I’m the nutritionist at Dr. Lipman’s Eleven Eleven Wellness Center and I recently received a diagnosis of osteoporosis. Everyone asked, “you mean osteopenia?” thinking maybe it was the more moderate beginning of bone loss. No, it was a full blown osteoporosis diagnosis. I was shocked and everyone at the wellness center was confused. I walk-the-walk, as they say. I eat healthy, exercise, my weight is healthy, and I’ve been doing this for most of my life. So what went wrong? Once we started digging into my history, diet and lifestyle, it was easy to see – I am actually the perfect candidate for osteoporosis.

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Despite being healthy in many ways, I have a pile of risk factors for bone loss. I am a Caucasian woman and I’ve been a vegetarian or pescetarian for a majority of my life making it harder to get a sufficient amount of protein in my diet. I was born with congenital hip dysplasia and as a kid, I was the skinny one. Now as an adult I’ve always been on the thin side and I have osteoarthritis in my hip. In my 30s, my Vitamin D level was 7 for some amount of time, an optimal healthy level is about 50-80, and Vitamin D is essential for bone health. I do exercise, but in truth, it is the first thing I skip when I have a busy schedule. I am 54 years old and in menopause. And there you have it! It wasn’t confusing, it made perfect sense.

What are Osteopenia and Osteoporosis?

Osteoporosis and osteopenia are diseases of the bone and unless you get a fracture, there are not many outward signs that tip you off. That is why It’s called a silent disease. Osteopenia is the loss of bone mineral density (BMD) which weakens your bones and osteoporosis is the more severe version, making your bones fragile and brittle, putting you at greater risk for bone fractures.

What Are The Risk Factors For Osteoporosis and Osteopenia That You Cannot Control?

• Gender - Women are at greater risk than men for osteoporosis. According to the CDC, 20% of women over 50 versus 5% of men over 50 are affected by bone loss.
• Age - In general, most people reach their peak bone mass between 25 and 30 years old, then start to lose more bone than they are building, leading to some bone loss as we age.
• Body Frame - A smaller body frame means less bone mass and less bone to draw from.
• Ethnicity - This is complicated! Postmenopausal Caucasian and Asian women are at highest risk. But with the amount of chronic disease that plagues the US population, more and more people, even those who are not included in the higher risk category, are at risk of developing osteopenia and osteoporosis. Those who are not receiving screening, decent health care, or who are not following dietary and lifestyle recommendations from their doctor (or not getting those recommendations to start with) are also at risk. American Bone Health shares some of the nuances gathered from research about ethnicity and bone health, if you want to read further. I think a take away here is that the risk exists for everyone, especially when chronic health issues are involved.
• Genetics - Family history of osteoporosis creates a greater risk. There are genetic tests (like 3X4 Genetics, which we use in our office) that dig into genes which are linked to bone health. A person may be at greater risk depending on these gene variants.

What are The Risk Factors for Osteoporosis and Osteopenia That You Can Address?

• Poor diet - The Standard American Diet (SAD) is full of salt, sugar, saturated fats - all of which wreak havoc on bone health for a variety of reasons when consumed on a regular basis. These foods and beverages contribute to nutrient deficiencies, inflammation, obesity, and other chronic diseases common to the SAD. Excess alcohol and caffeine also stress the body and can put us at risk of poor bone health. Protein is essential for bone health - important at a young age to build bone mass and in later years for preserving bone and muscle. Diets that are low in protein (vegan/vegetarian for example) can be an issue for optimal bone health.

• Nutrient deficiencies - If you think that getting calcium from dairy in your diet is all you need to prevent bone loss, I’m here to tell you that there is much more to that story. There are many vitamins, minerals and other nutrients that are needed to support your bones: 

1. Calcium
2. Vitamin D
3. Magnesium
4. Protein
5. Manganese
6. Copper
7. Boron
8. Iron
9. Zinc
10. Vitamin A
11. Vitamin K
12. Vitamin C
13. B vitamins

• Inflammation - Osteoblasts build bone and osteoclasts break down bone and release minerals into the bloodstream - this process needs to be in balance to prevent bone loss. Inflammation in the body promotes the osteoclastic process. Chronic diseases, like diabetes, cardiovascular disease, metabolic diseases, are inflammatory.

• MCAS - a review of literature on Mast Cell Activation Syndrome and bone loss showed that mast cells, which also increase inflammation, have been associated with low remodeling and accelerated bone loss.  

• Too Much or Too Little Exercise - it turns out that too little or too much exercise can actually contribute to bone loss. Too little exercise and a sedentary lifestyle is more often talked about, but chronic overexercising may also lead to lower bone mineral density.

• Certain Medications - Long term use of drugs such as PPIs, SSRIs, steroids, cancer drugs, organ transplant drugs, among others, can weaken your bones.

• Poor Gut Health - We are always discussing the importance of gut health and with bones there is no exception. Absorption of nutrients can be altered by poor gut health, but also inflammation of the body and the play between the gut microflora and hormones may affect bone health.

• Celiac Disease - Untreated celiac disease can lead to poor calcium absorption and poor bone health often leading to osteopenia or osteoporosis.

• Eating Disorders - People with eating disorders, especially anorexia, are at high risk for poor bone health. In fact, when young women have an eating disorder, they are less likely to get to their ideal peak bone mass in those important years up to about 30 years old where bone loss starts to happen naturally.

• Smoking - Smoking contributes to poor bone health in a few different ways, reducing the blood supply, reducing the absorption of calcium, and slowing osteoblasts which are responsible for building bone.

• Out-of-Whack Hormones - This applies to both men and women. Most obviously, estrogen loss in menopausal women is associated with low bone density. It turns out that low testosterone in men has also been associated with low bone density. Other hormonal diseases like untreated hypothyroidism can also lead to bone loss.

• Chronic Stress - Chronic stress can exacerbate osteoporosis. This comes from a variety of interactions including  inflammation, estrogen, seratonin and more. Not to mention, when we are stressed, our food choices are not the best including sugars, fats, salts - the SAD. Stress can also lead to inactivity and increase in alcohol intake, both risk factors for poor bone health.

If Osteopenia and Osteoporosis are Silent Diseases, How Do You Know If You Have Bone Loss?

• Broken Bones - Especially from a minor fall or daily activities like coughing, bending or twisting.

• Loss in Height, Poor Balance, or Falls  - People with bone loss can have weak muscles (leading to poor balance and falls) and spinal kyphosis (caused from broken bones causing a curve in the spine, and therefore loss in height).  

• N-Telopeptide Levels - This blood marker measures a type of collagen, which if high, correlates to bone breakdown exceeding bone formation - potentially a sign of osteopenia or osteoporosis.

• DEXA Scan - A low dose x-ray to show how strong or weak your bones are. This is currently not a standard test until a woman is 65. Only if you have broken bones by 50 will this be suggested at an earlier age.

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If you read through this list and believe that your bones are at risk of osteopenia or osteoporosis, please talk to you doctor about running a DEXA scan.

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Stay tuned for our next article about osteopenia and osteoporosis - including an action plan to prevent and address bone health through diet, lifestyle, supplements and some interesting new tools!