Osteoporosis / Bone Loss: Nutritional causes, therapies, remedies & prevention

Acu-Cell Disorders - Osteoporosis - Bone Loss and DRI/RDA for Vitamin A, D & K.

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OSTEOPOROSIS: Nutritional Causes, Prevention and Therapies

Many individuals rely on extra amounts of Calcium + Vitamin D when trying to treat and/or prevent

osteopenia (early stages of bone loss) or osteoporosis, and when unsuccessful, they generally resort

to using drugs specifically formulated to stop the progression of this disease.

Long-term effects of many of these medications are still unclear since increased bone mass doesn't

always translate into increased bone strength. On the other hand, when analyzing individual reasons

for developing osteoporosis, it becomes clear that most factors can be resolved through a change in

lifestyle, or through individually-tailored nutritional supplementation.

Without the addition of weight-bearing exercise however, no program for the treatment or prevention

of osteoporosis can be considered complete. Climbing stairs, running, lifting weights - and to some

extent walking - are all among those exercises considered beneficial in maintaining bone density, in

contrast to activities such as swimming, which are less helpful for osteoporosis.

While weight-bearing exercises require some degree of mobility, there is a passive, drug-free concept

that helps prevent bone loss even for infirm or wheelchair-bound individuals. It consists of subjecting

bone to mild Vibrations, which - just like vigorous exercise - helps actually increase bone density, and

it is an effective treatment for normal and problem fractures as well. Increases of up to 30% in bone
density were reported in sheep studies after one year by having them stand on a vibrating platform for

a few minutes a day.

Controlled human studies on postmenopausal women are still underway, but in a pilot study of disabled

children, all of those who stood on the vibrating device showed increased bone density, in contrast to

those who had not. Despite spending about 2 hours each day working out with all kinds of devices,

astronauts still experience muscle and bone loss at a rate of about 0.2% per month, so therapies with
such devices, which - depending on design - vibrate at a rate of 20 to 90 Hz, are therefore a convenient

solution.

Vibrating platforms for personal and professional use (e.g. Power Plate) are selling from a few hundred
to a few thousand dollars. They promise to increase bone density, muscle strength and tone, improve

circulation, help heal sports injuries faster and reduce pain with just three 15-minute workouts per week.

Osteoporosis is a disease of excessive demineralization of bone, which on average starts to take
place in both sexes after age 35. While men are less affected, the decrease in the bone density of

postmenopausal women is a much more serious problem, however by age 75, the gap closes where

both genders become equally prone for bone loss. For instance, after sustaining a hip fracture, it is

estimated that 20% of patients die within one year, 50% cannot walk any longer without assistance,
while 25% may have to be institutionalized in long-term nursing care facilities.

Causes of osteoporosis include a decrease in osteoblast function, a change in parathyroid activity as

a compensatory factor for decreased calcium absorption, and usually a combination of either less sun

exposure and/or a decreased ability to synthesize Vitamin D, or insufficient dietary intake of Vitamin D.

Additional causes include sedentary lifestyles, which play a significant part, there are genetic factors,

which are less-common, while insufficient sex hormones and body weight (anorexia), various stimulants

and drugs (caffeine, alcohol, glucocorticoids [cortisone, prednisone, dexamethasone] , Lupron [GnRH
agonist to lower hormones], Depo-Provera [a form of progesterone]...), hyperthyroidism, and kidney
disease are also contributing factors.

Bone remodeling is a process where the adult skeleton undergoes a continuous turnover whereby

old bone is resorbed by osteoclasts and new bone is formed by osteoblasts. Osteoclasts are cell types

that degrade bone and its protein components by releasing calcium from bone into circulation, where

calcium can either remain, or be excreted in urine and feces, while osteoblasts are cell types that
synthesizes new bone.

A number of hormones, including thyroid, parathyroid, sex hormones, Vitamin D3, and others exert

their influence on bone remodeling and interact with immune system proteins such a interleukin-6 (IL-6).

Their production in turn is inhibited by estrogen and testosterone, so there is evidence that the balance

of sex hormones and interleukin-6 affects trabecular bone loss. Research also implicates the same

mechanism as a potential cause of some forms of hyperthyroidism, hyperparathyroidism, rheumatoid
arthritis, Paget's disease, multiple myeloma, and others.

In contrast, an increase in bone density through higher levels of sex hormones, versus a decrease in

interleukin-6 - or for that matter any number of similar mechanisms that increases bone density - poses

a greater risk for cancer, particularly breast cancer, which should be a concern when recommending a

routine (hormonal) drug approach in the prevention of osteoporosis.

Common drugs used to treat osteoporosis include:

• Evista (SERM / Selective Estrogen Receptor Modulators),

• Calcimar, Miacalcin (injectable calcitonin, and nasal spray calcitonin),

• Forteo (injectable parathyroid hormone),

• Fosamax, Actonel, Didronel (oral bisphosphonates),

• Aredia, Zometa (injectable bisphosphonates),

• Reclast, Aclasta (once a year injectable bisphosphonates).

Potential side effects experienced with SERMs are hot flashes, leg cramps, fever, or flu-like symptoms
and/or increased incidence of infections, headaches, joint pain, indigestion, abdominal pain, insomnia,

urinary / gynecological problems, dizziness, sinusitis, weight gain.

Potential side effects experienced with calcitonin spray are nasal irritations, runny nose, nosebleeds,

itching, hives, difficulty breathing, swelling of lips, tongue, or face. With injectable calcitonin, they are

nausea, vomiting, skin rash and/or flushing, and allergic reactions similar to those with the spray.

Potential side effects experienced with Teriparatide (Forteo) are joint pains, headaches, leg cramps,

hypertension, angina, shortness of breath, nausea, various digestive problems, dizziness, depression,

insomnia, fatigue, rhinitis, skin rash and sweating.

Potential side effects experienced with bisphosphonates include heartburn and various digestive

problems, allergic reactions, esophageal ulcer, esophageal cancer, difficulty swallowing, headaches,

joint / muscle pain or cramps, fever / flu-like symptoms, serious atrial fibrillation (abnormal heart rhythm),

and osteonecrosis of the jaw. This is a condition in which the bone tissue in the jaw fails to heal after

minor trauma such as a tooth extraction, causing the bone to be exposed.

The exposure can eventually lead to infection and fracture and may require long-term antibiotic therapy

or surgery to remove the dying bone tissue. Patients using bisphosphonates should try to avoid tooth

extractions and other major dental work while on the drugs.

After the approval of Fosamax in 1995 by the FDA, Merck & Co (the maker of Fosamax) launched a
marketing campaign to promote the preventative aspects of this drug for osteoporosis and osteopenia.
Part of that campaign saw a more than 10-fold increase in bone measuring devices, sponsored by the
same drug manufacturers, to target healthy, middle-aged (and even younger) women, despite a lack of

evidence that these machines or drugs actually benefited these women.

In 1997, the U.S. Food and Drug Administration warned Merck to stop implying that all women develop
osteoporosis at menopause, and again In 2001, the FDA warned Merck that its Fosamax Web site
"overstates the benefits while minimizing the risks associated with the drug."

While an increase in bone density as a result of biphosphonate therapy has certainly been confirmed,

this increase in bone mass did not translate in increased bone strength, or bone quality.

A steadily growing number of critics not only question the varying standards and accuracy of different

bone density measuring machines, but also the widely varying T-scores (from different machines) and

their value in predetermining an individual's risk to develop osteoporosis. T-scores were close to being

abandoned altogether by the medical community, had it not been for the efforts by the pharmaceutical

companies, and manufacturers of bone density measuring devices to maintain their use until a better

way was found to assess fracture risks.

World Health Organization standards for the diagnosis of Osteoporosis:

1.0 SD (Standard Deviation)

Normal Bone Mass

1.0 SD to -1.0 SD

Mild or Borderline Osteopenia

-1.0 SD to -2.5 SD

Low Bone Mass or Moderate Osteopenia

-2.5 SD or Lower

Osteoporosis.

T Score: This score compares the bone mineral status of the patient to an average, healthy 25 to

30 year old Caucasian subject of the same sex.

Z Score: This score compares the bone mineral status of the patient to a subject of the same age,

sex, and ethnic background.

Nutritional Considerations for Osteoporosis:

There are two types of bone, the one being a solid cortical tissue, while the other is an interconnecting

honeycomb structure, called trabecular tissue. In the early stages of osteoporosis, this honeycomb

structure of trabecular bone may already be damaged, however bone density tests would not show
anything abnormal because the bone mass is still the same. Trabecular bone has a turnover rate of
about 25%, in contrast to about 3% of cortical bone undergoing remodeling every year

Bone is about 9% calcium carbonate, and 85% tricalcium phosphate, with the "phosphorus" part being

frequently disregarded. Too much or too little Phosphorus contributes to osteoporosis: Too much

promotes calcium loss through an excess acid medium, and too little encourages calcification, where

calcium is deposited outside of bone, or where an improper calcium / phosphorus ratio weakens the

bone matrix.

Magnesium - as magnesium phosphate (about 2%) - also has to be considered as being part of the
bone mineral make-up, where the amount should be adjusted to create a genetically ideal Ca/Mg ratio,
which for most practitioners is still an unresolved science in itself. (see also Acu-Cell "Mineral Ratios").

While Fluoride increases bone mass, too much of it increases brittleness of bone and thus promotes

fractures. Nevertheless, a certain amount is needed - about 4% as calcium fluoride - to harden bone.

Silicon, usually taken in the form of Silica (e.g from horsetail), is another trace mineral that helps in the

prevention of osteoporosis, and it is also especially helpful after fractures. This is in contrast to using
calcium, which when high, will actually slow the union process. It is not unusual to see patients, whose
fractures only heal properly after discontinuing calcium supplements.

Manganese helps to keep calcium soluble or bioavailable, and like Vitamin C and Zinc, assists with
calcium absorption. It also exhibits estrogenic qualities, making it useful in the treatment of menopausal

symptoms as well. Boron lowers manganese, which is an advantage with some types of liver diseases

where manganese is elevated and as a result, calcium levels are very low. However, in other situations,

boron could create a high calcium / manganese ratio if too much is consumed, so there is a potential of

creating other problems or conflicts (calcification), unless it is carefully matched to a patient's chemistry.

High Sodium retention - as a result of kidney problems - has the potential to reduce bone density by

negatively affecting an individual's calcium / magnesium ratio, so salt should be used sparingly under

those circumstances. The same consideration should be given to long-term use of Aspirin or other

NSAIDs, which tend to reduce magnesium, and eventually calcium levels, so they not only encourage

osteoporosis in prone individuals, but interfere with the healing of fractures as well. Cox-2 inhibitors

(Celebrex, Vioxx, Bextra...) share the same negative association, however because of increasing the

risk of heart disease, many of these types of pain medications are not as readily prescribed any longer.

Steroid-types of drugs unfortunately also have a reputation of promoting osteoporosis and arthritis.

Vitamin B5 (pantothenic acid) reduces bone loss when due to elevated phosphorus, and for the same

reason it can be helpful for patients with certain gouty-types of arthritis. Although Vitamin A has been

found to be somewhat protective for several types of cancer, a higher intake encourages osteoporosis

(unless Estrogen is taken at the same time), so the same cautionary approach needs to be taken as
with some other forms of treatment - such as estrogen therapy alone - where the positive effect on one
condition (increased bone density) is offset by a greater risk for other serious consequences (cancer).

This adverse effect of preformed Vitamin A on bone density does not apply to beta carotene or mixed
carotenoids.

Vitamin K is mostly known for its involvement in blood coagulation, however it also plays an important,

but underrated role in the fight against osteoporosis. Vitamin K is able to regulate calcium through the
amino acid gamma-carboxyglutamic acid (Gla), and in particular the protein osteocalcin, which helps
maintain calcium in bone, but at the same time keeps it out of soft tissue. While Vitamin D helps in the
synthesis of osteocalcin, Vitamin K is required for it to function properly.

Research has shown that both, Vitamin K and Vitamin E help reduce calcification of arteries, however

Vitamin K (ideally in the form of K2) was additionally able to slow calcium loss in those with a tendency
to lose it, and that it better helped maintain bone density and prevent osteoporosis than Vitamin D and
synthetic estrogen.

An analysis of several studies on the effects of Vitamin K on calcium metabolism suggested that people
suffering from osteoporosis are also at a greater risk for stroke and cardiovascular disease, particularly

calcification of the middle layer of arteries, resulting in arteriosclerosis.

Requesting an Osteocalcin Test will give patients some indication of their Vitamin K status, since

carboxylation (of osteocalcin) is dependant on Vitamin K. This in turn will give them some idea of their

risk for osteoporosis, and - to some degree - cardiovascular disease.

Stomach acid is another very important aspect with osteoporosis through its implication on calcium &
magnesium levels, whereby high acid levels encourage calcium loss, and low levels promote excessive
calcium storage (calcification, spurs...), resulting in bio-unavailability of calcium. Both extremes - too
much or too little stomach acid - have an unfavorable impact on osteoporosis. Using calcium citrate in
low-acid cases, and calcium carbonate in high-acid cases will compensate to some degree, but taking

calcium with meals, and supplementing it at smaller amounts (500mg or less at a time) throughout the

day will help the absorption of all types of calcium, and somewhat negate the otherwise negative effects

of abnormally high or low stomach acid levels. (see also Acu-Cell Nutrition "Calcium & Magnesium" for

information on solubility and absorbability of various types of calcium).

Both, Chromium and Copper also contribute to healthy bones and reduce the risk for osteoporosis,
however copper levels are invariably much higher than chromium, so the high copper / chromium ratio

in practice actually encourages osteoporosis by resulting in a weaker trabecular bone and frequently

arthritis or other inflammatory diseases as well. The same applies when chromium is abnormally low in

ratio to potassium, selenium, and/or rarely, vanadium.

Chromium is required for proper parathyroid functions, so any chromium antagonists (selenium, copper,

potassium, vanadium,) can contribute to, or become responsible for bone loss if they are supplemented

needlessly, or if their levels remain too high for any other medical or dietary reasons.

AAACa / AdvaCAL Calcium consists of a patented oyster shell supplement that is made by heating

calcium to about 800°C, which breaks calcium carbonate up into calcium oxide and calcium hydroxide.

It is then combined with a heated algal ingredient to form AAACa. According to its developer Dr. Fujita,

AAACa was apparently more effective increasing trabecular bone density than calcium carbonate or

AACA alone (without the algal ingredient) containing the same amount of elemental calcium and without

the need for Vitamin D. If its high cost is no object, perhaps the potential health risks associated with

eliminating Vitamin D should be (see Acu-Cell "Diets & MLM" for detailed information on AdvaCal).

Coral Calcium is a heavily promoted product with lots of anecdotal success stories and the usual

unsubstantiated claims of miracle cures. Because there are various forms of Coral Calcium available
with many different mineral / nutritional formulations, there is no predictability as to the actual calcium
uptake a patient may expect. For those reasons, and some unwelcome side effects reported, patient
response under controlled clinical settings has been mostly negative, so Coral Calcium is not on the list

of products that can be recommended. (see also Acu-Cell "Diets & MLM" for details on Coral Calcium).

Strontium is not considered to be an essential trace mineral for humans at this time, however it can be

found in many multi-mineral formulations, in products that offer nutritional support in the prevention and
treatment of bone loss, and drugs used to treat osteoporosis, such as Protelos (strontium ranelate).

The action of strontium is closely related to that of calcium, although strontium retention varies inversely

with calcium intake. Normal diets provide just a few mgs of strontium a day, however to treat or prevent

bone loss, over 1,000 mg of strontium has to be ingested daily. This not only has the potential to cause

medical problems such as dental caries, rickets, and other side effects, but long-term supplementation
can also lower WBC, insulin, stomach acid levels, germanium, silicon, fluoride, and bismuth.

These effects should be kept in mind when considering the addition of any forms of strontium in the
treatment of osteoporosis, particularly since it does not appear to serve any unique or specific purpose

that no other nutrient could fulfill.

Since the consumption of sweets (candy, pastries, sweet fruit, sugar-added foods, soft drinks, honey),
as well as alcohol increases chromium requirements, and since these are rarely met in most individuals

unless extra amounts are supplemented, Sugar, from refined and natural sources - or all simple carbs -

are a major overlooked factor when dealing with osteoporosis, and one that is particularly prevalent in

Western Societies. (see also Acu-Cell "Sugar & Glycemic Index").

While complex carbohydrates from grain sources do not promote VLDL triglycerides and are thus much
healthier than simple carbs in regard to cardiovascular and other diseases, consuming large amounts

(of complex carbs) may in some individuals result in a higher phosphorus / calcium ratio, which is also

a well-recognized cause of osteoporosis.

Finally, there are those who claim that a high Protein intake in Western Societies is the most common

cause of osteoporosis. While high protein intake - particularly from fad diets - is definitely a concern not

only for osteoporosis, but also kidney functions, it is phosphorus, the end product of protein metabolism
that needs to be evaluated. It really doesn't matter whether one deals with abnormally high phosphates
from high protein or high grain consumption. Subsequently, high protein intake is safe in regard to

bone density and kidney functions as long as an individual's phosphorus status remains normal.

Many Vegetarians are under the assumption that in contrast to omnivores, their lower protein intake

protects them from osteoporosis, however for the above-mentioned reasons, a high grain intake, or
high sugar intake puts them into the same risk category as those following a high meat / protein diet.

It should also be mentioned that high oxalic acid-containing food sources such as spinach, rhubarb,

beet greens, or chards can have a very negative impact on individuals who have difficulty maintaining
adequate levels of calcium. As a result, they are equally at risk for osteoporosis since oxalic acid binds

to calcium and so reduces its absorption. Kale, broccoli, or collards are a better choice in such cases.

Patients prescribed Potassium Chloride (Slow K) might consider switching to Potassium Citrate for

its more favorable effect on bone mineral density.

Osteoporosis, soft tissue calcification, or bone (heel) spurs may also develop as a result of Excessive

uptake, or Retention of Calcium - following long-term use of Acid-lowering Drugs, supplementation

of too much calcium, or lack of calcium co-factors (Vitamin C, zinc, manganese, magnesium, protein...),

which will render calcium bio-unavailable.

In that case, oxalic acid or phosphorus-rich sources, or any acid-forming foods such as meat, seafood,

eggs, dairy, pasta, bread.., would either prevent excessive uptake and storage of calcium, or they would

help render calcium more soluble by increasing bioavailability (and subsequently absorption into bone).

Increasing stomach acid has the same effect, while adequate Vitamin K prevents calcification of soft

tissue through its interaction with osteocalcin. ¤

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Dietary Reference Intake (DRI) is the latest term replacing daily dietary reference values such as

Adequate Intake (AI), Tolerable Upper Intake Level (UL), Estimated Average Requirements (EAR),

Nutrient Reference Value (NRV), and Recommended Dietary Allowance / Intake (RDA / RDI).

Vitamin A (Retinol):Vitamin D (Calciferol):

Vitamin A2 (3,4-dehydro-retinol),Vitamin D2 from plants (Ergocalciferol)

Vitamin A3 (3-hydroxy-retinol)Vitamin D3 from animals (Cholecalciferol)

DRI (RDA):DRI (RDA):

0-6 months

2,000 IU or 400mcg

0-6 months

400 IU or 10mcg

6-12 months

2,000 IU or 400mcg

6-12 months

400 IU or 10mcg

1-3 years

2,000 IU or 400mcg

1-3 years

400 IU or 10mcg

4-6 years

2,500 IU or 500mcg

4-6 years

400 IU or 10mcg

7-10 years

3,500 IU or 700mcg

7-10 years

400 IU or 10mcg

11-18 years

4,000 IU or 800mcg

11-18 years

400 IU or 10mcg

18+ years Males

5,000 IU or 1,000mcg

18+ years Males

400 IU or 10mcg

18+ years Females

4,000 IU or 800mcg

18+ years Females

400 IU or 10mcg

50+ years Males / Females

400 IU or 10mcg

pregnant / lactating

4,000 IU or 800mcg

pregnant / lactating

+200 IU or 5mcg

Unofficial daily intake recommended by many

researchers for adults living in the Northern

Hemisphere is 1,000 to 2,000 IU (25-50mcg)

of Vitamin D3 per day.

Therapeutic Range:

5,000 IU - 100,000 IU

Therapeutic Range:

400 IU - 100,000 IU

Therapeutic Range for Beta carotene:10,000 IU - 100,000 IU (preferably from mixed carotenoids).

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Cellular / Intracellular Attributes and Interactions:

Vitamin A Synergists:Vitamin D Synergists:

Iron, manganese, Vitamin C, fats, conjugated

Vitamin C, Vitamin E, boron, [selenium],

linoleic acid (CLA), [zinc, Vitamin E, alcohol],

lycopene, UV light,

Vitamin A Antagonists / Inhibitors:Vitamin D Antagonists / Inhibitors:

Zinc, Vitamin D, Vitamin E, mineral oil, [iron],

Calcium, strontium, Vitamin A, Vitamin K,
alcohol, light, heat, air,

cadmium, alcohol, mineral oil, light (Vit D2),

Low Levels / Deficiency - Symptoms and/or Risk Factors:

Vitamin A:Vitamin D:

Night blindness, eye disorders / blindness, weak

Rickets, osteomalacia, osteopenia, bone pain,

dental enamel, poor bone growth, dry / rough skin,

osteoporosis, weak muscles, spasms, cramps,

low resistance to infections, excessive mucous,

hypocalemia (low blood calcium), some types

air-born allergies, bronchitis, bronchial asthma,

of multiple sclerosis, psoriasis, some cancers,

acne, some cancers,

High levels / Overdose / Toxicity / Negative Side Effects - Symptoms and/or Risk Factors:

Vitamin A:Vitamin D:

Birth defects (over 8,000 IU / day) osteoporosis, hair

Calcification of soft tissue (arteriosclerosis),

loss, bone pain, elevated blood sugar, liver damage,

bone pain, osteoporosis, high blood pressure,

headaches, dizziness, double vision, bleeding gums,

loss of appetite, abdominal pain, weight loss,

seizures, confusion, dry / peeling skin, hydrocephaly,

nausea, seizures, retarded growth (physical +
dry cough, asthma,

mental), kidney damage, tetany of muscle, skin

erruptions, constipation, headaches, allergies,

Beta carotene: Carotenemia (orange skin color).

worsens symptoms of autoimmune diseases,

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Vitamin A Sources:Vitamin D Sources:

Fish liver oils, liver, eggs, dairy products,

Fish liver oils, seafood, fortified dairy products,

Beta carotene Sources: Carrots, broccoli, apricots, sweet potatoes, watermelon, pumpkin, kohlrabi.

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Vitamin K:

Vitamin K1(phylloquinone, phytonadione) = from plants sources

Vitamin K2(menaquinone, menatetrenone)

MK4 = from animal sources (meat, eggs, dairy)

MK7 = from fermented food or intestinal bacteria

Vitamin K3(menadione, menadiol, menaquinone, menaphthone) = synthetic

DRI (RDA):

0-12 months

10-20mcg

1-10 years

15-60mcg

11-18 years

50-100mcg

18 years +

100mcg+

Therapeutic Range:

100mcg - 45mg

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Cellular / Intracellular Attributes and Interactions:

Vitamin K Synergists:Vitamin K Antagonists:

Calcium, copper, Vitamin B5, Vitamin D,

Vitamin A, Vit E, mineral oil, oxalates, alcohol,
[(Bio)flavonoids],

blood thinners / anticoagulants (coumadin),

Antibiotics - by killing intestinal bacteria,

Low Levels / Deficiency - Symptoms and/or Risk Factors:

Bleeding, abnormal / prolonged blood clotting time, bruising, osteoporosis, cardiovascular disease,

stroke, calcification, behavioral problems, failure to grow and develop normally in infants

Vitamin K3 only:

High levels / Overdose / Toxicity / Negative Side Effects - Symptoms and/or Risk Factors:

Liver impairment / damage, hemolytic anemia, stomach upset, skin rash, brain damage in infants.

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Vitamin K Sources:

Green tea, kale, collards, spinach, cauliflower, cabbage, alfalfa, soybeans, tomatoes, oats, liver, egg

yolk, meat, fish liver oils, blackstrap molasses. Vitamin K is also made by bacteria in the intestines. ¤

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General recommendations for nutritional supplementation: To avoid stomach problems and promote

better tolerance, supplements should always be taken earlier, or in the middle of a larger meal. When

taken on an empty stomach or after a meal, there is a greater risk of some tablets causing irritation, or
eventually erosion of the esophageal sphincter, resulting in Gastroesophageal Reflux Disease (GERD).

It is also advisable not to lie down immediately after taking any pills.

When taking a very large daily amount of a single nutrient, it is better to split it up into smaller doses to

not interfere with the absorption of other nutrients in food, or nutrients supplemented at lower amounts.

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Acu-Cell Disorders: Osteoporosis / Bone Loss

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