Is calcium a safe and effective osteoporosis treatment?

effective osteoporosis treatmentAre you using a dangerous or safe and effective osteoporosis treatment yourself? I ask, knowing that many of my readers are women around my age. (Note young women with risk factors and men are at risk too!)

Many people believe that “thin bones” AKA osteoporosis is due to a calcium deficiency.

So, they follow the dictum of decades passed, now considered to be obsolete and in fact dangerous. They take 1000-1500 mg of calcium in the form of supplements daily.

If this is what you’re doing, let me assure you that I’ll tell you what you should actually be doing. Then I’d like you to educate whatever “bonehead” doctor told you to do this as he/she needs to “keep up” with what’s current!

First of all, know that bone is composed of at least a dozen minerals. If you simply take high dose calcium as your only supplement, you will likely worsen your bone density, and increase your risk of osteoporosis! Stay tuned and don’t worry because I’ll tell you how to fix this.

Let me just add here there is evidence that over-consumption of calcium supplements creates other mineral deficiencies which increase your risk of heart disease, kidney stones, gallstones, osteoarthritis, hypothyroidism, obesity and type 2 diabetes.

Many articles point out that the population trying to prevent and reverse heart disease is the same population taking high dose calcium supplementation. The data points to the fact that soft coronary plaques harden with calcium which can easily result from blood containing the high calcium levels you get with calcium supplements containing more than 300 mg of elemental calcium per capsule.

Scientific evidence for the supplements which are effective osteoporosis treatment:

The COMB study (Combination of Micronutrients for Bone), published in the Journal of Environmental and Public Health, convincingly showed that giving bones the nutrients plus regular weight-bearing exercise is as or even more effective than any of the popular drugs used to treat osteoporosis. (Yes, I sure will get to them!) Before I get into the protocol, know that results were measured by comparing before and after bone density studies.

Here is what supplements were used daily for study participants. They were given the DHA component of omega 3 fish oils at 250 mg per day. They received daily vitamin D3 (2,000 IU) with vitamin K2 (100 mcg), 25 mg of magnesium, strontium citrate (680 mg), and no supplemental calcium; participants obtained calcium from their diet.

Note that dietary sources were recommended but not measured nor monitored!  In addition, daily impact exercise was encouraged—again not dictated nor monitored. This regimen was “at least as effective as bisphosphonates” in raising bone mineral density levels in hip, spine, and femoral neck sites. What is amazing is the supplement regimen was also effective “in individuals where bisphosphonate therapy was previously unsuccessful in maintaining or raising BMD.” Imagine that!

What about diet and exercise?

Since the COMB study isn’t the only lifestyle study “out there,” let me incorporate other positive ways to hang on to your bones as you age. One of the key strategies for healthy bones is to eat an anti-inflammatory diet full of whole foods. If you eat a diet full of processed foods, it will cause the biochemical milieu in your body not only to decrease your bone density but to cause metabolic diseases.

One particular food besides the obvious calcium rich spinach that is worth discussing is onions. They are high in gammaglutamyl peptides that have been shown to increase bone density. You’ll want to eat your fair share of good, wild caught fish, rich in omega-3 fatty acids. Meats, milk and certain oils (corn, soy, and safflower oil) are full of inflammatory omega 6 fatty acids. The more omega-6’s you eat, the more omega-3’s you need to “cancel them out” so just remember that “factoid.”  Further, what about exercise?

As you will learn in a bit, bone-building is a very dynamic process. This means you will want to exert enough force on your bones to stimulate what are called osteoblasts to build new bone. Upright exercise such as walking is a good start. However, the best clinical results are from weight training. You’ll want to specifically train “at risk” areas such as the muscles around your arms, forearms, wrist and back.

Supplements for effective osteoporosis treatment:

I think the evidence is incredibly “in” for everyone to supplement with vitamin D and omega-3 fish oils unless medically forbidden (contraindicated). You can easily get your strontium with a daily serving of lettuce or spinach and even poultry. Magnesium threonate is the best magnesium supplement for health. We also know magnesium is great for your brain, sleep, anxiety levels, aches and pains and more! Accordingly, you’ll get your calcium from your spinach or fortified almond milk. So, there you go!

What about hormones?

Forteo (teriparatide) is the synthetic variation of human parathyroid hormone and is generally used as a self-injection. Remember this fact: it is the only FDA-approved medication that promotes new bone growth instead of inhibiting resorption. It has potentially uncomfortable side-effects and is associated with bone cancer.

Because of side effects and an association with bone cancer, use is limited to a two-year course of treatment or less. I have prescribed the bio-identical (hormonal) version of this a few times when I’ve had patients who had such severe osteoporosis from long-term steroid use that I was afraid a sneeze would cause a fracture!

Although they are not “indicated” for prevention or treatment of osteoporosis, we have seen countless studies showing the utility of bioidentical estrogen, testosterone and human growth hormone for osteoporosis. The debate would rage on too long in this one article so let me just say this is a choice that is up to you and your hormone specialist.

Let’s discuss bone metabolism:

Now is the time to address this important point because you need to understand how osteoporosis drugs work. Bones are alive, and constantly “re-modeling” themselves. This dynamic process keeps our bones strong and healthy.  Bones contain two types of cells: osteoblasts and osteoclasts. The osteoclasts tear down old whereas the osteoblasts build new bone.

Most present drugs target the clasts, seeking to lessen bone resorption, rather than accelerating the formation of new bone by the blasts.

Yes, now I’ll discuss the drugs touted as effective osteoporosis treatment:

The “in vogue” drugs are the bisfosphonate drugs like Fosamax, Actonel, or Boniva. Yes, you’ve seen Sally Fields and other popular actors touting the benefits of these. I’m going to chalk that up to ignorance. These drugs are actually one of the worst strategies for treating osteoporosis, and not just because I dislike pharmaceuticals. Will they increase your bone density? Yes. But what is the quality of the bone, please? Aha! That’s the crux of the problem.

These drugs work by destroying osteoclasts. Recall that these are the cells that destroy bone as part of the bone regeneration process. When these cells die off, you’re left with only the bone-building osteoblasts. As a result, you get bones that are denser, but NOT stronger. Your bones actually become weaker. Long-term studies now reveal you eventually have an increased risk of developing a fracture. Not to mention nasty side effects which cause class-action lawsuits such as osteonecrosis of the jaw.

Are there other drugs?

Well, yes, but I gave you healthy options,! So, you still want more drugs? Oh OK, just so that you know what’s out there!

All of the drugs:

On the market since only 2010, Prolia prevents the creation of new osteoclasts without killing off all the old ones. It’s a twice-yearly injection, so convenience is a major selling point. Right now, we know of fewer side effects and increased efficacy compared to the bisphosphonates. Prolia works by inhibiting a protein controlling several cellular functions called NF-kappa-B. The end of the cascading effect is that NF-kappa-B inhibition causes osteoclastic apoptosis (cellular suicide). But, in that cascade might also come impairment of the immune function of white blood cells, since all white blood cells require NF-kappa-B to mature.

As I just stated, Prolia has only been licensed since 2010. In my opinion, there have not been enough people taking the drug for a sufficient time to know whether some of them will experience the same “atypical” hip fractures as Fosamax-users. Bones appear to be strengthened by the ongoing process of remodeling, with bone resorption being a full half the process. I guess we’ll have to settle for a “we’ll see” on this one.

The latest pharmaceutical-money-maker drug is called odanacatib. It has been in testing for more than 15 years of tests, and it’s still not under FDA review. That is sure a lot of “back to the drawing boards” on this, isn’t it? Odanacatib is supposed to be taken orally every two weeks. It interferes with a chemical signal in bone called collagenase cathepsin K. It, too, merely inhibits bone resorption by osteoclasts! Thus far reports convey it has less severe side effects than bisphosphonates or Prolia, but here we go again with looking at the resorption side only. Read my mind.

Conclusion:

I presented everything you need to know to make your choice or choices of how to preserve or rebuild your bones. It all starts with a healthy diet and a good exercise plan. My way to protect my bones should be crystal clear especially if you are a regular reader. Remember that after the third pharmaceutical, side effects are exponential, not linear. Live well and live safely.

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