Fragile bones:

are found when there is a decrease in bone mass resulting in weak and brittle bones. It affects 1 in 3 women by the age of 70, is often hereditary, about 20% of cases are in men, and occasionally young women are affected. Calcium is continually being added to and removed from bones throughout life and this process is kept in equilibrium by hormones and other substances. Osteoclasts absorb old bone tissue, and osteoblasts lay down new. High calcium and magnesium levels and oestrogen act to increase bone growth by the release of the thyroid hormone calcitonin, this inhibits osteoclasts, and also moves calcium from blood to the bone. Calcitonin also stimulates osteoblasts. Calcitonin and /or oestrogen can be given but must be accompanied by calcium to prevent bone loss.

Parathyroid hormone production is stimulated by low calcium and magnesium blood levels and it stimulates osteoclasts to dissolve old bone releasing calcium which increases blood calcium levels – oestrogen stops the production of parathyroid hormone.

Oestrogen is not the most important factor in bone loss – the rate of bone loss is far higher in modern women than it was in the 18th century. Bone loss starts before the menopause and before any decrease in oestrogen. This would indicate that it is dietary or environmental factors that matter more than hormone replacement. Many studies have found that it is a lack of vitamins and micronutrients that are often missing in processed and refined foods that is the main culprit in many cases of osteoporosis and not simply a lack of calcium and/or oestrogen.

With age and nutrient deficiency, bones lose increasing amounts of protein and minerals and osteoblasts cannot keep up, resulting in fragile bones. Increasing bone mass early in life through diet and exercise decreases the chances of osteoporosis, however it is never too late to improve bone density.

Exercise is vital  and needs to be weight bearing – weight training, walking etc even women in their 80’s can improve bone mass by weight training at least 30 minutes every other day

Vegetarians consistently have higher bone density than non vegetarians – reasons include less protein, more available minerals, use of fermented soya products

It is generally considered that calcium is the most important factor in bone density loss, but it was found that skeletal calcium deficiency is present in only 25% of those with weak bones, and that it was only these women who responded to calcium supplements (Nutrients and bone health Gaby and Wright 1988) Calcium supplementation can be in excess, causing kidney stones and soft tissue calcification such as arteriosclerosis.

Bone is more than just calcium and has requirements for many nutrients, one study found that adding ‘all known micronutrients’ to calcium reduced bone loss more than calcium alone.

Important nutrients in bone health are:

  • Vitamin K – used in osteocalcin synthesis, a protein which forms a matrix for calcium – it has been found that those with fragile bones often have a low vitamin K level , and increased calcium loss through urine
  • Vitamin D – is required for intestinal calcium absorption
  • Magnesium – is important in several biochemical reactions involved in bone formation – dietary surveys have found that the diet of 80% of American women is deficient in Mg
  • Manganese – is required for bone mineralisation and for synthesis of connective tissue in cartilage and bone – a study found that a group of women with fragile bones had manganese levels only 25% of normal
  • Folic acid – is involved in bone health through its role in homocysteine metabolism. Homocysteine is derived from methionine and has an adverse effect on bone . Folic acid appears to reduce homocysteine levels which rise after menopause
  • Boron – supplementation of postmenopausal women decreased urinary calcium excretion by 44% and increased oestrogenic hormone levels – fruit, nuts and vegetables are the best source of boron
  • Strontium – occurs in bones and teeth – non radioactive – studies of supplementation have shown reduction in bone pain
  • Silicon – strengthens connective tissue matrix in growing bones
  • Vitamin B6 – increases connective tissue strength and helps to break down homocysteine
  • Zinc is essential for normal bone formation, also enhances action of vitamin D – widespread zinc deficiency has been found
  • Copper – may be important in bone mineral content – animal studies only
  • Vitamin C – deficiency results in fragile bones – deficiency was found in 20% of elderly women even though they were consuming more than the RDA of 60mg/day

Causes of increased bone loss and reduced calcium absorption:

  • Relying on dairy for calcium – one study found that 35% of women with osteoporosis were lactase deficient ( the enzyme that digests dairy foods), compared to 3% of controls without fragile bones
  • The nurses study at Harvard university (78000 nurses studied over 12 years) found that those who drank 2 or more glasses of milk a day had twice the risk of hip fracture as those who drank one glass or less a week
  • Excess protein >70g/day reduces calcium absorption – high meat consumption has a strong link with loss of bone density – it has been estimated that for every extra 10g of protein we eat, 100mg of calcium is lost in urine
  • Increased calcium loss in urine is directly linked with intake of alcohol, caffeine, tannin (tea), protein and phosphoric acid found in many soft drinks
  • Phytates from bran and raw grains can prevent mineral absorption – always cook, soak or sprout grains before eating
  • Prolonged glucocorticoid or corticosteroid treatment eg cortisone – inhibits absorption in the stomach, and also inhibits new bone formation
  • Heparin, anticonvulsive drugs, antacids containing aluminium, diuretics and thyroid drugs are also associated with increased bone loss
  • High BP causes increased calcium loss
  • Some diseases affect bone growth through hormone imbalance or through poor nutrient absorption eg Cushings, diabetes, anorexia, Crohns, irritable bowel syndrome, hyperthyroidism, liver disease, myeloma and kidney disease
  • Lack of exercise
  • Vitamin D deficiency causes poor calcium absorption
  • Inadequate production of gastric acids – hypochlorhydria – also reduces calcium absorption

Good sources of natural calcium and magnesium (essential for calcium absorption)

  • Nettle leaf, raspberry leaf, alfalfa, horsetail (contains silica, essential for absorption), dandelion leaf, parsley, watercress, red clover, oats
  • Seaweeds such as kelp and arame
  • Comfrey and fenugreek are osteoprotectives
  • Pau d’arco bark – also helps with any inflammation
  • Sardines, salmon, dark green leafy vegetables although those containing oxalates (eg spinach, beet leaf) actually prevent calcium absorption, molasses, nuts and seeds
  • Increased acidity eg with lemon juice or vinegar, improves absorption
  • Herbal vinegar – nettle, raspberry leaf, comfrey leaf, horsetail, dandelion, plantain leaf, dock leaf and red clover – macerated in cider vinegar for 6 weeks – take 1 tablespoon before meals – 150-200mg
  • Supplements may not be the best source – if overdosed then they can cause problems, and they are contraindicated with kidney stones or other problems, sarcoidosis and hyperparathyroidism – calcium citrate is the only form that is easily absorbed, other forms can be poorly absorbed