Osteoporosis 骨質疏鬆

Osteoporosis literally means porous bones. It is a slow, progressive disease characterized by a gradual loss of calcium from bones until they become very porous and weak. Eventually they are no longer able to support your weight and fracture. Although osteoporosis can occur in any bone and can even be localized, bone loss is usually greatest in the spine, hips, and ribs. There is decline in bone mass after the age of 35-40, and it is accelerated in patients with osteoporosis.

There are 1.2 million fractures each year in the United States due to osteoporosis, costing an estimated $6.1 billion annually, not to mention the pain and suffering it causes. This problem is most common in women (but by no means limited to them) and accounts for more suffering in our elderly population than any other.

More and more doctors today are recommending that their patients take calcium to protect them from osteoporosis. Many assume that simply increasing dietary calcium or taking a calcium supplement will prevent bone loss. This is not necessarily true! Bone loss can be caused by many things including deficiencies of magnesium, silica, phosphorus, zinc, vitamin K, and copper. Adequate intake of calcium and these nutrients is essential.

There are six basic components to healthy bone mineralization:

1.  Provide your body with the nutrients necessary to build healthy bones – we generally use a nutritional supplement called OSTEOBUILD available through our Supplement Dispensary.  It should be emphasized that providing the body with all of the nutrients to build bone does not stimulate the mineralization of bone unless there is a deficiency in one or more of the essential co-factors such as manganese, vitamin D, etc.  Providing the nutrients only enables the deposition of bone minerals and matrix.  It is important to note that intake does not always mean entry into the body.  Fat malabsorption (which could be due to biliary insufficiency) can cause calcium loss in the feces since calcium binds strongly to fat.  Lack of stomach acid (often from medication) can reduce the absorption of certain minerals that require ionization by stomach acid for optimal entry into the body.

2.  Manage any medical conditions that promote osteoporosis including:

• Endocrine problems such as overactivity of the thyroid, parathyroid, or adrenal gland or underactivity of the parathyroid glands or gonads (testicles or ovaries).
• Diabetes mellitus (insulin), kidney disease, liver disease, gall bladder dysfunction, rheumatoid arthritis, anorexia nervosa.
• Inherited conditions such as Marfan's syndrome, homocystinuria, Ehlers-Danlos syndrome, and osteogenesis imperfecta.
• A family history of osteoporosis and/or Northern European descent.
• A vegetarian diet.
• Cigarette smoking is also associated with the development of osteoporosis.
• Reduce inflammation, which impedes bone mineralization.  This can be due to infections such as an unresolved dental abscess, hepatitis, colitis, etc.

3.  Avoid medications known to reduce bone mineral density such as alcohol, chronic heparin, methotrexate, corticosteroids, Lasix, Dilantin, and acid blockers (cimetidine, Prilosec, Prevacid, Nexium, Pepcid, Zantac, etc). 

4.  Alkalinization to promote storage of minerals in your bone rather than using these minerals to buffer excess acidity elsewhere.  There is a great deal of mis-understanding about acid-alkaline balance not only by the public and internet, but also among many nutritionally-oriented health care professionals.  Most people are mis-led by the belief that urine and saliva pH levels determine if you are generally alkaline or acidic.  This is not true because there are circumstances (and not uncommon) in which the body is acidic but the pH of both the saliva and urine are actually alkaline (pH>7.0).  How long you can hold your breath is the best simple indicator of general acid-alkaline status with the urine and saliva pH identifying the type of acid-alkaline imbalance.

Dietary factors play a critical role.  One reported culprit in osteoporosis is excessive cooked animal protein. The hypothesis was digestion and metabolism of animal protein results in organic acids that must be neutralized (buffered) by alkaline minerals. If there is mineral depletion (very common according to the U.S. Department of Agriculture), the body uses the alkaline reserve in bone (calcium) to buffer the acid byproducts of protein metabolism. Total protein intake greater than 47 grams a day has been shown to promote osteoporosis. While a large serving of vegetables can contribute up to 16 grams of protein, a 6-ounce sirloin steak contains 40 grams itself! Furthermore, the more protein you eat, the faster calcium is lost. None of this is important if you have adequate calcium and alkaline mineral intake according to more recent studies, however. To emphasize the importance of alkaline buffers, a study found using potassium bicarbonate alone was effective in treating osteoporosis without giving any calcium.

Pasteurized milk is often thought of as a good calcium source. However, milk may not only not prevent osteoporosis but may actually contribute to it! The two countries with the highest milk consumption are the U.S. and New Zealand. Both lead the world in incidence of osteoporosis. An article in the American Journal Of Public Health (97;87:992-7) reported that 75,000 Nurses who were followed for 12 years showed no greater protection against bone fractures from increased milk intake, in fact the high milk drinkers had a higher risk! Another study published in the American Journal of Epidemiology (94;139:493-505) revealed the same results in Australian women. One reason is that pasteurization (heating the milk) destroys a crucial enzyme in raw milk that allows utilization of calcium. Since pasteurized milk contains phosphorus and cooked protein, pasteurized milk becomes a promoter of osteoporosis. It is no wonder that the most successful bone-building products we recommend are in their raw whole food state!

5.  Another important aspect to bone health is the balance between calcium and phosphorus in the blood. When phosphorus is high, calcium may be pulled from bone to keep the ratio balanced. While hormones play a major role in determining the calcium-phosphorus ratio, food choices plays a critical role as well. Sugar pulls calcium from bone and cells and puts it into the bloodstream. Notice that diabetes is a risk factor for osteoporosis as high insulin levels promote bone loss. Phosphoric acid-containing colas are triple trouble. The body not only has to buffer the extra phosphorus in the soda, it has to deal with the high sugar concentration (which forces insulin secretion and contributes to acidosis), and finally the caffeine is associated with accelerated bone loss.

5.  Promote bone deposition by stimulating your bone cells (osteoblasts and osteoclasts) to work in balance together to build healthy mineral-rich bones.  There are two consistent mechanisms which promote this balance:

a.  Exercise with weight bearing.  It should be noted that over-exercising to the point of breaking the body down is counter-productive.  Because swimming negates much of the effect of gravity, swimming is not expected to enhance bone mineralization.

b.  Proper hormone balance especially the sex hormones (estrogen, progesterone, testosterone, DHEA, etc).

There are two basic types of bone regulating cells: osteoclasts and osteoblasts. The osteoclasts function to dissolve older bone and leave tiny unfilled spaces behind.  The osteoblasts then move into these spaces and produce new bone. This process of dissolving older bone mass by osteoclasts and new bone formation by osteoblasts is the mechanism for the repair and continuing strength of bone. Like all living cells, osteoblasts and osteoclasts require hormonal guidance to properly function. Osteoblasts depend primarily on progesterone and testosterone, while osteoclasts need estrogen-like hormones. In the absence of these hormones, osteoblasts and osteoclasts cease to function properly and bone deterioration rapidly occurs.

Osteoporosis can occur when osteoclasts dissolve more bone than what the osteoblasts are able to replace. Estrogen regulates the activity of osteoclasts, which results in a slowing of dissolving older bone. Progesterone, on the other hand, promotes the production of osteoblasts that are required to form new bone.  Progesterone has been shown to stimulate the new bone formation required to prevent and reverse osteoporosis.  Synthetic forms of progesterone, called progestins (Birth control pills, Aygestin, Provera, etc.), do not seem to have this effect.

6.  Restoring kidney vitality. Traditional Chinese medical theory states, "The kidneys are in charge of the bones."  The Yellow Emperor's Internal Classic teaches that the growth, development, repair and degeneration of the skeleton is closely related to kidney vitality and function.  This means the physiology of your bones are related to the function of your kidneys.  In addition, the kidneys promote the general vital essence (qi or "chi") believed to be responsible for health and vitality throughout the body.  Loss of "chi" is not necessarily seen in traditional blood tests, which show kidney clearance and do not reveal "chi." 

Blood stasis, also associated with qi, is the second root cause for bone diseases according to traditional Chinese medical theory.  Promoting blood circulation to remove the stagnancy and stasis to produce new bone are considered important measures for preventing and treating osteoporosis. Western medicine strongly supports this theory, and repeatedly encourages vigorous exercise for general well-being and weight-bearing exercise for bone health. Both cultures agree that when blood and oxygen supplies to the bones are increased, bone nutrition improves and bone density increases.

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