling elderly. Nippon Koshu Eisei Zasshi. 2006;53(2):112-121.
3. Rubin C, Turner AS, Muller R, et al. Quantity and quality of trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechanical intervention. J Bone Min Res 2002;17:349-357.
4. Tucker KL, Hannan MT, Chen H, et al. Potassium, magnesium, and fruit and vegetable intakes are associated with greater mineral density in elderly men and women. Am J Clin Nutr 1999;69(4):727-736.
New SA, Robins SP, Campbell MK, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 2000;71(1):142-151.
5. Feskanich D, Weber P, Willett WC, et al. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr 1999;69(1):74-79.
6. Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr 1994;59(suppl):1238S-1241S.
7.Feskanich D, Willet WC, Stampfer MJ, Colditz GA. Milk dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Public Health 1997;87:992-997.
8. Melhus H, Michaelson K, Kindmark A, et al. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk of hip fracture. Ann Intern Med 1998;129(10):770-778.
9. Bjelakovic G, Nikolava D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patient with various diseases. Cochrane Database Syst Rev 2008;16(2):CD00776.
10. Optimal Calcium Intake. NIH Consensus Statement Online 1994 June 6-8; 12(4):1-31
11. Feskanich D; Willett WC; Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 2003 Feb;77(2):504-11.
12. Bjelakovic G, Nikolava D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patient with various diseases. Cochrane Database Syst Rev 2008;16(2):CD00776.
13. Greendale GA, Salem GJ, Young JT, et al. A randomized trial of weighted vest use in ambulatory older adults: strength, performance, and quality of life outcomes. J Am Geriatr Soc 2000 48(3):305-11. Greendale, GA, Hirsh SH, Hahn TJ. The effect of a weighted vest on perceived health status and bone density in older persons. Qual Life Res 1993 2(2):141-52. Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci 1998 53(1):M53-8. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Bio Sci Med 2000;55(9):M489-91.