Are You at Risk?
and
What Can You Do About It?

Ellen picks up her grocery bag containing a few items and leaves the store. As she steps off the curb onto the asphalt parking lot, her right leg gives way and she falls. Ellen receives much attention and help and is eventually taken to the hospital where an x-ray shows that she has broken her hip. "How could this happen?" she asked the doctor, "I only stepped off the curb!"

This is unfortunately an all-too-often occurrence that we are all familiar with. Each of us probably knows someone just like Ellen. And, like Ellen, many of us ask, "How could this happen?" Yet more often than not, osteoporosis is the culprit.

Osteoporosis is a loss of bone material causing a porous structure to remain. Studies have indicated that 10% of males and 35% of females over the age of 60 have frank osteoporosis--a condition wherein the bones have lost 50% of their mass. Osteoporosis is the cause of 90% of all fractures in people 65 years and older. In the population over 60 years of age, 40% of lost teeth is due to osteoporosis of the jaw with resultant periodontal disease. Statistics show that 14% of those suffering from osteoporosis will die from complications of hip fractures.

In 1988, the International Symposium on Osteoporosis presented papers indicating that more women die from complications of osteoporosis-related fractures than from cancer of the breast, uterus, and cervix combined. Complications of osteoporosis-related hip fractures leads to 200,000 deaths annually in the United States alone!

The effects of osteoporosis are greater on females than on males because women have less bone mass to begin with. Caucasian women (especially of northern European descent) are at greater risk, with fair-skinned petite women being the highest risk. But as bad as all this sounds, there is a way to prevent osteoporosis!

Calcium Metabolism

Bone is not inert--it is living tissue which requires nutrients, oxygen, and exercise for its maintenance. It is always in dynamic flux. Calcium is constantly being deposited at the same time it is being released from bone. If new bone formation and calcium deposition do not keep up with the rate of calcium being released from bone, osteoporosis results!

Bones are comprised of two types of bone cells. Osteoblasts are cells that deposit new bone material and calcium into bone. The osteoclasts secrete special enzymes which break down the bone material in order to release calcium. The body maintains stores of calcium in the bones, and when calcium is needed by the body (when the calcium present in the blood is too low), the osteoclasts break down the bone to release the stored calcium into the bloodstream.

There are four small glands behind the thyroid gland in your neck called the parathyroid glands. These glands produce a hormone, parathormone (PTH), which stimulates the osteoclasts to break down bone in order to release stored calcium. PTH causes the kidneys to conserve blood calcium by not allowing excess calcium to be excreted into the urine. Also it stimulates calcium absorption within the intestines by activating Vitamin D.

If bone breakdown exceeds bone deposition, then you have net calcium loss from the bone. As the calcium leaves the bones, the canals within the bone become enlarged and fill with fibrous and fatty tissue. This replacement tissue is not as strong; therefore these bones can easily fracture. In fact, women with osteoporosis can suffer what is called spontaneous fractures just from the weight of their body.

Causes of Calcium Metabolic Disorders

Excessive Dietary Protein

Excessive dietary protein is one of the causes of osteoporosis. Calcium is used in the body to buffer the pH of the blood. The pH is the measure of how acidic or alkaline a substance is. The blood should have a slightly alkaline pH of 7.4. Proteins leave a highly acidic ash after being metabolized. The ash is the residue left over from the protein metabolic process. This acidic ash must be buffered to maintain the proper pH of the blood--and that requires calcium to be released from the bones.

The average American takes in well over 100 grams of protein daily, yet most adults need less than that amount. Excessive intake of protein causes blood calcium to be utilized to buffer the acidity in the blood. This results in a negative calcium balance (more calcium is excreted as urinary and fecal calcium than is absorbed by the intestines). This loss of calcium from the blood causes osteoclasts to break down more bone to release more calcium into the blood.

Excess Dietary Phosphorus

Calcium must be balanced within the body by phosphorus. In fact, there should be 2 2 times as much calcium as phosphorus in the body to be properly utilized. When the body takes in too much phosphorus, the calcium-to-phosphorus ratio drops and this stimulates PTH production, which in turn produces calcium loss from the bones. The major sources of phosphorus in our diet are soft drinks (it is used to reduce the acidity from the carbonation) and fast food preparations (it is used to control bacterial growth).

Decreased Estrogen

Estrogen is a hormone produced by the maturing eggs within the ovaries. After menopause, the eggs stop maturing and all immature eggs degenerate. As a result, circulating estrogen levels in the blood decrease. Estrogen aids in the maintenance of normal bone mass by stimulating osteoblasts and checking the secretion of PTH by the parathyroid glands.

Estrogen Replacement Therapy (ERT) has been utilized by the medical profession for years in controlling bone density. Unfortunately, studies indicate that although initial short term use of ERT produces a positive calcium balance (bone density stabilizes or increases), long term treatment results in a negative calcium balance (bone density once again begins to decline). Additionally, ERT interferes with the metabolism of Vitamin D (necessary for your body's utilization of calcium) and has well known side-effects including increased risk of breast and uterine cancer, stroke, heart attacks, and gall bladder disease.

However, estrone is one of the estrogens produced by the body by both the ovaries and the fat cells. Estrone production continues after menopause. In addition to estrone, androsteredione and testosterone are both produced by the post-menopausal ovaries, and both hormones stimulate bone production.

Hypothyroid Conditions

Calcitonin is a hormone produced by the thyroid gland whose purpose is to counter PTH. Calcitonin inhibits osteoclast activity, thereby sparing bone density. Individuals suffering from either clinical or subclinical forms of hypothyroidism do not produce enough calcitonin.

Lack of Exercise

Bone maintains its strength in part by the applied stresses it must compensate for. Stress to the bones cause osteoblastic activity to build up bone and increase calcium deposition. Our couch potato friends do not stress the bones enough to produce additional bone density.

Vitamin D and Sunlight

Vitamin D is essential for the production of two enzymes which assist calcium transport within the bones. Our bodies produce Vitamin D from cholesterol and sunlight. (Because of the UV paranoia surrounding sunlight and the increased risk of skin cancer, our population is "sunlight phobic" and therefore we do not receive enough sunlight to produce the required amounts of Vitamin D.) In 1900, 75% of the population was employed in outdoor occupations. By 1970, this had dropped to less than 10%. A recent study published in the British medical journal, Lancet, indicated that 36% of the male population and 47% of the female population over the age of 65 were clinically deficient in Vitamin D.

Other Causes
Caffeine causes excess urinary and fecal loss of calcium.

Alcohol interferes with calcium metabolism.

Prednisone and other steroids inhibit calcium assimilation and increase urinary calcium excretion.

Antacids decrease stomach acidity, yet our body needs an acidic condition in the stomach to digest calcium. This change in stomach pH directly interferes with calcium absorption. Additionally, the magnesium and aluminum hydroxides contained in many of these antacids tend to lead to phosphorus deficiency which interferes with calcium uptake.

Testing Procedures

The need for testing for osteoporosis risk is attested to by the fact that greater than 50% of healthy females aged 30 to 40 years are at risk for developing osteoporosis.

Traditional testing makes use of Photon Absorptiometry or the "bone scan" to determine bone density. This method does provide a snapshot of the density of bone in an individual at the time the test is run. However, as we have previously discussed, your bone is not in a static state, but rather it is dynamic and constantly resorbing bone and laying down new bone. To measure this dynamic interchange and to determine if it is balanced, biochemical markers have been determined which can be measured. Pyridinoline and deoxypyridinoline are markers that can be measured easily from urine samples and are independent of diet.

Treatment Procedures

Treatment of osteoporosis must be directed at the underlying disorder of calcium metabolism thereby creating and maintaining a positive calcium balance within the body. Blood and urine testing are easily utilized to determine factors such as acid/alkaline balance, calcium-to-phosphorus ratio, calcium utilization coefficient, and to determine the overall calcium balance of the body. Once the underlying cause is determined, a nutritional and dietary program can be developed to restore proper calcium metabolism and to prevent osteoporosis.

If you want to investigate this further for yourself or someone you know, give us a call. We can help through testing and developing a nutritional program.

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