Solving the Osteoporosis Puzzle

Yoni Whitten, D.C., C.C.W.P.

In the United States osteoporosis is a national epidemic. It’s estimated that over 25 million adults in the U.S. have, or are at risk of developing osteoporosis. Osteoporosis is a condition characterized by fragile bones and it results in increased risk of bone fractures. We currently spend more than $17 billion per year managing osteoporosis and its related fractures. That’s over $46 million per day!

One of the great misconceptions about osteoporosis is who it affects. It is not just a problem for women over the age of 50. In fact, the stage for osteoporosis is set much earlier in life. Bone is living tissue and it’s constantly being broken down and built back up. Osteoporosis results when the body is consistently breaking down more bone than it forms. There are a number of factors responsible for tipping the balance within the body toward bone loss. The three most important pieces for solving this puzzle are lack of physical exercise, vitamin D deficiency as well as fruit and vegetable intake.

Several studies have concluded that physical exercise is the most important factor for building strong bones. In fact, one study published in the British Medical Journal, followed 1,400 men and women over a 15-year period and found that exercise may be the best protection against hip fractures. Interestingly these researchers also found that "reduced intake of dietary calcium does not seem to be a risk factor." Another study from Penn State University found that bone density is significantly affected by how much exercise girls get during their teen years, when 40 to 50 percent of their skeletal mass is developed. The researchers hypothesized that increased calcium intake would result in better adolescent bone gain and were quite surprised to find their hypothesis refuted – again, their research showed that calcium intake, which ranged from 500 to 1,500 mg per day, had no lasting effect on bone health.
Vitamin D is another essential ingredient for strong bones and the prevention of osteoporosis. In August of 2008, researchers at the University of Pittsburgh found low levels of vitamin D increase older women's risk for hip fracture by more than 70%. Vitamin D is necessary for promoting calcium absorption in the digestive tract. It also helps to maintain proper mineral concentrations within the blood for bone mineralization. A deficiency in vitamin D can cause bones to become weak, misshapen and prone to fracture.
We have been inundated with advice about eating dairy foods and drinking milk to protect our bones. The Harvard University's Nurses 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 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 much more important dietary factor to consider for improving bone density can be found in the produce aisle of your local market. A study from the American Journal of Clinical Nutrition looked at all aspects of diet and bone health and found that high consumption of fruits and vegetables positively affect bone health and that dairy consumption did not. According to Dr. John McDougall, an expert on osteoporosis: "On a nation-by-nation basis, people who consume the most calcium have the weakest bones and the highest rates of osteoporosis.”

Action Steps:

• Exercise every single day – Weight-bearing or resistance exercise is best.
  These include weight-lifting, walking, jogging, stair-climbing, step aerobics, hiking, dancing, racquet sports, and other activities that require your muscles to work against gravity.
• Get 15 minutes of direct sun exposure every day – Expose as much skin as possible.
  Most of the vitamin D in your body is synthesized during sun exposure, so make sure to get your daily serving of sunlight.
• Increase your intake of fruits and vegetables – Aim for 9-10 servings per day.

Remember:

• Calcium absorption form milk is approximately 30%. For green vegetables like broccoli, Brussels sprouts, mustard greens, turnip greens, kale and other green leafy vegetables that number is between 40%-64%.  So, eat more greens!

References:

1. R. Burge, B. Dawson-Hughes, D.H. Solomon,  J.B. Wong, A. King & A. Tosteson. Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States. Journal of Bone and Mineral Research, 2005–2025. March 2007: 22: 465-475

2. C. A. Wickham, K. Walsh, C. Cooper, D. J. Barker, B. M. Margetts, J. Morris, and S. A. Bruce. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. British Medical Journal. 1989 October 7; 299(6704): 889–892.
3.  American Journal of Clinical Nutrition, 2000; 72(3): 681-689.
4.  Pediatrics 2000;106:40-44.
5. U.S. Department of Health & Human Services - http://www.healthfinder.gov/newsletters/pain082508.aspx
6. McDougall, J.A. & Mary McDougall. The McDougall Program for Women. Plume Books, 2000.
7. National Institute of Health - http://ods.od.nih.gov/factsheets/vitamind.asp

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