Good bone health requires more than just calcium – it requires a combination of key nutrients to build strong, non-brittle bones, activity stresses the bones in a healthy way, and balance exercises to ensure you don’t fall!
INCORPORATE THESE KEY FACTORS:
Calcium, magnesium, and trace minerals
1200-1500mg total calcium from food and supplements.
Calcium + D increases BMD by 1-3%, reduces fracture 30%, likely more with all trace minerals
We like Bone Up (Jarrow) & Botani-Cal (New Mark)
Vitamin D3
Dosed based on lab tests to reach serum 50-70ng/dl.
Increases BMD 1-3%
Strontium citrate
200-250mg – this is different than prescription strontium ranelate (SR) which is available Europe.
SR reduced fracture ~50% and increases BMD 3-7%
Vitamin K2
45mg (MK4 preferably, MK7 is an acceptable, less well studied form).
Increases BMD 3-5%, reduces fractures significantly; one study of MK4 showed 90% reduction.
Weight bearing exercise
Weighted exercise vests, walking with a small backpack with weights, or weight training in the gym all put healthy stress on your bones, causing them to remodel into stronger, less brittle bone. Weighted walking vests can be found on Amazon. Start with 6lbs and work up.
Good balance
Osteoporosis isn’t much of an issue if you don’t fall! If your balance isn’t great, start with well supported activities like chair yoga. T’ai Chi, Qi Gong, and Yoga are all excellent options to build balance.
AVOID BONE DEPLETING FACTORS:
Medications – Proton pump inhibitors, glucocorticoids,
Smoking – Depletes bone
Sedentary behavior – Minimize bed rest; begin physical activity and rehabilitation as soon as possible following surgery or illness.
Excess alcohol intake – Depletes bone
GET EDUCATED:
Read Lara Pizzorno’s book “Your bones” (2011)
Explore the FRAX tool to estimate your personal risk. https://www.shef.ac.uk/FRAX/tool.jsp
Please also see my companion blog post, Are Bioidentical Hormones Right for Me?
IF FURTHER TREATMENT IS NEEDED, DISCUSS THE RISKS AND BENEFITS SPECIFIC TO YOU:
Bio-identical hormone replacement therapy (estradiol, estriol, testosterone)
Reduces fractures, increased BMD 1-8%, Very slight ncreased risk of breast cancer, CVD, blood clots and stoke. Progesterone and DHEA appear to have no bone-related effects.
Bisphosphonates
Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel), Zoledronate (Zometa, Aclasta)
Over 5 years, increases bone density 3-5%, decreases fractures 40-60%.
Overtime, decreases bone remodeling. This leads to adverse effects such as brittle-ness and osteonecrosis, cavitations, atypical fractures
Safe use requires a “drug holiday” after several years; 3-5 years on, 3-5 years off may be wise.
Selective estrogen receptor modulators (SERMs) i.e. Raloxifene (Evista)
Decreases fractures up to 35%, decreases breast cancer risk
Side effects consistent with estrogen-blockade – hot flashes, vaginal atrophy, cognitive function
Parathyroid hormone – Teriparatide (Forteo)
Best for glucocorticoid-induced osteoporosis, those who haven’t tolerated other therapy, or at high risk. Decreases fractures up to 70%, increased bone density 1-6%. It is given 3m on, 3m off for a max of 2 years. Lots of contraindicated conditions – ask your doctor. Must monitor calcium, PTH, and 25(OH)D
Calcitonin
Decreases fractures 30%, increases bone density 2%. Increases risk of malignancy, cannot be used long-term.
Denosumab (Prolia)
A monoclonal antibody treatment that affects bone remodeling. May be most appropriate for bone loss associated with auto-immune & inflammatory conditions like IBD.
To learn more, or to discuss which approaches are most relevant to you, schedule a consultation with Dr. Oberg.
