The progression of osteoporosis.
Unfortunately, as we approach middle age it is not just a few wrinkles and dodgy arteries we have to worry about. I have looked at general bone health in the last few blogs and today I will be covering Osteoporosis as this can develop in both women and men.
Admittedly, women are at a higher risk over 50 and are four times more likely to suffer from the disease than men.
Osteoporosis is when the bones in the body thin and begin to develop small holes reducing the density. The bones also become brittle, leading to fractures. Some of these may go undetected as they can be very small. For example, if you suffer from consistent back pain, do not dismiss out of hand, as you could be experiencing very small hairline fractures in your spine. If the condition is not treated or diagnosed, these small compression fractures can cause a vertebra to collapse, a condition that is extremely painful and difficult to treat.
The progress of the disease is subtle. You reach maximum bone density in your 30’s your bone strength will slowly decrease naturally. Then add into the mix the reduction of both oestrogen hormone in women over 50 and the decrease in testosterone in men of a similar age, and you have a further loss of density.
Osteoporosis affected bone.
There are other risk factors to taken into account.
For both men and women, having a slight body frame and being very slim means that there is less bone to begin with.
Smoking from an early age for a lifetime will put you at higher risk.
Those suffering from certain eating disorders can show decreased bone density in their teens and 20’s due to vitamin and mineral deficiency. (I have seen a 16 year old’s X-ray showing the bone density of an 80 year old)!
There can be a family history of osteoporosis, if not mother then look to grandmothers.
If you have a history of repeated fractures then it may be that you have brittle bones and you will need to be additionally careful and under medical supervision as you move into middle age.
If you already suffer from rheumatoid arthritis you could be at a higher risk of osteoporosis.
Heavy alcohol consumption can lead to thinning of the bones.
You have stopped exercising – especially weight bearing exercise that strengthens the bones such as walking regularly.
Last but not least is restricted diet. It is a vicious cycle as you get older. Our appetites decrease, we tend to reduce our weight bearing exercise, do not spend time outside in the sun and we listen to nutritional advice which tells us to drop full fat dairy, cheese and butter from our diets!!
Diagnosis of Osteoporosis.
I believe that every woman over 55 and men over 65 should have a bone density test to discover where their bone health actually is following the reduction of the two hormones involved. The doctor will also take into account your medical history – particularly if you have had a number of fractures in the past. You should also have a urine and blood test to rule out any other reasons for bone loss and the blood test will show the levels of both oestrogen and testosterone.
As I have already mentioned in a previous blog there are certain nutrients that are essential for bone health and I gave brief notes about them. Today I am going to go into one of the most important vitamins for bone health and that is vitamin D. Also, a vitamin that gets little press but that also plays an important role in our bone health and that is Vitamin K.
There is increasing concern that vitamin D (that incidentally thinks it is a hormone) is becoming deficient, particularly in children as we see a rise in the cases of rickets.
Once you have read the notes on this vital nutrient, you can identify if perhaps you are missing it in your diet or lifestyle, and if your family might be at risk.
If ever there was a reason to get out and lie or walk in the sun for 40 minutes in the mornings, getting your daily recommended dose of Vitamin D is it. In fact, 3 hours in sunlight, spread over a week, in moderate climates, without using any sunblock is sufficient to boost your levels of what is known as the sunshine vitamin. However, you may need less, or more, depending on latitude, time of day and air pollution.
It is not advisable to lie out in the heat of summer in Spain, for example, for 3 hours without protection but you will still receive beneficial amounts through sunblock of under factor-8. Most of what we require on a daily basis is produced in the skin by the action of sunlight and many of us who suffer from depression through the dark winter months are actually missing around 75% of our required daily dose of 1000 iu.
There are a number of diseases that result from a deficiency of Vitamin D and over the years, since it was identified in cod liver oil, there has been increasing research into its role in the body.
In Victorian times children with rickets or bow-legs were a common sight. You rarely see this in developed countries today, although in Southern Asia there is still a problem. In adults the condition is called osteomalacia (soft bones) and it is estimated that millions of people who suffer from unexplained bone and muscle pain actually have this condition. There has been an increase in recent years in the incidence of rickets in the western world and some of this is down to the decrease in outside activity for our children.
More of them are kept inside for safety reasons, many no longer walk to school, go outside at playtime, have football or other team sports encouraged. They sit in front of the television or computer instead of playing in the street and when they do go in the sun they are plastered in factor 30 and above.
They also have too much fizzy pop in their diets and the chemicals in these are not bone friendly. We have gone away from the free school milk and there is too much sugar in our diets which is acidic and leeches mineral from the bones.
How is Vitamin D involved in our bones?
Our bones are living tissue that grows and regenerates throughout our lifetime. It is not static and old bone is removed and replaced with new bone continuously, a process that requires that the essential elements of bone to be available from our diet and from chemical reactions in the body.
There are four main components in bone that are needed to ensure it is strong and able to repair itself on a daily basis.
- · Minerals – Calcium, Magnesium and Phosphorus.
- · Matrix – Collagen fibres (gristle)
- · Osteoclasts – Bone removing cells
- · Osteoblasts – Bone producing cells.
If you ever made papier-mâché sculptures at school you will have used a chicken-wire framework, first of all, to establish the shape that you wanted. Over this you would have laid your strips of wet paper and allowed them to harden. The bone making process is very similar.
A network of collagen fibres forms the base and they are then overlaid with minerals. The strength of the finished bone is dependent on the amount of mineralisation that takes place. Osteoclasts will remove old bone when needed and this results in a need to produce new collagen matrix to attract new minerals for the repair process.
Vitamin D is essential to ensure that sufficient calcium and phosphorus is attracted to the new matrix and that strong new bone is produced. It begins its work in the intestines where your food is processed and assists in the absorption of calcium. If you are deficient in Vitamin D the bone becomes calcium depleted (osteomalacia) increasing your risk of fractures.
Unfortunately, if you are deficient in this vitamin more bone is discarded than replaced leading to soft and malformed bones.
Rickets, for example, is the result of soft and insufficient bone material in the legs allowing them to bend and stunting their growth. In adults the disease is called osteomalacia and because the symptoms are usually related to unspecific muscle and bone pain it can remain undiagnosed for years. This leads to chronic pain and the truth is that therapeutic doses of vitamin D may be the only treatment necessary.
Food Sources and supplementation.
Apart from sunshine, vitamin D can be obtained from a small range of foods including egg yolk, fish oil and liver. A glass of milk contains only 100 IU of the vitamin. It can be tough from just food sources to reach 1000 IU per day of the vitamin so getting out into the daylight on a daily basis is important. Certainly, I have found that taking good quality fish oil capsules over the years has been of benefit to me. There are supplements that you can take and if this is recommended it is usually in the form of calcium and D3 together to aid absorption. There is a new D3 spray for children, but I do advise that you ask a qualified practitioner or your doctor before you use.
Vitamin K is of particular interest to women in relation to osteoporosis risk because one of the causes of heavy periods is a deficiency of this vitamin. And if this has been a regular occurrence during fertile years, this deficiency could lead to early thinning of the bones.
There are two forms of the vitamin that the body can utilise. The first is K1 (phylloquinone), which is from plant sources and the other is K2 (menaquinone) which is produced by bacteria in our own intestines. This is where many of us get into trouble because we are not eating sufficient raw and unprocessed foods for health and additionally many of us suffer from bacterial imbalances in the gut so do not produce sufficient from that source either.
The vitamin is fat-soluble and is stored in the liver. Studies indicate that approximately 50% of the stores come from our diet and the balance from bacteria in the intestines. We need healthy bile production for efficient absorption of Vitamin K and our lymphatic system circulates it throughout the body.
Apart from helping reduce excessive bleeding during menstruation it is also used therapeutically for the prevention of internal bleeding and haemorrhages, including emergency treatment for overdoses of blood thinners such as Warfarin.
Blood clotting is a critical function in the body that solidifies blood to prevent us from bleeding to death from external or internal injuries. Vitamin K is essential for the production of a protein called prothrombin and other factors involved in the blood-clotting function and is therefore necessary to prevent haemorrhages.
Also, interestingly, Vitamin K activates other enzymes that decrease the clotting ability so it assumes the role of regulator within the blood stream. An example of this might occur if a clot forms within a blood vessel that could block the flow, and needs to be dispersed.
As the vitamin works within the body it changes from function to function according to the various interactions with enzymes and at one stage it acts as an antioxidant preventing oxidative damage to cells. There may also be a role for the vitamin in cancer prevention as it is believed it may stimulate rogue cells to self-destruct.
Bone Health and Vitamin K
The vitamin has also been the subject of a great deal of research in recent years as scientists discovered that it played a significant role in liver function, energy production in the nervous system, and in preventing bone loss as we age by assisting the absorption of calcium.
Vitamin K is needed to activate osteocalcin, the protein that anchors calcium into the bone, building and repairing the structure. A deficiency in the vitamin can therefore lead to brittle bones and osteoporosis.
Food sources for Vitamin K
It is very easy to obtain sufficient Vitamin K through diet and you will find that good sources are:
- · Dark green leafy vegetables, such as
spinach, broccoli and cabbage
- · Asparagus Avocado Broccoli
- · Brussel sprouts Green beans Green Tea
- · Carrots Eggs Liver
- · Potatoes Tomatoes
Although the vitamin is fairly resilient it is better to eat plant sources either raw or lightly steamed to obtain the maximum benefits. Freezing reduces the amount of the vitamin so you need to eat a little extra of frozen vegetables than fresh.
Final note is on exercise. Whilst it is preferable that your exercise is taken outside in the fresh air and sunshine, it is obvious that during the winter months this is not always a pleasurable option. Dancing, yoga, aerobics, jogging, walking and light weight training are all good forms of inside activity. I have a treadmill that I use to cover a couple of miles a day and in the summer this is outside and I swim everyday. Find the combination that works for you. There is also a plus to even 30 minutes exercise per day. It will keep your weight down and also stimulate your appetite. This will enable you to continue to consume sufficient foods containing the essential nutrients you need for bone health.