Natural Approach to Osteoporosis

Comparison between normal, healthy bone with
osteoporotic bone. Note the characteristic spongy appearance
which gives rise to an increases risk of fractures and breakages.

There has been a lot of discussion around osteoporosis lately, probably due to the lastest figures showing that the incidence in the UK is rising and better education of the condition is needed as it is a preventatble disease but only if adequate measures are taken early on in life. Statistics for the UK show that there are about 3 million people in the UK with this condition and about 10 million diagnosed with it in the US. So what is osteoporosis and how can it be prevented?
Osteoporosis has been labelled 'brittle bone disease' because it causes the bone (tissue that is normally rigid and dense with calcium deposits) to become thin, fragile and porous. Moreover, the tissue integrity in osteoporosis is such that loss of calcium results in its characteristic spongy appearance that can only be detected in bone density scans (DEXA scans) without any observable symptoms.  Innovative new techniques in medical diagnostics may mean that it will be possible to detect osteoporosis much earlier on (bone loss at its earliest stages) with a simple urine test. The reasons that the current incidence of osteoporosis is a worry is that fragile bones are likely to fracture or break and what's worse is that there is no knowing if you have this condition as it is typically asymtomatic until a minor accident, fall or injury. In the UK, it is estimated that around 250,000 fractures/year are as a result of osteoporosis. There is an increased risk of fractures or breakages usually in the spine, hips, arms and/or wrists which may lead to complications later on especially in older sufferers whose ability to repair and regenerate healthy tissue is significantly diminished.
Osteoporosis takes many years to develop and healthy bones that are a feature of youth and robustness start to change in the pattern in which calcium is deposited. It has been argued that if you don't get the right nutrients and calcium (and also vitamin D) intake by a crucial life stage (usually by mid-late 20s), the bones will never be fully functional. From about the age of 35, bone density starts to decline ostensibly due to the manner in which calcium is deposited with what's termed 'bone turnover'. The rate of bone turnover is synonymous with calcium demineralisation.

High risk groups are:

• post-menopausal women with a decline in oestrogen (oestrogen influences bone density)
• endocrine disorders eg. hyperthyroidism (excess thyroxine hormone), pituitary gland diseases
• long-term oral corticosteroid medication eg. prednisolone given for arthritis affects bone strength
• malabsorption disorders eg. Crohn's disease, coeliac disease (leaky gut syndrome)
• heavy drinking and smoking (depletes vital nutrients needed for bone mineralisation)
• men with low testosterone levels (eg. hypogonadism) - testosterone is also needed for bone health
• family history of osteoporosis
• long-term inactivity (self-imposed or due to disability)
• overactivity of the parathyroid gland (this gland produces parathyroid hormone which regulates the amount of calcium in bones

Osteoporosis can be prevented, contrary to popular understanding with regular exercise, healthy eating, getting sufficient exposure to natural sunlight and lifestyle changes eg. giving up smoking and heavy drinking.

Treatments
Once diagnosis has been confirmed and depending on the level of bone loss/density according to bone density scans, the treatment can fall into 2 groups: conventional drugs and natural approaches.
Conventional drugs are sometimes necessary in cases where calcium needs to be replaced fairly quickly indicating the severity of the bone loss. These drug treatments include the following which are commonly prescribed:

• bisphosphonates - reduce the risk of bone breakages especially in the spine eg. alendronic acid (Fosamax), clyclical etidronate (Didronel PMO), ibandronate (Bonviva), risedronate(Actonel) and zoledronic acid (Aclasta)
• selective oestrogen receptor modulator (SERM) - mimics the action of oestrogen only in order to promote the protective effects that this hormone has in osteoporosis but does not influence other organs which are usually influenced by oestrogen such as the breast tissue and uterus eg. raloxifene (Evista)
• strontium ranelate (Protelos) - influences bone turnover rate by acting on the bone cells themselves (osteoclasts and osteoblasts)
• parathyroid hormone (PTH) treatment - builds new bone and only available from specialists eg. Preotact, Forsteo)
• monoclonal (human) antibodies - antibodies specifically designed to attack the rank ligand; a substance of bone metabolism that stimulates the cells that break down bone (osteoclasts) eg. Denosumab
• calcium and vitamin D therapy - absorption of calcium requires a healthy intake of vitamin D. These can be given as supplements either as treatment (in severe cases of depletion) or as a preventative measure

Other, less commonly used treatments

• calcitonin (Miacalcic) - for bone protection and for relieveing acute bone pain (fractures)
• calcitriol (Rocaltrol) - reduce fractures in women and prevent broken bones in men
• HRT (hormone replacement therapy) - replaces oestrogen (and sometimes progesterone) in women and testosterone in men (for hypogonadism). HRT is no longer the 1st line treatment in the menopause due to concerns over its risks and long-term use. However, there is some benefit for some regarding bone protection with HRT

Natural and Alternative Approaches to Treatment
By far the biggest benefit is nutrition and herbal medicine - so many people aren't getting the right balance of nutrients nor indeed the right quantities of them when they do get them from food. Osteoporosis is just one of the numerous health problems resulting from a poor diet, as well as lifetyle such as smoking and heavy drinking.

Nutritional Therapy
To know if you are at risk, is to have knowledge of whether you are getting sufficient quantities of calcium, vitamin D and some of the other, equally important nutrients. Studies suggest that diets rich in the following foods and nutrients may help prevent bone loss in both men and women:

• calcium - low fat milk & other daily products, cheese, brocolli. some foods are fortified (added) with calcium
• magnesium - avocado, banana, lima beans, low fat milk, potato, spinach, halibut fish
• potassium - whole grains, nuts, spinach, oatmeal, potato, peanut butter
• vitamin D - the body makes vitamin D from exposure to sunlight but precursors (raw materials and an inactive form of the vitamin) are needed. It is found in in fatty fish, fortified cereals and milk
• omega 3 essential fatty acids (see my earlier posts on EFAs - July 2012) - can maintain and possibly help increase bone mass
• vitamin K - dark green, leafy vegetables, cauliflower
• strontium
• fruits
• vegetables

If supplements are cruicial (for whatever reason) and especially if the nutritional deficiency is severe, then it's essential you buy calcium citrate as this is the form in which calcium can be most easily absorbed. However, supplements of these will cost more. Other forms that are absorbed are calcium carbonate and calcium phosphate. Best to check with a nutritionist to determine the recommended daily intake for each ndividual case.

Herbal Medicine
 Many people are worried about taking strong conventional drugs over a long period of time preferring a more natural approach to any health condition. In this regard, herbal medicines are a popular choice. Herbs that are commonly indicated for osteoporosis include those that contain notable quantities of isoflavones (phyto-oestrogens) which are plant chemicals that exert the same effects as endogenous oestrogens. These herbs are also popular choices for treating menopausal symptoms as they mimic the actions of naturally-occuring oestrogen which is lacking in sufficient quantities in the menopause resulting in typical symptoms seen such as hot flushes. Herbs that are high in phyto-oestrogens include black cohosh, red clover, wild yam and alfalfa. The best sources via the diet is from soy isoflavones (soy, tofu, soybeans, tempeh, tamari, miso). Traditional fermented soya is the only recommended type of soya since unfermented soya contains phytic acid which blocks the absorption of calcium and other nutrients (see my earlier post on soya - December 2010). Other herbs include:

• horsetail (Equisetum arvense) - contains silicon, believed to strengthen bone
• kelp (Fucus versiculosus) - rich in minerals so may enhance bone health along with other treatments
• oats straw (Avena sativa) - boosts hormone levels that support bone health and stimulates cell growth
• false unicorn root (Chamaelirium luteum) - contains steroidal saponins that act as mild oestrogens and so promote bone health

Natural Progesterone
There has been much debate and discussion over natural progesterone which comes essentially from extracts from wild yam which is combined with other ingredients to produce a cream that is applied topically for absorption through the skin. Claims of its benefits include an alleviation of menopausal symptoms, prevention of osteoporosis and stengthening of bones. Medical research showed that the risks associated with oestrogen-only HRT (uterine cancer) were reduced when given in combination with a synthetic form of progesterone known as progestogen. However, many were still unhappy with HRT and in the belief that it was the natural progesterone that was responsible for mitigating menopausal symptoms and preventing osteoporosis in post-menopausal women. Natural progesterone cream is often marketed as a natural alternative to HRT and, therefore, appeals to women seeking an alternative option to drug treatments for osteoporosis. Unfortunatiely, natural progesterone still remains unlicenced with official data on side-effects, adverse events and other problems not being recorded or publicly available. Strong scientifica data to support its benefits in osteoporosis is also lacking making natural progesterone cream an unlicenced product and taken at the user's risk.

Proper advice and or a consultation with a medical herbalist is highly recommended prior to any self-medication with OTC herbs.

For more information or advice on osteoporosis as well as help in nutrition or herbal remedies, please visit:
The National Osteoporosis Society (UK) www.nos.org.uk/
The British Association of Nutritional Therapists www.bant.org.uk/
The College of Practitioners of Phytotherapy www.phytotherapists.org/
The National Institute of Medical Herbalists www.nimh.org.uk/