Bahamas Anti-Aging Medical Institute

Osteoporosis is a crippling, potentially-disfiguring disease commonly associated with advancing age in women – indeed, like so many other age-related conditions, most people long thought of osteoporosis as an inevitable feature of an older woman’s life. Modern scientists know better: not only is osteoporosis no longer thought to be unavoidable, we now have powerful means to prevent it. We also recognize now that osteoporosis is also no longer a threat only to women – a substantial number of men are at substantial risk for the disease ^1-3. Finally, a responsible approach to osteoporosis begins early in life, and can be addressed by a careful combination of attention to diet, lifestyle, and appropriate medication.

What is osteoporosis? The condition arises as a result of an imbalance between new bone formation and old bone resorption, the process by which the living tissue we call bone is constantly remodeling itself ^4,5. We’re glad that bone can remodel – that’s how our skeletons can react to the various stresses imposed by gravity, by activity, and occasionally by trauma. Cells called osteoblasts are the manufacturers of new bone tissue, while cells called osteoclasts are the cleanup crews responsible for taking down older bone structures. Healthy bone relies on an exquisite and delicate balance between the activities of these two cell types, which are regulated by various hormones and other biological systems. Unfortunately, with advancing age and inadequate attention to nutrition, that balance can be disrupted, hampering osteoblasts’ ability to produce healthy new bone, and sometimes hastening the activity of osteoclasts in destroying bone.

What is bone made of? Everyone knows about the role of calcium, which helps form the rigid crystalline matrix that gives bone its strength – but that matrix is embedded in strong but yielding protein that allows bone to bend to an incredible degree before it breaks. Good bone health, then, depends not only on adequate calcium supplies, but on proper protein formation and all the processes that govern it. Here are just a few of the vital nutrients that are required to maintain bone health into advancing maturity:

• Calcium – most people simply don’t get enough calcium in their diets, making supplementation a virtual necessity. Calcium is lost in urine, and is an absolute requirement for nerve, muscle, brain, and heart activity – in fact, the body will “steal” calcium from stores in bone in order to meet these other needs⁵. Together this makes consumption of adequate calcium an absolute requirement for overall health^6,7.
• Vitamin D – this fat-soluble vitamin is required to assure proper absorption of calcium from the intestine, as well as for normal distribution of calcium throughout the body. Without vitamin D, calcium deficiency rapidly develops even in the presence of ample calcium intake. But we now understand that vitamin D has myriad other activities throughout the body – it is a neurohormone that is essential in brain development and function, it probably plays a role in preventing cardiovascular disease, and may have a role in cancer prevention as well. Together these data make regular vitamin D supplementation mandatory for maintenance of bone and total-body health ^6-8.
• Vitamin K – this is another fat-soluble vitamin long associated with blood clotting; only recently has the role of vitamin K in bone health begun to emerge. Just as vitamin D is required for proper bone mineralization (i.e., availability of calcium), vitamin K is required for proper protein formation – the other part of healthy bone development ^9,10. Also like vitamin D, vitamin K is turning out to have essential roles in many other body processes as well; vitamin K supplementation may help to prevent cardiovascular disease ^11,12.

Proper attention to changing levels of hormones, especially the sex hormones, is also vital in maintaining bone health. As estrogen and testosterone levels fall with advancing age, bone-building osteoblasts lose their main stimulus to action; hormone replacement therapy can help to prevent osteoporosis, though it is associated with certain risks ¹³. Some nutritional supplements may be helpful, such as the phystoestrogens, or plant-derived estrogens – but these may also have some significant side effects.

Good bone health requires an active lifestyle, a healthy and varied diet, and in most cases supplementation with vitamin D, calcium, and possibly other nutrients ¹⁴. Medications that reduce bone-destroying osteoclast activity are available, but these have substantial side effects and should be used only under a physician’s close supervision. Learn much more about osteoporosis, in both men and women, from Life Extension Foundation’s Health Concerns Textbook, at http://www.lef.org/protocols/metabolic_health/osteoporosis_01.htm.

References

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(2) Khosla S, Amin S, Orwoll E. Osteoporosis in men. Endocr Rev. 2008;29:441-464.

(3) Tuck SP, Datta HK. Osteoporosis in the aging male: treatment options. Clin Interv Aging. 2007;2:521-536.

(4) Seeman E. Structural basis of growth-related gain and age-related loss of bone strength. Rheumatology (Oxford). 2008;47 Suppl 4:iv2-8.:iv2-iv8.

(5) Weaver CM. The role of nutrition on optimizing peak bone mass. Asia Pac J Clin Nutr. 2008;17 Suppl 1:135-7.:135-137.

(6) Jackson RD, Shidham S. The role of hormone therapy and calcium plus vitamin D for reduction of bone loss and risk for fractures: lessons learned from the Women's Health Initiative. Curr Osteoporos Rep. 2007;5:153-159.

(7) Roux C, Bischoff-Ferrari HA, Papapoulos SE, de Papp AE, West JA, Bouillon R. New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion. Curr Med Res Opin. 2008;24:1363-1370.

(8) Schneider DL. Management of osteoporosis in geriatric populations. Curr Osteoporos Rep. 2008;6:100-107.

(9) Bugel S. Vitamin K and bone health in adult humans. Vitam Horm. 2008;78:393-416.:393-416.

(10) Francucci CM, Rilli S, Fiscaletti P, Boscaro M. Role of vitamin K on biochemical markers, bone mineral density, and fracture risk. J Endocrinol Invest. 2007;30:24-28.

(11) Lanham-New SA. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc Nutr Soc. 2008;67:163-176.

(12) Tsugawa N, Shiraki M, Suhara Y et al. Low plasma phylloquinone concentration is associated with high incidence of vertebral fracture in Japanese women. J Bone Miner Metab. 2008;26:79-85.

(13) Oyoo GO, Kariuki JG. Osteoporosis--from hormonal replacement therapy to bisphosphonates and beyond: a review. East Afr Med J. 2007;84:534-545.

(14) Lin JT, Lane JM. Nonpharmacologic management of osteoporosis to minimize fracture risk. Nat Clin Pract Rheumatol. 2008;4:20-25.