The Bones of Osteoporosis

Overview

“At least 10 million Americans over the age of 50 have osteoporosis, another 34 million are at risk for developing osteoporosis, and roughly 1.5 million people have suffered a bone fracture related to osteoporosis.”1

Osteoporosis is the most common bone disorder among Americans where the distinguishing features are low bone mass, bone deterioration and decreased bone strength, elevating the risk of fractures.1,2  Bone health and building strong bones needs to be started early on in life, as our peak bone mass occurs, surprisingly, in our 20’s.1,3  So diet and exercise early on are important components of any health program to reduce the risk factors and potential for bone disease later on in life.

Individuals can make use of a multi-factorial approach to lessen the  risk, and pain associated with osteoporosis, and even prevention early on in life with strategies that include diet, supplements, stress reduction, exercise.2

Osteoporosis is comprised of multiple factors including genetic, hormonal, metabolic, mechanical and immunology.2  Inflammation plays a role in many diseases processes including osteoporosis.  It may be inflammatory living, poor diet, sedentary lifestyle, and acidity in the body that worsens the projection.   In fact, there is a growing body of evidence showing that low level chronic inflammation may be the single most relevant factor in the development of the disease.2,4  Pro-inflammatory cytokines promote bone loss by activating osteoclasts, the cells that reabsorb bone further enhancing the breakdown of bone, whereas suppressing these inflammatory biochemicals is associated with supportive conditions that grow new bone.2,5  Interestingly, there is speculation that osteoporosis may be the result of imbalances caused by structural demand of nutrients and the biologic need during an inflammatory stress state.6

Diet and Therapeutic Foods

Inflammation is identified as the key contributor in a variety of disease processes including bone disease like osteoporosis.4  Certain foods such as highly refined carbohydrates and saturated fats have been evidenced as potential triggers for inflammation and the promotion of inflammatory illness.7

An anti-inflammatory diet is the key outline for a diet used in combination with pharmaceutical and lifestyle strategies.2  Such a diet reduces or eliminates entirely the common inflammatory foods: saturated fats, refined sugar, grain, and dairy.8 It is possible that the diet is successful simply because of the natural consequence of consuming more plant based foods, as these foods are more likely to contain the minerals, magnesium, potassium, Vitamin K, antioxidants that come from these phytonutrient rich plants.2

If the principles of an anti-inflammatory diet, and the conscientious effort to ensure enough intake of calcium and vitamin D are followed, the benefits should be amply received.2  One study in particular showed that following an anti-inflammatory diet showed lowered inflammatory markers:  CRP, IL -6, and TNFa after three and five years.4

Foods containing calcium and vitamin D should be a regular part of the diet.  Dietary intake of highly refined carbohydrates should be reduced,9 and sodium should be maintained at less than 2400 mg/day to ensure adequate absorption of bone building calcium.10

Supplements to Consider

Omega 3 fatty acids – Fats are essential nutrients that are utilized in cell membranes, including those of bone.  They are also known to have anti-inflammatory effects and suppress the production of inflammatory cytokines.2,11  EPA helps increase calcium in the body, assists in depositing calcium into the bone, and improves overall bone strength.1  They also play a key role in promoting osteoblasts in the formation of new bone cells.12  Evidence has shown that a diet higher in Omega 3 fats over the typical Omega 6 rich standard American diets correlates to support of bone health.12 Studies that were conducted for greater than 18 months showed a positive benefit on bone health when the participants utilized a mixture of fatty acids including ALA, EPA, and DHA.13  Dosage should typically come from dietary intake a few times a week, but a common supplemental dose is 2-4grams/day.1

Vitamin D – Inadequate intake of Vitamin D correlates with bone loss, greater predisposition to weakened bone growth and other additional poor health outcomes.1  In addition to sun exposure, one can find Vitamin D in fish, eggs, organ meats, and mushrooms.  Salmon, tuna, mackerel, egg yolk and fish liver oils are particularly recommended.1  One spoonful of cod liver oil contains about 1300 IU, where an 8oz glass of milk contains about 100IU.1  Oral supplementation might be needed in the range of 1800-4000IU/day to raise serum levels into protective and maintenance ranges.1  There are no strong contraindications and only minor precautions if dosage is within limits.2

Conclusion

It is evident that bone health care starts early on in life with the adoption of adequate exercise and proper intake of nutrients.  But even after disease progression, it is possible and necessary that exercise and diet can be both proactive and preventative when it comes to osteoporosis.

References:

1. Stump SE. Nutrition and Diagnosis Related Care. 8th Editio. (Klein EM, ed.). Wolters Kluwer Health/Lippincott Williams and Wilkins; 2015.

2. Rakel D. Integrative Medicine. In: Integrative Medicine. 4th ed. Elsevier; 2018:320-333.

3. Ross, Kim presented: Bone as part of the Masters in Clinical Nutrition Program at SCNM, Tempe A. Bone. Published online 2021.

4. Stromsnes K, Correas AG, Lehmann J, Gambini J, Olaso‐gonzalez G. Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines. 2021;9(8). doi:10.3390/BIOMEDICINES9080922

5. Ginaldi L, Di Benedetto MC, De Martinis M. Osteoporosis, inflammation and ageing. Immun Ageing. 2005;2. doi:10.1186/1742-4933-2-14

6. Yun AJ, Lee PY. Maldaptation of the link between inflammation and bone turnover may be a key determinant of osteoporosis. Med Hypotheses. 2004;63(3):532-537. doi:10.1016/S0306-9877(03)00326-8

7. Stromsnes K, Correas AG, Lehmann J, Gambini J, Olaso‐gonzalez G. Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines. 2021;9(8). doi:10.3390/BIOMEDICINES9080922

8. Sears B. Anti-inflammatory Diets. J Am Coll Nutr. 2015;34 Suppl 1:14-21. doi:10.1080/07315724.2015.1080105

9. THOM JA, MORRIS JE, BISHOP A, BLACKLOCK NJ. The influence of refined carbohydrate on urinary calcium excretion. Br J Urol. 1978;50(7):459-464. doi:10.1111/J.1464-410X.1978.TB06191.X

10. Harrington M, Cashman KD. High salt intake appears to increase bone resorption in postmenopausal women but high potassium intake ameliorates this adverse effect. Nutr Rev. 2003;61(5 Pt 1):179-183. doi:10.1301/NR.2003.MAY.179-183

11. Simopoulos AP. Evolutionary aspects of diet: the omega-6/omega-3 ratio and the brain. Mol Neurobiol. 2011;44(2):203-215. doi:10.1007/S12035-010-8162-0

12. Maggio M, Artoni A, Lauretani F, et al. The impact of omega-3 fatty acids on osteoporosis. Curr Pharm Des. 2009;15(36):4157-4164. doi:10.2174/138161209789909728

13. Orchard TS, Pan X, Cheek F, Ing SW, Jackson RD. A systematic review of omega-3 fatty acids and osteoporosis. Br J Nutr. 2012;107 Suppl 2(0 2). doi:10.1017/S0007114512001638