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8/10/06

Osteoporosis, part 1: The Bad News first

Bone is living tissue, continuously being built up and broken down. When the buildup doesn’t keep pace with the breakdown, and the bone’s protein structure and mineral content are lost, a condition called osteoporosis develops (literally “bone passages”). Normally dense bone tissue acquires holes and spaces. If the condition progresses, bone mass declines, the bones become more porous, weaker, and lighter, and the risk of fracture increases.

Osteoporosis is classified into primary and secondary types according to cause. Primary is due to lower estrogen levels in post-menopausal women causing a lessening of bone mass over time (loss varies between 5-40%), or to advancing age, when there’s lower absorption of calcium from the intestine as well as lower secretion of calcitonin, the hormone that prevents calcium from leaving the bones.

Secondary osteoporosis is a factor in a number of diseases. Endocrine gland disorders (the thyroid, parathyroid, and adrenals are all involved in bone formation); a sedentary life or bed rest diminishes intestinal absorption of calcium; and malnutrition (bones suffer with a lack of calories or nutrients in the diet). Illnesses such as liver disease, gastrointestinal tract disorders, kidney disease, and various cancers may have a secondary effect on bone formation. In addition, a number of pharmacological drugs (corticosteroids, anticoagulants, antiepileptic drugs, certain diuretics, lithium, antitumor agents, thyroid hormones, tranquilizers, sleeping pills) are known to cause bone loss.

Although post-menopausal women are the most highly targeted group for osteoporosis, older, alcoholic men are also at high risk. For women, the main risk factors are being small-boned, of European or Asian descent, post-menopausal, with a family history of hip fractures, and not having given birth. For men, it’s testosterone insufficiency, and advanced age. Men’s bones are bigger, thus less likely to break; also, men tend not to live as long as women, although as that changes, their incidence rate is also increasing.

For both genders, further risks include delayed puberty, alcohol consumption, smoking (due to poorer health in general, and less likely to walk for exercise), sedentary life or lack of exercise, being thin, insufficient calcium, insufficient vitamin D.

Significant dietary factors that may increase the propensity for developing osteoporosis include a high proportion of animal protein, high consumption of flour products and sweets, lots of nightshade vegetables (potatoes, tomatoes, eggplant, peppers), not enough vegetables, lack of good-quality fats, or insufficient protein.

Substances that decrease bone formation by removing calcium from the bones are ingested extensively in our culture. Caffeine (coffee, chocolate, black tea, soft drinks, headache remedies), refined sugar, meat, alcohol, tobacco, aluminum, pesticides, marijuana, and other intoxicants are all culprits.

It’s not as simple as adding calcium to the diet through supplements or more milk. Dietary calcium exceeding 450 mg per day was found to double the risk of hip fracture. Excess calcium encourages kidney stones and gallstones, and prevents the absorption of magnesium, which itself is needed to stimulate the absorption of calcium into the bones. Daily calcium supplement pills may cause abdominal discomfort or constipation. Excess vitamin D, often found in calcium supplements, may provoke bone loss. Excess calcium and vitamin D supplementation is also associated with increased fracture rates.

Cultures with high-protein, high-sodium diets (North America, Europe) need more calcium for nutrient balance, and have elevated levels of osteoporosis. Cultures where sodium, protein, and dairy consumption is minimal, and whose lifestyles include more weight-bearing and physical activities (North Africa, India, China, areas of Southeast Asia), have a much lower calcium requirement, and a small proportion of the number of bone fractures found in more developed countries.

Next issue: Osteoporosis, part 2: The Good News.

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