Monday, February 25, 2013

How to Prevent Osteoporosis and Fractures

Osteoporosis.  You might be thinking, "I'm not an old lady, this doesn't concern me, I'm going to go back to watching Honey Boo Boo and snacking on mayonnaise."  Wrong.  Whether you're a man or a woman, young or old, you need to know about osteoporosis.  It may be more common in post-menopausal women, but it happens in men too, and how you live in your 20s could have a HUGE impact on whether you fall and break a hip in your 70s.  So listen up.  There's a lot of misinformation around this topic, and I don't want you popping calcium, vitamin D, and Boniva pills and thinking everything will be okay.  Ready?  Let's go.

First, some basics.

Osteoporosis:  A disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist.

In other words, having osteoporosis means you have weak bones that'll break on you a whole lot easier than they should.  Osteoporosis is responsible for more than 1.5 million fractures each year.  That's a lot.  What's more, up to 1/3 of hip fracture patients die within one year of their fracture, and up to 75% never walk independently again (1).  Obviously, the vast majority happen to older adults.  But it may be your bone health in your 20s that best predicts your bone health in your 70s.  Why?  Peak bone mass.

Top line = men, bottom line = women

Peak bone mass is just what it sounds like:  the point in life at which you have the thickest, densest, healthiest bones.  And that point is in your late 20s.  After that, it's very difficult/impossible to build more bone mass, and so it slowly declines into old age.  Key point... the more bone mass you can develop in your 20s, the more you'll have to work with when you're older.  It's never too early to start.  How do you do that?  You ask and I answer... 

Things you should do to build/preserve strong bones.
  1. Lift weights.  This is one of the most important things you can do for your bones.  Lift weights, use resistance machines, do pushups, pullups, squats.  ESPECIALLY SQUATS.  Squatting is the most fundamental human movement.  As long as you can do a full, deep squat, you'll never have a problem getting up when you fall (provided you don't break a bone of course).  But beyond the functionality of being able to squat, resistance training is phenomenal for keeping your bones dense and strong (2).  And you don't need to adopt a powerlifting training program.  Even doing a total body circuit once a week will help you out.
  2. Eat calcium.  Yes I said eat calcium.  Don't take a supplement.  I don't care what your doctor tells you, you don't need 1500 mg of calcium every day.  This study found an intake of 600-1000 mg/day to be best (3); I wouldn't take that as the end-all-be-all, but it's probably a good range to shoot for.  Eat leafy green vegetables.  Eat some dairy.  Eat some canned sardines/salmon.  So calcium is one piece of the puzzle, but you need calcium's buddies too...
  3. Vitamin D.  Get some sun please.  Hold off on the sunscreen, at least for a little while.  Or in the winter, take a supplement... maybe 1000-2000 IU/day.  If you ever get your vitamin D level tested, it should be between 30-50 ng/ml.  Vitamin D increases calcium absorption in the GI tract, thereby decreasing the amount you need to get in the diet.  BOOM!  More calcium! 
  4. Vitamin K2.  And this is where vitamin K2 takes over.  Now that you've got more calcium, K2 makes sure it's used properly by activating osteocalcin, the protein responsible for depositing calcium in the bones and teeth.  Without K2, osteocalcin is useless.  We get some K2 from our friendly gut bacteria, but we need more from the diet for this process to run smoothly.  The best dietary sources are natto, goose liver pate, gouda, brie, pastured egg yolks, grass-fed butter, etc. (4).  In other words, you're not getting enough.  Luckily, supplementation works (5).  Try this one... or if you're really ambitious, get cod liver oil / butter oil blend from Green Pasture for a nice catch-all dose of K2, D, and vitamin A.
  5. Eat more protein.  It's true!  While we used to believe high-protein diets ruined our bones (you see more calcium in the urine on a high-protein diet), it turns out the opposite is true.  Eating more protein increases calcium absorption to an even greater degree, tipping the odds in your favor (6).  Thanks to my professor Jane Kerstetter for that bit of research.  Go have a steak.
Things you should NOT do to build/preserve strong bones.
  1. Take calcium supplements.  More calcium isn't the answer, especially in supplement form.  First of all, calcium supplements don't decrease your chances of breaking a bone (7).  But the problems go deeper.  High intakes of calcium from either diet or supplements (>1400 mg/day) are associated with higher death rates from all causes and from cardiovascular disease (8).  In addition, in a very recent Swedish study, women taking in over 1400 mg calcium per day doubled their risk of dying of heart disease.  Doubled!  Similar findings were shown in another recent study in men (9)!  Why the increased risk?  I'll take a stab at it.  We need a balance between calcium, vitamin D, and vitamin K2.  Calcium may be the raw material, but with too much calcium and not enough K2 to put it into the right places, it ends up in the wrong places... like our coronary arteries.  And then we die.  Ain't nobody got time for that.
  2. Take prescription drugs.  Boniva, Fosamax, Actonel, Reclast... this class of drugs is known as "bisphosphonates".  They sound great in theory... they prevent calcium from being taken out of bone, which is a normal part of the cycle of bone maintenance.  Keeping calcium around seems like a good idea right?  Maybe.  They seem to reduce fractures over the course of the first 5 years, but after that, there's no evidence to support their use (10).  In addition, they can lead to unusual fractures of the thigh, or femur.  Weird since the femur is the strongest bone in the body.  There's some funky shit going here.  Shit we don't fully understand.  Is anybody looking for a 5-year, temporary reduction in fractures, followed by some weird shit that may or may not involve a broken femur?  If so, you know what to do.

So there you have it... my comprehensive list of do's and do not's when it comes to bone health.  Remember, preventing osteoporosis starts at a young age.  Don't wait til you're 80, start now!  Do squats and get some sun!  Or do squats in the sun!  And take your cod liver oil!  And eat a steak!  And binge on Brie!  Tell all your friends!

Oh and I guess I should cite this book, "Vitamin K2 and the Calcium Paradox", since I thumbed through it for tips on this topic.  Check it.  Good read.


  1. In my opinion, best post yet (though I think I say that every time).

    Very well organized and interesting - particularly in regards to calcium supplementation throwing the balance of K2, D, and Ca out of whack. Forwarding this to my dad now

    1. Thank you Matteo! Glad you liked it!

    2. Is there something wrong with snacking on mayonnaise????

      Carole AKA Carbsaner

  2. You had me at “go have a steak”. :)

    I consulted with a doctor before because I was experiencing tightness in some joints, and when I asked him about what calcium supplements to take, I was surprised that he advised against it. Although he did give me a list of supplements, none of them had calcium in it. He just told me to try to include a bit more dairy into my diet. Apparently that’s the reason behind it.

    Mafalda Cramer

  3. My main source of Ca lately has been from the cartilage of bones - chicken wings/thighs particularly. Plus, the crunch makes me feel so primal

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  5. Oh nooo I loved your post, full of sense. And then Bang you go on and talk about atypical femoral fracture as a normal occurrence as a result of BP treatment, you do know that it's a very rare AE, don't you so it should be mentioned accordingly.

    1. Thanks for the comment. I will have to do more research on this. I admit I may not have looked into that as much as I should have! :)