There are three stages of bone health.

Stage 1 is the first 25 years of a man or woman’s life when you build the strongest, most dense bones and minimize any actions that may compromise bone building.

Stage 2 is from 30 years of age to menopause for women or andropause for men, where you take steps to avoid the breakdown of bone.

Stage 3 is post menopause or andropause for men, which is generally over 50 years or age, where you support both bone maintenance and limit bone loss.

For most individuals the risk for osteoporosis is strongly influenced by family history of a parent with a hip fracture and that risk is worsened by lifestyle issues. Other individuals can have medical conditions that cause or put them at risk for osteoporosis, but again, lifestyle can further increase that risk. Osteoporosis is a chronic, progressive disease with the most significant outcome being a fracture. It affects millions of Americans, particularly women. and it is estimated that anywhere between 20%-50% of post menopausal women are affected by low bone density (although not all have osteoporosis).¹ Although osteoporosis is often thought to be a disease primarily affecting women, men also incur substantial bone loss due to aging and decreased hormone production. Over two million men have this disease and men are more likely to incur fractures related to osteoporosis than to get prostate cancer.^1,2,3 The most serious complication of osteoporosis is fracture, specifically fractures of the hip which cause severe pain, disability and increased mortality.

The major causes of osteoporosis relate to age are hereditary (osteoporosis and especially a hip fracture), low body weight (<127 lb), being a current smoker and/or being on steroid therapy (e.g. Prednisone).⁴ The list of additional risk factors is long and includes vitamin D deficiency, hyperthyroid, hyper-parathyroid, renal calcium leak, poor nutrition, low hormone production, excess alcohol and lack of exercise. Osteoporosis is often preventable by taking simple steps to build and support bone density. It is frequently underdiagnosed and therefore often undertreated. For that reason the most important first step is to:

Find out the status of your bone density and evaluate your current lifestyle and diet.

Maybe you are getting enough calcium in your diet, but are you getting enough magnesium, vitamin D, zinc and co-factors? Maybe you are exercising and eating well, but do you smoke or drink too much alcohol? Only by undertaking a personal assessment of your bone density, current lifestyle and nutritional status, will you get a clear picture of where you are and what measures you need to take.

A bone health assessment is often covered by insurance companies, can be carried out by your health professional and includes a medical history, physical exam and the gold standard - a bone mineral density test, or DEXA Scan. Standard guidelines for DEXA scans are the following:

• All women 65 years and older
• Postmenopausal women with medical causes of bone loss (e.g. steroid use, hyperparathyroidism, malabsorption, immobilization)
• Postmenopausal women over 50 years with additional risk factors (fracture - other than skull, less than 127lb, history of hip fracture in parent, current smoker, alcohol intake more than 2 units/day (1 unit: beer = 12oz; wine = 4 oz; liquor = 1 oz).
• Postmenopausal women with a fragility fracture (a fall from standing height)

More extensive evaluation of underlying causes and management may include urinary and serum calcium levels, vitamin D levels, hormone analyses including parathyroid and thyroid tests, selected nutrient analysis and a lifestyle, exercise and nutritional assessment.

All information in the body is transferred by two types of messengers including – neurotransmitters and hormones. Neurotransmitters help cells communicate through the nervous system and hormones enable cells to communicate through the blood stream. These two messengers control nearly every aspect of the body’s function. They are so influential, and at the root cause of so many health issues, that your risk for many health conditions, like osteoporosis, are correlated to your hormone production.

Within the first 3-5 years of a woman becoming menopausal (no menses in 12 months), she loses on average 7-10% of her bone density. More interesting, is that during those first 3-5 years, most women are eating the same foods, exercising the same way and consuming the same amount of calcium, vitamin D and other vital nutrients. The only real change for a woman is that her body’s production of hormones dramatically declines, emphasizing the correlation between hormones and bone density and how the significant loss of hormones experienced post menopause directly relates to the initial loss of 7-10% of her bone density. ²⁹ Similarly, most men do not have bone health issues until later in life when testosterone levels significantly decline.

For this reason hormones are one of the most important, if not THE most important aspect of bone health, particularly growth hormone, estrogen, progesterone and testosterone. Additionally, often forgotten in bone health protocols is thyroid production, as hyperthyroidism or overproduction inhibits bone building and accelerates bone loss increasing the risk for osteoporosis. ²⁶

Bone and muscle are living tissues. They grow, shrink and become stronger or weaker. A key factor in bone health (which includes bone density, bone strength and bone architecture) is to provide all the necessary elements for your bone. Bone is a complex, highly mineralized tissue, which requires essential nutrients for its formation. These include protein, fatty acids, calcium, magnesium and Vitamins A, D, E, K and more. Below are a few of the more important building blocks you need.

Calcium

The first thing that usually comes to mind when people think of bone health is calcium. Calcium is essential for healthy bone formation; however, it requires the presence of optimal amounts of other trace minerals, vitamins and hormones to build bone and reduce risk of fracture. Also, research indicates that too much calcium (>1500 mg/day) can be associated with an increased risk of kidney stones 5 and possible increased risk of cardiovascular disease, as well as the inhibition of absorption of smaller nutrients. A solution to the question of too much or too little calcium is to estimate dietary calcium and then supplement the difference. Most adults will consume between 400-700 mg of calcium from the foods they eat each day. The current guideline for total daily calcium intake through combined diet and supplements (if needed) is:

Current research still reveals that the form or type of calcium is not an issue, if you take the calcium with food.⁶ For some, non-carbonate forms of calcium may be easier on the digestive system. Dairy products are the easiest form of calcium for most people to include in their diet. However, many have chosen to eat less dairy or perhaps none at all. Other food sources of calcium include sardines (with bones), sesame seeds, egg yolks, tofu, soybeans, molasses and green leafy vegetables, all preferably organic. The best solution is to get adequate calcium in your diet from recommended food sources; however, it may also be necessary to choose a calcium supplement to fill the gap and ensure that you meet your daily requirements. Less constipating forms of calcium and perhaps easier on the digestive system, especially for those with reduced stomach acid, include non-carbonate forms such as calcium citrate, calcium lactate, calcium acetate or calcium gluconate.⁷

A potentially more important aspect of bone health is gastrointestinal absorption: for dietary calcium and other minerals listed below to be optimally absorbed in the intestines, good digestive function is paramount, especially adequate pH levels.

Sufficient hydrochloric acid is needed in the stomach to properly convert inorganic calcium into soluble calcium. As you mature, gastric acid levels decline and your body’s ability to absorb goes from 75% as a child to 30% as an adult.^8,9,10 In addition, digestive disturbances which can result in bloating and gas are often treated with antacids. These will further inhibit your vital stomach acid production, possibly leading to malabsorption and insufficiencies of the minerals necessary to build strong, healthy bones. Metabolic function is also an issue as you age with declining metabolism resulting in a slowing of food processing. The slower your metabolism, the less you process and absorb vitamins and minerals in your food, thereby reducing the benefit you gain from consuming them. For that reason, including probiotics and prebiotics through food or supplements is important, as is eating less volume and better quality foods to help with balancing pH levels. Intake of calcium as we can see is vital, but so is retention and absorption. See the section on Lifestyle & Environment for more information on pH balance.

 Magnesium

Magnesium is extremely important as it is a co-factor in more than 300 enzymatic reactions in the human body, including alkaline phosphatase which plays a role in bone mineralization¹¹ and is a building block to progesterone. It promotes bone rebuilding and increases bone mass through stimulating the parathyroid hormone, which enhances calcium metabolism.¹² Magnesium is required to activate the enzymes involved in forming calcium crystals in bone¹³ and in converting Vitamin D to its active form. Magnesium also influences the assimilation of all the other minerals, including calcium, by regulating calcium metabolism. Today, most soils are deficient in magnesium making dietary sources unlikely to provide adequate levels of this vital mineral. Magnesium is available in several different forms and in general, all forms are equally absorbed. Consider increasing magnesium-rich sources of food such as wheat-bran, wheat germ, soybeans, parsnips, brewer’s yeast, molasses and green leafy vegetables, all preferably organic. Too much magnesium can lead to loose stools or diarrhea; if this occurs reduce the dose. Bowel tolerance is often the easiest way to determine your body’s daily requirement. Magnesium supplementation is often found in combination with calcium, which helps to reduce the constipating effects of calcium carbonate.

Vitamin D

Vitamin D is actually defined as a pro-hormone and some doctors believe it’s the most important supplement you can take. Vitamin D deficiency is often more of a concern than calcium deficiency in bone health. Vitamin D helps maintain serum calcium within a normal range, increases osteoblastic cell formation (bone building cells) and enhances intestinal absorption of calcium.^14,15,16 Vitamin D is also essential for your immune system and overall health. You can obtain Vitamin D three ways – from the sun, in small amounts from food and through supplements or fortified foods. Ideally, the majority of Vitamin D formation occurs through sun exposure, therefore,¹⁵ minutes of daily, unprotected sun exposure (ideally when UVB exposure is high from 10am to 2pm) is beneficial. Good sources of Vitamin D are naturally occurring in fatty fish (mackerel, salmon and sardines) and fish liver oils, though many grain and dairy products are also fortified with Vitamin D. Current government guidelines recommend the following:

Zinc, Copper, Manganese

Zinc is essential for the formation of osteoblasts and osteoclasts, enhances the biochemical action of vitamin D and is a key factor in the body’s production of testosterone. Zinc is also necessary for the synthesis of various proteins found in bone and is therefore ideally consumed with protein. Zinc is found in grass fed red meat, brewer’s yeast, wheat germ, wild fish, organic chicken and oysters. Zinc is kept in balance with copper, which is also important for proper bone development.18 A deficiency of copper is known to produce below normal bone development in growing children and may be a contributing cause of osteoporosis. In vitro studies have shown
that copper supplementation inhibits bone resorption.¹⁹ Foods high in copper include oysters, liver, nuts, chocolate, shellfish and most seeds. Manganese deficiency causes a reduction of calcium deposition in bone. Manganese also stimulates mucopolysaccharide production, which provides a framework for the calcification process.²⁰ Foods high in manganese include organic raspberries, pineapples, whole grains, pecans, beans, tomatoes and green leafy vegetables.

Vitamin K

Vitamin K is probably most known for its primary role in the manufacturing of clotting factors. In bone health, Vitamin K is responsible for converting a bone protein, osteocalcin, from its inactive form to its active form. Osteocalcin provides the protein matrix for mineralization and is thought to act as a regulator of bone mineralization.²¹ Vitamin K plays a key role in the formation, remodeling and repair of bone, by attracting calcium to the site of this protein matrix.²² Deficiencies are not common, but can be found in individuals with chronic gastrointestinal disorders, poor fat absorption and in some individuals who have taken high or long-term doses of antibiotics.

Vitamin K, in fat-soluble chlorophyll form, is found in liver, soybeans, kelp, cabbage and broccoli. Monounsaturated fats found in olive oil and canola oil are also naturally high in Vitamin K. While the recommended dietary intake of vitamin K is 90-120 mcg per day, the optimal dose and form of vitamin K supplementation to achieve a protective effect on bone loss and fracture reduction is not known.

B-12

B-12 has numerous health benefits, especially related to heart, nerve and brain health. Many often forget about Vitamin B-12’s role in bone health, but it has been shown to help osteoblast (bone building cell) function²³ and promotes the re-methylation of homocysteine to methionine, as well as reducing homocysteine levels directly.²⁴ Homocysteine has the potential to promote osteoporosis if it is not eliminated adequately. Vitamin B-12 is normally found in grass fed red meat, shellfish, liver, fish, cheese, spirulina and sea kelp. Sublingual tablets or liquid are often best absorbed and come in cyanocobalamin or methylcobalamin forms.

• Low exposure to the sun or excessive use of sun block can reduce Vitamin D synthesis in the skin.
• Smoking decreases estradiol, can lead to early menopause, reduces key antioxidants and decreases the body’s ability to heal.
• Excess consumption of alcohol affects production of hormones, vitamin status and can increase risk of falls.
• Corticosteroid use affects bone remodeling by interfering with osteoclastic and osteoblastic cell formation.
• Distilled water, which is low in mineral content, can lead to mineral deficiencies that can adversely affect bone health.
• Hormone medications/the pill: Like all medications there are pros and cons of menopause hormone therapies and hormonal contraception which can come in a variety of forms. The information that follows just relates to the pros and cons on bone health. Menopausal Hormone therapies, or the birth control pill, that include just estrogen or both estrogen and a progestogen can be a positive for bone density especially if you are prematurely menopausal or have a condition called hypothalamic amenorrhea. In fact insufficient levels of estrogen/progesterone for these two conditions, can actually dramatically increase one's risk of osteoporosis. On the other hand, progestin only birth control, such as the Depo-Provera shot form, can be a negative for a healthy bone density in young women and can increase the risk of osteoporosis, as well as alter select nutrients in the body. What hormones, at what age, for what conditions and the benefits vs the risk is a complicated medical arena, requires an individualized approach, and clinicians who are truly well educated experts in women's health and can provide you with hormone and non-hormone options.
• Pharmaceuticals such as anticoagulants, anticonvulsants, antianxiety medication, aromatase inhibitors, steroids, diuretics, immunosuppressant drugs and antacids have all been seen to reduce bone density.^{35,36,37,38,39,40} Proton pump inhibitor drugs, used to treat GERD and reduce stomach acid, may also have a negative impact on bone health and integrity with long term usage.⁴¹

When food is metabolized it is broken down into ash, which is either acidic or alkaline. Acidproducing foods promote loss of calcium and should be carefully monitored to ensure balance is maintained. The Standard American diet, which is typically high in phosphorus (processed foods, junk food and sugar), creates a more acidic state and can result in decreased calcium levels in the body.³⁴

The ideal pH level for most people is between 6.8 - 7.4

• Red meat (acidic) is high in phosphorus, which causes calcium to be excreted in the urine.
• Refined sugar (acidic) requires alkalizing minerals such as calcium and magnesium for its absorption.
• White Flour (acidic)
• Salt due to its poor structure and often added chemicals, puts unnecessary strain on the body and its function. Alternatively Original Himalayan Crystal Salt contains 84 trace minerals (including calcium) and the perfect structure to alkalize the body.
• Foods/beverages such as soda, coffee, tea, dairy and chocolate are high in phosphoric acid and can leach out available calcium and magnesium from the body, if used in excess.
• Alkalizing Foods such as green, leafy vegetables and supplements to strongly support pH balance.* Supplementation is encouraged especially with dietary indiscretion.

There is well established evidence that physical activity early in life contributes to higher peak bone mass, with resistance training and high impact exercise being the most beneficial.³⁰

Exercise during the middle years of life has numerous health benefits, but there are few studies on the effects of exercise on bone density. Regular exercise later in life, in the presence of adequate calcium and vitamin D intake, has shown a modest effect on slowing the decline in bone density.³⁰

Bone building occurs in two stages: remodelling and resorption. When you have healthy, dense bones these two processes are occurring together all the time. Where it becomes problematic is when there is an imbalance between the two stages. Weight bearing exercise puts direct force on the muscles, which then stresses the bone and activates a gene which makes a protein responsible for turning on osteoblasts (remodeling) to do the work of building bones. If you already have osteoporosis, you must start very slowly with weight bearing exercises and build up over time.

Bone loss is also related to muscle atrophy. Both bone and muscle are active tissues that strengthen and weaken based on the weight, tension or stress under which they are placed. As an example, individuals confined to bed will experience atrophy (decrease in size and strength) of muscles and bones. Conversely, weight bearing activities, such as high impact exercise, will cause muscles and bones to increase in size, strength and structure. However, it is important to point out that overtraining with physical exercise can result in injury and have a negative impact on bone health.⁴³ Additionally, overtraining or physical stress, like emotional stress, can result in elevated cortisol levels for extended periods of time which can accelerate bone loss. Exercise programs should be balanced with type, intensity and more importantly, consistency. Statistics confirm that people who are more active have denser bones and fewer fractures in old age. Exercise also decreases the risk of fracture by improving muscle strength and balance.

Maintaining healthy weight is also critically important. Ideally, the average woman’s body mass index (BMI) should be between 19 and 25. Weighing less than 127 lb, however, potentially increases risk for osteoporosis; but, if you are of short stature and a healthy body weight is indeed less than 127 pounds, the goal is not to be overweight… it’s just that women who weigh under 127 pounds have lower bone density and therefore may need more attention to healthy bone aging. Therefore, optimal results require planning and sometimes require help:

• The first step is to find a training partner, class you like or an activity that is emotionally stimulating. It has been shown that people exercise more consistently when doing so with others and choosing exercise programs that are fun and engaging.
• Second, consider getting a personal trainer who has experience in bone density. Professional direction will ensure you are doing things correctly, safely and effectively.
• Third, find activities that are weight bearing, such as lifting weights, yoga, hiking, running, brisk walking, Pilates, tai chi or dancing. Rebounding (small trampolines) has in recent years gained popularity as the ultimate low-impact fat-burning and bone building exercise.
• Fourth, dedicate time to exercise each week, ensuring it is effective and focused on achieving results. Set goals, be consistent and sweat! To gain the protective benefits from exercise, it is recommended you do a minimum of 3 sessions a week for at least an hour or 6 sessions lasting 30 minutes each. Also, be aware that when you train properly you will sweat and when you train consistently you will see and feel results within a matter of months.
• Finally, just do it! The moment you stop to think about what else you could do, how hard it will be, or if you have time (come up with an excuse!), is the moment you won’t do it. 99% of the time you exercise, you will not turn around afterwards and think, “I shouldn’t have done that.” Rather you will say, “I am so glad I did that!”

1. Empowerment & Knowledge

• Bone mineral density test
• Urinary and serum calcium levels, Vitamin D levels
• Estrogen, progesterone, testosterone, parathyroid and thyroid tests
• Measure height annually after menopause, normal age-related height loss is 1.0”-1.5”
• Lifestyle, exercise and nutritional analysis by a professional

2. Hormone Balance

• Estrogen
• Progesterone
• Testosterone
• Thyroid/Adrenals
• Femmenessence to support healthy hormone levels  

3. Diet & Nutrition

Eating a daily diet rich in healthy oils such as fish oils, fiber, and B vitamins supports health. These food sources or supplements that benefit cardiovascular health should be rich in:

4. Lifestyle & Environment

• Don’t smoke
• Reduce stress
• Meditate and sleep more
• Eat more protein and green leafy vegetables
• Walk in the sun 15 to 20 minutes a day
• Mineralize your water with Original Himalayan Crystal Salt Sole therapy
• Keep alcohol consumption to no greater than one drink per day of wine/beer
• Avoid soda pop, reduce coffee and tea
• Reduce consumption of processed foods, refined flour and refined sugar
• Minimize corticosteroids and pharmaceuticals
• Supplement with pH Quintessence, 3 capsules per day

5. Exercise & Movement

• Maintain healthy body weight, BMI and body fat percentage.
• Get a personal trainer
• Commit to regular exercise and weight bearing exercise three days per week
• Get a massage once a week

References:

1. Looker A, Orewoll E, Johnston C, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997;12:1761-1768
2. www.niams.nih.gov/Health_Info/Bone/Osteoporosis/men.asp
3. US Department of Health and Human Services. Bone Health and Osteoporosis: A report of the surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2004
4. Silverman S. Selecting patients for osteoporosis therapy. Curr Osteoporos Rep 2006;4:91-95
5. Jackson RD, et al. N Engl J Med. 2006;354:669-83
6. AM J Ther 1999;6(6):313-321
7. Recker R. “Calcium absorption and achlorhydia.” N Engl J Med 1985; 313:70-73
8. Krasinski SD, Russell RM, Samloff IM, Jacob RA, Dallal GE, McGandy RB, Hartz SC. Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc. 1986 Nov;34(11):800-6.
9. Grossman MI, Kirsner JB, Gillespie IE. Basal and histalog-stimulated gastric secretion in control subjects and in patients with peptic ulcer or gastric cancer. Gastroenterology 1963;45:15-26.
10. Sharp GS, Fister HW. The diagnosis and treatment of achlorhydria: ten-year study. J Amer Ger Soc 1967;15:786-791
11. Cohen L, Kitzes R. Infrared spectroscopy & magnesium content of bone mineral in osteoporotic women Isr J Med Sci 1981;17:1123-1125.
12. Blumenthal N, Betss F, Posner A. “Stabilization of amorphous calcium phosphate by Mg and ATP.” Calcif Tis Res 1977; 23:245-50.
13. Cohen L, Kitzes R. “Infrared spectroscopy & magnesium content of bone mineral in osteoporotic women.” Isr J Med Sci 1981;17:1123-25.
14. Van den Berg H. Bioavailability of vitamin D. Eur J Clin Nutr 1997;51:S76-9.
15. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press, 1997.
16. Cranney C, Horsely T, O'Donnell S, Weiler H, Ooi D, Atkinson S, et al. Effectiveness and safety of vitamin D. Evidence Report/Technology Assessment No. 158 prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02.0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality, 2007.
17. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22(2):142-146
18. Calhoun N, Smith J Jr, Becker K. “The Effects of Zinc on Ectopic Bone Formation.” Oral Surg 1975; 39:698-706
19. Follis R, et al. Bull Johns Hopkins Hosp 1955
20. Leach R. Arch Biochm Biophy 1969
21. Ducy, P, Desbois C, Boyce B, et al. Increased bone formation in osteocalcin-deficient mice. Nature. 1996;382(6590):448-452.
22. Booth SL, Tucker KL, Chen H, et al. Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr 2000;71:1201-1208.
23. New SA. Nutritional Factors Influencing the Development and Maintenance of Bone Health Throughout the Life Cycle, World Congress on Osteoporosis 2000. Day 1 - June 15, 2000
24. Brattstrom L, Hultbnerg B, Merdebo J. “Folic acid responsive postmenopausal homocysteinemia.” Metab 1985;34:1073-77
25. Thyroid. 2002 May;12(5):411-9.
26. Kameda, Takashi et al. Estrogen Inhibits Bone Resorption by Directly Inducing Apoptosis of the Bone-resorbing Osteoclasts. J Exp Med. 1997 August 18; 186(4): 489–495.
27. Cunningham et al. J Clin Endocrinol Metab. 89 (5)
28. http://www.nof.org/osteoporosis/diseasefacts.htm#prevalence
29. Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement. Online 2000 March 27-29; [cited year, month, day]; 17(1): 1-36 New Zealand Guidelines Group.
30. Best Practice Evidence based guidelines summary. HRT. 2004 revised & updated. http://www.nzgg.org.nz. Accessed June 2007.
31. Meissner HO, et al. Hormone-balancing Effect of Maca-GO (Lepidium peruvianum Chacon): (I) Biochemical and Pharmacodynamic Study on Maca-GO using Clinical Laboratory Model on Ovariectomized Rats. IJBS 2006, 2(3):260-272
32. Meissner HO. Short and Long-Term Physiological Responses of Male and Female Rats to Two Dietary levels of Maca-GO (Lepidium peruvianum Chacon). IJBS 2006, 2(1):15-29
33. Murray, M., Pizzorno, J. Encyclopedia of Natural Medicine, Revised Second Edition
34. Simonelli, C et al. (July 2006). "ICSI Health Care Guideline: Diagnosis and Treatment of Osteoporosis, 5th edition" (PDF). Institute for Clinical Systems Improvement. www.icsi.org/osteoporosis/diagnosis_and_treatment_of_osteoporosis__3.html. Retrieved 2008-04-08.
35. Ruiz-Irastorza G, Khamashta MA, Hughes GR (2002). "Heparin and osteoporosis during pregnancy: 2002 update". Lupus 11 (10): 680-82. doi:10.1191/0961203302lu262oa. PMID 12413068.
36. Gage BF, Birman-Deych E, Radford MJ, Nilasena DS, Binder EF (2006). "Risk of osteoporotic fracture in elderly patients taking warfarin: results from the National Registry of Atrial Fibrillation 2". Arch. Intern. Med. 166 (2): 241-46. doi:10.1001/archinte.166.2.241. PMID 16432096. http://archinte.ama-assn.org/cgi/content/full/166/2/241.
37. Aromatase inhibitors and bone loss- Risk perspective. Journal of Oncology, Vol 23, No. 22, August 2005:pp 4847-4849
38. Antianxiety drugs and CNS symptons in elderly population- Drug Intell Clin Pharm. 1985 Jan 19 (1):37-40. PMID 2857121
39. Drug induced osteoporosis:mechanisms and clinical implications. AM J Med. 2010 Oct;123 (10) 877-84. PMID 20920685.
40. Yang YX, Lewis JD, Epstein S, Metz DC (2006). "Long-term proton pump inhibitor therapy and risk of hip fracture". JAMA 296 (24): 2947-53. doi:10.1001/jama.296.24.2947. PMID 17190895.
41. Low-dose oral contraceptives in adolescents: how low can you go? J Pediatr Adolesc Gynecol. 2010 Aug;23(4):195-201. Epub 2010 Mar 15. PMID: 20227307
42. Longitudinal Changes in Bone Mineral Density in Male Master Cyclists & Nonathletes. J Strength Cnd Res. 2010 Jun 23. PMID: 20581701

There are three stages of bone health.

Stage 1 is the first 25 years of a man or woman’s life when you build the strongest, most dense bones and minimize any actions that may compromise bone building.

Stage 2 is from 30 years of age to menopause for women or andropause for men, where you take steps to avoid the breakdown of bone.

Stage 3 is post menopause or andropause for men, which is generally over 50 years or age, where you support both bone maintenance and limit bone loss.

For most individuals the risk for osteoporosis is strongly influenced by family history of a parent with a hip fracture and that risk is worsened by lifestyle issues. Other individuals can have medical conditions that cause or put them at risk for osteoporosis, but again, lifestyle can further increase that risk. Osteoporosis is a chronic, progressive disease with the most significant outcome being a fracture. It affects millions of Americans, particularly women. and it is estimated that anywhere between 20%-50% of post menopausal women are affected by low bone density (although not all have osteoporosis).¹ Although osteoporosis is often thought to be a disease primarily affecting women, men also incur substantial bone loss due to aging and decreased hormone production. Over two million men have this disease and men are more likely to incur fractures related to osteoporosis than to get prostate cancer.^1,2,3 The most serious complication of osteoporosis is fracture, specifically fractures of the hip which cause severe pain, disability and increased mortality.

The major causes of osteoporosis relate to age are hereditary (osteoporosis and especially a hip fracture), low body weight (<127 lb), being a current smoker and/or being on steroid therapy (e.g. Prednisone).⁴ The list of additional risk factors is long and includes vitamin D deficiency, hyperthyroid, hyper-parathyroid, renal calcium leak, poor nutrition, low hormone production, excess alcohol and lack of exercise. Osteoporosis is often preventable by taking simple steps to build and support bone density. It is frequently underdiagnosed and therefore often undertreated. For that reason the most important first step is to:

Find out the status of your bone density and evaluate your current lifestyle and diet.

Maybe you are getting enough calcium in your diet, but are you getting enough magnesium, vitamin D, zinc and co-factors? Maybe you are exercising and eating well, but do you smoke or drink too much alcohol? Only by undertaking a personal assessment of your bone density, current lifestyle and nutritional status, will you get a clear picture of where you are and what measures you need to take.

A bone health assessment is often covered by insurance companies, can be carried out by your health professional and includes a medical history, physical exam and the gold standard - a bone mineral density test, or DEXA Scan. Standard guidelines for DEXA scans are the following:

• All women 65 years and older
• Postmenopausal women with medical causes of bone loss (e.g. steroid use, hyperparathyroidism, malabsorption, immobilization)
• Postmenopausal women over 50 years with additional risk factors (fracture - other than skull, less than 127lb, history of hip fracture in parent, current smoker, alcohol intake more than 2 units/day (1 unit: beer = 12oz; wine = 4 oz; liquor = 1 oz).
• Postmenopausal women with a fragility fracture (a fall from standing height)

More extensive evaluation of underlying causes and management may include urinary and serum calcium levels, vitamin D levels, hormone analyses including parathyroid and thyroid tests, selected nutrient analysis and a lifestyle, exercise and nutritional assessment.

All information in the body is transferred by two types of messengers including – neurotransmitters and hormones. Neurotransmitters help cells communicate through the nervous system and hormones enable cells to communicate through the blood stream. These two messengers control nearly every aspect of the body’s function. They are so influential, and at the root cause of so many health issues, that your risk for many health conditions, like osteoporosis, are correlated to your hormone production.

Within the first 3-5 years of a woman becoming menopausal (no menses in 12 months), she loses on average 7-10% of her bone density. More interesting, is that during those first 3-5 years, most women are eating the same foods, exercising the same way and consuming the same amount of calcium, vitamin D and other vital nutrients. The only real change for a woman is that her body’s production of hormones dramatically declines, emphasizing the correlation between hormones and bone density and how the significant loss of hormones experienced post menopause directly relates to the initial loss of 7-10% of her bone density. ²⁹ Similarly, most men do not have bone health issues until later in life when testosterone levels significantly decline.

For this reason hormones are one of the most important, if not THE most important aspect of bone health, particularly growth hormone, estrogen, progesterone and testosterone. Additionally, often forgotten in bone health protocols is thyroid production, as hyperthyroidism or overproduction inhibits bone building and accelerates bone loss increasing the risk for osteoporosis. ²⁶

Bone and muscle are living tissues. They grow, shrink and become stronger or weaker. A key factor in bone health (which includes bone density, bone strength and bone architecture) is to provide all the necessary elements for your bone. Bone is a complex, highly mineralized tissue, which requires essential nutrients for its formation. These include protein, fatty acids, calcium, magnesium and Vitamins A, D, E, K and more. Below are a few of the more important building blocks you need.

Calcium

The first thing that usually comes to mind when people think of bone health is calcium. Calcium is essential for healthy bone formation; however, it requires the presence of optimal amounts of other trace minerals, vitamins and hormones to build bone and reduce risk of fracture. Also, research indicates that too much calcium (>1500 mg/day) can be associated with an increased risk of kidney stones 5 and possible increased risk of cardiovascular disease, as well as the inhibition of absorption of smaller nutrients. A solution to the question of too much or too little calcium is to estimate dietary calcium and then supplement the difference. Most adults will consume between 400-700 mg of calcium from the foods they eat each day. The current guideline for total daily calcium intake through combined diet and supplements (if needed) is:

Current research still reveals that the form or type of calcium is not an issue, if you take the calcium with food.⁶ For some, non-carbonate forms of calcium may be easier on the digestive system. Dairy products are the easiest form of calcium for most people to include in their diet. However, many have chosen to eat less dairy or perhaps none at all. Other food sources of calcium include sardines (with bones), sesame seeds, egg yolks, tofu, soybeans, molasses and green leafy vegetables, all preferably organic. The best solution is to get adequate calcium in your diet from recommended food sources; however, it may also be necessary to choose a calcium supplement to fill the gap and ensure that you meet your daily requirements. Less constipating forms of calcium and perhaps easier on the digestive system, especially for those with reduced stomach acid, include non-carbonate forms such as calcium citrate, calcium lactate, calcium acetate or calcium gluconate.⁷

A potentially more important aspect of bone health is gastrointestinal absorption: for dietary calcium and other minerals listed below to be optimally absorbed in the intestines, good digestive function is paramount, especially adequate pH levels.

Sufficient hydrochloric acid is needed in the stomach to properly convert inorganic calcium into soluble calcium. As you mature, gastric acid levels decline and your body’s ability to absorb goes from 75% as a child to 30% as an adult.^8,9,10 In addition, digestive disturbances which can result in bloating and gas are often treated with antacids. These will further inhibit your vital stomach acid production, possibly leading to malabsorption and insufficiencies of the minerals necessary to build strong, healthy bones. Metabolic function is also an issue as you age with declining metabolism resulting in a slowing of food processing. The slower your metabolism, the less you process and absorb vitamins and minerals in your food, thereby reducing the benefit you gain from consuming them. For that reason, including probiotics and prebiotics through food or supplements is important, as is eating less volume and better quality foods to help with balancing pH levels. Intake of calcium as we can see is vital, but so is retention and absorption. See the section on Lifestyle & Environment for more information on pH balance.

 Magnesium

Magnesium is extremely important as it is a co-factor in more than 300 enzymatic reactions in the human body, including alkaline phosphatase which plays a role in bone mineralization¹¹ and is a building block to progesterone. It promotes bone rebuilding and increases bone mass through stimulating the parathyroid hormone, which enhances calcium metabolism.¹² Magnesium is required to activate the enzymes involved in forming calcium crystals in bone¹³ and in converting Vitamin D to its active form. Magnesium also influences the assimilation of all the other minerals, including calcium, by regulating calcium metabolism. Today, most soils are deficient in magnesium making dietary sources unlikely to provide adequate levels of this vital mineral. Magnesium is available in several different forms and in general, all forms are equally absorbed. Consider increasing magnesium-rich sources of food such as wheat-bran, wheat germ, soybeans, parsnips, brewer’s yeast, molasses and green leafy vegetables, all preferably organic. Too much magnesium can lead to loose stools or diarrhea; if this occurs reduce the dose. Bowel tolerance is often the easiest way to determine your body’s daily requirement. Magnesium supplementation is often found in combination with calcium, which helps to reduce the constipating effects of calcium carbonate.

Vitamin D

Vitamin D is actually defined as a pro-hormone and some doctors believe it’s the most important supplement you can take. Vitamin D deficiency is often more of a concern than calcium deficiency in bone health. Vitamin D helps maintain serum calcium within a normal range, increases osteoblastic cell formation (bone building cells) and enhances intestinal absorption of calcium.^14,15,16 Vitamin D is also essential for your immune system and overall health. You can obtain Vitamin D three ways – from the sun, in small amounts from food and through supplements or fortified foods. Ideally, the majority of Vitamin D formation occurs through sun exposure, therefore,¹⁵ minutes of daily, unprotected sun exposure (ideally when UVB exposure is high from 10am to 2pm) is beneficial. Good sources of Vitamin D are naturally occurring in fatty fish (mackerel, salmon and sardines) and fish liver oils, though many grain and dairy products are also fortified with Vitamin D. Current government guidelines recommend the following:

Zinc, Copper, Manganese

Zinc is essential for the formation of osteoblasts and osteoclasts, enhances the biochemical action of vitamin D and is a key factor in the body’s production of testosterone. Zinc is also necessary for the synthesis of various proteins found in bone and is therefore ideally consumed with protein. Zinc is found in grass fed red meat, brewer’s yeast, wheat germ, wild fish, organic chicken and oysters. Zinc is kept in balance with copper, which is also important for proper bone development.18 A deficiency of copper is known to produce below normal bone development in growing children and may be a contributing cause of osteoporosis. In vitro studies have shown
that copper supplementation inhibits bone resorption.¹⁹ Foods high in copper include oysters, liver, nuts, chocolate, shellfish and most seeds. Manganese deficiency causes a reduction of calcium deposition in bone. Manganese also stimulates mucopolysaccharide production, which provides a framework for the calcification process.²⁰ Foods high in manganese include organic raspberries, pineapples, whole grains, pecans, beans, tomatoes and green leafy vegetables.

Vitamin K

Vitamin K is probably most known for its primary role in the manufacturing of clotting factors. In bone health, Vitamin K is responsible for converting a bone protein, osteocalcin, from its inactive form to its active form. Osteocalcin provides the protein matrix for mineralization and is thought to act as a regulator of bone mineralization.²¹ Vitamin K plays a key role in the formation, remodeling and repair of bone, by attracting calcium to the site of this protein matrix.²² Deficiencies are not common, but can be found in individuals with chronic gastrointestinal disorders, poor fat absorption and in some individuals who have taken high or long-term doses of antibiotics.

Vitamin K, in fat-soluble chlorophyll form, is found in liver, soybeans, kelp, cabbage and broccoli. Monounsaturated fats found in olive oil and canola oil are also naturally high in Vitamin K. While the recommended dietary intake of vitamin K is 90-120 mcg per day, the optimal dose and form of vitamin K supplementation to achieve a protective effect on bone loss and fracture reduction is not known.

B-12

B-12 has numerous health benefits, especially related to heart, nerve and brain health. Many often forget about Vitamin B-12’s role in bone health, but it has been shown to help osteoblast (bone building cell) function²³ and promotes the re-methylation of homocysteine to methionine, as well as reducing homocysteine levels directly.²⁴ Homocysteine has the potential to promote osteoporosis if it is not eliminated adequately. Vitamin B-12 is normally found in grass fed red meat, shellfish, liver, fish, cheese, spirulina and sea kelp. Sublingual tablets or liquid are often best absorbed and come in cyanocobalamin or methylcobalamin forms.

• Low exposure to the sun or excessive use of sun block can reduce Vitamin D synthesis in the skin.
• Smoking decreases estradiol, can lead to early menopause, reduces key antioxidants and decreases the body’s ability to heal.
• Excess consumption of alcohol affects production of hormones, vitamin status and can increase risk of falls.
• Corticosteroid use affects bone remodeling by interfering with osteoclastic and osteoblastic cell formation.
• Distilled water, which is low in mineral content, can lead to mineral deficiencies that can adversely affect bone health.
• Hormone medications/the pill: Like all medications there are pros and cons of menopause hormone therapies and hormonal contraception which can come in a variety of forms. The information that follows just relates to the pros and cons on bone health. Menopausal Hormone therapies, or the birth control pill, that include just estrogen or both estrogen and a progestogen can be a positive for bone density especially if you are prematurely menopausal or have a condition called hypothalamic amenorrhea. In fact insufficient levels of estrogen/progesterone for these two conditions, can actually dramatically increase one's risk of osteoporosis. On the other hand, progestin only birth control, such as the Depo-Provera shot form, can be a negative for a healthy bone density in young women and can increase the risk of osteoporosis, as well as alter select nutrients in the body. What hormones, at what age, for what conditions and the benefits vs the risk is a complicated medical arena, requires an individualized approach, and clinicians who are truly well educated experts in women's health and can provide you with hormone and non-hormone options.
• Pharmaceuticals such as anticoagulants, anticonvulsants, antianxiety medication, aromatase inhibitors, steroids, diuretics, immunosuppressant drugs and antacids have all been seen to reduce bone density.^{35,36,37,38,39,40} Proton pump inhibitor drugs, used to treat GERD and reduce stomach acid, may also have a negative impact on bone health and integrity with long term usage.⁴¹

When food is metabolized it is broken down into ash, which is either acidic or alkaline. Acidproducing foods promote loss of calcium and should be carefully monitored to ensure balance is maintained. The Standard American diet, which is typically high in phosphorus (processed foods, junk food and sugar), creates a more acidic state and can result in decreased calcium levels in the body.³⁴

The ideal pH level for most people is between 6.8 - 7.4

• Red meat (acidic) is high in phosphorus, which causes calcium to be excreted in the urine.
• Refined sugar (acidic) requires alkalizing minerals such as calcium and magnesium for its absorption.
• White Flour (acidic)
• Salt due to its poor structure and often added chemicals, puts unnecessary strain on the body and its function. Alternatively Original Himalayan Crystal Salt contains 84 trace minerals (including calcium) and the perfect structure to alkalize the body.
• Foods/beverages such as soda, coffee, tea, dairy and chocolate are high in phosphoric acid and can leach out available calcium and magnesium from the body, if used in excess.
• Alkalizing Foods such as green, leafy vegetables and supplements to strongly support pH balance.* Supplementation is encouraged especially with dietary indiscretion.

There is well established evidence that physical activity early in life contributes to higher peak bone mass, with resistance training and high impact exercise being the most beneficial.³⁰

Exercise during the middle years of life has numerous health benefits, but there are few studies on the effects of exercise on bone density. Regular exercise later in life, in the presence of adequate calcium and vitamin D intake, has shown a modest effect on slowing the decline in bone density.³⁰

Bone building occurs in two stages: remodelling and resorption. When you have healthy, dense bones these two processes are occurring together all the time. Where it becomes problematic is when there is an imbalance between the two stages. Weight bearing exercise puts direct force on the muscles, which then stresses the bone and activates a gene which makes a protein responsible for turning on osteoblasts (remodeling) to do the work of building bones. If you already have osteoporosis, you must start very slowly with weight bearing exercises and build up over time.

Bone loss is also related to muscle atrophy. Both bone and muscle are active tissues that strengthen and weaken based on the weight, tension or stress under which they are placed. As an example, individuals confined to bed will experience atrophy (decrease in size and strength) of muscles and bones. Conversely, weight bearing activities, such as high impact exercise, will cause muscles and bones to increase in size, strength and structure. However, it is important to point out that overtraining with physical exercise can result in injury and have a negative impact on bone health.⁴³ Additionally, overtraining or physical stress, like emotional stress, can result in elevated cortisol levels for extended periods of time which can accelerate bone loss. Exercise programs should be balanced with type, intensity and more importantly, consistency. Statistics confirm that people who are more active have denser bones and fewer fractures in old age. Exercise also decreases the risk of fracture by improving muscle strength and balance.

Maintaining healthy weight is also critically important. Ideally, the average woman’s body mass index (BMI) should be between 19 and 25. Weighing less than 127 lb, however, potentially increases risk for osteoporosis; but, if you are of short stature and a healthy body weight is indeed less than 127 pounds, the goal is not to be overweight… it’s just that women who weigh under 127 pounds have lower bone density and therefore may need more attention to healthy bone aging. Therefore, optimal results require planning and sometimes require help:

• The first step is to find a training partner, class you like or an activity that is emotionally stimulating. It has been shown that people exercise more consistently when doing so with others and choosing exercise programs that are fun and engaging.
• Second, consider getting a personal trainer who has experience in bone density. Professional direction will ensure you are doing things correctly, safely and effectively.
• Third, find activities that are weight bearing, such as lifting weights, yoga, hiking, running, brisk walking, Pilates, tai chi or dancing. Rebounding (small trampolines) has in recent years gained popularity as the ultimate low-impact fat-burning and bone building exercise.
• Fourth, dedicate time to exercise each week, ensuring it is effective and focused on achieving results. Set goals, be consistent and sweat! To gain the protective benefits from exercise, it is recommended you do a minimum of 3 sessions a week for at least an hour or 6 sessions lasting 30 minutes each. Also, be aware that when you train properly you will sweat and when you train consistently you will see and feel results within a matter of months.
• Finally, just do it! The moment you stop to think about what else you could do, how hard it will be, or if you have time (come up with an excuse!), is the moment you won’t do it. 99% of the time you exercise, you will not turn around afterwards and think, “I shouldn’t have done that.” Rather you will say, “I am so glad I did that!”

1. Empowerment & Knowledge

• Bone mineral density test
• Urinary and serum calcium levels, Vitamin D levels
• Estrogen, progesterone, testosterone, parathyroid and thyroid tests
• Measure height annually after menopause, normal age-related height loss is 1.0”-1.5”
• Lifestyle, exercise and nutritional analysis by a professional

2. Hormone Balance

• Estrogen
• Progesterone
• Testosterone
• Thyroid/Adrenals
• Femmenessence to support healthy hormone levels  

3. Diet & Nutrition

Eating a daily diet rich in healthy oils such as fish oils, fiber, and B vitamins supports health. These food sources or supplements that benefit cardiovascular health should be rich in:

4. Lifestyle & Environment

• Don’t smoke
• Reduce stress
• Meditate and sleep more
• Eat more protein and green leafy vegetables
• Walk in the sun 15 to 20 minutes a day
• Mineralize your water with Original Himalayan Crystal Salt Sole therapy
• Keep alcohol consumption to no greater than one drink per day of wine/beer
• Avoid soda pop, reduce coffee and tea
• Reduce consumption of processed foods, refined flour and refined sugar
• Minimize corticosteroids and pharmaceuticals
• Supplement with pH Quintessence, 3 capsules per day

5. Exercise & Movement

• Maintain healthy body weight, BMI and body fat percentage.
• Get a personal trainer
• Commit to regular exercise and weight bearing exercise three days per week
• Get a massage once a week

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