EVERYTHING ABOUT

bone health

Every week I am posting about  everything you need to know about hormones. This weeks topic is about bone health.

Did you know …

  • Bones are not hard and lifeless, they are actually living, growing tissue and keeping your bones healthy is a lifelong job.
  • The body has over 200 very alive bones, and they’re constantly rebuilding throughout your life.
  • We constantly lose old bone to make room for new bone.
  • Children and teenagers form bone faster than they lose bone until they reach peak bone mass which usually happens between the ages of 18 and 25.

The more bone at peak bone mass, the less risk of osteoporosis later in life.

  • During your life, your body continues to both reabsorb old bone and create new bone.
  • Your entire skeleton is replaced about every 10 years, though this process slows as you get older.
  • As long as your body has a good balance of new and old bone, your bones stay healthy and strong.
  • Bone loss occurs when more old bone is reabsorbed than new bone is created.
  • In midlife, bone loss usually speeds up in both men and women.
  • Bone loss increases after menopause, when Estrogen levels drop.
  • In the 5 to 7 years after menopause, women can lose up to 20 % or more of their bone density.
  • The International Osteoporosis Foundation estimate that 200 million people worldwide suffer with osteoporosis.
  • 1 in 3 women and 1 in 5 men over the age of 50 will break a bone due to osteoporosis.
  • In the UK over 3 million people are estimated to have osteoporosis with over 500,000 fragility fractures each year.
  • Any broken bones in people over the age of 50 that are not caused by a serious accident (car crash, falling off a ladder, etc.) can be the first sign of low bone density or osteoporosis.
  • Osteoporosis is frequently undiagnosed.
  • Osteoporosis is more common in older people, but can strike at any age.
  • Osteoporosis is more common in Caucasian and Asian women.
  • Osteoporosis is commonly called a “silent disease” as there is often no symptoms until you break your bones.
  • It’s never too late to take steps to protect your bones.

Meet Sally and get to know all about bone health

Intro bone health

Bone 101

The bone bank

Bone Health & Hormones

What affects bone health

Bones 101

  • Bones are made up of a framework of a protein called collagen.
  • Collagen is packed with the mineral calcium-phosphate, which gives the framework strength.
  • The combination of collagen and calcium makes bone strong and flexible enough to withstand stress.
  • Bones also act as store for calcium, which is released into the bloodstream when needed for other functions, such as nerve transmission, regulating blood pH levels, etc.
  • Bones are very light yet strong enough to support the entire body weight and help form body shape.
  • They protect the body’s organs, ie.

– The skull protects the brain and forms the shape of the face.

– The backbone protects the spinal cord.

– The ribs form a cage that shelters the heart and lungs.

– The pelvis help.s protect the bladder, part of the intestines, and in women, the reproductive organs.

  • Bones are made up of two types of tissues:

– Compact bone – is the solid, hard outside part of the bone. It looks like ivory and is extremely strong. Holes and channels run through it, carrying blood vessels and nerves.

– Cancellous bone – is soft and looks like a sponge, is inside compact bone. It is made up of a mesh-like network of tiny pieces of bone called trabeculae. This is where bone marrow is found. Soft bone is where most of the body’s blood cells are made. The bone marrow contains stem cells, which produce the body’s red blood cells and platelets, and some types of white blood cells / immune cells called B cells.

  • Bone contains three types of cells:

– osteoblasts – make new bone and help repair damage.

– osteoclasts – break down bone and help to sculpt and shape it.

– osteocytes – mature bone cells which help continue new born formation.

The Bone Bank

Think of the skeleton as a bone bank account where you “deposit” and “withdraw” bone.

  • During childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed.
  • The bone bank account becomes larger, heavier, and denser.
  • For most, bone formation continues at a faster pace than removal until bone mass peaks somewhere in the 20’s.
  • After age 20, bone “withdrawals” can begin to exceed “deposits.”
  • For many people, this bone loss can be prevented by continuing to get optimal levels of protein, calcium, magnesium, vitamin D, Vitamin K2 and exercise, by avoiding tobacco and excessive caffeine and alcohol and by controlling stress.
  • Osteoporosis develops when bone removal occurs too quickly and replacement occurs too slowly, or both.
  • You are more likely to develop osteoporosis if you did not reach your maximum peak bone mass during your bone-building years.

Bone Health & Hormones

Growth hormone (GH)
– drives the growth of bones until the adult size is reached.

Parathyroid hormone (PTH)
– promotes the number and activity of osteoblasts.

Estrogens
– until the end of puberty, estrogens are needed for maturation of the skeleton in males and females. Estrogen increases osteoblast activity. Estrogen induces apoptosis in osteoclasts causing them to self-destruct slowing down the destruction of bone.

Testosterone
– inhibit osteoclast activity.

Calcitonin and Thyroid Stimulating Hormone (TSH)
– inhibit the activity of osteoclasts.

Calcitriol
– the hormone version of vitamin D is necessary for the deposition of calcium into bone.

Osteoprotegerin
– a protein secreted by osteoblasts inhibit the production and activity of osteoclasts.

Leptin
– regulates the balance between osteoblast and osteoclast activity.

Serotonin
suppresses osteoblasts (at least in mice). This may account for the bone-weakening effect in humans of prolonged use of selective serotonin reuptake inhibitors (SSRIs).

Cortisol 
– increases osteoclast activity, blocks osteoblast activity, blocks calcium absorption in bone, and breaks down collagen. Making Cortisol bone enemy number one.

What affects bone health?

Brittle, fragile bones ie poor bone health is caused by anything that makes your body destroy too much bone, or keeps your body from making enough new bone.

Possible causes

Calcium – low calcium in the diet contributes to diminished bone density, early bone loss and an increased risk of fractures.

Physical activity – physical inactivity leads to a higher risk of osteoporosis

Tobacco, caffeine and alcohol use – research suggests these contributes to weak bones.

Sex – greater risk of osteoporosis if you’re a woman, because women have less bone tissue than do men.

Size – greater risk if you are extremely thin (a body mass index of 19 or less).

Women with low fat percentage – especially after menopause as fat cells produce Testosterone and Estrogen

Age – bones become thinner and weaker as you age.

Race and family history – greatest risk of osteoporosis if you’re Caucasian or of Asian descent, and or having a parent or sibling with osteoporosis.

Hormone levels

  • too much Thyroid hormone
  • too little Estrogen, due to menopause or amenorrhea (chronic absence of menstruation before menopause)
  • too little Testosterone
  • too much Cortisol
  • See the article Hormones and Bone health in this blog.

Eating disorders and malabsorption

  • severely restricting food intake, such as anorexia or bulimia, and or being underweight in general.
  • weight-loss surgery can affect your body’s ability to absorb calcium.
  • celiac disease can affect your body’s ability to absorb calcium.
  • Crohn disease.

Certain medications

  • Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, breaks down bone.
  • Aromatase inhibitors to treat breast cancer decrease Estrogen.
  • Antiandrogens, CYP17A1 inhibitors, 5α-reductase inhibitor, decrease Testosterone and DHT.
  • SSRI – selective serotonin reuptake inhibitors inhibit osteoblasts.
  • Methotrexate – supress osteoblasts and stimulate osteoclasts.
  • Anti-seizure medications, such as phenytoin (Dilantin) and phenobarbital – change calcium and bone metabolism.
  • Proton pump inhibitors inhibit the absorption of calcium.

Certain disease states

  • Rheumatoid Arthritis
  • Cushing syndrome
  • Chronic kidney / renal disease
  • Chronic liver disease
  • Hypogonadism
  • Primary hyperparathyroidism
  • Renal calcium leak
  • Type 1 Diabetes
  • Organ transplant.

Common Bone & Joint Disorders

Osteoporosis
– bones become weak due to changes in bone mineral density and mass, causing a higher risk for fractures. Osteoporosis is known as a “silent” disease as there are no obvious symptoms until a bone actually breaks. These fractures can occur anywhere, but typically in the hip, spine, and wrist.

Fracture
is a break in a bone which occurs when it is put under sudden or very strong pressure or force. Those at high risk of getting fractures are the elderly, individuals with osteoporosis and endocrine or intestinal disorders, and those taking corticosteroids. 

Scoliosis
– is an abnormal curvature of the spine resulting in an S or C shape. The disorder often occurs in a child’s growth spurt before puberty, with cases usually diagnosed in the first seven years. 

Paget’s disease
– is a chronic disorder that affects the way that bones break down and regrow. Symptoms of Paget’s disease rarely manifest, and when they do, they can be similar to that of arthritis.

Osteoarthritis
– the most common joint disorders arises when the cartilage between two joints is worn down. This causes the bones in the joint to rub together, causing swelling and stiffness in the area. Symptoms typically occur way into adulthood, with the average person over 60 displaying some of the symptoms. Risk factors for this disorder include age, weight, frequency and intensity of joint activity, sports that directly affect the joint, and family history.

Rheumatoid arthritis
– is an autoimmune and inflammatory disease that causes the body’s immune system to attack healthy cells mistakenly, leading to inflammation or painful swelling in affected joints, such as hands, wrists, and knees, and damage the joint tissue, leading to chronic pain, lack of balance or instability, and deformities. Occurs symmetrically on both sides of the body, like in both wrists or both knees. Other symptoms are weight loss, fever, fatigue, and weakness.

Gout
– is a common form of inflammatory arthritis marked by intense pain and caused by too much uric acid in the body. Uric acid crystals build up in the joints and surrounding tissues in the body. This disorder typically affects the big toe joint but can affect other toe joints, ankles, and knees. Risk factors include gender, obesity, certain health conditions, use of certain medications like diuretics, an increased intake of alcohol and high-fructose food and drink, and a purine-rich diet.

Bursitis
– is characterized by the inflammation of the bursa, the small fluid-filled sac that serves as a cushion between the bone and other moving parts like muscles, tendons, joints, or skin. The bursa may turn red and increase in fluid content, leading to painful swelling. Often caused by overuse or an increased activity level involving the joint. Trauma or a complication from rheumatoid arthritis, gout, or infection may also be a culprit.

Osteoarthritis 101

  • The most common form of arthritis among older people
  • The most frequent causes of physical disability among older adults.
  • Affects both men and women.
  • Before age 45, osteoarthritis is more common in men than in women.
  • After age 45, osteoarthritis is more common in women.
  • Occurs when cartilage that cushions the ends of the bones within the joints, breaks down and wears away, leaving bones that rub up against each other.
  • Developing osteoarthritis increases with:

– Genetics
– Age
– Putting too much stress on a joint that has been previously injured
– Improper alignment of joints
– Excess weight

  • The condition was once believed to be caused primarily by “wear and tear” damage to the joints over time.
  • It is now thought to be mainly the result of the body’s failed attempts to repair this damage.
  • The balance between build-up and breakdown of tissue is lost in osteoarthritis, leading to cartilage damage and, over time, complete breakdown.
  • Without the cartilage protection, bone damage occurs.
  • In response, the body builds new bone
  • This leads to overgrowth and reduced joint mobility
  • Cartilage damage triggers an immune response, causing inflammation leading to further joint damage.
  • Most commonly affects the hands, lower back, neck, and weight-bearing joints such as knees, hips, and feet.

Symptoms

  • Morning joint stiffness
  • Aching pain
  • Tender joints
  • Limited range of motion
  • Mild pain that comes and goes
  • Severe joint pain
  • Swelling

Diagnosing

  • Medical history
  • Physical examination
  • X-rays
  • Blood tests
  • Other laboratory tests.

Treatment

There are treatments that can relieve symptoms, but there are no treatments that can cure the condition.

  • Exercise
  • Rest
  • Joint care – hyaluronic acid injections
  • Pain relief
  • Weight control
  • Medicines – NSAID, opiates, cannabis, CBD
  • Surgery.

Osteoporosis 101

  • Comes from Latin for “porous bones.”
  • More spaces occur in the inner spongy cancellous bone, causing the bone to lose strength and density.
  • The outer compact bone grows weaker and thinner.
  • Can occur in people of any age, but it’s more common in older adults, especially Asian and Caucasian women.
  • People with osteoporosis are at a high risk of fractures, or bone breaks, while doing routine activities such as standing or walking
  • The most commonly affected bones are the ribs, hips, and the bones in the wrists and spine.
  • As bones get thinner and weaker, the risk of fracture increases.
  • Fracture from a fall, stubbing your toe or even from a strong sneeze or cough is common
  • Loss of height can indicate osteoporosis.
  • Back or neck pain can be a sign of a facture in one or more of the vertebrae

Osteoporosis symptoms

  • In the early stages there are often no symptoms or warning signs.
  • In most cases, people with osteoporosis don’t know they have the condition until they have a fracture.
  • Early symptoms may include:

– receding gums
– weakened grip strength
– weak and brittle nails

  • If you have a family history of osteoporosis, talk with your doctor to assess your risk.

Preventing Osteoporosis

Prevention is essential as treatments are not full proof and many have very serious side effects.

  • Build optimal bone tissue in teenage years.
  • Maintain a balance between the hormones estrogen / testosterone and cortisol, ie. the anabolic/building processes and the catabolic/breakdown processes.
  • Support Estrogen and Testosterone after 50.
  • Protein rich diets.
  • Collagen supplements
  • Sunshine and or Vit D3 supplements.
  • Optimal levels of Vit C, Vit K2, calcium, magnesium, phosphorus, through diet and supplements.
  • Weight-bearing, impact exercises every day.
  • No smoking.
  • Avoid excessive caffeine and or alcohol intake.
  • Check bone density, already from 50 years of age.
  • More information in the article ‘Treating Osteoporosis’ in this blog.

Treating Osteoporosis

There’s no cure for osteoporosis, but treatment can help protect and strengthen your bones. Some treatments slow the breakdown of bone. Some spur the growth of new bone.

Medications – All come with a risk of side effects

BISPHOSPHONATES
– prevent the loss of bone mass by poisoning osteoclasts so they don’t breakdown bone. They may be taken orally or by injection, such as:

  • alendronate (Fosamax)
  • ibandronate (Boniva)
  • risedronate (Actonel)
  • zoledronic acid (Reclast)

Known side effects

  • Fever and flu-like symptoms.
  • Low levels of calcium in your blood – hypocalcaemia Bone and joint pain.
  • Changes in bowel movements.
  • Tiredness and low energy levels.
  • Kidney problems.
  • Irritation of the food pipe (oesophagus).
  • Jaw problems – Osteonecrosis / death of bone tissue.

TESTOSTERONE REPLACEMENT THERAPY
– increase bone growth by stimulating osteoblast activity and inhibiting osteoclast

Known side effects

  • Acne and oily skin
  • Excess hair growth on face, nipples
  • Prostate enlargement

ESTROGEN REPLACEMENT THERAPY 
– used during and after menopause can help stop bone density loss by increasing he life span of osteoblasts

Known side effects

RALOXIFENE (EVISTA)
– a SERM, works as Estrogen in bone tissue.

Known side effects

  • hot flashes
  • leg cramps.
  • swelling of the hands, feet, ankles, or lower legs.
  • flu-like syndrome.
  • joint pain.
  • difficulty falling asleep or staying asleep.

DENOSUMAB INJECTION (PROLIA)
– prevents bone breakdown by preventing the development of osteoclasts. May prove even more promising than bisphosphonates at reducing bone loss.

Known side effects

  • Same as bisphosphonates

TERIPARATIDE (FORTEO) 
-is a portion of human parathyroid hormone (PTH) stimulates bone growth by activating osteoblasts more than osteoclasts

Known side effects

  • heartburn or sour stomach.
  • leg cramps.
  • redness, pain, swelling, bruising, a few drops of blood or itching at the injection site.
  • back spasm

CALCITONIN
– a Thyroid hormone nasal spray decrease bone breakdown by inhibiting osteoclast activity

Known side effects

  • Crusting, patches, or sores inside the nose.
  • Dryness, itching, redness, swelling, tenderness, or other signs of nasal irritation not present before use of this medicine.
  • Headaches (severe or continuing)
  • Nosebleeds
  • Stuffy nose.

ROMOSOZUMAB (EVENITY)
– increases bone formation and decreases bone breakdown. A newer drug/injection. Not recommended for people with a history of CV problems.

Known side effects

  • Increased risk for heart attacks and strokes
  • New or unusual pain in your thigh, hip, or groin
  • Jaw pain or numbness
  • Red or swollen gums
  • Loose teeth
  • Infected gums
  • Low calcium level
  • Muscle spasms or contractions
  • Numbness or tingly feeling around your mouth, or in your fingers and toes

Natural treatments

Plant hormones in red clover, soy, and black cohosh. Few, if any, studies support the use of these supplements for treating low bone density and or osteoporosis. They can cause side effects. They can interact with medications.

DIET

  • Collagen – BUY HERE 
  • Protein – minimum 1.2 g per kilo body weight per day, even better with 1.5g, approx. 30g per meal – see macronutrient list here
  • Vit C – BUY HERE 
  • Vitamin D3 – BUY HERE 
  • Vitamin K2 – BUY HERE
  • Calcium – BUY HERE 
  • Magnesium – BUY HERE 
  • Zinc – BUY HERE 
  • Boron
  • Combine the intake magnesium and vitamin K2 with Vitamin D for best effect – otherwise you may need 2.5 x more vitamin D – super bone supplement – BUY HERE 

LIFESTYLE

  • Exercise – do some EVERY day.
  • Weight bearing, impact exercise, like:

– climbing stairs
– jumping jacks
– skipping
– stomping
– squats
– push-ups

  • H:I:T – short duration, high load

– resistance bands
– dumbbells
– free weights
– resistance exercise machines

Rest MORE – this is when you build bone

  • Control Cortisol levels

– 6am – 6pm – activity
– 6pm – 6am – rest
– decrease stress – especially emotional stress.

Understanding a DEXA Scan

  • Tests your bone density, ie. how strong your bones are.
  • The most widely used is a scan called dual energy X-ray absorptiometry (DXA or DEXA).
  • The test determines bone health and your risk of fracture due to osteoporosis.
  • DXA scanning focuses on two main areas — the hip and the spine which also indicates fracture risk in other bones in your body.
  • Generally takes 10 to 20 minutes
  • Is painless
  • Low amount of radiation
  • You lie still on an open X-ray table – no laying in tubes
  • Able to go home straight after the test
  • The DXA scanner produces two X-ray beams – one is high energy and the other is low energy.
  • The machine measures the amount of X-rays that pass through the bone from each beam, ie how much high and how much low, which is affected by bone thickness / density
  • Based on the difference between the two beams, bone density is evaluated.

Results

  • Called a T-score which shows how your bone density compares with a healthy 30-year-old
  • The lower your score, the weaker your bones are:
  • T-score of -1.0 or above = normal bone density
  • T-score between -1.0 and -2.5 = low bone density / osteopenia
  • T-score of -2.5 or lower = osteoporosis

Who Should Get a DXA Scan?

  • Women aged 65 or older
  • Women aged 60 or older who have an increased fracture risk
  • I recommend from age 50 if there is a family history of osteoporosis or other factors that increase risk
  • Talk to your doctor about whether the test is a good idea for you.

Blood & Urine Tests for Osteoporosis

Blood

  • Bone-specific alkaline phosphatase / Bone ALP or BALP – estimates the rate of bone formation over your entire skeleton. People with osteoporosis generally have BALP levels that are up to 3 times normal.
  • Osteocalcin – high levels indicate low bone density.
  • Vitamin D
  • Calcium
  • Magnesium
  • Phosporus
  • Alkaline phosphatase – high levels indicate higher bone loss.
  • Albumin – low levels my indicate ow bone density.
  • Parathyroid hormone PTH – high levels decrease bone density.
  • Calcitonin hormone – low levels decrease bone density.
  • Cortisol hormone – high levels decrease bone density. 

Urine

  • Urinary N-telopeptide of type I collagen, or uNTX – is a marker of bone resorption aka bone loss – high levels low bone density.
  • Cortisol hormone – high levels indicate low bone density.

Questions? Please don't hesitate to contact me

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